Avaliação perioperatória: elaboração de protocolo para o Hospital das Clínicas da Faculdade de Medicina de Botucatu
Data
2018-07-03
Autores
Paula, Nadia Rahmeh de
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A atual mudança no perfil epidemiológico, com aumento da expectativa de vida mundial e no Brasil, contribui para o crescimento da população de idosos e consequentemente de ampliação do espectro das comorbidades destes. Adicionalmente, independentemente da idade, existe aumento de doenças crônicas associadas principalmente aos hábitos modernos. Esses fatores elevam os riscos de complicações durante e após as cirurgias. Por outro lado, nota-se ainda avanço no que diz respeito às propostas e técnicas anestésicas e cirúrgicas, cada vez menos invasivas e mais resolutivas, permitindo aos idosos e portadores de doenças crônicas, serem submetidos a diferentes procedimentos. Portanto, é crucial que seja realizada criteriosa avaliação perioperatória individualizada, visando prever, intervir e minimizar efeitos indesejados associados aos procedimentos cirúrgicos e aos fatores de risco individuais de cada paciente. Objetivo: O presente trabalho propõe a criação de protocolo, de ficha de atendimento e de Manual para guiar a avaliação e manejo perioperatório dos pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Metodologia: O método utilizado na pesquisa foi a busca avançada em inglês no banco de dados da Pubmed, Cochrane, Lilacs e Scielo dos termos: “Preoperative risk screening”; “Preoperative Cardiovascular risk stratification”, “Preoperative pulmonary risk stratification”, “perioperative management of the cirrhotic patient”, “perioperative renal care”, dispostos isoladamente e em combinações entre si, filtrando apenas artigos de revisão publicados sobre humanos. Além disso, foram utilizados como referência guidelines Americano, Europeu e Brasileiro de manejo perioperatório. Ademais, foram analisados apenas artigos de revisões sistemáticas, meta-análises e as supracitadas diretrizes, com exclusão de trabalhos que tenham abordado cuidados pós-operatórios, cirurgias cardíacas, pediátricas e em gestantes. Além de extensa revisão literária, foram considerados o perfil deste serviço e de doentes atendidos pelo sistema único de saúde, em um país em desenvolvimento. Adicionalmente, foram consultados diferentes profissionais com experiência na área que auxiliaram no desenho dos fluxogramas de atendimento. Resultados: As produções técnicas resultantes desse trabalho foram as criações de protocolos estruturados em fluxogramas de atendimento sendo organizados por órgãos e sistemas; ficha de atendimento e manual com conceitos, discussão e esclarecimentos sobre o tema. Discussão: Apesar da fundamental importância e relevância sempre atual do tema, é possível notar a grande necessidade de estudos guiando diretrizes e protocolos que auxiliem o manejo perioperatório de maneira geral. Cabe a nós realizar avaliação criteriosa, anamnese e exame físicos rigorosos que possibilitem individualizar o cuidado e aplicar as medidas que, conhecidamente, reduzem morbimortalidade e proporcionam maior conforto ao doente durante esse período crítico. 8 Conclusão: O presente trabalho cumpriu com os objetivos gerando produções técnicas ao Serviço de Saúde.
