Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000600013
Brazilian Journal of Anesthesiology
Review Article

Como o anestesiologista pode contribuir para a prevenção de infecção no paciente cirúrgico

Ways the anesthesiologist can contribute to the prophylaxis of infection in the surgical patient

Fabiana Aparecida Penachi Bosco Ferreira; Maria Ligia Gomes Marin; Tânia Mara V Strabelli; Maria José Carvalho Carmona

Downloads: 1
Views: 1062

Resumo

JUSTIFICATIVA E OBJETIVOS: O paciente cirúrgico com infecção hospitalar, além de aumentar os custos hospitalares, pode não recuperar sua condição prévia e até morrer. Além dos riscos individuais bem estabelecidos, o desenvolvimento de infecção pósoperatória depende do procedimento a que será submetido, das condições hospitalares e do cirurgião. Apesar de haver muitos protocolos visando o controle da infecção, falta padronização de intervenções intraoperatórias visando a otimização desse paciente. Assim, esta revisão teve como objetivo discutir algumas dessas intervenções que são eficazes e necessárias, alertando o anestesiologista da sua importância na prevenção da infecção hospitalar. CONTEÚDO: Nesta revisão foram abordadas as causas de infecção no paciente cirúrgico e discutiu-se como a adequada administração de antibióticos, o controle térmico e glicêmico e as estratégias de ventilação mecânica, hidratação e transfusão podem reduzir as taxas de infecção no paciente cirúrgico. CONCLUSÕES: O anestesiologista é o profissional que deve intervir no intraoperatório com medidas simples para otimizar o atendimento do paciente cirúrgico e diminuir índices de infecção.

Palavras-chave

ANTIBIÓTICOS, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Besides the increase in hospital costs, surgical patients with nosocomial infection may not recover their previous condition and their condition can even evolve to death. Besides well-established patient-related risks, postoperative infection is also dependent on the surgical procedure, the hospital conditions and the surgeon. Despite several protocols to prevent nosocomial infections, standardization of intraoperative interventions to optimize those patients does not exist. Thus, the objective of this review was to discuss some of those interventions that are effective and necessary, alerting anesthesiologists of their importance in preventing nosocomial infections. CONTENTS: In this review, the causes of infections in surgical patients as well as the adequate administration of antibiotics, temperature and blood glucose control, and strategies of mechanical ventilation, hydration, and transfusions that can reduce the incidence of infections in surgical patients are discussed. CONCLUSIONS: The anesthesiologist is the professional who should intervene in the intraoperative period with simple measures to optimize the care of surgical patients and to reduce the incidence of infections.

Keywords

ANTIBIOTICS, COMPLICATIONS

References

Haley RW, Culver DH, White JW. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol. 1985;121:159-167.

Burke JP. Infection control: a problem for patient safety. N Engl J Med. 2003;348:651-656.

Kluytmans J. Surgical Site Including Burns. Wenzel - Prevention and Control of Nosocomial Infections. 1997.

Whitehouse JD, Sexton DJ. Epidemiology and pathogenesis of and risk factors for surgical site infection. 24/0.

Culver DH, Horan TC, Gaynes RP. Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infection Surveillance System. Am J Med. 1991;91:152s-157s.

Maksimovic J, Markovic-Denic L, Bumbasirevic M. Surgical site infection in orthopedic patients: prospective cohort study. Croat Med J. 2008;49:58-65.

Sosis MB, Braverman B. Growth of Staphylococcus aureus in four intravenous anesthetics. Anesth Analg. 1993;77:766-768.

Trépanier CA, Lessard MR. Propofol and the risk of transmission of infection. Can J Anaesth. 2003;50:533-537.

Mauermann WJ, Nemergut EC. The anesthesiologist's role in the prevention of surgical site infections. Anesthesiology. 2006;105:413-421.

Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706-1715.

Bratzler DW, Houck PM, Richards C. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Project. Arch Surg. 2005;140:174-182.

Polk HC Jr, Lopez -Mayor JF. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969;66:97-103.

Pass SE, Miygawa CI, Healy DP. Serum concentrations of cefuroxime after continuous infusion in coronary bypass graft patients. Ann Pharmacother. 2001;35:409-413.

Nascimento JWL, Carmona MJC, Strabelli TMV. Systemic availability of prophylactic cefuroxime in patients submitted to coronary artery bypass grafting with cardiopulmonary bypass. J Hosp Infect. 2005;59:299-303.

Trick WE, Scheckler WE, Tokars JI. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000;119:108-114.

Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95:531-543.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization: Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209-1215.

