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 <!DOCTYPE html>
<html lang="pt-BR">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Protocolo Tx Hepático - HUWC-HSC | Anestesiologia</title>
<script src="https://cdn.tailwindcss.com"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.4.0/css/all.min.css">
<style>
.slide {
display: none;
padding: 2rem;
height: 100vh;
overflow-y: auto;
}
.active-slide {
display: block;
}
.progress-bar {
height: 5px;
background: linear-gradient(90deg, #3b82f6 0%, #10b981 100%);
transition: width 0.3s ease;
}
.chart-container {
position: relative;
height: 300px;
width: 100%;
}
.flowchart {
display: flex;
flex-direction: column;
align-items: center;
}
.flowchart-step {
position: relative;
padding: 1rem;
margin: 0.5rem;
border-radius: 0.5rem;
width: 80%;
text-align: center;
box-shadow: 0 4px 6px -1px rgba(0, 0, 0, 0.1);
}
.flowchart-arrow {
width: 0;
height: 0;
border-left: 15px solid transparent;
border-right: 15px solid transparent;
border-top: 15px solid #3b82f6;
}
.highlight {
background-color: #fef3c7;
padding: 0.2rem 0.5rem;
border-radius: 0.25rem;
}
</style>
</head>
<body class="bg-gray-100 font-sans">
<!-- Progress Bar -->
<div class="progress-bar fixed top-0 left-0" style="width: 0%"></div>
<!-- Slides Container -->
<div class="slides-container relative">
<!-- Slide 1: Title -->
<div class="slide active-slide bg-gradient-to-br from-blue-900 to-blue-700 text-white">
<div class="flex flex-col items-center justify-center h-full">
<img src="https://img.icons8.com/color/96/000000/hospital.png" alt="Hospital Icon" class="mb-6">
<h1 class="text-4xl md:text-5xl font-bold mb-4 text-center">Protocolo de Transplante Hepático</h1>
<h2 class="text-2xl md:text-3xl font-semibold mb-8 text-center">HUWC-HSC | Serviço de Anestesiologia</h2>
<div class="bg-white text-blue-900 px-6 py-3 rounded-full font-medium">
Capacitação para Médicos Residentes
</div>
<p class="mt-8 text-blue-200">Hospital São Domingos | Departamento de Anestesiologia</p>
</div>
</div>
<!-- Slide 2: Objetivos -->
<div class="slide bg-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-bullseye mr-4 text-blue-600"></i> Objetivos do Protocolo
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6">
<div class="bg-blue-50 p-6 rounded-lg border-l-4 border-blue-500">
<h3 class="text-xl font-semibold text-blue-700 mb-3">Objetivo Principal</h3>
<p class="text-gray-700">Padronizar a abordagem anestésica para transplantes hepáticos no HUWC-HSC, garantindo segurança e eficácia.</p>
</div>
<div class="bg-green-50 p-6 rounded-lg border-l-4 border-green-500">
<h3 class="text-xl font-semibold text-green-700 mb-3">Objetivos Específicos</h3>
<ul class="list-disc pl-5 text-gray-700 space-y-2">
<li>Otimizar o manejo perioperatório</li>
<li>Reduzir complicações intra e pós-operatórias</li>
<li>Uniformizar condutas entre a equipe</li>
<li>Melhorar desfechos clínicos</li>
</ul>
</div>
</div>
<div class="mt-8 bg-yellow-50 p-6 rounded-lg border-l-4 border-yellow-500">
<h3 class="text-xl font-semibold text-yellow-700 mb-3">Público-Alvo</h3>
<p class="text-gray-700">Médicos residentes do serviço de anestesiologia do Hospital São Domingos envolvidos no cuidado de pacientes submetidos a transplante hepático.</p>
</div>
</div>
</div>
<!-- Slide 3: Epidemiologia -->
<div class="slide bg-gray-50">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-chart-line mr-4 text-blue-600"></i> Epidemiologia do Transplante Hepático
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8">
<div>
<h3 class="text-xl font-semibold text-gray-800 mb-4">Dados Globais</h3>
<div class="bg-white p-4 rounded-lg shadow">
<div class="chart-container">
<canvas id="epidemiologyChart"></canvas>
</div>
<p class="text-sm text-gray-600 mt-2">Fonte: Global Observatory on Donation and Transplantation (2022)</p>
</div>
</div>
<div>
<h3 class="text-xl font-semibold text-gray-800 mb-4">Principais Indicações</h3>
<div class="bg-white p-4 rounded-lg shadow">
<div class="chart-container">
<canvas id="indicationsChart"></canvas>
</div>
</div>
</div>
</div>
<div class="mt-8 bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Dados Nacionais</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-white">
<thead class="bg-blue-800 text-white">
<tr>
<th class="py-3 px-4 text-left">Ano</th>
<th class="py-3 px-4 text-left">Transplantes</th>
<th class="py-3 px-4 text-left">Lista de Espera</th>
<th class="py-3 px-4 text-left">Mortalidade</th>
