Evaluación de la ansiedad preoperatoria y el dolor postoperatorio en pacientes sometidos a dacriocistorrinostomía

Lemaître, S.; Kang, S.; Moral, D.M.; Ezra, D.
doi:10.1016/j.redar.2020.07.009
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lo cual puede incrementar consecuentemente la presi&#243;n arterial<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> y causar hemorragia postoperatoria&#46; Como la hemorragia es la complicaci&#243;n m&#225;s frecuente en la DCR &#40;con p&#233;rdida de sangre potencialmente severa&#41;&#44; la gesti&#243;n preoperatoria de la ansiedad y el tratamiento postoperatorio del dolor son primordiales&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Realizamos un estudio piloto prospectivo y unic&#233;ntrico a fin de evaluar la ansiedad preoperatoria&#44; la necesidad de informaci&#243;n&#44; as&#237; como el dolor postoperatorio en pacientes sometidos a DCR externa o endonasal bajo anestesia general o local con sedaci&#243;n&#46; La anestesia local &#40;AL&#41; consisti&#243; en una inyecci&#243;n de lignoca&#237;na al 2&#37; o bupivaca&#237;na al 0&#44;5&#37; en el &#225;rea del cantus medial y&#47;o mucosa nasal &#40;dependiendo de la preferencia del cirujano&#41;&#46; Se realiz&#243; la evaluaci&#243;n preoperatoria de la ansiedad utilizando la <span class="elsevierStyleItalic">Amsterdam Preoperative Anxiety and Information Scale</span> &#40;APAIS&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#44; que consiste en 6<span class="elsevierStyleHsp" style=""></span>&#237;tems calificados por el paciente de 1 &#40;ausentes&#41; a 5 &#40;extremos&#41;&#58; Me preocupa la anestesia &#40;A1&#41;&#44; Pienso en la anestesia constantemente &#40;A2&#41;&#44; Me gustar&#237;a saber el m&#225;ximo posible sobre la anestesia &#40;A3&#41;&#44; Me preocupa el procedimiento quir&#250;rgico &#40;S1&#41;&#44; Pienso en la operaci&#243;n constantemente &#40;S2&#41;&#44; Me gustar&#237;a saber el m&#225;ximo posible sobre la operaci&#243;n &#40;S3&#41;&#46; Cuando la puntuaci&#243;n de ansiedad global es superior o igual a 11 &#40;A1 &#43;<span class="elsevierStyleHsp" style=""></span>A2 &#43;<span class="elsevierStyleHsp" style=""></span>S1 &#43; <span class="elsevierStyleHsp" style=""></span>S2<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; el nivel de ansiedad no se considera id&#243;neo para el estr&#233;s quir&#250;rgico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; El dolor postoperatorio se evalu&#243; transcurrida aproximadamente una hora desde la salida del quir&#243;fano&#44; utilizando una escala num&#233;rica de 0 a 10&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se incluyeron 15 pacientes&#46; Existi&#243; una preponderancia de mujeres &#40;66&#44;7&#37;&#41; porque la obstrucci&#243;n primaria del conducto adquirida es m&#225;s frecuente en ellas&#46; La cirug&#237;a caus&#243; m&#225;s ansiedad preoperatoria que la anestesia&#58; la puntuaci&#243;n &#40;S1 &#43;<span class="elsevierStyleHsp" style=""></span>S2&#41; media fue de 4&#44;4 &#40;rango 2-10&#41;&#44; mientras que la puntuaci&#243;n &#40;A1 &#43;<span class="elsevierStyleHsp" style=""></span>A2&#41; media fue de 3&#44;5 &#40;rango 2-7&#41;&#46; Todos los pacientes&#44; salvo uno&#44; fueron sometidos a DCR bajo anestesia general &#40;AG&#41;&#46; El paciente que recibi&#243; AL con sedaci&#243;n ten&#237;a comorbilidades significativas y no fue considerado apto para anestesia general&#46; Esta paciente ten&#237;a una puntuaci&#243;n de ansiedad preoperatoria global de 4 y evalu&#243; su dolor postoperatorio con una puntuaci&#243;n de 4 &#40;solo se pudo realizar una peque&#241;a osteotom&#237;a debido al malestar preoperatorio&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se encontraron los siguientes factores asociados a los niveles m&#225;s altos de ansiedad preoperatoria y dolor postoperatorio&#58; sexo masculino&#44; edad &#8804;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; cirug&#237;a realizada por un residente&#44; enfoque endonasal y DCR bilateral &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; En los pacientes que recibieron tanto anestesia general como local&#44; el dolor postoperatorio medio fue de 5&#44;3 &#40;rango 0-10&#41;&#46; Dos pacientes recibieron AG sin AL y puntuaron su dolor postoperatorio en 0 y 9 &#40;media 4&#44;5&#41;&#46; Se anotaron episodios hemorr&#225;gicos en dos pacientes&#58; exudaci&#243;n durante la DCR en uno &#40;ansiedad preoperatoria general&#58;<span class="elsevierStyleHsp" style=""></span>7&#44; dolor postoperatorio&#58;<span class="elsevierStyleHsp" style=""></span>9&#41; y sangrado m&#237;nimo en la nasofaringe en el otro &#40;ansiedad preoperatoria general&#58;<span class="elsevierStyleHsp" style=""></span>9&#44; dolor postoperatorio&#58;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Ninguno de los 15 pacientes tuvo hemorragia postoperatoria &#40;en particular sin epistaxis&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La necesidad de informaci&#243;n &#40;A3 &#43;<span class="elsevierStyleHsp" style=""></span>S3&#41; fue superior en los varones&#44; cuando el cirujano era un residente&#44; si la DCR era endonasal o bilateral&#44; y si se trataba de reintervenci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El folleto informativo sobre el procedimiento supuso una fuente de ansiedad preoperatoria en un &#250;nico paciente&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; esta auditor&#237;a refleja que el tratamiento del dolor postoperatorio podr&#237;a optimizarse en los pacientes sometidos a DCR&#46; La AL sistem&#225;tica en el cantus medial y la mucosa nasal en los pacientes que han recibido AG podr&#237;a ser &#250;til para reducir el dolor postoperatorio &#40;aunque su efecto no fue obvio en nuestra peque&#241;a muestra de pacientes&#41;&#46; El nivel de ansiedad preoperatoria fue aceptable en la mayor&#237;a de los pacientes &#40;80&#37;&#41;&#44; pero adoptar medidas tales como terapia musical o hipnosis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> podr&#237;a ser de utilidad para los pacientes con ansiedad&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0035" class="elsevierStylePara elsevierViewall">No se ha reportado ning&#250;n conflicto de intereses&#46;</p></span></span>"
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