HARMONIA CIRÚRGICA: CUIDADOS MINUCIOSOS NA ANESTESIA DE PACIENTES PEDIÁTRICOS COM CARDIOPATIA EM PROCEDIMENTOS CIRÚRGICOS

Surgery in pediatric patients with congenital heart disease presents unique challenges due to the complexity of heart disease and the vulnerability of these patients. Therefore, anesthesia for these patients requires a careful and thorough approach to ensure the safety and success of the surgical procedure. Surgical harmony, characterized by effective collaboration between the medical team, plays a crucial role in this context, allowing for adequate coordination of care and minimization of risks. Objective: To highlight the importance of an integrated and careful approach in the administration of anesthesia in pediatric patients with heart disease undergoing surgical procedures. Methodology: The Cochrane, Scielo and Medline databases were used, searching for articles published between 2020 and 2023, in Portuguese or English. Final Considerations: The search for surgical harmony in pediatric procedures in patients with heart disease is essential to ensure the safety and success of the procedure. Therefore, meticulous attention to detail when administering anesthesia, considering the physiological and anatomical particularities of these patients, is essential to minimize risks and guarantee a positive result.A cirurgia em pacientes pediátricos com cardiopatia congênita apresenta desafios únicos devido à complexidade da doença cardíaca e à vulnerabilidade desses pacientes. Dessa forma, a anestesia desses pacientes requer uma abordagem cuidadosa e minuciosa para garantir a segurança e o sucesso do procedimento cirúrgico. A harmonia cirúrgica, caracterizada pela colaboração eficaz entre a equipe médica, desempenha um papel crucial nesse contexto, permitindo a coordenação adequada dos cuidados e a minimização de riscos. Objetivo: Destacar a importância da abordagem integrada e cuidadosa na administração da anestesia em pacientes pediátricos com cardiopatia submetidos a procedimentos cirúrgicos. Metodologia:  Foram utilizadas as bases de dados Cochrane, Scielo e Medline, buscando artigos publicados entre os anos de 2020 e 2023, nos idiomas Português ou Inglês. Considerações Finais: A busca pela harmonia cirúrgica em procedimentos pediátricos em pacientes com cardiopatia é essencial para garantir a segurança e o sucesso do procedimento. Assim, a atenção minuciosa aos detalhes na administração da anestesia, considerando as particularidades fisiológicas e anatômicas desses pacientes, é fundamental para minimizar os riscos e garantir um resultado positivo

COMPARAÇÃO DA EFICÁCIA DA ANALGESIA EPIDURAL E RAQUIDIANA EM PARTURIENTES PRIMÍPARAS

The aim of this study is to comprehensively compare the efficacy of epidural and spinal analgesia in relieving pain during labor in primiparous women. Methodology:  To achieve the proposed objective, we conducted a systematic literature review, consulting electronic databases such as PubMed, Scopus, and Web of Science. A combination of search terms was used. Only comparative studies, such as randomized controlled trials and cohort studies, that directly investigated the efficacy of epidural versus spinal analgesia in primiparous women were included. The methodological quality of the selected studies was assessed following specific guidelines and predefined criteria. Results:  After a thorough analysis of the included studies, we observed that both epidural and spinal analgesia were effective in relieving pain during labor in primiparous women. However, the results indicated that epidural analgesia may provide more complete and prolonged pain relief, while spinal analgesia tends to have a quicker onset of action. Additionally, both techniques were associated with acceptable rates of complications and adverse effects, although some differences were observed regarding safety profiles. Conclusion: Based on the results obtained, we conclude that both epidural and spinal analgesia are effective options for pain relief during labor in primiparous women. The choice between these techniques should be individualized, taking into consideration patient preferences, progression of labor, and specific characteristics of each technique. A detailed discussion between the patient and the medical team is essential to determine the best analgesic approach for each case.O objetivo deste estudo é comparar de maneira abrangente a eficácia da analgesia epidural e raquidiana no alívio da dor durante o trabalho de parto em parturientes primíparas. Metodologia: Para atingir o objetivo proposto, realizamos uma revisão sistemática da literatura, consultando bases de dados eletrônicas, como PubMed, Scopus e Web of Science. Utilizou-se uma combinação de termos de busca. Foram incluídos apenas estudos comparativos, como ensaios clínicos randomizados e estudos de coorte, que investigaram diretamente a eficácia da analgesia epidural versus raquidiana em parturientes primíparas. A qualidade metodológica dos estudos selecionados foi avaliada seguindo diretrizes específicas e critérios predefinidos. Resultados: Após uma análise minuciosa dos estudos incluídos, observamos que tanto a analgesia epidural quanto a analgesia raquidiana demonstraram ser eficazes no alívio da dor durante o trabalho de parto em parturientes primíparas. No entanto, os resultados indicaram que a analgesia epidural pode proporcionar um alívio mais completo e prolongado da dor, enquanto a analgesia raquidiana tende a ter um início mais rápido de ação. Além disso, ambas as técnicas foram associadas a taxas aceitáveis de complicações e efeitos adversos, embora algumas diferenças tenham sido observadas em relação aos perfis de segurança. Conclusão: Com base nos resultados obtidos, concluímos que tanto a analgesia epidural quanto a raquidiana são opções eficazes de alívio da dor durante o trabalho de parto em parturientes primíparas. A escolha entre essas técnicas deve ser individualizada, levando em consideração as preferências da paciente, a progressão do trabalho de parto e as características específicas de cada técnica. É fundamental uma discussão detalhada entre a paciente e a equipe médica para determinar a melhor abordagem analgésica para cada caso

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research