Introduction: The current change in the epidemiological profile, with an increase in life expectancy worldwide and in Brazil, contributes to the growth of the elderly population and, consequently, to a broader spectrum of their comorbidities. In addition, regardless of age, there is an increase in chronic diseases associated with modern habits. These factors raise the risk of complications during and after surgeries. On the other hand, there is still progress in regard to proposals and anesthetic and surgical techniques, which are becoming less invasive and more resolutive, allowing the elderly and patients with chronic diseases to undergo different procedures. Therefore, it is crucial that a careful individualized perioperative evaluation is performed, in order to predict, intervene and minimize unwanted effects associated with surgical procedures and individual risk factors of each patient. Objective: This paper proposes the creation of a protocol, an information sheet and a manual to guide the evaluation and perioperative management of patients at the Hospital das Clínicas, Botucatu Medical School. Methodology: The method used in the research was the advanced search in English in the database of Pubmed, Cochrane, Lilacs and Scielo of the terms: "Preoperative risk screening"; "Preoperative Cardiovascular risk stratification", "Preoperative pulmonary risk stratification", "perioperative management of the cirrhotic patient", "perioperative renal care", arranged in isolation and in combinations, filtering only published review articles on humans. In addition, American, European and Brazilian guidelines for perioperative management were used as reference. Only articles of systematic reviews, meta-analyzes and the above-mentioned guidelines were analyzed, excluding studies that have addressed postoperative care, cardiac, pediatric and pregnant surgeries. In addition to an extensive literary review, the profile of this hospital and patients treated on it, by a health care system in a developing country were considered. In addition, different professionals with experience in the area were consulted who assisted in the design of service flow diagrams. Results: The technical productions resulting from this work were the creation of protocols structured in service flow charts being organized by organs and systems; information sheet and manual with concepts, discussion and clarification on the subject. Discussion: Despite the fundamental importance and always current relevance of the topic, it is possible to note the great need for studies guiding guidelines and protocols that help perioperative management in general. It is up to us to carry out rigorous physical evaluation, anamnesis and physical examination that allow to individualize the care and to apply the measures that, knowingly, reduce morbimortality and provide greater comfort to the patient during this critical period. Conclusion: The present work fulfilled with the objectives generating technical productions to the Health Service.
Introduction: The current change in the epidemiological profile, with an increase in life expectancy worldwide and in Brazil, contributes to the growth of the elderly population and, consequently, to a broader spectrum of their comorbidities. In addition, regardless of age, there is an increase in chronic diseases associated with modern habits. These factors raise the risk of complications during and after surgeries. On the other hand, there is still progress in regard to proposals and anesthetic and surgical techniques, which are becoming less invasive and more resolutive, allowing the elderly and patients with chronic diseases to undergo different procedures. Therefore, it is crucial that a careful individualized perioperative evaluation is performed, in order to predict, intervene and minimize unwanted effects associated with surgical procedures and individual risk factors of each patient. Objective: This paper proposes the creation of a protocol, an information sheet and a manual to guide the evaluation and perioperative management of patients at the Hospital das Clínicas, Botucatu Medical School. Methodology: The method used in the research was the advanced search in English in the database of Pubmed, Cochrane, Lilacs and Scielo of the terms: "Preoperative risk screening"; "Preoperative Cardiovascular risk stratification", "Preoperative pulmonary risk stratification", "perioperative management of the cirrhotic patient", "perioperative renal care", arranged in isolation and in combinations, filtering only published review articles on humans. In addition, American, European and Brazilian guidelines for perioperative management were used as reference. Only articles of systematic reviews, meta-analyzes and the above-mentioned guidelines were analyzed, excluding studies that have addressed postoperative care, cardiac, pediatric and pregnant surgeries. In addition to an extensive literary review, the profile of this hospital and patients treated on it, by a health care system in a developing country were considered. In addition, different professionals with experience in the area were consulted who assisted in the design of service flow diagrams. Results: The technical productions resulting from this work were the creation of protocols structured in service flow charts being organized by organs and systems; information sheet and manual with concepts, discussion and clarification on the subject. Discussion: Despite the fundamental importance and always current relevance of the topic, it is possible to note the great need for studies guiding guidelines and protocols that help perioperative management in general. It is up to us to carry out rigorous physical evaluation, anamnesis and physical examination that allow to individualize the care and to apply the measures that, knowingly, reduce morbimortality and provide greater comfort to the patient during this critical period. Conclusion: The present work fulfilled with the objectives generating technical productions to the Health Service.
Descrição
Palavras-chave
Risco perioperatório, estratificação de risco cardiovascular preoperatório, Estratificação de risco pulmonar preoperatório, Protocolo de avaliação perioperatória, Perioperative risk, stratification of preoperative cardiovascular risk, stratification of preoperative pulmonary risk, perioperative evaluation protocol