Objetivo: O presente estudo avaliou o efeito dos cuidados de fisioterapia respiratória, no período pós-operatório, na incidência de complicações pulmonares em pacientes submetidos à esofagectomia. Métodos: Este estudo retrospectivo avaliou 70 pacientes consecutivos (nenhuma exclusão) divididos em 2 grupos: controle (GC; N=30) e fisioterapia respiratória (GFR; N=40). As informações referentes aos períodos pré, peri e pós-operatório foram obtidas através do prontuário médico dos pacientes. Resultados: Os pacientes dos GC e GFR apresentaram média de idade (53,57 ± 12,51 vs 56,55 ± 14,23 anos) e de índice de massa corpórea (22,38 ± 3,41 vs 22,68 ± 3,91 kg/m2) semelhantes, assim como o percentual de diagnóstico de neoplasia que foi de 80% em ambos os grupos. As durações da cirurgia e da anestesia também foram similares entre GC e GFR, respectivamente (370 vs 390 min e 483,83 ± 98,45 vs 496,88 ± 125,77 min). Os pacientes submetidos à esofagectomia que receberam cuidados de fisioterapia respiratória (GFR) apresentaram uma redução nas complicações pulmonares quando comparado com o grupo controle (15,0% vs 36,3%; p<0,05). Esta foi conseqüente à redução na incidência de derrame pleural (10% vs 23%), atelectasia (2,5% vs 3,3%) e broncopneumonia (2,5% vs 10%). Foi também verificado que os pacientes do GFR fizeram menor uso de antibióticos (cefalosporina de 3ª geração), com finalidade terapêutica (p<0,05) e permaneceram menos tempo com o dreno no hemitórax direito (p<0,05). Conclusão: Nossos resultados sugerem que os cuidados de fisioterapia respiratória no período pós-operatório reduzem a incidência de complicações respiratórias, beneficiando os pacientes submetidos à esofagectomia. / The main goal of the present study was to evaluate the effect of late postoperative chest physiotherapy on pulmonary complications in patients submitted to oesophagectomy. This retrospective study involved a sample of 70 consecutive oesophagectomy patients (none excluded) who were divided into two groups as follows: control group (no physiotherapy) and chest physiotherapy group. Patients receiving chest physiotherapy were not submitted to positive airway pressure ventilation. Our results show that patients in the control group were similar to those in the chest physiotherapy group in terms of age and body mass index (53.5 ± 12.5 years vs. 56.5 ± 14.2 years; 22.3 ± 3.4 kg/m2 vs. 22.6 ± 3.9 kg/m2). Patients in the control group and chest physiotherapy group, respectively, also presented the same rate of surgery for malignant disease (80% vs. 80%), surgical time (370 vs. 390 min) and anaesthesia duration (483.8 ± 98.4 min vs. 496.8 ± 125.7 min). Patients in the chest physiotherapy group less frequently presented pulmonary complications (15% vs. 36.3%; p < 0.05), pleural effusion (10% vs. 23%), atelectasis (2.5% vs. 3.3%), and bronchopneumonia (2.5% vs. 10%). Among chest physiotherapy group patients, antibiotic (thirdgeneration cephalosporins) treatment regimens were of shorter duration (p < 0.05). In addition, right hemithorax drainage was less prolonged among the chest physiotherapy group patients (p < 0.05). Our results suggest that chest physiotherapy reduces pulmonary complications in patients undergoing oesophagectomy.

INTRODUÇÃO: A simpatectomia é o tratamento de escolha para hiperidrose localizada primária. A evolução da técnica visa à melhora dos resultados operatórios e à minimização dos efeitos colaterais, sendo o principal deles o suor reflexo. Esse suor reflexo pode afetar a satisfação em longo prazo, e pode variar conforme as estações do ano, juntamente com a satisfação dos pacientes com os resultados da operação. No entanto, não há dados objetivos quanto ao efeito da sazonalidade sobre os resultados operatórios e sobre os fatores relacionados à satisfação. Os objetivos do presente estudo são: avaliação da variabilidade sazonal sobre o grau das resoluções da sudorese palmar e plantar, bem como a incidência e a intensidade do suor reflexo e análise da influência desses fatores sobre a satisfação; avaliação da dor como fator relacionado à satisfação imediata; avaliação da segurança dos métodos de expansão pulmonar pós-operatória com e sem drenagem pleural e relação dos mesmos à dor. MÉTODOS: Estudo clínico, prospectivo, em duas fases. A primeira, para avaliação de fatores imediatos relacionados à satisfação (fatores antropométricos, dor, presença e intensidade do suor reflexo, grau de resolução da sudorese palma r e plantar, época do ano em que a simpatectomia foi realizada) e segurança dos métodos de expansão pulmonar, cujo desenho é prospectivo, aleatorizado e cego. A segunda, para as avaliações tardias e sazonais dos fatores relacionados à satisfação (fatores antropométricos, presença e intensidade do suor reflexo, grau de resolução da sudorese palmar e plantar), possui desenho prospectivo de coorte. Foram eleitos para o estudo pacientes com hiperidrose palmo-plantar primária submetidos à simpatectomia torácica videoassistida; o período de inclusão foi de 16 meses e o seguimento médio final de 623,63 ± 15,13 dias. Foram então avaliados no período de hospitalização (avaliação da dor, método de expansão pulmonar e do pneumotórax residual) e no sétimo dia de pós-operatório (dor, resultados operatórios e satisfação). Então, tardiamente, na primavera, no verão e no outono/inverno (resultados operatórios e satisfação). Foram considerados resultados operatórios os graus de resolução palmar e plantar e a presença e a intensidade do suor reflexo. Foram estudadas como variáveis independentes relacionadas à satisfação a época do ano onde a simpatectomia foi feita, a dor, os graus de resolução palmar e plantar, presença e intensidade do suor reflexo e fatores antropométricos, a saber, idade, gênero, etnia, índice de massa corporal. RESULTADOS: Foram incluídos 82 pacientes consecutivos, sendo que 80 completaram o seguimento imediato e 75 completaram todo o seguimento. Os resultados operatórios (resolução palmar e plantar, presença e intensidade do suor compensatório) tiveram variação entre todas as estações do ano. A satisfação teve igual variação sazonal e os fatores que estiveram relacionados à queda da satisfação foram distintos, conforme a estação do ano. A drenagem pleural tubular fechada e a expansão com Valsalva foram igualmente eficientes quanto à presença de pneumotórax residual, porém a drenagem pleural em selo d\'água aumentou o tempo cirúrgico e a dor pós-operatória nas primeiras 12 horas; o pneumotórax residual não aumentou a dor. CONCLUSÕES: OS melhores resultados operatórios foram obtidos imediatamente e na primavera, os piores no verão e em nível intermediário no outono/inverno. Na primavera, o único parâmetro relacionado à queda na satisfação foi a não resolução plantar; já no verão e no outono/inverno, foi a presença do suor reflexo, indepedente da sua intensidade. A drenagem pleural tubular fechada teve desempenho inferior à expansão pulmonar sob visão direta com manobra de Valsalva. O pneumotórax residual não influenciou a intensidade dor pós-operatória. / INTRODUCTION: Sympathectomy is the treatment of choice for primary and localized hyperhidrosis. Efforts in evolution of this technique have the aim to improve the surgical results and minimizing the collateral effects, witch told to be the sudomotor reflex. This sudomotor reflex could influence the long term satisfaction; it also could change between the seasons of the year, as well as the