</tr>
</thead>
<tbody class="text-gray-700">
<tr class="border-b border-gray-200">
<td class="py-3 px-4">2020</td>
<td class="py-3 px-4">1,850</td>
<td class="py-3 px-4">2,300</td>
<td class="py-3 px-4">8.2%</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">2021</td>
<td class="py-3 px-4">1,920</td>
<td class="py-3 px-4">2,450</td>
<td class="py-3 px-4">7.8%</td>
</tr>
<tr>
<td class="py-3 px-4">2022</td>
<td class="py-3 px-4">2,050</td>
<td class="py-3 px-4">2,600</td>
<td class="py-3 px-4">7.5%</td>
</tr>
</tbody>
</table>
</div>
<p class="text-sm text-gray-600 mt-4">Fonte: Associação Brasileira de Transplante de Órgãos (ABTO)</p>
</div>
</div>
</div>
<!-- Slide 4: Indicações -->
<div class="slide bg-gradient-to-br from-blue-50 to-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-list-check mr-4 text-blue-600"></i> Indicações para Transplante Hepático
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8">
<div>
<div class="bg-white p-6 rounded-lg shadow-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-4 border-b pb-2">Indicações Absolutas</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-check-circle text-green-500 mt-1 mr-3"></i>
<span>Falência hepática aguda</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-500 mt-1 mr-3"></i>
<span>Cirrose descompensada (Child-Pugh ≥7)</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-500 mt-1 mr-3"></i>
<span>Carcinoma hepatocelular dentro dos critérios de Milão</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-500 mt-1 mr-3"></i>
<span>Doenças metabólicas com manifestação hepática</span>
</li>
</ul>
</div>
</div>
<div>
<div class="bg-white p-6 rounded-lg shadow-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-4 border-b pb-2">Indicações Relativas</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-exclamation-circle text-yellow-500 mt-1 mr-3"></i>
<span>Hipertensão portal com sangramento recorrente</span>
</li>
<li class="flex items-start">
<i class="fas fa-exclamation-circle text-yellow-500 mt-1 mr-3"></i>
<span>Encefalopatia hepática refratária</span>
</li>
<li class="flex items-start">
<i class="fas fa-exclamation-circle text-yellow-500 mt-1 mr-3"></i>
<span>Síndrome hepatopulmonar</span>
</li>
<li class="flex items-start">
<i class="fas fa-exclamation-circle text-yellow-500 mt-1 mr-3"></i>
<span>Qualidade de vida inaceitável</span>
</li>
</ul>
</div>
</div>
</div>
<div class="mt-8 bg-white p-6 rounded-lg shadow-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-4 border-b pb-2">Critérios de Exclusão</h3>
<div class="grid grid-cols-1 md:grid-cols-2 gap-4">
<ul class="space-y-2">
<li class="flex items-start">
<i class="fas fa-times-circle text-red-500 mt-1 mr-3"></i>
<span>Infecção ativa não controlada</span>
</li>
<li class="flex items-start">
<i class="fas fa-times-circle text-red-500 mt-1 mr-3"></i>
<span>Neoplasia extra-hepática</span>
</li>
</ul>
<ul class="space-y-2">
<li class="flex items-start">
<i class="fas fa-times-circle text-red-500 mt-1 mr-3"></i>
<span>Doença cardiopulmonar grave irreversível</span>
</li>
<li class="flex items-start">
<i class="fas fa-times-circle text-red-500 mt-1 mr-3"></i>
<span>Dependência de álcool/drogas ativa</span>
</li>
</ul>
</div>
</div>
</div>
</div>
<!-- Slide 5: Avaliação Pré-Operatória -->
<div class="slide bg-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-user-md mr-4 text-blue-600"></i> Avaliação Pré-Operatória
</h2>
<div class="flowchart mb-8">
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-history mr-2"></i> História Clínica Completa
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-procedures mr-2"></i> Exame Físico Detalhado
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-vial mr-2"></i> Exames Laboratoriais
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-heartbeat mr-2"></i> Avaliação Cardiopulmonar
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-brain mr-2"></i> Avaliação Neurológica
</div>
</div>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6">
<div class="bg-blue-50 p-4 rounded-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-3">Exames Essenciais</h3>
<ul class="list-disc pl-5 space-y-2 text-gray-700">
<li>Hemograma completo</li>
<li>Coagulograma (TAP, TTPA, fibrinogênio)</li>
<li>Função renal (ureia, creatinina)</li>
<li>Eletrólitos</li>
<li>Gasometria arterial</li>
<li>Testes de função hepática</li>
<li>Ecocardiograma</li>
</ul>
</div>
