Orientadores: Desanka Dragosavac, Luciana Castilho de Figueiredo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T10:18:25Z (GMT). No. of bitstreams: 1 Rodrigues_CristianeDelgadoAlves_D.pdf: 6776527 bytes, checksum: 911dcad00f3a4026901b992e7babcae5 (MD5) Previous issue date: 2015 / Resumo: OBJETIVO: Estudo de coorte retrospectivo realizado com o objetivo de verificar a presença de Disfunção Transitória da Troca Gasosa (DTTG) no pós-operatório de cirurgia cardíaca e determinar se esse transtorno está relacionado a eventos cardiorrespiratórios. MÉTODOS: Foram incluídos 942 pacientes consecutivos submetidos à cirurgia cardíaca e procedimentos cardíacos, encaminhados para a UTI, entre junho de 2007 e novembro de 2011. RESULTADOS: A Síndrome do Desconforto Respiratório Agudo (SDRA) foi observada em 15 pacientes (2%), apresentaram Disfunção Transitória da Troca Gasosa (DTTG) leve 199 (27.75%) pacientes, DTTG moderada em 402 (56.1%) pacientes e DTTG grave em 39 (5.4%) pacientes. A presença de hipertensão arterial e choque cardiogênico foram associadas ao surgimento de DTTG moderada no período pós-operatório (p=0.02 e p=0.019, respectivamente) e foram considerados fatores de risco para esta disfunção (p=0.0023 e p=0.0017, respectivamente). A presença de diabetes mellitus também foi considerada um fator de risco para DTTG (p=0.03). Houve correlação entre a presença de pneumonia e a presença de DTTG moderada em 8.9% dos casos (p = 0.001). A presença de DTTG grave foi associada a pacientes que necessitaram de terapia de substituição renal (p=0.0005), hemoterapia (p=0.0001), nutrição enteral (p=0.0012), ou arritmia cardíaca (0.0451). CONCLUSÕES: A presença de hipertensão pré-operatória e choque cardiogênico foram associados com a ocorrência de DTTG pós-operatória. Os fatores de risco pré-operatórios foram hipertensão, choque cardiogênico e diabetes. No pós-operatório, a pneumonia, pneumonia associada à ventilação (PAV), terapia de substituição renal, hemoterapia e arritmia cardíaca foram associados com o aparecimento de certo grau de DTTG, que foi fator de risco para reintubação, pneumonia, PAV e terapia de substituição renal no pós-operatório de cirurgia cardíaca e procedimentos cardíacos / Abstract: OBJECTIVE: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange (TDGE) in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. METHODS: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the ICU between June 2007 and November 2011. RESULTS: Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild TDGE, 402 (56.1%) had moderate TDGE, and 39 (5.4%) had severe TDGE. Hypertension and cardiogenic shock were associated with the emergence of moderate TDGE postoperatively (p = 0.02 and p = 0.019, respectively) and were risk factors for this dysfunction (p = 0.0023 and p = 0.0017, respectively). Diabetes mellitus was also a risk factor for TDGE (p = 0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate TDGE (p = 0.001). Severe TDGE was associated with patients who had had renal replacement therapy (p = 0.0005), hemotherapy (p = 0.0001), enteral nutrition (p = 0.0012), or cardiac arrhythmia (0.0451). CONCLUSIONS: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative TDGE. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, VAP, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of TDGE, which was a risk factor for reintubation, pneumonia, VAP, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

ABSTRACTBackground: Thoracic surgery includes surgical diseases in the thorax and is dominated by coronary artery surgery. Pain after heart surgery is often most intense three to four days after the surgery. The pain treatment has improved over the last 20-30 years. Despite this, 30-50% report unbearable postoperative pain. Pain can in many cases be relieved by non- pharmacological methods such as Transcutaneous Electric Nerve Stimulation (TENS). TENS activates the body's own pain-relieving mechanisms by stimulating peripheral nerves. Aim: The aim of this study was to explore whether TENS has an effect on postoperative pain after thoracic surgery and to describe obstacles and opportunities for TENS as a pain management method. Method: The study has a descriptive design. The method of the study is a quantitative literature review that included 11 articles. The database PubMed was used to find articles. Result: TENS had a positive effect on self-estimated pain and reduced the consumption of analgesics after thoracic surgery. The few articles that included obstacles and opportunities showed that nurses perceived using TENS moderately difficult. Furthermore, they did not show any side effects. Conclusion: TENS as a pain management method after thoracic surgery relieves pain and reduces the consumption of analgesics, which could lead to less suffering for the individual, reduced burden on healthcare and a lower social cost.

