Complicações associadas à posição prona na neurocirurgia: uma revisão sistemática / Complications associated with prone positioning in neurosurgery: a systematic review

Autores

  • Josué da Silva Brito Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Isadora Dias Lacerda Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Marcela Silveira Castro Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Marina Guarienti Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Michelly Rodrigues Cavalcante Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Victória Araújo Silva Centro Universitário Atenas (UniAtenas). Curso de Medicina. Paracatu – MG - Brasil
  • Carlos Umberto Pereira Fundação de Beneficência Hospital de Cirurgia (FBHC). Departamento de Neurocirurgia da FBHC. Aracaju – SE - Brasil
  • Ní­collas Nunes Rabelo Faculdade Atenas. Departamento de Neurocirurgia. Passos – MG - Brasil

DOI:

https://doi.org/10.26432/1809-3019.2021.66.024

Resumo

Introdução: A escolha da posição do paciente na neurocirurgia é um processo que se baseia no sítio de intervenção e na prevenção de complicações, considerando-se a máxima
segurança para o paciente. O posicionamento em prona está ligado a complicações transitórias e permanentes pouco discutidas. Método: Pesquisou-se os termos “pronação”,
“decúbito ventral”, “prona”, complicações”, “intercorrências” e variações utilizado os operadores booleanos OR e AND, em diferentes estratégias. Resultados: Selecionou-se
49 artigos, que relataram complicações hemodinâmicas, visuais, neurológicas, musculares e venosas, de caráter transitório ou permanente. As complicações estão associadas tanto a aspectos da cirurgia, como movimentação adotada durante o procedimento, hipovolemia, hemorragia e tempo cirúrgico, quanto a comorbidades dos pacientes, como obesidade, hipertensão arterial e diabetes mellitus. Discussão: A posição prona exige observação dos fatores de risco, para escolha de posicionamentos alternativos, e, caso adotada, a monitorização do paciente, a fim de reduzir complicações. Conclusão: Nenhum posicionamento está destituído de riscos,  sendo necessário conhecer as complicações a fim de se melhor avaliar a escolha do posicionamento. 

Palavras chave: Decúbito ventral, Neurocirurgia, Laminectomia, Cuidados pós-operatórios

ABSTRACT
Introduction: The choice of patient positioning in neurosurgery is a process that is based on the intervention site and prevention of complications, in order to ensure maximum
patient safety. The prone position requires patient monitoring to reduce complications. Alternative positions must be considered if there are patient risk factors Method: The
terms “pronation”, “prone position”, “prone”, “complications” and variations were used with the boolean operators OR and AND in different strategies. Results: Forty-nine articles were selected that reported transient or permanent hemodynamic, visual, neurological, muscular and venous complications. Complications are associated with surgical aspects, such as movements adopted during the procedure, hypovolemia, hemorrhage, surgical time, and patients’ comorbidities, such as obesity, arterial hypertension, and diabetes mellitus. Discussion: The prone position requires patient monitoring to reduce complications. Alternative positions must be considered if there are patient risk factors. Conclusion: No positioning is without risks, and it is necessary to know the complications to better assess the positioning choice.
Keywords: Prone position, Neurosurgery, Laminectomy, Postoperative care

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Publicado

2021-08-03

Edição

Seção

ARTIGO DE REVISÃ0 SISTEMÁTICA