satisfaction could change in this matter. However, there is no objective data regarding the influence of the seasonality over the surgical results and satisfaction. The objectives of this study is to assess the seasonal variability of palmar and plantar resolution, as well as the incidence of sudomotor reflex and its intensity; to correlate this factors with satisfaction. To evaluate the pain as a factor related to immediate satisfaction; to assess the safety of lung expansion methods and relate this with postoperative pain. METHODS: A two stage prospective clinical assay. The first stage consists of assessment of the immediate factors related to satisfaction (anthropometrics factors, pain, presence and intensity of the sudomotor reflex, palmar and plantar resolutions, season of the year in witch the operation was performed) and the safety of lung expansion methods; it is a prospective, randomized and blinded study. The second stage is a cohort study, assessing the late factors related to satisfaction (anthropometrics factors, presence and intensity of the sudomotor reflex and palmar and plantar resolutions), under distinct climatic situations. There were included patients with typical palmar and plantar primary hyperhidrosis treated by thoracic video-assisted sympathectomy; the inclusion period was 16 months and the final follow-up time was 623 ± 15,13 days in average. They were assessed in hospital stay (pain, lung expansion technique and residual pneumothorax) and at seventh postoperative day (pain, surgical results and satisfaction). Thereafter they were assessed in spring, summer and autumn/winter (surgical results and satisfaction). The surgical results were palmar and plantar resolutions and presence and intensity of the sudomotor reflex. The independent variables related to satisfaction were season of the year in that the sympathectomy was performed, pain, palmar and plantar resolutions, sudomotor reflex (presence and intensity) and anthropometric parameters (age, gender, ethnics, body mass index). RE8UL T8: 82 consecutives patients were included; thereafter, 80 completed the immediate assess and 75 completed the long term follow-up. The surgical results (palmar and plantar resolutions, presence and intensity of the sudomotor reflex) had significant variation throughout the seasons of the year. Equally, the satisfaction had significant variation, as well as the factor related to dissatisfaction, throughout the seasons of the year. The underwater pleural drainage and the lung expansion with Valsalva maneuver were equally efficient in matter of residual pneumothorax; however the underwater pleural drainage was more painful and more operating time consuming; the residual pneumothorax do not increased the postoperative pain. CONCLUSIONS: The best results are obtained in immediate postoperative period and in spring; the worst results are seen in spring; the intermediate results are obtained in autumn/winter. In the spring, the unique factor related to dissatisfaction was the non resolution of plantar hyperhidrotic symptoms; in the summer and in the autumn/winter the presence of the sudomotor reflex, independently of its intensity, was related to dissatisfaction. The underwater pleural drainage should not be indicating after thoracic video-assisted sympathectomy for lung expansion. The residual pneumothorax does not influence the postoperative pain.

Pectus excavatum é a deformidade congênita na parede torácica anterior mais comum e seu tratamento é essencialmente cirúrgico. Tratamentos cirúrgicos e repouso prolongado no leito levam a alterações metabólicas, músculoesqueléticas, cardiovasculares e respiratórias, que podem prolongar o tempo necessário para a recuperação funcional dos pacientes no pós-operatório, aumentar o tempo de internação e os custos em saúde. A reabilitação precoce após cirurgias, com a realização de exercícios físicos e respiratórios, reduzir estes efeitos adversos, garante melhor recuperação pós-operatória, com aumento da independência dos pacientes, maior bem-estar psicológico e melhores resultados funcionais. O objetivo deste estudo foi avaliar se os pacientes submetidos a reabilitação precoce após correção cirúrgica de Pectus excavatum pela técnica de Nuss apresentam melhor capacidade funcional de exercício e função pulmonar no dia da alta hospitalar quando comparados com os pacientes submetidos a cuidados convencionais. Os Candidatos a correção cirúrgica foram alocados aleatoriamente em 2 grupos: o grupo reabilitação precoce (GRP), que iniciou a intervenção logo após a cirurgia e o grupo de cuidados convencionais (GC), que recebeu os cuidados de rotina da instituição. O teste de função pulmonar por meio da espirometria simples e a avaliação da capacidade funcional de exercício pelo teste de caminhada de seis minutos (TC6), foram realizados antes da cirurgia (pré-operatório) e no dia da alta hospitalar (pós-operatório). Quarenta pacientes foram analisados, 20 em cada grupo. No teste de função pulmonar, todos os pacientes apresentaram redução significativa dos valores de CVF, VEF1 e PFE no pós-operatório, sem diferença entre os grupos. Todos os pacientes apresentaram redução significativa da distância percorrida no TC6 pós-operatório comparada com a distância percorrida no pré-operatório (p < 0,005). Houve diferença estatisticamente significante entre o GRP e GC na avaliação pós-operatória (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02), e a diferença entre as distâncias percorridas no pré-operatório e no dia da alta hospitalar foi significativamente menor no GRP em comparação com o GC (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). Concluímos que os pacientes submetidos a reabilitação precoce após técnica de Nuss apresentam melhor capacidade funcional de exercício no dia da alta hospitalar em comparação com os pacientes do grupo convencional, sem diferença da função pulmonar entre os grupos / Pectus excavatum is the most common congenital chest wall deformity and its treatment is essentially surgical. Surgical treatments and postoperative bed rest lead to metabolic, musculoskeletal, cardiovascular and respiratory alterations, with the possibility of prolonging the time required for postoperative patient recovery, increasing hospitalization time and health expenditure. Early rehabilitation after surgeries, which involves physical and breathing exercises, reduces these adverse effects and ensure better postoperative recovery, with increased independence of patients, greater psychological well-being and better functional outcomes. The objective of this study was to assess whether patients undergoing early rehabilitation after Pectus excavatum repair using the Nuss procedure have better functional exercise capacity and lung function on hospital discharge day compared with patients undergoing conventional care. Patients were randomly allocated into two groups: the early rehabilitation group (ERG) which started rehabilitation after surgery and the group of conventional care (CG) which received routine care of the institution. The lung function was assessed by simple spirometry and the functional exercise capacity by the 6-minute walk test (6MWT) were performed before surgery (preoperative) and in hospital discharge day (postoperative). Forty patients were evaluated, 20 in each group. All patients presented a significant reduction in FVC, FEV1 and PEF in the postoperative lung function test and there was no statistically significant difference between groups. All patients showed significant reduction in postoperative distance walked in 6MWT compared with the preoperative distance (p < 0.005). There was statistically significant different in functional exercise capacity between the ERG and CG in the postoperative evaluation (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02) and the difference between distance walked in the preoperative and postoperative period was significantly lower in the ERC compared to the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). We conclude that patients undergoing early rehabilitation after Nuss procedure presented better postoperative functional exercise capacity in hospital discharge day compared to patients in the conventional group, with no difference in lung function between groups