Flores-Maldonado A, Medina-Escobedo CE, Rios-Rodriguez HM. Mild perioperative hipothermia and the risk of wound infection. Arch Med Res. 2001;32:227-231.

Barone JE, Tucker JB, Cecere J. Hypothermia does not result in more complications after colon surgery. Am Surg. 1999;65:356-359.

Sessler DI, Akca O. Nonpharmacological prevention of surgical wound infections. Clin Infect Dis. 2002;35:1397-1404.

Hopf HW, Hunt TK, West JM. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg. 1997;132:997-1004.

van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-1367.

Capes SE, Hunt D, Malmberg K. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773-778.

Ouattata A, Lecomte P, Le Manach Y. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103:687-694.

Rassias AJ, Marrin CA, Arruda J. Insulin infusion improves neutrophil function in diabetic cardiac surgery patients. Anesth Analg. 1999;88:1011-1016.

Zerr Kj, Furnary AP, Grunkemeier GL. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356-361.

Malbouisson LMS, Humberto F, Rodrigues RR. Atelectasias durante anestesia: fisiopatologia e tratamento. Rev Bras Anestesiol. 2008;58:73-83.

Bendixen HH, Hedley-Whyte J, Laver MB. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: A concept of atelectasis. N Engl J Med. 1963;269:991-996.

Bergman NA. Distribution of inspired gas during anesthesia and artificial ventilation. J Appl Physiol. 1963;18:1085-1089.

Eichenberger A, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788-1792.

Rothen HU, Sporre B, Engberg G. Atelectasis and pulmonary shunting during induction of general anaesthesia: can they be avoided?. Acta Anaesthesiol Scand. 1996;40:524-529.

Belda FJ, Aguilera L, Garcia de la Asuncion J. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005;294:2035-2042.

Greif R, Akca O, Horn EP. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection: Outcomes Research Group. N Engl J Med. 2000;342:161-167.

Pryor KO, Fahey TJ 3rd, Lien CA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA. 2004;291:79-87.

Dellinger EP. Increasing inspired oxygen to decrease surgical site infection: time to shift the quality improvement research paradigm. JAMA. 2005;294:2091-2.

Kotani N, Hashimoto H, Sessler DI. Supplemental intraoperative oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages. Anesthesiology. 2000;93:15-25.

Neumann P, Rothen HU, Berglund JE. Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand. 1999;43:295-301.

Brismar B, Hedenstierna G, Lundquist H. Pulmonary densities during anesthesia with muscular relaxation: a proposal of atelectasis. Anesthesiology. 1985;62:422-428.

Auler Jr JOC, Nozawa E, Toma EK. Manobra de recrutamento alveolar na reversão da hipoxemia no pós-operatório imediato em cirurgia cardíaca. Rev Bras Anestesiol. 2007;57:476-488.

Jonsson K, Jensen JA, Goodson WH 3rd. Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg. 1987;74:263-267.

Arkilic CF, Taguchi A, Sharma N. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery. 2003;133:49-55.

Lang K, Boldt J, Suttner S. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg. 2001;93:405-409.

Nisanevich V, Felsenstein I, Almogy G. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25-32.

Leal-Noval SR, Rincon-Ferrari MD, Garcial-Curiel A. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest. 2001;119:1461-1468.

Levi N, Sandberg T. Blood transfusion and postoperative wound infection in intracapsular femoral neck fracture. Bull Hosp Joint Dis. 1998;57:69-73.

Blumberg N, Heal JM. Immunomodulation by blood transfusion: an evolving scientific and clinical challenge. Am J Med. 1996;101:299-308.

Agarwal N, Murphy JG, Gayten CG. Blood transfusion increases the risk of infection after trauma. Arch Surg. 1993;128:171-176.

Houbiers JG, van de Velde CJ, van de Watering LM. Transfusion of red cells is associated with increased incidence of bacterial infection after colorectal surgery: a prospective study. Transfusion. 1997;37:126-134.

Hebert PC, Fergusson D, Blajchman MA. Clinical outcomes following institutions of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA. 2003;289:1941-1949.

Fergusson D, Khanna MP, Tinmouth A. Transfusion of leukoreduced red blood cells may decrease postoperative infections: two meta-analyses of randomized controlled trials. Can J Anaesth. 2004;51:417-424.

Koch CG, Li L, Sessler DI. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358:1229-1339.

Levin ASS, Dias MBS, Oliveira MS. Guia de Utilização de Anti-infecciosos e Recomendações para Prevenção de Infecções Hospitalares. . 2007:158-162.

5dd594380e88256a70c8fca7 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections