Ecocardiografia Transtorácica e Transesofágica no Peri-operatório em Cirurgia Não Cardíaca

  • André Carrão Interno de Formação Específica de Anestesiologia, Serviço de Anestesiologia do Hospital Beatriz Ângelo, Loures, Portugal
  • Sónia Pereira Assistente Hospitalar Graduada de Anestesiologia, Serviço de Anestesiologia do Hospital Beatriz Ângelo, Loures, Portugal
Palavras-chave: Avaliação de Risco; Doenças do Coração/complicações; Ecocardiografia; Ecocardiografia Transesofágica; Período Perioperatório

Resumo

As complicações cardiovasculares são responsáveis por grande parte da morbi-mortalidade peri-operatória. A avaliação cardíaca préoperatória é, por isso, fundamental. Este trabalho pretende determinar quais os doentes propostos para cirurgia não cardíaca que beneficiam da realização pré-operatória de ecocardiograma transtorácico para estratificação de risco e eventual otimização e quais os doentes que,
tendo em conta a sua patologia cardiovascular e o tipo de intervenção a que vão ser submetidos, devem ser monitorizados durante o período peri-operatório com ecocardiograma transesofágico.
Foi realizada uma pesquisa do PubMed de artigos datados de Janeiro de 1990 até Setembro de 2018 e com interesse para o tema deste trabalho. Os trabalhos selecionados incluem maioritariamente guidelines nacionais e internacionais, revisões sistemáticas e estudos randomizados com data de publicação posterior à das guidelines e que apresentam informação relevante.
Para além da história clínica, exame objetivo, scores de risco, avaliação laboratorial e electrocardiografia, o ecocardiograma, tanto em repouso como de stress, pode ser útil na estratificação do risco cardíaco em situações selecionadas, tendo em conta o impacto sobre a optimização do doente. Têm sido publicadas guidelines para a sua utilização em doentes propostos para cirurgia não cardíaca, sendo recomendado sobretudo em doentes propostos para cirurgia de elevado risco cardíaco ou doentes com patologia
cardíaca significativa (insuficiência cardíaca, cardiopatia isquémica,
valvulopatias) propostos para cirurgia de risco cardíaco intermédio
ou elevado. O recurso ao ecocardiograma transesofágico intraoperatório
em cirurgia não cardíaca não é recomendado por rotina,
estando reservado para a cirurgia vascular major ou nos doentes com
alterações hemodinâmicas graves e persistentes.

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Publicado
2019-06-13
Como Citar
Carrão, A., & Pereira, S. (2019). Ecocardiografia Transtorácica e Transesofágica no Peri-operatório em Cirurgia Não Cardíaca. Revista Da Sociedade Portuguesa De Anestesiologia, 28(2), 110-118. https://doi.org/10.25751/rspa.17470