Preoperative endocrine and metabolic considerations

Tracheal suture in rats with hypothyroidism: wound healing study

PURPOSE: To evaluate the influence of hypothyroidism in tracheal wound healing process. METHODS: A controlled study was designed with 48 male Wistar rats, divided into two groups: study and control groups. In the first one hypothyroidism was surgically induced and 10 weeks after, a tracheal opening followed by suture was performed in both groups, subdivided into 7, 14, and 21 days in accordance with the date of animals death. A laboratorial evaluation was performed to prove the decreased in thyroid function in the study group. Also a macroscopic evaluation through a stablished protocol and a microscopic analysis with Hematoxylin-eosin and Sirius-Red staining methods were done. RESULTS: The laboratorial evaluation certified suppressed thyroid function in the study group. The macroscopic evaluation showed the presence of suture blockade in the study group in all the evaluated days. Microscopic analysis showed a prolongated inflammatory process and less collagen with delay in organization in the study group comparing to control group. All these data were statistic significant. CONCLUSION: Hypothyroidism had an influence in tracheal wound healing process, promoting delay in the inflammatory and organization processes and diminished tissue collagen quantity.

Preparing the medically compromised patient for surgery

Preparing the medically compromised patient for surgery requires identifying and treating preoperative risk factors and anticipating postoperative complications. Preoperative evaluation of all patients should include careful screening for bleeding disorders and prior anesthetic complications and assessment of nutritional status. In addition, patients with preexisting cardiac, pulmonary, and endocrine problems must be identified, since these problems represent the greatest risk factors for postoperative complications. Perioperative care is more effective when directed at specific organ systems. Communication among internists, anesthesiologists, and surgeons promotes optimal treatment for surgical patients with medical illness.

[The pre-operative visit in cardiovascular surgery]

This text is intended for new residents in the development of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients' medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.