Manejo anestesico en cirugia abdominal

1. Anestesia para
Cirugía abdominal
HGR #1 CULIACÁN, SINALOA

2. Tabla de contenidos
01
03
02
Consideraciones
preanestésicas
Técnicas anestésicas
Manejo de la anestesia
04
Cconsideraciones para
procedimientos
específicos

3. Consideraciones
preanestésicas
01
1.- Estado hídrico prequirúrgico

4. Etiología de
hipovolemia
● Ingesta reducida: ayuno.
● Emesis o drenaje gástrico: cantidad,
calidad, duracion y frecuencia.
● Diarrea
● Sangrado
● Secuestro de liquido
● Fiebre.
Estado hídrico prequirúrgico
Valoración del
estado
volumétrico
● Exploración fisica de los tegumentos.
● Laboratorios: BUN-creat, osmolaridad
sérica, electrolitos y gasto urinario.
● Monitoreo invasivo: cateter arterial,
cateter en la artetia pulmonar y monitor
Doppler.

5. Duración de la
cirugía
● Depende de si la patologia es clara o no
● Depende del historial medico del
paciente: cirgias previas.
Estado hídrico prequirúrgico
Desequilibrio
metabólico y
hematológico
● Alcalosis metabólica hipopotasémico
● Hipovolemia: acidosis metabólica
● Septisemia: CID.

6. Todos los pacientes
para procedimientos
de emergencia se
consideran
ESTOMAGO LLENO
● Induccion de secuencia rapida (ISR)
● Premediación con un antagonista H2 y
antiácido.
Estado hídrico prequirúrgico
Anticipar
evolución
posoperatoria
Para considerar:
● Tipo de anestesia
● Administración de líquidos
● Consideraciones analgésicas
● Manejo posquirúrgico inmediato

7. Técnicas
anestésicas
02

8. Anestesia General
1.-
● You can organize your ideas clearly
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Ventajas Desventajas
1.- Protección de la vía
aérea
1.- Perdida de los reflejos
de la vía aérea
2.- Asegura una
ventilación adecuada
2.- Riesgo de aspiración
incrementado
3.- Asegura inducción
rápida
3.- Consecuencias
hemodinámicas
4.- Profundidad y duración
controlados
4.- Tiempo muy
prolongado de
recuperación

9. Técnicas regionales
Bloqueo
neuro axial
Subaracnoideo
Peridural
Caudal
Bloqueo de
nervios
periféricos
Bloqueo de la
vaina de los
rectos
TAP abdominal,
subcostal,
ilioinguinal e
iliohipogástrico

10. Técnicas regionales
Abdomen
inferior
Técnica de catéter
continuo
“ Dosis única” para
procedimientos < 3
horas.
Bloqueo de nervios
periféricos
Abdomen
superior
Son por arriba del
ombligo (T10)
No suelen
tolerarse bien solo
con anestesia
regional
Requieren un nivel
sensitivo hasta
T2 – T4
Ventajas Desventajas
1.- El paciente puede comunicar sus síntomas. 1.- Toxicidad sistémica inadvertida o absorción.
2.- Se preservan los reflejos de la vía aérea. 2.- Necesidad de cooperación del paciente para
el bloqueo.
3.- La relajación muscular profunda y la
contracción intestinal optimizan la exposición
quirúrgica.
3.- Su falla, requiere de conversión a Anestesia
General.
4.- La simpatectomía aumenta el flujo sanguíneo
al intestino.
4.- Contraindicado en patología hematológica.
5.- Analgesia postquirúrgica
6.- Ahorradora de opioides
5.- provoca vaso/veno dilatación.
6.- El bloqueo de nervios torácicos puede
comprometer la función pulmonar.
7.- El paciente despierto puede requerir
comunicación y confortación.

11. Manejo de la
anestesia
03

12. Transoperatorio
Monitoreo
básico
Inducción
anestésica:
restaurar
pérdidas y SIR
Mantenimiento Protocolo ERAS

13. Va de la mano con
monitorizacion invasiva, los
casos muy prolongados con
exposicion intestinal
requeriran de 10-15 ml/kg/h
para reposicion.
Se estima por observación
directa, trampas de succion y
peso de las compresas.
Drenaje abrupto de liquico
ascítico = hipotensión aguda
Drenaje por SNG y otros, se
cuantifican y se reemplazan.
Es crítica, ya que la distencion
intestinal, el edema y
trasplante de organos
aumentan el volumen del
contenido abdominal y
dificultad el cierre.
Remplazo hidrico Sangrado Pérdidas insensibles
Varían desde 0.5 a 1 mL/kg/h
Colocacion PRE-quirurgica está
indicada descompresion del
estómago.
Colocación INTRA-quirurgica
es necesaria para drenar
líquido y aire.
Drenajes Relajacion muscular Sondas NG
Mantenimiento

14. Se origina por retraccion quirúrgica de
las vísceras abdominales para mejorar la
exposición, insuflación de gas y
posición de trendelenburg.
Resultado de manipulación intestinal e
insuflación abdominal.
Pérdida de calor en procedimientos
abiertos.
Prevenir la hipotermia ayuda a evitar las
infecciones postoperatorias,
complicaciones cardiacas, las
necesidades de trasfusiones o
sangrado, mejora la función inmune,
reduce el periodo postoperatorio y la
supervivencia.
Contaminación fecal por perforación
del tracto gastrointestinal que puede
causar infección y sepsis.
Compromiso pulmonar
Control de la temperatura
Cambios hemodinámicos
Contaminación
Problemas transoperatorios