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-14T19:32:04Z No. of bitstreams: 1 Tallita Mello Delphino.pdf: 2292421 bytes, checksum: 1c5d2e29ee8a7afca245d4511f3ec3a5 (MD5) / Made available in DSpace on 2016-10-14T19:32:04Z (GMT). No. of bitstreams: 1 Tallita Mello Delphino.pdf: 2292421 bytes, checksum: 1c5d2e29ee8a7afca245d4511f3ec3a5 (MD5) Previous issue date: 2016 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: A cirurgia de facectomia tem sido cada vez mais freqüente, com isso, há necessidade de estratégias que auxiliem no seguimento pós-operatório com vistas a recuperação cirúrgica e minimização de complicações. Ao considerar a vulnerabilidade dos idosos a ocorrência de possíveis complicações pós-operatórias, definiu-se como itens de investigação os componentes do diagnóstico de enfermagem Recuperação cirúrgica retardada, proposto pela NANDA-I. Objetivos: Comparar a incidência do diagnóstico de recuperação cirúrgica retarda ao longo de 04 semanas no grupo acompanhado por telefone e no grupo controle; Analisar o acompanhamento telefônico para sujeitos em pós-operatório de facectomia no grupo experimento. Método: Trata-se de um estudo clínico randomizado cego para avaliação da efetividade do acompanhamento por telefone pela enfermeira na recuperação cirúrgica de idosos em pós-operatório de extração de catarata. A amostra do estudo consistiu em 95 participantes idosos com 60 anos ou mais de idade, em pré-operatório de cirurgia de catarata, provenientes do serviço de oftalmologia de dois hospitais localizados no município de Niterói-RJ, e que possuíssem telefone celular ou fixo disponível para o contato pela enfermeira. A amostra foi dividida em dois grupos Experimento e Controle, de forma randomizada, e foi obtida por cálculo amostral proposto por Pocock (1983). O grupo Experimento teve acesso à intervenção acompanhamento por telefone, que consistiu em 04 ligações no período das 04 semanas, realizada pela pesquisadora através de um protocolo de ligação semi-estruturado, como também acesso ao tratamento convencional. O grupo Controle teve acesso ao tratamento convencional sem o acompanhamento por telefone. O dois grupos foram acompanhados no ambulatório no 1º, 7º e 30º dia de pós-operatório durante 04 semanas para identificação da presença do diagnóstico de enfermagem recuperação cirúrgica retardada. Resultados: Houve ausência na primeira avaliação dos desfechos analisados em ambos os grupos. Na segunda avaliação, a ocorrência de recuperação cirúrgica retardada foi de 36,2% no grupo Controle e de 6,3% no grupo Experimento (p-0,000). A razão de chances (Odds Ratio = 0,118; Intervalo de Confiança = 0,032;0,437) indica a possibilidade de um efeito protetor do acompanhamento por telefone contra retardo na recuperação cirúrgica. Constatou-se também que o acompanhamento por telefone auxilia fortemente os pacientes na redução de chances de ocorrências de Evidência de interrupção na cicatrização da área cirúrgica (p-0,000); Relato de desconforto (p-0,001); Dor (p-0,003); Sentimento pós-operatório de ansiedade (p-0,000), Sentimento pós-operatório de preocupação(p-0,031), e Infecção pós-operatória no local da cirurgia (p-0,000). A ocorrência dessas características definidoras e fatores relacionados são significativamente menores no grupo experimento. Conclusão: Pacientes submetidos à intervenção acompanhamento por telefone têm chances significativamente reduzidas de apresentarem retardo na recuperação cirúrgica. O seguimento dos pacientes com orientações pós-alta auxilia principalmente na segurança e compreensão dos cuidados domiciliares, como também na detecção de complicações precocemente. / Introduction: Cataract surgery has been increasingly frequent, with this, there is need for strategies to assist in the postoperative follow-up to a full recovery and minimizing surgical complications. Considering the vulnerability of the elderly to possible occurrence of postoperative complications, defined as research items the components of the nursing diagnosis surgical recovery delayed, proposed by NANDA-I. Objectives: To compare the incidence of diagnosis of surgical recovery slows over 04 weeks in the group accompanied by telephone and in the control group; Analyze the telephone follow-up for subjects in cataract surgery after surgery in the experimental group. Method: This is a blind randomized clinical trial to evaluate the effectiveness of follow-up by phone the nurse in the surgical recovery in elderly postoperative cataract extraction. The study sample consisted of 95 elderly participants aged 60 or older in the preoperative period of cataract surgery, from the ophthalmology service of two hospitals located in Niterói-RJ, and possessing cell phone or landline available to contact the nurse. The sample was divided into two experiment groups and control, randomly, and was obtained by sample calculation proposed by Pocock (1983). Experiment group had access to intervention Telephone follow-up, which consisted of 04 bonds in the period of 04 weeks, conducted by researcher through a semi-structured connection protocol, as well as access to conventional treatment. The control group had access to conventional treatment without follow-up by telephone. The two groups were followed at the clinic on the 1st, 7th and 30th day postoperatively for 04 weeks to identify the presence of nursing diagnosis surgical recovery delayed. Results: There was absence in the first evaluation of the outcomes analyzed in both groups. In the second evaluation, the occurrence of delayed surgical recovery was 36.2% in the control group and 6.3% in the experiment group (p-0.000). The odds ratio (odds ratio = 0.118; confidence interval = 0.032; 0.437) indicates the possibility of a protective effect of telephone follow-ups against delay in surgical recovery. It was also found that monitoring by phone strongly supports patients in reducing chances of interruption Evidence of occurrences in the healing of surgical area (p-0.000); Reporting discomfort (p-0.001); Pain (p-0.003); Postoperative anxiety feeling (p-0.000), postoperative feeling of concern (p-0.031), and postoperative infection at the surgical site (p-0.000). The occurrence of these defining characteristics and related factors are significantly lower in the experimental group. Conclusion: Patients undergoing intervention Telephone follow-up have significantly reduced chances of presenting delay in surgical recovery. The follow-up of patients with post-discharge guidelines helps especially in safety and understanding of home care, as well as to detect complications early.

