Efectos hemodinámicos de hipovolemia intraoperatoria en pacientes pediátricos sometidos a cirugía correctiva de escoliosis idiopática
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2023
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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RESUMEN La estabilidad hemodinámica es clave en anestesiología, se ve afectada cuando existe pérdida sanguínea o una pobre carga hídrica administrada. El objetivo es determinar los efectos hemodinámicos de hipovolemia intraoperatoria en pacientes pediátricos que se someten a cirugía para corregir la escoliosis idiopática. El estudio es de tipo analítico, observacional, longitudinal, ambispectivo, con enfoque cuantitativo, la unidad de análisis fue un hospital de la ciudad de Guayaquil desde el periodo 1 enero del 2020 hasta el 31 diciembre del 2022. La población fue 141 pacientes, la muestra fue de tipo probabilística simple (n=103) cumpliéndose los criterios de inclusión y exclusión preestablecidos. De 103 pacientes pediátricos sometidos a cirugía correctiva de escoliosis que presentaron efectos hemodinámicos durante el intraoperatorio fueron, femenino 92 (89,3%); entre 12 a 14 años 66 (64,1%); peso comprendido >50 kg, 44 (42,15%) ; factores predisponentes pacientes con Neurofibromatosis tipo I 12 (11,6%) el tiempo quirúrgico 6 a 12 horas, 47 (45,6); las complicaciones hemodinámicas fue presión arterial media < 65mmHg en el grado III (n=23) y frecuencia cardiaca > 110 lpm en grado III (n=23) y en grado IV (n=3) mediante chi cuadrado existe correlación p=0,001 entre la cantidad de sangrado y las alteraciones hemodinámicas., además entre la hemodianamia y en nivel de fijación ósea el valor de p =0,005. El presente estudio concluye que las principales complicaciones hemodinámicas de hipovolemia intraoperatorias fueron sangrado, y por consiguiente hipotensión arterial y arritmias cardiacas, además que, a mayor número de fijaciones mayor sangrado, sin embargo, no fueron motivo de mortalidad. Palabras claves: Hemodinamia, hipovolemia, intraoperatoria, escoliosis idiopática
Hemodynamic stability is key in anesthesiology, it is affected when there is blood loss or a poor administered fluid load. The objective is to determine the hemodynamic effects of intraoperative hypovolemia in pediatric patients undergoing corrective surgery for idiopathic scoliosis. The study is analytical, observational, longitudinal, ambispective, with a quantitative approach, the unit of analysis was a hospital in the city of Guayaquil from the period January 1, 2020 to December 31, 2022. The population was 141 patients, the The sample was of the simple probabilistic type (n=103), fulfilling the pre-established inclusion and exclusion criteria. Of 103 pediatric patients who underwent corrective surgery for scoliosis who presented hemodynamic effects during the intraoperative period, 92 (89.3%) were female; between 12 and 14 years old 66 (64.1%); weight included >50 kg, 44 (42.15%); predisposing factors patients with Neurofibromatosis type I 12 (11.6%) surgical time 6 to 12 hours, 47 (45.6); hemodynamic complications were mean arterial pressure < 65mmHg in grade III (n=23) and heart rate > 110 bpm in grade III (n=23) and grade IV (n=3) using chisquare correlation p=0.001 between the amount of bleeding and the hemodynamic alterations, in addition between the hemodynamics and the level of bone fixation the value of p = 0.005. The present study concludes that the main hemodynamic complications of intraoperative hypovolemia were bleeding, and consequently arterial hypotension and cardiac arrhythmias, in addition to the fact that the greater the number of fixations, the greater the bleeding, however, they were not a cause of mortality. Keywords: Hemodynamics, hypovolemia, intraoperative, idiopathic scoliosis
Hemodynamic stability is key in anesthesiology, it is affected when there is blood loss or a poor administered fluid load. The objective is to determine the hemodynamic effects of intraoperative hypovolemia in pediatric patients undergoing corrective surgery for idiopathic scoliosis. The study is analytical, observational, longitudinal, ambispective, with a quantitative approach, the unit of analysis was a hospital in the city of Guayaquil from the period January 1, 2020 to December 31, 2022. The population was 141 patients, the The sample was of the simple probabilistic type (n=103), fulfilling the pre-established inclusion and exclusion criteria. Of 103 pediatric patients who underwent corrective surgery for scoliosis who presented hemodynamic effects during the intraoperative period, 92 (89.3%) were female; between 12 and 14 years old 66 (64.1%); weight included >50 kg, 44 (42.15%); predisposing factors patients with Neurofibromatosis type I 12 (11.6%) surgical time 6 to 12 hours, 47 (45.6); hemodynamic complications were mean arterial pressure < 65mmHg in grade III (n=23) and heart rate > 110 bpm in grade III (n=23) and grade IV (n=3) using chisquare correlation p=0.001 between the amount of bleeding and the hemodynamic alterations, in addition between the hemodynamics and the level of bone fixation the value of p = 0.005. The present study concludes that the main hemodynamic complications of intraoperative hypovolemia were bleeding, and consequently arterial hypotension and cardiac arrhythmias, in addition to the fact that the greater the number of fixations, the greater the bleeding, however, they were not a cause of mortality. Keywords: Hemodynamics, hypovolemia, intraoperative, idiopathic scoliosis
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COMPLICACIONES INTRAOPERATORIAS, CIRUGIA, ESCOLIOSIS IDIOPATICA, HOSPITAL DE NIÑOS DR. ROBERTO GILBERT ELIZALDE, CANTON GUAYAQUIL, ECUADOR, HEMODINAMIA