<div class="bg-green-50 p-4 rounded-lg">
<h3 class="text-xl font-semibold text-green-700 mb-3">Escalas de Avaliação</h3>
<div class="space-y-4">
<div>
<h4 class="font-medium text-green-800">Child-Pugh</h4>
<div class="bg-white p-2 rounded mt-1">
<div class="flex justify-between text-sm">
<span>A (5-6)</span>
<span>B (7-9)</span>
<span>C (10-15)</span>
</div>
<div class="w-full bg-gray-200 rounded-full h-2.5 mt-1">
<div class="bg-green-600 h-2.5 rounded-full" style="width: 30%"></div>
</div>
</div>
</div>
<div>
<h4 class="font-medium text-green-800">MELD</h4>
<div class="bg-white p-2 rounded mt-1">
<div class="flex justify-between text-sm">
<span><15</span>
<span>15-25</span>
<span>>25</span>
</div>
<div class="w-full bg-gray-200 rounded-full h-2.5 mt-1">
<div class="bg-green-600 h-2.5 rounded-full" style="width: 60%"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- Slide 6: Preparo Pré-Operatório -->
<div class="slide bg-gray-50">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-clipboard-check mr-4 text-blue-600"></i> Preparo Pré-Operatório
</h2>
<div class="grid grid-cols-1 md:grid-cols-3 gap-4 mb-8">
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-blue-500">
<div class="text-blue-600 mb-2">
<i class="fas fa-prescription-bottle-alt text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Correção de Coagulopatia</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Vitamina K (10mg EV)</li>
<li>Plasma fresco congelado</li>
<li>Crioprecipitado se fibrinogênio <100mg/dL</li>
<li>Plaquetas se <50.000/mm³</li>
</ul>
</div>
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-green-500">
<div class="text-green-600 mb-2">
<i class="fas fa-tint text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Manejo de Ascite</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Paracentese pré-operatória se volumosa</li>
<li>Albumina 20% (8g/L removido)</li>
<li>Restrição hídrica cuidadosa</li>
</ul>
</div>
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-purple-500">
<div class="text-purple-600 mb-2">
<i class="fas fa-brain text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Encefalopatia Hepática</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Lactulose (30ml 6/6h)</li>
<li>Rifaximina (550mg 12/12h)</li>
<li>Evitar sedativos</li>
</ul>
</div>
</div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Preparo Anestésico</h3>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6">
<div>
<h4 class="font-medium text-blue-700 mb-2">Jejum</h4>
<ul class="list-disc pl-5 text-gray-700 space-y-1">
<li>6h para sólidos</li>
<li>2h para líquidos claros</li>
<li>Considerar risco de aspiração</li>
</ul>
</div>
<div>
<h4 class="font-medium text-blue-700 mb-2">Pré-Medicação</h4>
<ul class="list-disc pl-5 text-gray-700 space-y-1">
<li>Ranitidina 50mg EV</li>
<li>Metoclopramida 10mg EV</li>
<li>Sedativos com cautela</li>
</ul>
</div>
</div>
</div>
</div>
</div>
<!-- Slide 7: Monitorização Intraoperatória -->
<div class="slide bg-gradient-to-br from-blue-900 to-blue-700 text-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold mb-6 flex items-center">
<i class="fas fa-heartbeat mr-4"></i> Monitorização Intraoperatória
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8">
<div>
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Monitorização Básica</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>ECG contínuo (DII e V5)</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Pressão arterial invasiva</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Plethismografia (SpO₂)</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Capnografia</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Temperatura (nasofaríngea/vesical)</span>
</li>
</ul>
</div>
</div>
<div>
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Monitorização Avançada</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-star text-yellow-300 mt-1 mr-3"></i>
<span>Cateter venoso central (CVC)</span>
</li>
<li class="flex items-start">
<i class="fas fa-star text-yellow-300 mt-1 mr-3"></i>
<span>Cateter de artéria pulmonar (opcional)</span>
</li>
<li class="flex items-start">
<i class="fas fa-star text-yellow-300 mt-1 mr-3"></i>
<span>Ecocardiografia transesofágica (ETE)</span>
</li>
<li class="flex items-start">
<i class="fas fa-star text-yellow-300 mt-1 mr-3"></i>
<span>Monitorização da coagulação (TEG/ROTEM)</span>
</li>
<li class="flex items-start">
<i class="fas fa-star text-yellow-300 mt-1 mr-3"></i>