Bakgrund   Muskuloskeletala systemet, även benämnt som rörelseapparaten, kräver alltid postoperativ omvårdnad efter operation i de nedre extremiteterna. En viktig aspekt av vårdprocessen är personcentrerad omvårdnad, som betonar vikten av preoperativ information, postoperativ rehabilitering och aktiv patientmedverkan. Tidig mobilisering efter operation är avgörande för att minska risken för komplikationer och förkorta sjukhusvistelsen, samtidigt som det finns en strävan att förbättra patientens livskvalitet och återställa funktion. Denna studie fokuserar på att analysera den postoperativa vården efter ortopedisk kirurgi. Syfte  Syftet var att belysa postoperativ vård efter ortopedisk kirurgi. Metod  En icke-systematisk litteraturöversikt baserad på 15 vetenskapliga originalartiklar med kvalitativa, kvantitativa eller mixad design. Artiklarna valdes ut från databaserna PubMed och CINAHL. Samtliga artiklar har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Integrerad dataanalys användes för att sammanställa resultatet. Resultat Resultatet sammanställdes med hjälp av två huvudkategorier: Tidig mobilisering och Vårdandets perspektiv. Resultatet visade att tidig mobilisering är fördelaktigt i det tidiga stadiet av postoperativ omvårdnad då det påskyndar rehabiliteringen, förbättrar behandlingsprocessen och sänker vårdkostnaderna. Dessutom framhölls vikten av väl anpassad patientinformation för att stärka den personcentrerade vården. Det är avgörande att vårdgivarna anpassar informationen för att optimera varje patients behandlingsupplevelse och resultat. Slutsats Denna litteraturöversikt understryker vikten av tidig mobilisering efter ortopedisk kirurgi för att påskynda patientens återhämtning, förkorta sjukhusvistelser samt minska smärta, vilket förbättrar både fysiska och psykiska utfall. Genom att implementera ett personcentrerat förhållningssätt som anpassade smärtbehandlingsprotokoll och grundlig preoperativ utbildning kan vårdgivare övervinna hinder som åldersfaktorer och rörelserädsla. Tidig mobilisering, som en del av ERAS-program, visar även ekonomiska fördelar genom minskade vårdkostnader och effektivare resursanvändning, vilket gör det till en kritisk komponent i postoperativ vård. / Background The musculoskeletal system always requires postoperative care after surgery in the lower extremities. An important aspect of the care process is person-centered nursing, which emphasizes the importance of preoperative information, postoperative rehabilitation, and active patient participation. Early mobilization after surgery is essential to reduce risk of complications and shorten the hospital stay, while striving to improve the patient's quality of life and restore function. This study focuses on analyzing the postoperative care after orthopedic surgery. Aim The aim was to shed light on postoperative care after orthopedic surgery. Method A non-systematic literature review based on 15 original scientific articles with a qualitative, quantitative or mixed design. The articles were selected from the databases PubMed and CINAHL. The articles have been quality checked based on Sophiahemmet University's assessment document for scientific classification and quality. Integrated data analysis was used to compile the results. Results The results were compiled with the help of two main categories: Early Mobilization and the Nursing perspective. The result showed that early mobilization is beneficial in the early stage of postoperative care that accelerates rehabilitation, improves the treatment process and lowers costs. Additionally, the importance of well-adapted patient information to strengthen person-centered care was highlighted. It's critical that caregivers adapt the information to optimize each patient's treatment experience and outcomes. Conclusions This literature review highlights the importance of early mobilization after orthopedic surgery to accelerate recovery, shorten hospital stays, and reduce pain, improving both physical and psychological outcomes. Implementing person-centered approaches such as customized pain management protocols and thorough preoperative education, caregivers can overcome barriers like age factors and movement fear. Early mobilization, as part of ERAS, also demonstrates economic benefits through reduced healthcare costs and more efficient resource usage, making it a critical component of postoperative care.

A quantitative descriptive study was conducted to establish professional nurses’ and patients’ knowledge and understanding of laparoscopic surgery and to determine whether nurses are sufficiently knowledgeable to disseminate adequate information about laparoscopic surgery to patients. Two state hospitals based in KwaZulu-Natal where laparoscopic surgery is done were selected and the respondents were selected through convenience sampling. Data were collected by administering questionnaires to theatre nurses (n=39), ward nurses (n=87) and patients (n=42) scheduled for laparoscopic surgery. The SPSS version 15 for Windows was used to compute the results. The findings revealed that the professional nurses were not sufficiently knowledgeable about laparoscopic surgery to give adequate information to patients and the patients themselves were not fully informed about all aspects of laparoscopic surgery including the possibility of conversion to open surgery, complications and advantages and after care. There is therefore a dire need for improvement of patient education to assist patients gaining optimal recovery / Health Studies / M.A. (Health Studies)

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital. / AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

<p>Uvod: U svakodnevnom kliničkom radu anesteziologa, postoperativna vizita anesteziologa na odelјenjima rutinski se ne izvodi, niti su ustanovlјeni jasni kriterijumi i stavovi o njenom značaju na zadovolјstvo bolesnika anestezijom. Cilј ovog istraživanja je bio konstrukcija i psihometrijska provera instrumenta koji može rutinski da se koristi za procenu zadovolјstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima, kao i da se ispita uticaj postoperativne vizite anesteziolioga na zadovolјstvo bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena. Materil i metode rada: U istraživanje je bilo uklјučeno 218 ispitanika, starijih od 18 godina, koji dobro govore i pi&scaron;u srpski jezik, koji su ASA I i ASA II statusa i koji su bili operisani u op&scaron;toj anesteziji. Ispitanici su podelјeni u tri grupe: prvu grupu čini 74 bolesnika, koje je postoperativno na odelјenju obi&scaron;ao anesteziolog koji je davao anesteziju, drugu grupu čini 70 bolesnika, koje je posle operacije obi&scaron;ao medicinski tehničar na anesteziji, koji nije učestvovao u anesteziji i treću grupu čini 74 bolesnika, koji nisu imali postoperativnu vizitu. U prvoj fazi iztraživanja prikuplјali su se osnovni sociodemografski