Daniel Volquind

Anterior cervical interbody fusion with hydroxyapatite graft: clinical and radiological analysis of graft breakage.

Study Design. Prospective longitudinal cohort. Objective. To evaluate the efficacy of hydroxyapatite (HA) grafts in combination with cervical plates in terms of fusion, restoration, and maintenance of cervical lordosis and to compare clinical and radiologic outcomes of patients who experienced graft breakage with patients who did not. Summary of Background Data. The most common complication related to the use of HA graft for cervical anterior fusion is graft breakage. However, the implication of graft breakage in terms of loss of graft height, cervical alignment, plate migration, and clinical outcomes has not been adequately evaluated. Methodology. A prospective study of 40 patients who underwent anterior cervical fusion in which HA graft and plate systems were used. Clinical and radiologic assessments were made 1 month after surgery and again at the final follow-up. Results. At the final follow-up evaluation, 80% of patients had an excellent clinical outcome, 15% had a good outcome, and 5% had a fair outcome based on Odom’s classification. All patients achieved lordotic alignment in the immediate postoperative period. Graft breakage was observed in 25% of cases. Patients who experienced HA block breakage have 21 times more chance to have intervertebral height loss greater than 2 mm, 4.9 times more likely to undergo loss of cervical alignment exceeding 3°, and 12.4 times more likely to present migration of the plates when compared to patients who had normal HA grafts. Conclusion. Despite the positive clinical results observed in this study, breakage of HA grafts was a common complication occurring in 25% of patients. Graft breakage was associated with strut height loss of more than 2 mm, loss of cervical alignment exceeding 3° and a higher rate of plate migration. These changes related to the HA graft breakage demonstrate the necessity to continue searching for better grafting methods to perform cervical interbody fusion.

Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss

BACKGROUND AND OBJECTIVES The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patients hospitalization and 15 and 30 days after surgery in review visits. RESULTS There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. CONCLUSION Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.

Uso do ácido tranexâmico em artroplastia total primária de joelho: repercussões na perda sanguínea perioperatória

BACKGROUND AND OBJECTIVES The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis (DVT) in primary total knee replacement. METHOD 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5minutes before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24hours after surgery. DVT was investigated during patients hospitalization and 15 and 30 days after surgery in review visits. RESULTS There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. CONCLUSION Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.

Anestesia para cesariana em paciente com síndrome de Guillain-Barré: relato de caso

BACKGROUND AND OBJECTIVES Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL-1) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg-1) and maintained with 2% sevoflurane in oxygen and fentanyl (3 μg.kg⁻¹). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.

Anesthesia for Cesarean Section in a Patient with Guillain-Barre Syndrome: Case Report

BACKGROUND AND OBJECTIVES Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL(-1)) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg(-1)) and maintained with 2% sevoflurane in oxygen and fentanyl (3 μg.kg(-1)). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.

Riscos e doenças ocupacionais relacionados ao exercício da anestesiologia

JUSTIFICATIVA Y OBJETIVOS: El ejercicio de la anestesiologia no esta exento de riesgos para el anestesiologo. Considerado como un local de trabajo insalubre a causa de los riesgos potenciales a que conlleva, el quirofano es el local en donde el anestesiologo pasa la mayor parte del tiempo. En esta revision, proponemos un analisis de los riesgos ocupacionales a los que estan expuestos los anestesiologos en su practica diaria. CONTENIDO: Presentamos una clasificacion de los riesgos y sus relaciones con las enfermedades ocupacionales. CONCLUSIONES: El control de los riesgos ocupacionales a los que estan expuestos los anestesiologos diariamente es necesario para lograr un local de trabajo adecuado y con riesgos reducidos para la buena practica de la anestesiologia, lo que contribuye para la disminucion del absentismo, la mejoria de la asistencia prestada al paciente y de la calidad de vida del anestesiologo.

Manejo da via aérea na angina de Ludwig – um desafio: relato de caso

BACKGROUND Ludwigs angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. OBJECTIVE Describe a case of a patient with Ludwigs angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. CASE REPORT Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. CONCLUSIONS Airway management in patients with Ludwigs angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patients life.

Long-Term Outcome of Deep Wound Infection following Lumbar Arthrodesis for Degenerative Disc Disease

Introduction Deep wound infections are one of the most common and serious complications of spinal surgery. The impact of such infections on long-term outcomes is not well understood. The purpose of this study was to evaluate the functional status and satisfaction in patients who suffered a deep wound infection after undergoing lumbar arthrodesis for symptomatic degenerative disc disease. Patients and Methods The authors conducted a prospective study in 13 patients with a clinical and radiological diagnosis of symptomatic degenerative lumbar stenosis and instability; after undergoing decompression and instrumentation–augmented arthrodesis, the patients suffered a deep wound infection (infection group). A 3:1 (39 patients) matched cohort was selected for comparison (control group). All surgeries were performed during the same period and by a single surgeon. The postoperative infections were all treated in a similar manner and the instrumentation was not removed. Both groups were followed up and assessed with validated following outcome instruments: Numerical Rating Scale of pain, Oswestry Disability Index, 36-Item Short Form Health Survey, Beck Depression Inventory, and Hospital Anxiety and Depression Scale. Patient satisfaction was also determined. Results The median follow-up duration was 22 months (range, 6–108 months). The mean patient age was 62 ± 10 years, and 59.6% of the patients were female. There was no significant difference between the groups in pain, functional disability, quality of life, or depression and anxiety. However, 53.8% of the patients with infection were not satisfied with the procedure at the final evaluation, compared with 15.4% of the patients without a deep wound infection (p = 0.003). Conclusion Patients with successfully treated postoperative deep wound infections do not have a difference in functional outcome compared with patients who underwent an identical operation but did not suffer a complicating infection. Patients who suffered an infection were more likely to be unsatisfied with the procedure than patients who did not.

Comentário a: Anestesia para craniotomia em paciente acordado: relato de caso

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