<span>BIS para profundidade anestésica</span>
</li>
</ul>
</div>
</div>
</div>
<div class="mt-8 bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Parâmetros Alvo</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-blue-900 bg-opacity-50">
<thead>
<tr class="text-blue-200">
<th class="py-3 px-4 text-left">Parâmetro</th>
<th class="py-3 px-4 text-left">Valor Alvo</th>
</tr>
</thead>
<tbody class="text-white">
<tr class="border-b border-blue-700">
<td class="py-3 px-4">PAM</td>
<td class="py-3 px-4">>65 mmHg</td>
</tr>
<tr class="border-b border-blue-700">
<td class="py-3 px-4">PVC</td>
<td class="py-3 px-4">8-12 mmHg</td>
</tr>
<tr class="border-b border-blue-700">
<td class="py-3 px-4">SatO₂</td>
<td class="py-3 px-4">>95%</td>
</tr>
<tr class="border-b border-blue-700">
<td class="py-3 px-4">Débito urinário</td>
<td class="py-3 px-4">>0.5 mL/kg/h</td>
</tr>
<tr>
<td class="py-3 px-4">BIS</td>
<td class="py-3 px-4">40-60</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<!-- Slide 8: Indução Anestésica -->
<div class="slide bg-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-syringe mr-4 text-blue-600"></i> Indução Anestésica
</h2>
<div class="flowchart mb-8">
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-user-shield mr-2"></i> Pré-oxigenação (100% O₂ por 3-5 min)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-procedures mr-2"></i> Monitorização Básica + Acesso Venoso
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-prescription-bottle mr-2"></i> Pré-medicação (Fentanil 1-2μg/kg)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-capsules mr-2"></i> Indução (Propofol 1-2mg/kg ou Etomidato 0.2-0.3mg/kg)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-lungs mr-2"></i> Intubação (Rocurônio 0.6-1mg/kg ou Succinilcolina 1-1.5mg/kg)
</div>
</div>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6">
<div class="bg-blue-50 p-4 rounded-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-3">Considerações Especiais</h3>
<ul class="list-disc pl-5 space-y-2 text-gray-700">
<li>Redução de doses em pacientes com encefalopatia</li>
<li>Cuidado com hipotensão após indução</li>
<li>Preparar vasopressores (fenilefrina/noradrenalina)</li>
<li>Evitar hipóxia e hipercapnia</li>
</ul>
</div>
<div class="bg-green-50 p-4 rounded-lg">
<h3 class="text-xl font-semibold text-green-700 mb-3">Manejo das Vias Aéreas</h3>
<ul class="list-disc pl-5 space-y-2 text-gray-700">
<li>Tubo endotraqueal reforçado (proteção contra mordida)</li>
<li>Capnografia essencial</li>
<li>Preparar para via aérea difícil (MELD alto, ascite)</li>
<li>Posicionamento cuidadoso (risco de sangramento)</li>
</ul>
</div>
</div>
</div>
</div>
<!-- Slide 9: Manutenção Anestésica -->
<div class="slide bg-gray-50">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-clock mr-4 text-blue-600"></i> Manutenção Anestésica
</h2>
<div class="grid grid-cols-1 md:grid-cols-3 gap-4 mb-8">
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-blue-500">
<div class="text-blue-600 mb-2">
<i class="fas fa-cloud-meatball text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Agentes Inalatórios</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Isoflurano ou Sevoflurano (0.8-1.2 CAM)</li>
<li>Evitar Halotano (hepatotoxicidade)</li>
<li>Monitorar efeitos hemodinâmicos</li>
</ul>
</div>
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-purple-500">
<div class="text-purple-600 mb-2">
<i class="fas fa-prescription-bottle-alt text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Opioides</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Fentanil (1-5μg/kg/h)</li>
<li>Remifentanil (0.05-0.2μg/kg/min)</li>
<li>Evitar morfina (metabolismo hepático)</li>
</ul>
</div>
<div class="bg-white p-4 rounded-lg shadow border-t-4 border-green-500">
<div class="text-green-600 mb-2">
<i class="fas fa-syringe text-2xl"></i>
</div>
<h3 class="text-lg font-semibold text-gray-800 mb-2">Relaxantes Musculares</h3>
<ul class="text-sm text-gray-700 space-y-1">
<li>Rocurônio (0.3-0.6mg/kg/h)</li>
<li>Cisatracúrio (0.1mg/kg/h)</li>
<li>Monitorar com TOF</li>
</ul>
</div>
</div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Monitorização da Profundidade Anestésica</h3>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6">
<div>
<h4 class="font-medium text-blue-700 mb-2">BIS (Bispectral Index)</h4>
<ul class="list-disc pl-5 text-gray-700 space-y-1">
<li>Manter entre 40-60</li>
