Cirugía de hombro en posición silla de playa: estrategias y recomendaciones para la prevención de complicaciones isquémicas

Abstract

Introduction:The commonly used concentrations of local anesthetics (LA) for femoral nerve block (FNB) cause a significant decrease in the quadriceps strength (QS), limiting physiotherapy and determining a risk factor for patient's falls. The use of more dilute solutions could determine the preservation of motor function without impairing analgesia. methods: Five patients scheduled for total knee arthroplasty (TKA) received a preoperative FNB with 20 mL of bupivacaine in decreasing concentrations (0.0875%, 0.075%, 0.0625%, 0.050%, 0.0375%). Sensory block to cold in the anterior knee region, QS, surface electromyography (SEMG) of vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) plus were recorded before and 30 minutes after the blockage. Posteriorly, the clinical data of 20 patients who underwent TKA and received a continuous femoral nerve block (CFNB) with bupivacaine in the most dilute concentration that granted sensory blockade and significantly preserved the QS in the previous analysis were retrospectively analyzed. Postoperative pain at 24 and 48 hours, morphine consumption at 24 hours, the ability to successfully perform physiotherapy on the first postoperative day (POD) and reports of falls were rescued from the patients' files. Finally, seventy-five patients that underwent TKA during 2018 who received a CFNB with a similar dilution, but using levobupivacaine, were also retrospectively analyzed. Postoperative pain, need for advanced rescue analgesia, ability to perform physiotherapy, CFNB related complications and reports of patients falls during the first 72 hours post-

Factores que predisponen a la elevación de la tensión arterial en pacientes normotensos operados en cirugía electiva

“…Se destaca que factores de riesgo modificables como el tabaco, el consumo nocivo de alcohol, la dieta poco saludable, la insuficiente actividad física, la obesidad, así como la hipertensión, la hiperglucemia y el hipercolesterolemia, constituyen factores de riesgo principales que contribuyen a la patología subyacente de las enfermedades cardiovasculares 1,32,[38][39][40][41][42][43][44] .…”

“…Se deben conjugar varios factores de riesgos como los antecedentes patológicos personales, la ansiedad, la vulnerabilidad al estrés y el tabaquismo que pueden influir en la descompensación hemodinámica de los pacientes. Según la literatura, existen muchos factores más que se conjugan para desencadenar la HTA, la que desencadena otros procesos que representan un gran peligro para la vida 3,5,7,44,53 .…”