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2013, Número 4

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Rev Mex Anest 2013; 36 (4)


Anestesia para endoscopía digestiva en el paciente cardiópata isquémico

Gómez-Ríos N, Rodríguez-Ortega MF, Rojas-Sánchez A, Alonso-Mercado JC, Pérez-Bustamante J, Jaymes-Nuñez A, Vargas-Trujillo C

Idioma: Español
Referencias bibliográficas: 124
Paginas: 257-274
Archivo PDF: 275.11 Kb.


RESUMEN

El gran avance que ha tenido la endoscopía digestiva en los últimos años ha hecho que el número de procedimientos aumente, haciendo de éste una práctica común en la medicina moderna; por ello, en el paciente cardiópata se solicita cada vez más la sedación-analgesia para este tipo de intervenciones. Objetivo: Analizar el tratamiento anestésico en el paciente cardiópata al que se le realizó algún procedimiento endoscópico. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios. Diseño: Estudio descriptivo, observacional, transversal y prospectivo. Análisis estadístico: Porcentaje como medida de resumen para variables cualitativas. Método: Se revisaron los expedientes clínicos de los pacientes a los que se les realizó algún procedimiento endoscópico y presentaban antecedente de cardiopatía isquémica, de junio de 2006 a junio de 2011. Se analizaron las siguientes variables: edad y género, tratamiento y tiempo de evolución de la cardiopatía isquémica, comorbilidades, procedimiento endoscópico (alto, bajo o colangiopancreatografía retrógrada endoscópica), tiempo del procedimiento (diagnóstico o terapéutico), hallazgos electrocardiográficos transprocedimiento, protocolo anestésico empleado y morbimortalidad. Resultados: 82 pacientes con antecedente de cardiopatía isquémica, promedio de edad de 55 años, género masculino 58.6, con tratamiento médico más trombólisis a 29 pacientes, intervencionismo en 39 y procedimiento quirúrgico en 14, con tiempo promedio de evolución de seis meses, con terapia dual en 66 pacientes, 42 con antecedente de diabetes mellitus tipo 2. Realizando 45 esofagogastroduodenofibroscopías, 25 rectosigmoidocolonofibroscopías y 12 colangiopancreatografías retrógradas endoscópicas, la alteración electrocardiográfica que se presentó con más frecuencia fue extrasístole ventricular en 23 pacientes, no se reportó isquemia o infarto agudo al miocardio, no se reportaron complicaciones inherentes al procedimiento anestésico ni mortalidad cardiovascular a un año de seguimiento. Conclusión: Es necesaria la estratificación del riesgo quirúrgico y complejidad del procedimiento en la población cardiópata isquémica para la adecuada decisión anestésica y así disminuir las complicaciones perioperatorias.


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