15. Anestesia combinada = regional + multimodal + AGB
Terapia hídrica dirigida por objetivos
Jupiter is a gas giant and the biggest planet in the Solar System. It's the fourth-
brightest object in the night sky and was named after a Roman god
Se basa en la medición objetiva del estado hídrico del paciente.
Se prefieren soluciones balanceadas ( ringer lactato, fisiológica o Hartman), otras
causan acidosis metabólica.
Liquidos claros con cierta cantidad de carbohidratos 2 a 3 horas previas al evento.
Ingesta de sólidos 6 horas previas al evento quirurgico.
Tiempo de ayuno reducido
Protocolo ERAS
RECUPERACIÓN MEJORADA DESPÚES DE LA CIRUGIA

16. Alimentación temprana
Ambulación temprana
La alimentación enteral completa iniciada inmediatamente después de la
operación normalizó los niveles de glucosa y se asoció con la abolición de la
respuesta catabólica a la cirugía, de modo que no hubo pérdida neta
Las complicaciones del reposo prolongado en cama incluyen atrofia y debilidad
del músculo esquelético, pérdida ósea, disminución de la sensibilidad a la
insulina, enfermedad tromboembólica, disfunción microvascular, atelectasia y
úlceras por presión
Se ha demostrado que la ansiedad del paciente es un predictor de dolor
postoperatorio.
Prevención de NVPO
Premedicación
Protocolo ERAS

17. Consideraciones
para
procedimientos
específicos.
04

18. Apendicectomía
• Se realiza mediante una incisión pequeña o
por medio de laparoscopía.
• Prequirúrgico: hidratación IV
• Transanestésico: considerar bloqueo TAP

19. Colecistectomía
• Se realiza mediante cirugía abierta o por
medio de laparoscopía.
• Se prefiere AGN

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21. Jupiter is a gas giant
20,000
The Sun is a bright star
50,000
5,000
Earth harbors life

22. Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a bit
larger than the Moon
259,273

23. Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
Understanding the numbers
Use this slide to present data on the outcomes of
patients who have received treatment for a
particular condition or disease. A column chart can
be an effective way to illustrate changes in patient
outcomes over time. Consider including data from
clinical trials or real-world patient populations to
showcase the impact of your breakthrough
Column chart

24. Discovery
Preclinical research
Early phase clinical trial
Phase I clinical trial
Phase II clinical trial
Phase III clinical trial
FDA review
Post-market monitoring
Milestones

25. Treatment option Efficacy rate Side effects Cost Availability
Medication A 80% Mild $$ Widely available
Medication B 70% Moderate $$$ Available only with prescription
Surgery 90% High $$$$ Requires specialized facilities
Radiation therapy 75% Moderate $$ Available in most hospitals
Immunotherapy 65% Moderate $$$$ Available only in select medical centers
Physical therapy 60% Mild $$ Widely available
Treatment options

26. Phase 1: safety
and dosage
● Participants: 20-100
healthy volunteers
● Objective: To determine
safe dosage range and
identify side effects
● Duration: 6 months
● Success rate: 80% of
participants completed
the trial without
experiencing significant
side effects
Phase 2: efficacy
and side effects
● Participants: Up to
several hundred people
with the condition
● Objective: To determine
effectiveness and further
evaluate safety
● Duration: 12 months
● Success rate: 65% of
participants experienced
a significant improvement
in symptoms
Phase 3: large-scale
testing
● Participants: From
several hundred to several
thousand people with the
condition
● Objective: To confirm
effectiveness, monitor
side effects, and compare
to standard treatments
● Duration: 24 months
● Success rate: New
treatment was better
than standard in 75% of
the cases
Phase 4: post-market
monitoring
● Participants: Thousands
of people with the
condition who are taking
the drug as prescribed
● Objective: To monitor
long-term safety and
effectiveness and detect
rare side effects
● Duration: Ongoing
● Success rate: No major
safety concerns have
been identified in the two
years since the drug was
approved for market use
Clinical trial phases

27. Key performance indicator Number
Patients treated 2,500
Success rate 95%
Average recovery time 3 days
Trend in patient outcomes
Data and statistics
The tool increased
early diagnosis
rates by 50%
100 lives saved by
new treatment in
1st year
25% less
complications with
new technique
Follow the link in the graph to modify its data and then paste the new one here. For more info, click here

28. —John Smith, medical professional
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discomfort in daily activities”
"I've seen a significant improvement in patient outcomes. This
breakthrough makes treatment more efficient and personalized."
"We are impressed with the safety and effectiveness of this
breakthrough. It will greatly benefit patients and healthcare systems.
—Jane Doe, patient
—Sanjay Patel, regulatory body representative
Implications

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Describe the design of the study, such as whether it was a randomized
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Summarize the main findings of the investigation, including statistical results
and any important trends or patterns observed
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Discuss the implications of the findings for patients, healthcare providers,
and other stakeholders. You could also mention any potential limitations of
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Discuss the implications of the
findings and how they relate to the
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Results and conclusions
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