<li>Evitar consciência intraoperatória</li>
<li>Otimizar uso de anestésicos</li>
</ul>
</div>
<div>
<h4 class="font-medium text-blue-700 mb-2">Parâmetros Clínicos</h4>
<ul class="list-disc pl-5 text-gray-700 space-y-1">
<li>Pressão arterial</li>
<li>Frequência cardíaca</li>
<li>Resposta autonômica</li>
<li>Movimento</li>
</ul>
</div>
</div>
</div>
</div>
</div>
<!-- Slide 10: Fases Cirúrgicas -->
<div class="slide bg-gradient-to-br from-blue-900 to-blue-700 text-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold mb-6 flex items-center">
<i class="fas fa-procedures mr-4"></i> Fases Cirúrgicas e Desafios Anestésicos
</h2>
<div class="grid grid-cols-1 md:grid-cols-3 gap-4 mb-8">
<div class="bg-blue-800 bg-opacity-50 p-4 rounded-lg">
<h3 class="text-lg font-semibold mb-3">Fase 1: Dissecção</h3>
<ul class="text-sm text-blue-100 space-y-1">
<li>Hepatectomia do fígado nativo</li>
<li>Risco de sangramento</li>
<li>Monitorar coagulação</li>
<li>Reposição volêmica cuidadosa</li>
</ul>
</div>
<div class="bg-blue-800 bg-opacity-50 p-4 rounded-lg">
<h3 class="text-lg font-semibold mb-3">Fase 2: Anepática</h3>
<ul class="text-sm text-blue-100 space-y-1">
<li>Clampeamento vascular</li>
<li>Instabilidade hemodinâmica</li>
<li>Acidose metabólica</li>
<li>Hipotermia</li>
</ul>
</div>
<div class="bg-blue-800 bg-opacity-50 p-4 rounded-lg">
<h3 class="text-lg font-semibold mb-3">Fase 3: Reperfusão</h3>
<ul class="text-sm text-blue-100 space-y-1">
<li>Síndrome pós-reperfusão</li>
<li>Hipercalemia</li>
<li>Hipotensão severa</li>
<li>Arritmias</li>
</ul>
</div>
</div>
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Manejo por Fase</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-blue-900 bg-opacity-50">
<thead>
<tr class="text-blue-200">
<th class="py-3 px-4 text-left">Fase</th>
<th class="py-3 px-4 text-left">Desafios</th>
<th class="py-3 px-4 text-left">Intervenções</th>
</tr>
</thead>
<tbody class="text-white">
<tr class="border-b border-blue-700">
<td class="py-3 px-4">Dissecção</td>
<td class="py-3 px-4">Sangramento, coagulopatia</td>
<td class="py-3 px-4">Reposição sanguínea, PFC, plaquetas</td>
</tr>
<tr class="border-b border-blue-700">
<td class="py-3 px-4">Anepática</td>
<td class="py-3 px-4">Hipotensão, acidose</td>
<td class="py-3 px-4">Vasopressores, bicarbonato</td>
</tr>
<tr>
<td class="py-3 px-4">Reperfusão</td>
<td class="py-3 px-4">Síndrome pós-reperfusão</td>
<td class="py-3 px-4">Calcio, vasopressores, antiarrítmicos</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<!-- Slide 11: Monitorização Hemodinâmica -->
<div class="slide bg-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-tachometer-alt mr-4 text-blue-600"></i> Monitorização Hemodinâmica Avançada
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8 mb-8">
<div>
<div class="bg-blue-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-4">Cateter de Artéria Pulmonar</h3>
<div class="flex items-center mb-4">
<img src="https://img.icons8.com/color/96/000000/heart-monitor.png" alt="Monitor" class="mr-4">
<div>
<p class="text-gray-700">Mede:</p>
<ul class="list-disc pl-5 text-gray-700">
<li>Pressão capilar pulmonar (PCP)</li>
<li>Débito cardíaco (DC)</li>
<li>Resistência vascular sistêmica (RVS)</li>
<li>Saturação venosa mista (SvO₂)</li>
</ul>
</div>
</div>
</div>
</div>
<div>
<div class="bg-green-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold text-green-700 mb-4">Ecocardiografia Transesofágica</h3>
<div class="flex items-center mb-4">
<img src="https://img.icons8.com/color/96/000000/echocardiogram.png" alt="Echo" class="mr-4">
<div>
<p class="text-gray-700">Avalia:</p>
<ul class="list-disc pl-5 text-gray-700">
<li>Função ventricular</li>
<li>Volume de enchimento</li>
<li>Anomalias valvares</li>
<li>Trombos no fluxo venoso</li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="bg-gray-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Parâmetros Hemodinâmicos Ideais</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-white">
<thead class="bg-blue-800 text-white">
<tr>
<th class="py-3 px-4 text-left">Parâmetro</th>
<th class="py-3 px-4 text-left">Valor Alvo</th>
<th class="py-3 px-4 text-left">Significado</th>
</tr>
</thead>
<tbody class="text-gray-700">
<tr class="border-b border-gray-200">
<td class="py-3 px-4">PAM</td>
<td class="py-3 px-4">>65 mmHg</td>
<td class="py-3 px-4">Perfusão orgânica adequada</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">SvO₂</td>