No description available.

Die vorliegende Arbeit befasst sich mit der Häufigkeit eines postoperativen Dumping-Syndroms (DS) bei Roux-en-Y gastric bypass (RYGB) und Sleeve-Gastrektomie (SG) Patienten. Primärer Endpunkt der Studie war die Häufigkeit der postoperativen Hypoglykämie (Spätdumping, definiert als Blutzucker < 50 mg/dl mit typischen Beschwerden oder < 40 mg/dl mit oder ohne typische Beschwerden) im modifizierten OGTT (mod. OGTT). Vorab wurde dieser mod. OGTT, der sich vom Standard-OGTT bei gleicher absoluter Glucosemenge nur im reduzierten Volumen (100 ml statt 300 ml) unterschied, validiert. Hierzu wurden beide Tests bei 10 gesunden Probanden durchgeführt. Es wurden insgesamt 30 RYGB Patienten und 12 SG Patienten in die Studie eingeschlossen. Insgesamt zeigt die vorliegende Arbeit, dass ein Jahr postoperativ eine relevante Anzahl von RYGB und SG Patienten ein Frühdumping im mod. OGTT aufwies und über Dumpingbeschwerden im Alltag berichtete. Während ein Frühdumping bei RYGB und SG Patienten gleichermaßen vorkam, wurden Hypoglykämien nur bei RYGB Patienten festgestellt. Der mod. OGTT scheint hierbei zur Detektion von DS Patienten, aufgrund seines geringen Volumens, eine gute Alternative zu den bisherigen diagnostischen Verfahren darzustellen. Der 13C-Octanoat-Atemgastest ermöglichte - auf Basis unserer Ergebnisse - keine eindeutige Abgrenzung der Dumping-Patienten von den Non-Dumpern. / Early and late dumping symptoms are a common problem after bariatric surgery. However, data on a standardized evaluation of these patients are still scarce, especially for patients after sleeve gastrectomy (SG). The aim of this prospective study was to get more insight in the frequency and severity of dumping after SG and Roux-en-Y gastric bypass (RYGB). Additonally, we aimed at studying the diagnostic value of a 13C-octanoid acid breath test to objectify dumping symptoms. Early dumping defined by both an increase in hematocrit and symptoms (Sigstad score) was frequent in both SG and RYGB. Late dumping with hypoglycemia only occurred in RYGB. Glucose and insulin peaks were higher in patients with RYGB than in those with SG. Accepted dumping criteria (rise in hematocrit, hypoglycemia) showed no correlation with subjective symptoms measured with the Sigstad score. The 13C-octanoid acid breath test seems to be no useful tool after bariatric surgery. There was an increase in t1/2 within the limits of normal in RYGB patients. This paradox occurs probably due to altered absorption of 13C-Octanoate.

Purpose: The purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. Design: A retrospective, exploratory design was used. Methods: A retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. Findings: The analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (χ2 = 1,207.11, df = 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (χ2 = 54.94, df = 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. Conclusions: Results support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.