podaci i bolesnicima su usmeno postavlјena pitanja. U drugoj fazi istraživanja svim bolesnicima je data op&scaron;ta balansirana anestezija. U trećoj fazi istraživanja, sprovedena je prva postoperativna vizita anesteziologa za bolesnike prve grupe i prva postoperativna poseta medicinskog tehničara na anesteziji za bolesnike druge grupe. Treća, kontrolna grupa bolesnika nije imala postoperativnu vizitu. U okviru ove vizite procenjivalo se objektivno (PAS skor) i subjektivno stanje bolesnika. Druga postoperativna vizita sprovedena je prvog postoperativnog dana. Drugog postoperativnog dana bolesnicima je odelјenska medicinska sestra, koja nije učestvovala u perioperativnom periodu bolesnika, davala upitnik za merenje zadovolјstva bolesnika anestezijom. Rezultati: Upitnik zadovolјstva bolesnika anestezijom je konstruisan za potrebe istraživanja. Prve metrijske provere upitnika su utvrđene u pilot studiji na 100 ispitanika, na osnovu kojih je neizmenjen upitnik primenjen na celom uzorku. Na osnovu teorijskih okvira formulisana je 21 stavka. Upitnik se sastoji od četiri faktora: prvi faktor je Zadovolјstvo odnosom anesteziologa prema bolesniku, drugi faktor Perianestezijski komfor, treći faktor Nezadovolјstvo postoperativnom brigom i četvrti faktor Strah od anestezije Mera pouzdanosti upitnika na ovom uzorku izražena Kronbahovom alfom iznosi 0.889. Kada se uzmu u obzir sve stavke mera pouzdanosti izražena Kronbahovom alfom celog upitnika iznosi 0.845, &scaron;to ukazuje na visoku pouzdanost skale u celini. Kako bi se proverila konstruktna validnost upitnika, sprovedena je faktorska analiza na uzorku od 218 pacijenata. Bartletov test (p&lt;.01) i KMO vrednosti (KMO=0.880) ukazuju da je sprovođenje faktorske analize na ovom upitniku statistički opravdano. Srednje vrednosti interkorelacija faktora pokazuju da &scaron;to je odnos između anesteziologa i bolesnika bolјi, da će bolesnik imati manji strah od anestezije, biti zadovolјniji postoperativnom brigom i imati veći nivo komfora. Rezultati jednosmerne analize varijanse pokazuju da postoji statistički značajna razlika između grupa kada su u pitanju Zadovolјstvo odnosom anesteziologa prema bolesniku, Strah od anestezije i Nezadovolјstvo postoperativnom brigom. Grupe se statistički značajno ne razlikuju u Perianestezijskom komforu Kada je u pitanju faktor Zadovolјstvo odnosom anesteziologa prema bolesniku, eksperimentalna grupa koja je imala postoperativnu vizitu od strane anesteziologa je bila zadovolјnija ovim aspektom i od eksperimentalne grupe koja je imala postoperativnu vizitu od strane medicinskog tehničara koji nije učestvovao u davanju anestezije i od kontrolne grupe. Grupe se međusobno nisu statistički značajno razlikovale u proceni Perianestezijskog komfora. Kada je u pitanju Nezadovolјstvo postoperativnom brigom, kontrolna grupa se statistički značajno razlikuje u odnosu na obe eksperimentalne grupe. Bolesnici u kontrolnoj grupi su imali izraženiji Strah od anestezije u odnosu na eksperimentalnu grupu gde je postoperativnu posetu obavio anesteziolog. Zaklјučak: U ovom istraživanju konstruisan je visoko pouzdan upitnik koji može rutinski da se koristi za procenu zadovolјstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima. Postoji statistički značajna razlika u zadovolјstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između bolesnika koji su imali postoperativnu vizitu anesteziologa i onih koji je nisu imali u korist bolesnika koji su imali postoperativnu vizitu anesteziologa. Postoji statistički značajna razlika u zadovolјstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između onih koje je postoperativno obi&scaron;ao anesteziolog i onih koje je postoperativno obi&scaron;ao medicinski tehničar na anesteziji koji nije učestvovao u anesteziji.</p> / <p>Uvod: U svakodnevnom kliničkom radu anesteziologa, postoperativna vizita anesteziologa na odeljenjima rutinski se ne izvodi, niti su ustanovljeni jasni kriterijumi i stavovi o njenom značaju na zadovoljstvo bolesnika anestezijom. Cilj ovog istraživanja je bio konstrukcija i psihometrijska provera instrumenta koji može rutinski da se koristi za procenu zadovoljstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima, kao i da se ispita uticaj postoperativne vizite anesteziolioga na zadovoljstvo bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena. Materil i metode rada: U istraživanje je bilo uključeno 218 ispitanika, starijih od 18 godina, koji dobro govore i pi&scaron;u srpski jezik, koji su ASA I i ASA II statusa i koji su bili operisani u op&scaron;toj anesteziji. Ispitanici su podeljeni u tri grupe: prvu grupu čini 74 bolesnika, koje je postoperativno na odeljenju obi&scaron;ao anesteziolog koji je davao anesteziju, drugu grupu čini 70 bolesnika, koje je posle operacije obi&scaron;ao medicinski tehničar na anesteziji, koji nije učestvovao u anesteziji i treću grupu čini 74 bolesnika, koji nisu imali postoperativnu vizitu. U prvoj fazi iztraživanja prikupljali su se osnovni sociodemografski podaci i bolesnicima su usmeno postavljena pitanja. U drugoj fazi istraživanja svim bolesnicima je data op&scaron;ta balansirana anestezija. U trećoj fazi istraživanja, sprovedena je prva postoperativna vizita anesteziologa za bolesnike prve grupe i prva postoperativna poseta medicinskog tehničara na anesteziji za bolesnike druge grupe. Treća, kontrolna grupa bolesnika nije imala postoperativnu vizitu. U okviru ove vizite procenjivalo se objektivno (PAS skor) i subjektivno stanje bolesnika. Druga postoperativna vizita sprovedena je prvog postoperativnog dana. Drugog postoperativnog dana bolesnicima je odeljenska medicinska sestra, koja nije učestvovala u perioperativnom periodu bolesnika, davala upitnik za merenje zadovoljstva bolesnika anestezijom. Rezultati: Upitnik zadovoljstva bolesnika anestezijom je konstruisan za potrebe istraživanja. Prve metrijske provere upitnika su utvrđene u pilot studiji na 100 ispitanika, na osnovu kojih je neizmenjen upitnik primenjen na celom uzorku. Na osnovu teorijskih okvira formulisana je 21 stavka. Upitnik se sastoji od četiri faktora: prvi faktor je Zadovoljstvo odnosom anesteziologa prema bolesniku, drugi faktor Perianestezijski komfor, treći faktor Nezadovoljstvo postoperativnom brigom i četvrti faktor Strah od anestezije Mera pouzdanosti upitnika na ovom uzorku izražena Kronbahovom alfom iznosi 0.889. Kada se uzmu u obzir sve stavke mera pouzdanosti izražena Kronbahovom alfom celog upitnika iznosi 0.845, &scaron;to ukazuje na visoku pouzdanost skale u celini. Kako bi se proverila konstruktna validnost upitnika, sprovedena je faktorska analiza na uzorku od 218 pacijenata. Bartletov test (p&lt;.01) i KMO vrednosti (KMO=0.880) ukazuju da je sprovođenje faktorske analize na ovom upitniku statistički opravdano. Srednje vrednosti interkorelacija faktora pokazuju da &scaron;to je odnos između anesteziologa i bolesnika bolji, da će bolesnik imati