<td class="py-3 px-4">>70%</td>
<td class="py-3 px-4">Balanço oferta/consumo O₂</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">DC</td>
<td class="py-3 px-4">4-8 L/min</td>
<td class="py-3 px-4">Débito cardíaco adequado</td>
</tr>
<tr>
<td class="py-3 px-4">RVS</td>
<td class="py-3 px-4">800-1200 dyn.s/cm⁵</td>
<td class="py-3 px-4">Resistência vascular adequada</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<!-- Slide 12: Monitorização da Coagulação -->
<div class="slide bg-gray-50">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-tint mr-4 text-blue-600"></i> Monitorização da Coagulação
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8 mb-8">
<div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-blue-700 mb-4">Tromboelastografia (TEG)</h3>
<div class="chart-container">
<canvas id="tegChart"></canvas>
</div>
<ul class="list-disc pl-5 text-gray-700 mt-4 space-y-2">
<li>Avaliação global da hemostasia</li>
<li>Tempo de reação (R)</li>
<li>Tempo de formação do coágulo (K)</li>
<li>Força máxima do coágulo (MA)</li>
</ul>
</div>
</div>
<div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-blue-700 mb-4">ROTEM</h3>
<div class="chart-container">
<canvas id="rotemChart"></canvas>
</div>
<ul class="list-disc pl-5 text-gray-700 mt-4 space-y-2">
<li>Similar ao TEG, mas com tecnologia diferente</li>
<li>CT (tempo de coagulação)</li>
<li>CFT (tempo de formação do coágulo)</li>
<li>MCF (força máxima do coágulo)</li>
</ul>
</div>
</div>
</div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Interpretação dos Resultados</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-white">
<thead class="bg-blue-800 text-white">
<tr>
<th class="py-3 px-4 text-left">Parâmetro</th>
<th class="py-3 px-4 text-left">Valor Normal</th>
<th class="py-3 px-4 text-left">Alteração</th>
<th class="py-3 px-4 text-left">Intervenção</th>
</tr>
</thead>
<tbody class="text-gray-700">
<tr class="border-b border-gray-200">
<td class="py-3 px-4">R/CT</td>
<td class="py-3 px-4">5-10 min</td>
<td class="py-3 px-4">↑ Deficiência fatores</td>
<td class="py-3 px-4">PFC</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">K/CFT</td>
<td class="py-3 px-4">1-3 min</td>
<td class="py-3 px-4">↑ Deficiência fibrinogênio</td>
<td class="py-3 px-4">Crioprecipitado</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">MA/MCF</td>
<td class="py-3 px-4">50-70 mm</td>
<td class="py-3 px-4">↓ Disfunção plaquetas</td>
<td class="py-3 px-4">Plaquetas</td>
</tr>
<tr>
<td class="py-3 px-4">LY30</td>
<td class="py-3 px-4"><7.5%</td>
<td class="py-3 px-4">↑ Fibrinólise</td>
<td class="py-3 px-4">Ácido tranexâmico</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<!-- Slide 13: Manejo Hemodinâmico -->
<div class="slide bg-gradient-to-br from-blue-900 to-blue-700 text-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold mb-6 flex items-center">
<i class="fas fa-heartbeat mr-4"></i> Manejo Hemodinâmico
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8 mb-8">
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Objetivos Hemodinâmicos</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>PAM >65 mmHg</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>SvO₂ >70%</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Débito urinário >0.5 mL/kg/h</span>
</li>
<li class="flex items-start">
<i class="fas fa-check-circle text-green-300 mt-1 mr-3"></i>
<span>Lactato <2 mmol/L</span>
</li>
</ul>
</div>
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Estratégias de Resuscitação</h3>
<ul class="space-y-3">
<li class="flex items-start">
<i class="fas fa-tint text-blue-300 mt-1 mr-3"></i>
<span>Reposição volêmica guiada</span>
</li>
<li class="flex items-start">
<i class="fas fa-prescription-bottle text-purple-300 mt-1 mr-3"></i>
<span>Vasopressores (Noradrenalina 0.05-0.3μg/kg/min)</span>
</li>
<li class="flex items-start">
<i class="fas fa-heart text-red-300 mt-1 mr-3"></i>
<span>Inotrópicos se baixo débito (Dobutamina 2-10μg/kg/min)</span>
</li>
<li class="flex items-start">
<i class="fas fa-vial text-green-300 mt-1 mr-3"></i>
<span>Correção de distúrbios metabólicos</span>
</li>
</ul>
</div>
</div>
<div class="bg-blue-800 bg-opacity-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold mb-4">Algoritmo de Manejo Hemodinâmico</h3>
<div class="flowchart">
<div class="flowchart-step bg-blue-700 text-white font-semibold">
<i class="fas fa-question-circle mr-2"></i> Hipotensão?
