Comparação intra e pós-operatória de duas técnicas cirúrgicas para simpatectomia torácica com intubação orotraqueal simples
Data
2020-12-18
Autores
Silva, Reinaldo Agnelo Silveira da 
Orientadores
Falcão, Luiz Fernando dos Reis
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A hiperidrose primária é uma doença que acomete 3% da população mundial, caraterizada por aumento da atividade simpática colinérgica, levando ao excesso de suor em extremidades. Não há na literatura estudos que comparem técnicas de simpatectomia torácica com intubação orotraqueal (IOT) simples. O presente estudo comparou duas técnicas cirúrgicas para simpatectomia com IOT simples: carbotórax e apneia. A hipótese do estudo é que a técnica por carbotórax possa diminuir a atelectasia e ter melhor função pulmonar no pós-operatório. Objetivo: Comparar duas técnicas cirúrgicas em relação a espirometria no pós-operatório imediato e tardio e impactos respiratório, hemodinâmico e metabólico no intraoperatório. Método: Estudo clínico, prospectivo e randomizado em 36 pacientes submetidos a simpatectomia torácica por toracoscopia. Os pacientes foram randomizados em dois grupos: carbotórax (n=18) e apneia (n=18). A espirometria foi comparada no pós-operatório imediato (POI) e 2 semanas após a cirurgia (POT). Os efeitos respiratórios, hemodinâmicos e metabólicos foram avaliados pela mecânica respiratória, frequência respiratória, gasometria arterial e macro hemodinâmica no intraoperatório, além da duração dos procedimentos cirúrgico e anestésico, visualização de costelas intratorácicas, dor e analgesia pós-operatória. Resultados: Em ambos os grupos houve redução da VEF1 e CVF no POI (p<0,001) e normalização no POT (p<0,001), sem diferença entre os grupos (p=0,328). Houve queda de pH (p<0,001) e aumento de PaCO2 (p<0,001) significantes no grupo apneia, com normalização no POI. Não houve diferença macro hemodinâmica. Houve queda significante da saturação de oxigênio (SaO2) ao final do procedimento no grupo apneia (p<0,001). Não houve diferença na dor pós-operatória (p=0,276) e consumo de opióides (p>0,999) na RPA. A técnica por carbotórax possibilitou melhor campo cirúrgico com visualização de maior número de costelas (p=0,007), porém sem diminuição da duração dos procedimentos cirúrgico (p=0,951) e anestésico (p=0,624). Conclusão: A videotoracoscopia para simpatectomia torácica é um procedimento seguro e pouco invasivo. Não há diferença na função pulmonar no pós-operatório entre as duas técnicas, entretanto a técnica por carbotórax apresentou menor queda de SaO2 e pH e menor retenção de CO2, com menor acidose respiratória intraoperatória e melhor qualidade do campo cirúrgico.
Introduction: Primary hyperhidrosis is a disease that affects 3% of the population, being characterized by increased cholinergic sympathetic activity, leading to excess sweating in extremities. There are no data comparing thoracic sympathectomy techniques using only single lumen intubation. The present study compared two surgical techniques for sympathectomy with single lumen intubation: carbothorax and apnea. The hypothesis of this study is that carbothorax technique can decrease atelectasis and may have better lung function on postoperative period. Objective: To compare two surgical techniques in relation to spirometry in the immediate and late postoperative period and respiratory, hemodynamic and metabolic impacts in intraoperative period. Method: Clinical, prospective and randomized study in 36 patients underwent to thoracic sympathectomy by thoracoscopy. Patients were randomized into two groups: carbothorax (n=18) and apnea (n=18). Spirometry was compared in the immediate postoperative period and 2 weeks after surgery. Respiratory, hemodynamic and metabolic effects were analyzed by respiratory mechanics, respiratory rate, arterial blood gas and macro hemodynamics in intraoperative. Surgical and anesthetic duration, intrathoracic ribs visualization and postoperative pain were assessed too. Results: In both groups there was a reduction in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in immediate postoperative (p0.999) in postoperative recuperation. The carbothorax technique enabled a better surgical field with visualization of a greater number of ribs (p=0.007), but without decreasing the surgical duration (p=0.951) and anesthetic duration (p=0.624). Conclusion: Thoracoscopy for thoracic sympathectomy is a safe and minimally invasive procedure. There is no difference in pulmonary function in the postoperative period between the two techniques, however the carbothorax technique showed better SaO2 and respiratory acidosis and better quality of the surgical field.
Introduction: Primary hyperhidrosis is a disease that affects 3% of the population, being characterized by increased cholinergic sympathetic activity, leading to excess sweating in extremities. There are no data comparing thoracic sympathectomy techniques using only single lumen intubation. The present study compared two surgical techniques for sympathectomy with single lumen intubation: carbothorax and apnea. The hypothesis of this study is that carbothorax technique can decrease atelectasis and may have better lung function on postoperative period. Objective: To compare two surgical techniques in relation to spirometry in the immediate and late postoperative period and respiratory, hemodynamic and metabolic impacts in intraoperative period. Method: Clinical, prospective and randomized study in 36 patients underwent to thoracic sympathectomy by thoracoscopy. Patients were randomized into two groups: carbothorax (n=18) and apnea (n=18). Spirometry was compared in the immediate postoperative period and 2 weeks after surgery. Respiratory, hemodynamic and metabolic effects were analyzed by respiratory mechanics, respiratory rate, arterial blood gas and macro hemodynamics in intraoperative. Surgical and anesthetic duration, intrathoracic ribs visualization and postoperative pain were assessed too. Results: In both groups there was a reduction in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in immediate postoperative (p0.999) in postoperative recuperation. The carbothorax technique enabled a better surgical field with visualization of a greater number of ribs (p=0.007), but without decreasing the surgical duration (p=0.951) and anesthetic duration (p=0.624). Conclusion: Thoracoscopy for thoracic sympathectomy is a safe and minimally invasive procedure. There is no difference in pulmonary function in the postoperative period between the two techniques, however the carbothorax technique showed better SaO2 and respiratory acidosis and better quality of the surgical field.