manji strah od anestezije, biti zadovoljniji postoperativnom brigom i imati veći nivo komfora. Rezultati jednosmerne analize varijanse pokazuju da postoji statistički značajna razlika između grupa kada su u pitanju Zadovoljstvo odnosom anesteziologa prema bolesniku, Strah od anestezije i Nezadovoljstvo postoperativnom brigom. Grupe se statistički značajno ne razlikuju u Perianestezijskom komforu Kada je u pitanju faktor Zadovoljstvo odnosom anesteziologa prema bolesniku, eksperimentalna grupa koja je imala postoperativnu vizitu od strane anesteziologa je bila zadovoljnija ovim aspektom i od eksperimentalne grupe koja je imala postoperativnu vizitu od strane medicinskog tehničara koji nije učestvovao u davanju anestezije i od kontrolne grupe. Grupe se međusobno nisu statistički značajno razlikovale u proceni Perianestezijskog komfora. Kada je u pitanju Nezadovoljstvo postoperativnom brigom, kontrolna grupa se statistički značajno razlikuje u odnosu na obe eksperimentalne grupe. Bolesnici u kontrolnoj grupi su imali izraženiji Strah od anestezije u odnosu na eksperimentalnu grupu gde je postoperativnu posetu obavio anesteziolog. Zaključak: U ovom istraživanju konstruisan je visoko pouzdan upitnik koji može rutinski da se koristi za procenu zadovoljstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima. Postoji statistički značajna razlika u zadovoljstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između bolesnika koji su imali postoperativnu vizitu anesteziologa i onih koji je nisu imali u korist bolesnika koji su imali postoperativnu vizitu anesteziologa. Postoji statistički značajna razlika u zadovoljstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između onih koje je postoperativno obi&scaron;ao anesteziolog i onih koje je postoperativno obi&scaron;ao medicinski tehničar na anesteziji koji nije učestvovao u anesteziji.</p> / <p>Introduction: In daily clinical practice the anesthesiologist, anesthesiologist postoperative rounds on the wards routine is not performed, not have established clear criteria and attitudes about its importance to the satisfaction of patients anesthesia. The aim of this study was to design and psychometric instrument checks that can routinely be used to assess patient satisfaction with anesthesia in everyday clinical practice anesthesiologist in our region, as well as to investigate the influence of post-operative rounds of anesthesiologisr to the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament. Matera and methods: The study included 218 patients, aged 18 years, who speak and write the Serbian language, which are ASA I and ASA II status and who were operated under general anesthesia. Subjects were divided into three groups: the first group consists of 74 patients, which is postoperatively in the department visited the anesthesiologist who gave the anesthesia, the second group consists of 70 patients, which is postoperatively visited the medical technician to anesthesia, who was not involved in the anesthesia and the third group makes 74 patients who had postoperative rounds. In the first phase Researches were collected basic socio-demographic data and patients are oral questions. In the second phase of the study all patients received general balanced anesthesia. In the third phase of the study, conducted the first post-operative rounds anesthesiologist for patients of the first group and the first post-operative visit a medical technician in anesthesia for patients other groups. The third, control group patients had postoperative rounds. Within these rounds judged objectively (PAS score) and subjective state of patients. The second post-operative rounds conducted the first postoperative day. On the second postoperative day, the patients underwent Classroom nurse, who did not participate in the perioperative period, patients given a questionnaire to measure satisfaction with anesthesia. Results: The questionnaire satisfaction with anesthesia was designed for research purposes. The first metric verification of the questionnaire were determined in a pilot study on 100 subjects, on which it is unchanged from the questionnaire applied to the whole sample. Based on the theoretical framework formulated in paragraph 21. The questionnaire consists of four factors: the first factor is the ratio of pleasure anesthesiologist to the patient, another factor perianesthesian comfort, the third factor Dissatisfaction postoperative care and the fourth factor, fear of anesthesia questionnaire to measure the reliability of the sample expressed Cronbach alpha is 0.889. When taking into account all items measure expressed by Cronbach alpha reliability of the whole questionnaire is 0.845, which indicates the high reliability of the scale as a whole. In order to test the construct validity of the questionnaire, factor analysis was conducted on a sample of 218 patients. Bartlett&#39;s test (p &lt;.01) and the KMO value (KMO = 0.880) indicate that the implementation of factor analysis on the questionnaire statistically significant. Mean values Intercorrelation factors show that the relationship between the anesthesiologist and patient better, the patient will have less fear of anesthesia, be satisfied with the postoperative care and have a higher level of comfort. Results-way analysis of variance show that there is a statistically significant difference between the groups in terms of their satisfaction with the anesthesiologist to the patient, and the fear of anesthesia and postoperative care Dissatisfaction. The groups do not differ significantly in perianesthesia comfort when it comes to sexual satisfaction factor anesthesiologist to the patient, the experimental group had post-operative rounds by the anesthesiologist was pleased with this aspect of the experimental group had post-operative rounds by medical technicians who did not participated in giving anesthesia and the control group. Groups each other not statistically significant in assessing perianesthesia comfort. When it comes to the dissatisfaction of postoperative care, the control group was significantly different from both experimental groups. Patients in the control group had a pronounced fear of anesthesia compared to the experimental group in which the postoperative visit carried anesthesiologist. Conclusion: In this study constructed a highly reliable questionnaire that can be routinely used to assess patient satisfaction with anesthesia in everyday clinical practice anesthesiologist in our region. There was a statistically significant difference in the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament between the patients who had postoperative rounds anesthesiologist and those who did not have the benefit of patients who had postoperative rounds anesthesiologist. There was a statistically significant difference in the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament between those postoperatively visited the anesthesiologist and those he visited postoperative medical technician in anesthesia who was not involved in anesthesia.</p>

