Anestesiologia
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- Acute onset pulmonary toxicity associated to amiodaronePublication . Ferreira, PG; Saraiva, F; Carreira, CAmiodarone is a potent anti-arrhythmic drug with a well-known potential chronic pulmonary toxicity. We describe a case of acute pulmonary toxicity (APT) induced by amiodarone in a 57 year old patient submitted to a perfusion of 900 mg in just 6 hours, to control an auricular flutter with rapid ventricular response. During the administration, the patient developed hemodynamic instability and oxygen dessaturation that led to an electrical cardioversion with return of sinus rhythm. Still, the patient continued in progressive respiratory deterioration with acute bilateral infiltrates on chest x-ray and apparent normal cardiac filling pressures confirmed by echocardiography. Anon-cardiogenic pulmonar edema progressing to clinico-physiological ARDS criteria was diagnosed. Expeditive therapeutic measures were undertaken, namely by initiation of non-invasive positive airway pressure support, that attained a good result.Albeit rare, amiodarone-induced APT might have severe consequences, namely progression to ALI/ARDS with a high mortality index.As it is a frequently prescribed drug, there should be a high clinical suspicion towards this phenomenon, allowing precocious therapeutic measures to be taken in a timely fashion to prevent the associated unfavorable outcome.
- Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosisPublication . Viana, JS; Furtado, E; Romero, A; Furtado, AL
- Alterações precoces dos enzimas hepáticos após colecistectomia: estudo prospectivo incluindo cintigrafia hepatobiliar quantificadaPublication . Milheiro, A; Diogo, C; Lapa, P; Cunha, MJ; Manso, E; Martins, L; Mártires, E; Pedroso de Lima, J; Castro e Sousa, F
- An unusual cause of acute cardiogenic shock in the operating roomPublication . Baptista, R; Fonseca, J; Marconi, L; Furriel, F; Prieto, D; Bento, C; Antines, MJ; Figueiredo, AA 51-year-old man with a renal carcinoma with inferior vena cava (IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by low left and right atrial volumes and increased septum mobility. No other abnormalities were found that could explain the shock, namely ventricular dysfunction or valvular disease. Cardiac surgery consultation was immediately obtained, ultimately deciding to perform a median sternotomy with direct exploration of right atrium. Under cardiopulmonary bypass, a 6-cm long thrombotic mass was identified, involving the IVC filter, blocking all lower body venous return; the removal of the mass reversed the shock. The patient had an uneventful recovery. Adverse outcomes associated with IVC filters are common. Our case highlights the importance of a team approach to rapid changes in hemodynamic status in the operating room, including the surgeon, the anesthesiologist, and the cardiologist. It also emphasizes the pivotal role of transesophageal echocardiogram in the clinical evaluation of severely unstable patient
- Anestesia e Cirurgia Ortopédica:Anticoagulação, Antiagregação, Garrotagem e Terapêutica pré-operatóriaPublication . Mesquista, I; Jesus, J; Bento, J
- Anestesia no Século XIX e XX e os Hospitais da Universidade de CoimbraPublication . Martins-Nunes, J; Sousa-Rocha, M; Mesquita, A
- Anestesia nos Hospitais da Universidade de Coimbra: contributos para a história da anestesiologiaPublication . Martins-Nunes, J
- [Anesthesia and Alzheimer disease - Current perceptions]Publication . Marques, AF; Lapa, TABACKGROUND AND OBJECTIVES: It has been speculated that the use of anesthetic agents may be a risk factor for the development of Alzheimer disease. The objective of this review is to describe and discuss pre-clinical and clinical data related to anesthesia and this disease. CONTENT: Alzheimer disease affects about 5% of the population over 65 years old, with age being the main risk factor and being associated with a high morbidity. Current evidence questions a possible association between anesthesia, surgery, and long-term cognitive effects, including Alzheimer disease. Although data from some animal studies suggest an association between anesthesia and neurotoxicity, this link remains inconclusive in humans. We performed a review of the literature in which we selected scientific articles in the PubMed database, published between 2005 and 2016 (one article from 1998 due to its historical relevance), in English, which address the possible relationship between anesthesia and Alzheimer disease. 49 articles were selected. CONCLUSION: The possible relationship between anesthetic agents, cognitive dysfunction, and Alzheimer disease remains to be clarified. Prospective cohort studies or randomized clinical trials for a better understanding of this association will be required.
- Antiagregantes:quem e quando parar?Publication . Matias, F
- Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategiesPublication . Lapa, TA; Madeira, FM; Viana, JS; Pinto-Gouveia, JAnesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.