Postoperative corneal complications from pars plana vitrectomy surgery on the retina have been studied extensively in the literature. Researchers are aware of possible issues with oil tamponades, laser techniques, and other methods used. There could be clear markers to focus on a pattern of retina diagnoses of the patients that seem more prone to these problems in the front of the eye. Studies have noted refractive issues and increased cataract or posterior capsule opacification (PCO) progression but it is inconclusive in many studies on a corneal safety standpoint. Furthermore, a 23 or 27gauge pars plana vitrectomy has varying protocols depending on the diagnosis of the retina patient including endolaser, tamponade exchange, or even endoscopic cyclophotocoagulation. This study was conducted to research data looking at varying combinations of surgical type, diagnosis, and other patient characteristics to gain statistical evidence or relative frequency to better understand what type of retinal demographics cause corneal complications. The list of corneal complications in this study include: visual distortion involving anisometropia or photophobia, increased intraocular pressure including Uveitis-Glaucoma Hyphema syndrome, allergic conjunctivitis, a lens subluxation, herpes virus (zoster or simplex), a corneal scar or lesion, neurotrophic cornea, bullous keratopathy and corneal neovascularization. This was a retrospective case study evaulating 57 patients and 58 eyes that underwent a retinal surgery, with corneal complications at Beth Israel Deaconess Medical Center between October 2013 to December 2016. Number of patients, systemic demographics including frequency of hypertension and diabetes, and frequency of retina surgery per eye was analyzed. Moreover, we looked at different retina diagnoses to view which groups have a higher occurrence of complications after surgery. We used silicone oil as a way to divide the corneal complication patients to determine if the use of oil had an effect on a higher rate of issues after surgery. Eyes were divided into treatment with silicone oil group (n=23) and a non-silicone oil group (n=34), and we found that the silicone group had a significantly higher frequency of retinal surgeries (p<0.001). Moreover, there was no significant evidence between certain systemic factors (p<0.05), that allowed us to include the silicone oil and non-silicone oil patients as a unified group. When looking at our retina diagnoses we saw some groups had a higher percentage of complications when we took total number of problematic postoperative outcomes and divided that by total number of surgeries. Over one quarter of the surgeries per category leading to corneal complications occurred in the categories of subluxed lens, endophthalmitis, trauma, and uveitis-glaucoma hyphema Syndrome or neovascular glaucoma. Vitreomacular traction similarly had a high percentage of patients with corneal complications. Retinal detachment and epiretinal membrane were largest quantities of a specific retinal problem with low percentages of fewer than 15% with complications postoperatively. The study found that in our patient demographic silicone oil did not seem to be a factor in causing more corneal complications but it did cause more retinal surgeries. Moreover, certain retina diagnoses seem more prone to cause challenging outcomes, which leaves room for further studies distinguishing certain factors that could cause such specific issues.

No description available.

Tonsillektomi är en av de vanligast utförda operationerna på barn i världen och kan innebära en lång och smärtsam återhämtning. Syftet med denna studie var att belysa vilka upplevelser som framkom under återhämtningen efter tonsillektomi på barn. Metoden var en litteraturstudie där tolv vetenskapliga studier ingick. Resultatetvisade att halssmärta var den dominerande upplevelsen och varade i dagar till veckor. Att svälja gjorde smärtan värre. Analgetika gavs i för små eller för få doser för att ge tillräcklig smärtlindring. Smärtan påverkade barnens möjligheter att äta, dricka och sova. Barnen hade egna strategier att hantera smärtan. Utökadpreoperativ information gjorde föräldrar och barn tryggare och säkrare. Postoperativtuppföljningssamtal gav föräldrarna möjlighet att få upprepad information ochkänslomässigt stöd. Som slutsats är det viktigt med adekvat, anpassad och upprepadinformation till barn och föräldrar om återhämtningen. Detta för att skapa trygghet till barn och föräldrar samt göra barns återhämtning så lindrig och smärtfrisom möjligt. / Tonsillectomy is one of the most common paediatric surgery performed over theworld and the recovery can be long and painful. The aim of this study was to illustrate the experiences associated with recovery after tonsillectomy on children.The method was a literature review where twelve scientific studies were included.The results showed that throat pain was the most difficult experience which lasted for many days or weeks. When swallowing, the pain became more severe. The painkiller at home was given in to small or too rare doses to give enough pain release. The pain influenced the child’s possibility to eat, drink and sleep. Children had their own strategies to cope with the pain. Extended preoperative information made the parents and children feel secure and more comfortable. Postoperative telephone follow-up gave the parents a possibility to get repeated information and emotional support. As a conclusion it is important to give a more adequate, adaptive and repeated information about the recovery to the child and the parents. This will encourage the child and the parents and make the child´s recovery as comfortable and painless as possible.