Introdução: Trombocitopenia é a redução dos níveis plaquetários ocasionada por diversas condições, como hepatopatias e a Trombocitopenia Imune (TI), por exemplo. A redução de plaquetas na hepatopatia pode ocorrer devido à deficiência medular por hipovitaminose, aumento do consumo celular e hiperesplenismo e/ou devido à coagulação intravascular disseminada. Na Trombocitopenia Imune, a redução plaquetária ocorre tanto por maior destruição destas células quanto por diminuição medular de sua produção. Portadores de trombocitopenia podem apresentar achados orais como petéquias e/ou equimoses e sangramento gengival, espontâneo ou provocado. Procedimentos cirúrgico-odontológicos nestes pacientes devem ser realizados com cautela, após avaliação do seu quadro clínico e, preferencialmente, por profissional especializado. Muita controvérsia ainda existe em relação à abordagem cirúrgico-odontológica destes pacientes tanto em relação aos níveis plaquetários, quanto em relação à reposição plaquetária prévia, não havendo ainda, um protocolo internacionalmente estabelecido. Diversos métodos hemostáticos locais auxiliam durante este tipo de abordagem, sendo o agente a base de quitosana um dos métodos que têm se mostrado efetivo em diversos estudos e apresenta-se, ainda, menos oneroso que o selante de fibrina, por exemplo, um dos métodos mais utilizados. Objetivo: Desta forma, o objetivo desta pesquisa foi observar e descrever o desempenho clínico do agente a base de quitosana em pacientes com contagem plaquetária <= a 30.000/mm3 (Grupo Quitosana) submetidos a exodontias unitárias, utilizando como padrão de comparação o grupo de pacientes trombocitopênicos com contagem plaquetária entre 31.000 e 50.000/mm3 (Grupo Controle), submetidos a exodontias unitárias, sem o uso do curativo hemostático a base de quitosana e ainda, descrever o atendimento odontológico a pacientes com contagem plaquetária inferior a 50.000/mm3 . Casuística e métodos: Pacientes trombocitopênicos com contagem abaixo de 50.000/mm3 foram submetidos a exodontias unitárias, estando divididos em Grupo Quitosana(GQ):pacientes com plaquetas abaixo de 30.000/mm3, que receberam o agente a base de quitosana após a extração e, Grupo Controle(GC): pacientes com plaquetas entre 31.000/mm3 e 50.000/mm3 e que não receberam o agente a base de quitosana. O sangramento foi observado 7 dias após a exodontia através do Índice de Sangramento Alveolar Pós- Exodontia (ISAPE) e para análise estatística foi utilizado o programa SPSS (Statistical Package for Social Sciences) 20.0; nível de significância de 5% (p=0,05), e realizado o teste de Mann-Whitney, análise de Correlação de Spearman e, teste do Chi-Quadrado e Fator de risco com intervalo de confiança (IC) de 95%. Resultados: Foram realizadas 41 exodontias unitárias entre 03/2011 e 09/2012. A média de idade dos pacientes estudados foi de 46,58 ±10,87anos, com mediana de 48,50 (variando de 20 a 64). Dentre eles, 51,20% (n=21) eram do gênero feminino e 48,79% (n=20) do masculino. 21 procedimentos foram incluídos no GQ e, 20 procedimentos, no GC. O GQ apresentou contagem plaquetária entre 5.000 e 30.000/mm3 e ISAPE médio de 0,10; sendo que 2 (9,52%) pacientes tiveram ISAPE acima de zero. Já o GC apresentou plaquetas entre 31.000 e 50.000/mm3, ISAPE médio de 0,40 e 6 (30%) pacientes com ISAPE acima de zero. Não houve significância estatística em relação ao ISAPE. Discussão: Até o presente momento não foram encontrados outros trabalhos nos moldes da presente pesquisa nas bases de dados pesquisadas (Lilacs, Medline, Bireme). Inúmeros trabalhos buscam estabelecer a contagem plaquetária mínima necessária para um paciente ser submetido à cirurgia odontológica e ainda, quando será indicada reposição plaquetária prévia. Em ambos os aspectos a literatura se mostra controvérsia, havendo autores que indicam reposição plaquetária prévia a pacientes com plaquetas em torno de 100.000/mm3, e autores que relatam que cirurgias orais simples, como as exodontias unitárias, podem ser realizadas de forma segura sem reposição plaquetária em pacientes com plaquetas em torno de 30.000/mm3. Não existe atualmente um protocolo de atendimento estabelecido internacionalmente. O ISAPE não apresentou significância estatística entre os grupos estudados, aspecto possivelmente influenciado pela heterogeneidade dos grupos e/ou ainda, pelo número reduzido da amostra. Porém, a porcentagem dos pacientes que apresentaram ISAPE maior que 0 mostra efetividade do agente hemostático em 90,48% do GQ, concordando com Belman et al.(2006), Brown et al.(2007) e Wedmore et al.(2006) que mostram 80,0%, 79,0% e 97,0%, respectivamente. Conclusão: Não houve diferença estatística entre os grupos em relação ao desempenho clínico hemostático do curativo a base de quitosana. Foi possível descrever o protocolo de atendimento a pacientes trombocitopênicos efetivo e resolutivo, já utilizado rotineiramente na Divisão de Odontologia HC-FMUSP / Introduction: Thrombocytopenia is an abnormally low amount of platelets caused by many conditions as liver disorders and immune thrombocytopenia for example. The reduction of platele count in liver disorders may be caused by bone marrow deficiency due to hypovitaminosis, hypersplenism and disseminated intravascular coagulation while in immune thrombocytopenia may be caused by greater desctruction of these cells or its diminished production by the bone marrow. Patients with thrombocytopenia may present oral manifestations as petechiae and/or ecchymosis and provoked/spontaneous gingival bleeding. In these patients, surgical dental procedures should be performed with caution and only after a detailed medical assessment, preferably performed by a specialist. The dental management of patients with thrombocytopenia is still controversial regarding the amount of platelets and the need of platelet infusion prior to these procedures. To this date, no clinical guidelines has been developed regarding the dental management of patients with thrombocytopenia. Many hemostatic agents has been used to control post surgical bleeding. Many studies had shown thay chitosan is effective and cheaper than fibrin sealant, one of the most popular hemostatic agents. Objetive: This study was design to assess the effect of chitosan as a local haemostatic agent in patients with platelet count <= 30.000/mm3 compared to patients with thrombocytopenia and platelet count of 31.000/mm3 to 50.000/mm3 submitted to single dental extraction and to describe the protocol for dental treatment of patients with platelet count lower than 50.000/mm3 in a tertiary health science center. Methods: Patients with thrombocytopenia with platelet count lower than 50.000/mm3 were assessed. Patients with platelet count lower than 30.000/mm3 (study