Navegando por Palavras-chave "Cardiovascular surgical procedures"
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- ItemAcesso aberto (Open Access)Cardiovascular behavior during rehabilitation after coronary artery bypass grafting(Soc Brasil Cirurgia Cardiovasc, 2010-10-01) Botega, Fernando de Souza [UNIFESP]; Cipriano Junior, Gerson [UNIFESP]; Lima, Francisco Valdez Santos de Oliveira [UNIFESP]; Arena, Ross [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: the aim of the present study was to assess the behavior of cardiovascular variables during an in-hospital cardiovascular rehabilitation program in patients following myocardial revascularization surgery.Methods: A total of 14 patients (mean age: 55.4 +/- 6.4 years, 78.6% male) participated in the study, all of whom had a previous diagnosis of coronary insufficiency and indication for elective surgery. the protocol consisted of a group of low-impact (2-3 METs) upper/lower extremity and walking exercises performed both pre and post-operatively (3(rd) and 4(th) days). the following variables were evaluated at rest and following the exercise program: heart rate (HR, bpm); systolic arterial pressure (SAP, mmHg); diastolic arterial pressure (DAP, mmHg); mean arterial pressure (MAP, mmHg); double product (DPr, bpm/mmHg); and the Rating of Perceived Exertion (RPE) scale.Results: There was a significant increase in HR and DPr in the individual analysis (P<0.001) as well as in between days (P<0.001 for HR and P<0.05 for DPr), but only attaining maximal values that were <= 30% of predicted. Moreover, a negative correlation was found between the RPE scale and both SAP and MAP.Conclusion: the exercises proposed proved to be safe with the change in key physiologic variables throughout the experiment below recommended values for the hospitalization phase. Furthermore, the RPE scale appears to have a correlation with some hemodynamic variables and thus may be a useful tool for this group of patients.
- ItemAcesso aberto (Open Access)Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery(Sociedade Brasileira de Cirurgia Cardiovascular, 2010-03-01) Mota, Fabiane de Almeida [UNIFESP]; Marcolan, Joao Fernando [UNIFESP]; Pereira, Mara Helena Corso; Milanez, Adriano Márcio de Melo; Dallan, Luis Alberto Oliveira; Diccini, Solange [UNIFESP]; Clinics Hospital; Universidade Federal de São Paulo (UNIFESP); Heart Institute; Heart Institute Heart Surgical Diseases GroupINTRODUCTION: Acute and severe pain is frequent in patients who undergo cardiothoracic surgery. Patient controlled analgesia (PCA) can be used to manage postoperative pain. OBJECTIVE: To compare analgesia of morphine PCA alone (without continous infusion) with morphine PCA plus a continuous infusion on postoperative period after cardiac surgery and to evaluate pain scores, morphine consumption, number of demand, patient satisfaction and side effects. METHODS: Randomized trial was conducted to assess patients who underwent cardiac surgery receiving either morphine PCA alone or morphine PCA plus continous infusion. In the post operative period, PCA was started at extubation in both regiments according to randomization. Pain intensity, morphine consumption, number of demand, satisfaction and side effects were assessed at zero, six, twelve, eighteen, twenty four and thirty hours after patients' extubation. RESULTS: The study enrolled 100 patients. 50 patients received morphine PCA alone, (Group A) and 50 patients received morphine PCA plus a background infusion, (Group B). Group B patients had less demand, consumed more morphine and were more satisfied regarding analgesia. No statistical differences were shown between groups related to pain intensity, and side effects. CONCLUSIONS: Pain control was effective and similar in both groups. Morphine PCA alone seems to be better for postoperative pain manage in cardiac surgery, due to its less morphine expense with the same effectiveness.