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-700 text-white font-semibold">
<i class="fas fa-tint mr-2"></i> Avaliar volume (PVC, ETE)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-700 text-white font-semibold">
<i class="fas fa-vial mr-2"></i> Reposição volêmica (cristaloides/coloides)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-700 text-white font-semibold">
<i class="fas fa-prescription-bottle mr-2"></i> Vasopressores (Noradrenalina)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-700 text-white font-semibold">
<i class="fas fa-heart mr-2"></i> Inotrópicos se baixo débito (Dobutamina)
</div>
</div>
</div>
</div>
</div>
<!-- Slide 14: Reposição Volêmica -->
<div class="slide bg-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-tint mr-4 text-blue-600"></i> Reposição Volêmica e Hemoderivados
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-6 mb-8">
<div class="bg-blue-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold text-blue-700 mb-4">Cristaloides</h3>
<ul class="list-disc pl-5 text-gray-700 space-y-2">
<li>Ringer lactato (preferencial)</li>
<li>Solução fisiológica 0.9% (risco de acidose hiperclorêmica)</li>
<li>Evitar sobrecarga (avaliar PVC, ETE)</li>
<li>Balanceados (Plasmalyte) podem ser opção</li>
</ul>
</div>
<div class="bg-green-50 p-6 rounded-lg">
<h3 class="text-xl font-semibold text-green-700 mb-4">Coloides</h3>
<ul class="list-disc pl-5 text-gray-700 space-y-2">
<li>Albumina 5% (20-25% em ascite refratária)</li>
<li>Hidroxietilamido (controvérsias em doença hepática)</li>
<li>Gelatinas (risco de coagulopatia)</li>
<li>Indicados em hipoalbuminemia grave</li>
</ul>
</div>
</div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Transfusão de Hemoderivados</h3>
<div class="overflow-x-auto">
<table class="min-w-full bg-white">
<thead class="bg-blue-800 text-white">
<tr>
<th class="py-3 px-4 text-left">Produto</th>
<th class="py-3 px-4 text-left">Indicação</th>
<th class="py-3 px-4 text-left">Dose</th>
<th class="py-3 px-4 text-left">Efeito Esperado</th>
</tr>
</thead>
<tbody class="text-gray-700">
<tr class="border-b border-gray-200">
<td class="py-3 px-4">Concentrado de hemácias</td>
<td class="py-3 px-4">Hb <7-8 g/dL (ou sintomático)</td>
<td class="py-3 px-4">1U eleva Hb ~1g/dL</td>
<td class="py-3 px-4">↑ Capacidade transporte O₂</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">PFC</td>
<td class="py-3 px-4">TAP >1.5x ou sangramento</td>
<td class="py-3 px-4">10-15 mL/kg</td>
<td class="py-3 px-4">Correção fatores coagulação</td>
</tr>
<tr class="border-b border-gray-200">
<td class="py-3 px-4">Crioprecipitado</td>
<td class="py-3 px-4">Fibrinogênio <100-150 mg/dL</td>
<td class="py-3 px-4">1U/10kg</td>
<td class="py-3 px-4">↑ Fibrinogênio ~50mg/dL</td>
</tr>
<tr>
<td class="py-3 px-4">Plaquetas</td>
<td class="py-3 px-4">Plaquetas <50.000/mm³</td>
<td class="py-3 px-4">1U/10kg</td>
<td class="py-3 px-4">↑ Plaquetas ~30.000/mm³</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<!-- Slide 15: Síndrome Pós-Reperfusão -->
<div class="slide bg-gray-50">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-exclamation-triangle mr-4 text-blue-600"></i> Síndrome Pós-Reperfusão
</h2>
<div class="grid grid-cols-1 md:grid-cols-2 gap-8 mb-8">
<div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-red-600 mb-4">Fisiopatologia</h3>
<ul class="list-disc pl-5 text-gray-700 space-y-2">
<li>Liberação de mediadores inflamatórios</li>
<li>Acidose metabólica</li>
<li>Hipercalemia</li>
<li>Disfunção miocárdica transitória</li>
<li>Vasodilatação sistêmica</li>
</ul>
</div>
</div>
<div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-red-600 mb-4">Manifestações Clínicas</h3>
<ul class="list-disc pl-5 text-gray-700 space-y-2">
<li>Hipotensão grave (PAM pode cair >30%)</li>
<li>Bradicardia/arritmias</li>
<li>Hipercalemia</li>
<li>Coagulopatia exacerbada</li>
<li>Hipotermia</li>
</ul>
</div>
</div>
</div>
<div class="bg-white p-6 rounded-lg shadow">
<h3 class="text-xl font-semibold text-gray-800 mb-4">Manejo da Síndrome Pós-Reperfusão</h3>
<div class="flowchart">
<div class="flowchart-step bg-red-100 text-red-800 font-semibold">
<i class="fas fa-exclamation-triangle mr-2"></i> Diagnóstico
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-yellow-100 text-yellow-800 font-semibold">
<i class="fas fa-syringe mr-2"></i> Calcio gluconato 10% (10-30mg/kg)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-blue-100 text-blue-800 font-semibold">
<i class="fas fa-prescription-bottle mr-2"></i> Vasopressores (Noradrenalina)
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-green-100 text-green-800 font-semibold">
<i class="fas fa-heart mr-2"></i> Inotrópicos se necessário
</div>
<div class="flowchart-arrow"></div>
<div class="flowchart-step bg-purple-100 text-purple-800 font-semibold">
<i class="fas fa-vial mr-2"></i> Bicarbonato se acidose grave (pH<7.2)
</div>
</div>
<div class="mt-4 text-sm text-gray-600">