group) and patients with platelet count of 31.000/mm3 to 50.000/mm3 (control group) were submitted to single dental extraction. Chitosan was used only in the study group and no other type of hemostatic agent was used in the control group. Bleeding was measured according to the post dental extraction index (ISAPE) seven days after dental extraction. The results were statistically analyzed using the Statistical Package for Social Sciences (SPSS) 20.0 program. For statistical analysis, the Mann-Whitney test, Chi-square test, Spearman\'s rank correlation coeficient and confidence interval for relative risk (95%) were used. P< 0.05 was considered statistically significant. Results: Forty-one single dental extractions were performed between March/2011 and September/2012. The mean age of patients was 46,58 ±10,87 years of age. Median was 48,50 ranging from 20 to 64 years of age. Fifty-one percent (n=21) were females and 48,79% (n=20) males. Twenty-one extarctions were performe in the Chitosan group and 20 in the control group. Chitosan group presented platelet count of 5.000 to 30.000/mm3 and mean ISAPE médio of 0,10; where two patients (9.52%) had ISAPE greater than zero Control group presented with platelet count of 31.000 to 50.000/mm3, mean ISAPE of 0,40 and six patients (30%) with ISAPE greater than zero. No statistical significance was related to the ISAPE between groups. Discussion: The dental management of patients with thrombocytopenia is still controversial regarding the amount of platelets and the need of platelet infusion prior to these procedures. To this date, no clinical guidelines has been developed regarding the dental management of patients with thrombocytopenia. Many studies have tried to establish the minimal platelet count and the need of platelet infusion prior to oral surgery. Unfortunately, the scientific literature is controversial. Some authors recommend platelet infusion prior to oral surgery in patients with platelel count of 100.000/mm3 while others report that single extractions can be performed safely in patients with platelet count 30.000/mm3. In our study, the ISAPE was not stastistically diferent between groups, what may be explained by the heterogenicity of patients in both groups and by the small sample. However, the greater amount of patients (90%) who presented ISAPE greater 0 showed the effectiveness of chitosan as a hemostatic agent in agreement with previous authors as Belman et al.(2006), Brown et al.(2007) e Wedmore et al.(2006) that presented 80,0%, 79,0% e 97,0%, respectively. Conclusion: No difference was found regarding the effectiveness of chitosan as hemostatic agent between groups. A clinical guideline was developed on dental management of patients with thrombocytopenia and since then it has been used daily at the Department of Dentistry HC-FMUSP

Made available in DSpace on 2016-01-26T12:51:50Z (GMT). No. of bitstreams: 1 liliangoraieb_dissert.pdf: 2524026 bytes, checksum: 35df67e734bc16baa9fa59b0adee085f (MD5) Previous issue date: 2005-12-12 / Objective: To evaluate the behavior of the pulmonary compliance and resistance of the airway passage in patients with high blood flow congenital heart disease undergoing surgical treatment with cardiopulmonary bypass. Method: The static pulmonary compliance and the airway resistance were evaluated in 35 patients during the intraoperative period, in four distinct instants: the first, before the thorax opening, with the infants being already anesthetized, under mechanical ventilation; the second, after thorax and pericardium opening, with the retractors in position; the third, five minutes after the end of cardiopulmonary bypass; the forth, after thorax closing. Pulmonary measurements were performed non-invasively by means of the airway occlusion at the end of inspiration, and the use of proper mathematical formula. In different periods, the observed and related variables with the pulmonary changes were: preoperative, the age, weight and systemic and pulmonary blood flow; intraoperative, the perfusion and the anoxia duration and the minimum body temperature; and, postoperative, duration of mechanical ventilatory support and the length of stay in the ICU. Results: At the end of the surgery, the pulmonary compliance showed a significant and immediate increase (P<0.001) in all the patients. Patients over 30-months as well as the ones with weight over 10kg showed greater increase; P=0.0004, P=0.0006, respectively. Patients with 50-minute duration of cardiopulmonary bypass delayed more to present increase of pulmonary compliance (P=0.04). The resistance of the airway passage did not present significant alteration at the end of surgical correction (P=0.393). Conclusion: All the patients presented pulmonary compliance improvement at the end of the surgery. It was influenced significantly by the age, weight and duration of cardiopulmonary bypass; however, the resistance of the airway passage has not changed. / Avaliar o comportamento da complacência pulmonar e resistência da via aérea nos pacientes portadores de cardiopatias congênitas com hiperfluxo pulmonar submetidos a tratamento cirúrgico com auxílio de circulação extracorpórea. Método: Trinta e cinco pacientes foram avaliados com medidas de complacência estática e resistência da via aérea em quatro instantes distintos durante a cirurgia: O primeiro antes da abertura do tórax, com a criança já anestesiada e sob ventilação mecânica. O segundo, após a abertura do tórax e pericárdio, com os afastadores posicionados. O terceiro, cinco minutos após a saída de circulação extracorpórea e o quarto, após o fechamento do tórax. As medidas pulmonares foram feitas de forma não invasiva com o método de oclusão da via aérea ao final da inspiração e uso de fórmulas matemáticas específicas. As variáveis observadas e relacionadas às alterações pulmonares foram: No período pré-operatório, idade, peso e a relação entre fluxo sanguíneo sistêmico e pulmonar, no intra-operatório, tempos de perfusão, de anóxia e temperatura mínima, no pós-operatório, tempo de ventilação mecânica e tempo de permanência na unidade de terapia intensiva. Resultados: A Complacência pulmonar ao final da cirurgia mostrou aumento significativo imediato (P<0,001) em todos os pacientes. Pacientes maiores de 30 meses tiveram maior aumento (P=0,0004). Os com peso superior a 10kg também apresentaram maior aumento (P=0,0006). Pacientes com tempo de circulação extracorpórea maior que 50 minutos demoraram mais para apresentar aumento da complacência pulmonar (P=0,04). A resistência da via aérea não apresentou alteração significativa ao final da correção cirúrgica (P=0,393). Conclusão: A complacência pulmonar apresentou melhora ao final da cirurgia em todos os pacientes, sendo influenciada de forma significativa pela idade, peso e tempo de circulação extracorpórea. A resistência da via aérea, entretanto, não se alterou.