- ItemAcesso aberto (Open Access)Efeitos agudos da ventilação mecânica não invasiva na perfusão tecidual no pós-operatório de cirurgia de revascularização do miocárdio em pacientes com disfunção ventricular esquerda(Universidade Federal de São Paulo (UNIFESP), 2017-10-10) Marcondi, Natasha de Oliveira [UNIFESP]; Guizilini, Solange [UNIFESP]; Gomes, Walter José [UNIFESP]; http://lattes.cnpq.br/9877675594064089; http://lattes.cnpq.br/1563905009199506; http://lattes.cnpq.br/7215082988156640; Universidade Federal de São Paulo (UNIFESP)Introdução: O uso da ventilação mecânica não invasiva (VMNI) em pacientes com disfunção ventricular esquerda (DVE) pode melhorar o desempenho cardíaco por diminuir o esforço inspiratório e a pós-carga do ventrículo esquerdo (VE). O objetivo do presente estudo foi avaliar os efeitos agudos da VMNI nos valores de saturação venosa central de oxigênio (ScVO2) e lactato arterial em pacientes com DVE no pósoperatório imediato de cirurgia de revascularização do miocárdio (CRM). Método: Neste estudo foram avaliados 100 pacientes no pós-operatório de CRM eletiva. Amostras sanguíneas foram coletadas em cinco momentos para avaliar marcadores de perfusão tecidual (como lactato e ScVO2): 1) no período intraoperatório (após indução anestésica); 2) vinte minutos após a chegada à UTI (sob ventilação mecânica invasiva); 3) vinte minutos após extubação (em respiração espontânea); 4) após uma hora de VMNI; 5) vinte minutos após a descontinuação da VMNI. Resultados: Um aumento significante nos níveis de lactato arterial e queda na ScVO2 foram observados na chegada à UTI em comparação aos valores intraoperatórios (p < 0,01). Após extubação, em respiração espontânea, a ScVO2 diminuiu significantemente (p < 0,01) e o lactato arterial aumentou, embora estatisticamente não significante (p = 0,21) comparado a admissão (sob ventilação mecânica invasiva). Durante a aplicação da VMNI, a ScVO2 aumentou significantemente (p < 0,01) e o lactato arterial diminuiu significantemente (p < 0,01) comparado aos valores da respiração espontânea, após extubação. Após a remoção da VMNI, a ScVO2 e o lactato arterial não apresentaram diferença em relação aos valores durante a VMNI e mantiveram-se otimizados quando comparados ao momento da extubação (p < 0,01). Conclusão: A aplicação aguda da VMNI melhorou os valores de ScVO2 e lactato arterial durante o pós-operatório imediato de CRM em pacientes com DVE.
- ItemAcesso aberto (Open Access)Estudo angiográfico comparativo da artéria pulmonar no pré e pós-operatório de pacientes submetidos a operação de derivação cavopulmonar bidirecional(Sociedade Brasileira de Cirurgia Cardiovascular, 2001-12-01) Westphal, Fernando Luiz [UNIFESP]; Maluf, Miguel Angel [UNIFESP]; Silva, Célia Maria Camelo da [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: This study analyzed the alterations in the pulmonary artery (PA) diameters after bilateral cavopulmonary derivation (BCPD). MATERIAL AND METHODS: Eighteen patients submitted to BCPD in the period from March 1990 to January 1997, with available cineangiographic examinations in the pre- and postoperative period, were included. Measurements in right pulmonary artery (RPA) and left pulmonary artery (LPA) were performed at three sites: at the origin, immediately before bifurcation and at the beginning of the inferior lobe artery. The diameters of each site were indexed with respect to body surface or diameter of the aorta at the level of the diaphragm. Angiographic and oximetric data were submitted to statistical analysis. RESULTS: On analyzing absolute diameters, it was observed that most suffered a non-significant increase in the postoperative period, while the LPA diameter presented a decrease. The total indexes I e III presented a significant decrease in the postoperative period, this reduction of the total index II being non-significant. Analysis of the postoperative follow-up variable showed a significant reduction in the total indexes in patients with a postoperative follow-up less than 23,6 months. Presence of additional blood flow elicited an increase in RPA I and III indexes and a small reduction in the other. The PA measurements indexed with respect to the diameter of the aorta showed a behavior similar to those with respect to body surface. In the absence of collateral venous circulation (CVC) a significant increase in O2 saturation was observed. On the other hand, its presence elicited a non-significant increase during the period of observation.