Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.
Os bloqueadores neuromusculares (BNM) estão no cotidiano dos anestesiologistas e fazem parte de um arsenal terapêutico amplo na prática médica. Entretanto, a succinilcolina permanece como única droga de ação ultracurta e segura em relação a bloqueio residual para a maioria dos pacientes. O bloqueio neuromuscular residual está associado a aumento da morbimortalidade peroperatória, principalmente devido às complicações pulmonares pós-operatórias. Diante disso, deu-se início à criação dos novos BNMs gantacúrio e seu sucessor CW002 que, associados à cisteína, molécula reversora do bloqueio, podem diminuir os riscos de bloqueio residual. Nesse cenário, o sugammadex vê o calabadion, fármaco com mecanismo de ação similar, superar e ampliar seus desfechos relacionados à reversão do bloqueio neuromuscular profundo.
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