Syftet med denna empiriska studie var att granska hur sjuksköterskan dokumente-rar smärta på en postoperativ avdelning och hur åtgärder i samband med smärt-lindring följs upp. Studien genomfördes på Universitetssjukhuset i Malmö genom granskning av journaler för 14 patienter som givit sitt samtycke att delta i studien. Analysen resulterade i tre kategorier: god/tillfredsställande, delvis tillfredsställan-de och bristfällig/obefintlig dokumentation. Resultatet av studien visade brister gällande dokumentation av smärta. Avsaknad av användning av visuell analog skala, smärtans karaktär och uppföljning av smärtlindring kunde noteras i ett fler-tal journaler. Bristerna var särskilt uttalade i fråga om dokumentation av uppföljning. Vidare forskning på området är angelägen för att kunna ta itu med problemet och i framtiden bör sjuksköterskan få fördjupa sina kunskaper i utbildningen eller på sin arbetsplats. / The aim of this empirical study was to examine how nurses document pain in a postoperative unit and the follow up of the alleviation of pain. The study was car-ried out in Malmö University Hospital, Sweden, through examining journals from 14 patients whom agreed to participate. The analyse identified three categories: good/satisfying, partly satisfying and deficient/non-existing documentation. Fur-thermore the study showed qualitative shortages concerning documentation of pain e.g. Lack of using a pain scale, pain character and follow up of alleviation of pain could be seen in many journals. Further research in this area is needed to be able to handle the problem and in service training as well as increased focus on the documentation problems in basic nurse training is recommended.

Intresset och användandet av komplementärmedicinska behandlingsmetoder växer bland både patienter och sjukvårdspersonal. Syftet med denna litteraturstudie var att undersöka effekten av tre komplementärmedicinska behandlingsmetoder vid postoperativ smärta. Centrala frågeställningar var om transkutan elektrisk nerv-stimulering, massage och musik har smärtlindrande effekt postoperativt. Good-mans sju steg (Willman m fl, 2006) följdes genom processen i denna litteratur-studie. 11 artiklar inkluderades totalt efter sökningar i databaserna PubMed och CINAHL. Granskning och kvalitetsbedömning gjordes enskilt efter kriterier av Polit & Beck (2006) och ett granskningsprotokoll av Willman m fl (2006). Resultat från de inkluderade studierna visade att transkutan elektrisk nerv-stimulering kan lindra postoperativ smärta samt minska analgetikaanvändandet. Resultat visade också att massage kan minska både intensitet och upplevt obehag av postoperativ smärta. Det framkom även att musik både kan minska postoperativ smärta och analgetikaanvändande. Fler studier är önskvärda för att ytterligare kunna påvisa effekt och evidens av de tre komplementärmedicinska behandlingsmetoderna vid postoperativ smärta. / The interest for complementary medicine treatment is increasing among patients as well as health care professionals. The aim of this literature review was to examine the effect of three complementary therapies on postoperative pain. Central questions were if transcutaneous electrical nerve stimulation, massage and music have a pain-relieving effect on postoperative pain. The seven steps of Goodman (Willman et al, 2006) were used through the process of this literature review. A total of 11 articles were included after searches in the databases PubMed and CINAHL. The scrutiny and the judge of quality were made indi-vidually, using guidelines of Polit & Beck (2006) and a protocol by Willman, et al (2006). Results of the included articles showed that transcutaneous electrical nerve stimulation can relieve postoperative pain and decrease the use of anal-gesics. Results also showed that massage can reduce both the intensity and the unpleasantness of postoperative pain. It also appeared that music can both reduce postoperative pain and the use of analgesics. Further studies are required to additionally be able to establish the effect and evidence of the three comple-mentary therapies in postoperative pain.