Determinantes de complicações neurológicas no uso da circulação extracorpórea (CEC)

Abstract

performance of surgeries. To attribute one given alteration to a single procedure is a complex idea; however, some authors classify ECC as an independent variable for the occurrence of neurological dysfunctions 7-9. Nonetheless, some studies mention other factors as the cause of cerebral lesions, namely: advanced age, severity of disease, anesthetic-surgical procedure, and others 10,11. Given the frequent use of ECC and the assumption that neurological complications affect the quality of life, it is necessary to consider the evidences of cerebral dysfunction in the management of ECC. Risk factors inherent to ECC and interventions that minimize the incidence and severity of the lesions should also be identified, taking into account the level of safety of this procedure. Methods This is an integrative review on neurological complications caused by the use of ECC. Integrative reviews permit the synthesis and analysis of the scientific knowledge already produced on the subject investigated, meeting the same standards as primary research in terms of clarity and rigor 12. This type of review permits the analysis of studies that have different methodological approaches, but address the subject at issue. The outcomes of the studies selected in this type of review lead to the construction of a body of knowledge necessary for the technical and scientific improvement of the care provided. The analysis was based on the classification of strength of evidence elaborated by Stetler et al, who proposed levels for the main sources of scientific evidence 13. Level I encompasses systematic reviews with meta-analysis, and level VI studies are based on the opinions of experts or of legal or regulatory agencies, as shown in Table 1. The bibliographic survey of indexed publications was carried out in the period between January 1998 and September 2008, in the following databases: Literatura Latino-Americana e do Caribe em Ciências de Saúde (Latin-American and Caribbean Literature on Health Sciences-LILACS), electronic Index Medicus of the National Library of Medicine (MEDLINE), SciELO and Cochrane Library. Reverse search of original articles, which is a study selection method from the references of primary works retrieved in the previous search 14 , was also used. After search in the databases, manuscripts from MEDLINE and LILACS databases were selected and included, based on the following criteria: manuscripts addressing the themes "extracorporeal circulation" and "neurological complications", restricted to the past 10 years, in the Portuguese, English and

Aspectos hemodinâmicos da circulação extracorpórea em cães

“…Apesar de ser uma técnica já estabelecida e amplamente aplicada na medicina humana 7 , ainda existem avanços a serem alcançados em ambas as áreas, sendo que na medicina veterinária precisa ser aperfeiçoada ou adaptada a fim de reduzir a mortalidade ao máximo. Objetivou-se com este trabalho descrever a técnica de circulação extracorpórea e seus efeitos hemodinâmicos, quando aplicada em cães, considerando a pressão arterial média, pressão venosa central, saturação arterial de oxigênio e a concentração de CO2 ao final da expiração.…”

Comportamento do fluxo arterial periférico em pacientes submetidos a cirurgia cardíaca: Um estudo piloto

“…Seus efeitos no organismo ainda não estão inteiramente definidos, assim como é especulativa a fisiopatologia de diversas reações do organismo a esse procedimento. [4][5][6] A associação entre as DCV pode ocorrer, principalmente, porque os fatores de risco são os mesmos, estando em muitos casos a DAC associada a doença arterial periférica (DAP). Esta atinge os membros inferiores e é uma síndrome aterosclerótica altamente prevalente em todo o mundo, especialmente entre as pessoas com mais de 55 anos, estando frequentemente associada à redução da qualidade de vida, ocorrência de eventos isquêmicos fatais e não fatais, como AVC, infarto agudo do miocárdio, angina e ao aumento da mortalidade.…”

Gaseous microemboli in cardiac surgery with cardiopulmonary bypass: the use of veno-arterial shunt as a preventive method

“…Technology has led to a reduction of morbimortality in cardiac surgery [1][2]. However, neurological complications related to it still represent an important cause of morbidity in the postoperative period [3,4].…”

“…The process of cooling and reheating the blood modifies the physical properties of the dissolved gases (their solubility) and this predisposes the formation of microbubbles in the bloodstream [10,15]. Perfusionist interventions to administer drugs and collect blood samples produce gaseous microbubbles [2,11,16], as well as vacuum assisted drainage [17,18].…”