Desafios e Soluções: Abordagem Anestésica em Cirurgias Gerais para Pacientes Oncológicos

Introduction: The anesthetic approach in general surgeries for cancer patients is a complex and challenging area of ​​medicine, which involves the interaction between anesthesia and cancer treatment. Cancer patients often require surgical interventions to diagnose, stage or treat the disease, but the presence of the tumor and the effects of treatment can complicate the administration of anesthesia. In this context, unique challenges arise that require a careful and personalized approach. Objective: To present the challenges and solutions in an anesthetic approach to general surgeries in cancer patients. Methodology: The Scielo, Medline and Science Direct databases were used, with articles published between 2019 and 2024, available in English or Portuguese. Final Considerations: The anesthetic approach in general surgeries for cancer patients is crucial to ensure the success of the surgical intervention, as well as the quality of life and survival of these patients. The challenges are diverse, from the need to carefully assess the patient's clinical condition to choosing the most appropriate drugs and anesthetic techniques for each case.Introdução: A abordagem anestésica em cirurgias gerais para pacientes oncológicos é uma área complexa e desafiadora da medicina, que envolve a interação entre a anestesia e o tratamento do câncer. Pacientes com câncer frequentemente requerem intervenções cirúrgicas para diagnóstico, estadiamento ou tratamento da doença, mas a presença do tumor e os efeitos do tratamento podem complicar a administração da anestesia. Nesse contexto, surgem desafios únicos que exigem uma abordagem cuidadosa e personalizada. Objetivo: Apresentar os desafios e soluções em uma abordagem anestésica nas cirurgias gerais em pacientes oncológicos. Metodologia: Foram utilizadas as bases de dados Scielo, Medline e Science Direct, com artigos publicados entre os anos 2019 e 2024, disponíveis em inglês ou português. Considerações Finais: A abordagem anestésica em cirurgias gerais para pacientes oncológicos é crucial para garantir o sucesso da intervenção cirúrgica, bem como a qualidade de vida e a sobrevida desses pacientes. Os desafios são diversos, desde a necessidade de avaliar cuidadosamente a condição clínica do paciente até a escolha dos fármacos e técnicas anestésicas mais adequados para cada caso

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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)