<p><span class="font-semibold">Nota:</span> A síndrome geralmente é autolimitada, durando 5-15 minutos. Manter calma e seguir protocolo.</p>
</div>
</div>
</div>
</div>
<!-- Slide 16: Extubação e Despertar -->
<div class="slide bg-gradient-to-br from-blue-900 to-blue-700 text-white">
<div class="container mx-auto px-4 py-8">
<h2 class="text-3xl font-bold mb-6 flex items-center">
<i class="fas fa-lungs mr-4"></i> Extubação e Despertar
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<h3 class="text-xl font-semibold mb-4">Critérios para Extubação</h3>
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<span>Paciente acordado e responsivo</span>
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<span>Capacidade ventilatória adequada</span>
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<span>Hemodinâmica estável</span>
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<span>Temperatura >36°C</span>
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<span>Bom controle da dor</span>
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<span>Coagulação adequada</span>
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<h3 class="text-xl font-semibold mb-4">Contraindicações para Extubação</h3>
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<span>Encefalopatia hepática grave</span>
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<span>Hipoxemia refratária</span>
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<span>Instabilidade hemodinâmica</span>
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<span>Sangramento ativo significativo</span>
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<span>Edema de vias aéreas</span>
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<span>Hipotermia grave</span>
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<h3 class="text-xl font-semibold mb-4">Protocolo FAST HUG</h3>
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<span class="font-bold">F</span>eeding (nutrição)
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<span class="font-bold">A</span>nalgesia
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<span class="font-bold">S</span>edation (sedação)
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<div class="bg-blue-700 p-3 rounded">
<span class="font-bold">T</span>hromboprophylaxis
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<span class="font-bold">H</span>ead of bed elevation
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<span class="font-bold">U</span>lcer prevention
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<span class="font-bold">G</span>lycemic control
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<p class="mt-4 text-blue-200">Avaliar todos os itens antes da extubação</p>
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</div>
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<!-- Slide 17: Analgesia Pós-Operatória -->
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<h2 class="text-3xl font-bold text-blue-800 mb-6 flex items-center">
<i class="fas fa-pills mr-4 text-blue-600"></i> Analgesia Pós-Operatória
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<h3 class="text-lg font-semibold text-gray-800 mb-2">Opioides</h3>
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<li>Fentanil (0.5-1μg/kg/h)</li>
<li>Morfina com cautela (metabolismo hepático)</li>
<li>PCA (Patient Controlled Analgesia)</li>
<li>Monitorar sedação excessiva</li>
</ul>
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<i class="fas fa-spray-can text-2xl"></i>
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<h3 class="text-lg font-semibold text-gray-800 mb-2">Bloqueio Nervoso</h3>
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<li>Bloqueio TAP (Transversus Abdominis Plane)</li>
<li>Bloqueio paravertebral</li>
<li>Epidural (controversa em coagulopatia)</li>
<li>Considerar ultrassom-guiado</li>
</ul>
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<h3 class="text-lg font-semibold text-gray-800 mb-2">Adjuvantes</h3>
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<li>Paracetamol (4g/dia máximo)</li>
<li>Dexametasona (4-8mg EV)</li>
<li>Ketamina em infusão (0.1-0.2mg/kg/h)</li>
<li>Gabapentina (100-300mg 8/8h)</li>
</ul>
</div>
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<h3 class="text-xl font-semibold text-gray-800 mb-4">Escalas de Avaliação da Dor</h3>
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<h4 class="font-medium text-blue-700 mb-2">Escala Visual Analógica (EVA)</h4>
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<span class="text-sm mr-2">0</span>
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<span class="text-sm ml-2">10</span>
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<p class="text-sm text-gray-600 mt-1">0 = Sem dor; 10 = Pior dor imaginável</p>
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<h4 class="font-medium text-blue-700 mb-2">Escala Numérica (EN)</h4>
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