Revista brasileira de anestesiologia最新文献

{"title":"Bloqueio PECS I para analgesia pós‐operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado, duplo‐cego, controlado por placebo","authors":"Jean Desroches ,&nbsp;Maxim Roy ,&nbsp;Marc Belliveau ,&nbsp;Benoit Leblanc ,&nbsp;Pierre Beaulieu","doi":"10.1016/j.bjan.2020.04.013","DOIUrl":"10.1016/j.bjan.2020.04.013","url":null,"abstract":"<div><h3>Background and objectives</h3><p>PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population.</p></div><div><h3>Methods</h3><p>This was a randomized, double‐blind, placebo‐controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg^‐1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0<!--> <!-->−<!--> <!-->10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha<!--> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Results</h3><p>In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23<!--> <!-->−<!--> <!-->5.56; mean 95% CI), 3.75 (3.13<!--> <!-->−<!--> <!-->4.37), 3.79 (2.93<!--> <!-->−<!--> <!-->4.64), and 2.29 (1.56<!--> <!-->−<!--> <!-->3.01), respectively, whereas in the placebo group, they were 4.96 (4.32<!--> <!-->−<!--> <!-->5.60), 4.00 (3.50<!--> <!-->−<!--> <!-->4.49), 3.93 (3.12<!--> <!-->−<!--> <!-->4.73), and 2.29 (1.56<!--> <!-->−<!--> <!-->3.01), respectively.</p></div><div><h3>Conclusions</h3><p>PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 333-342"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38270143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro","authors":"Sevgi Kesici ,&nbsp;Mehmet Demırci ,&nbsp;Ugur Kesici","doi":"10.1016/j.bjan.2020.04.010","DOIUrl":"10.1016/j.bjan.2020.04.010","url":null,"abstract":"<div><h3>Study objective</h3><p>In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use.</p></div><div><h3>Design</h3><p>In vitro prospective study.</p></div><div><h3>Setting</h3><p>University Clinical Microbiology Laboratory.</p></div><div><h3>Measurements</h3><p>In our study, in vitro antimicrobial effect of 0.05 mg.mL^‐1 fentanyl citrate, 5 mg.mL^‐1 bupivacaine were tested against <em>Staphylococcus aureus</em> American Type Culture Collection (ATCC) 29213, <em>Pseudomonas aeruginosa</em> ATCC 27853, <em>Klebsiella pneumoniae</em> ATCC 13883, <em>Escherichia coli</em> ATCC 25922 and <em>Candida albicans</em> ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. <em>S. aureus</em> ATCC 29213, <em>P. aeruginosa</em> ATCC 27853, <em>Klebsiella pneumoniae</em> ATCC 13883 and <em>Escherichia coli</em> ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and <em>Candida albicans</em> ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18‐24 hours at 37<!--> <!-->°<span>C</span>.</p></div><div><h3>Main results</h3><p>In terms of inhibition zone diameters, <em>S. Aureus</em> ATCC 29213, <em>P. aeruginosa</em> ATCC 27853, and <em>C. albicans</em> ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (<em>p</em> &lt; 0.001)<em>.</em> In terms of inhibition zone diameters, <em>E. coli</em> ATCC 25922, and <em>K. pneumomiae</em> ATCC 13883 values obtained after 12 and 24<!--> <!-->hours of incubation were significantly higher in Group B than Group F (<em>p</em> &lt; 0.001, E. coli 12ª hour <em>p</em> = 0.005)<em>.</em></p></div><div><h3>Conclusions</h3><p>Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against <em>E. Coli</em> is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 357-363"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38285184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecção de embolia gasosa venosa em procedimentos de neurocirurgia. O que é necessário antes de colocar o paciente na posição sentada?","authors":"Christiano dos Santos e Santos ,&nbsp;Bernadette E. Grayson","doi":"10.1016/j.bjan.2020.04.006","DOIUrl":"10.1016/j.bjan.2020.04.006","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 448-449"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38176810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SBA 2020: Atualização das recomendações para segurança em anestesia regional","authors":"Liana Maria Tôrres de Araújo Azi ,&nbsp;Neuber Martins Fonseca ,&nbsp;Livia Gurgel Linard","doi":"10.1016/j.bjan.2020.02.005","DOIUrl":"10.1016/j.bjan.2020.02.005","url":null,"abstract":"<div><p>The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre‐procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost‐effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 398-418"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38128276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efeito dos estressores emocionais nos índices de condutância cutânea no pós‐operatório: estudo piloto de coorte prospectivo","authors":"Semih Gungor ,&nbsp;Hanne Storm ,&nbsp;James J. Bae ,&nbsp;Valeria Rotundo ,&nbsp;Paul J. Christos","doi":"10.1016/j.bjan.2020.04.009","DOIUrl":"10.1016/j.bjan.2020.04.009","url":null,"abstract":"<div><h3>Background</h3><p>Skin conductance response reflects the activity of the sympathetic nervous system and is used to measure acute pain. This pilot study examines correlations of skin conductance response with emotional stressors postoperatively.</p></div><div><h3>Methods</h3><p>The correlation of skin conductance response with pain, anxiety, nausea and intellectual task performance was analyzed in postoperative patients.</p></div><div><h3>Results</h3><p>Significant correlations were observed between anxiety and pain during physical activity on both postoperative day 1 and 2. No significant correlations were found between skin conductance response <em>versus</em> mild pain, nausea, anxiety or intellectual task performance.</p></div><div><h3>Conclusion</h3><p>This pilot study suggests that when the pain is well‐controlled in the early postoperative period, skin conductance response monitoring may not be influenced by other emotional stressors.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 325-332"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38299689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eficácia de diferentes doses e esquemas de administração de ácido tranexâmico em cirurgias ortopédicas de grande porte: estudo randomizado","authors":"Ravi Saravanan,&nbsp;Rajagopalan Venkatraman,&nbsp;Krishnamoorthy Karthik,&nbsp;Anand Pushparani","doi":"10.1016/j.bjan.2020.03.013","DOIUrl":"10.1016/j.bjan.2020.03.013","url":null,"abstract":"<div><h3>Background</h3><p>Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication.</p></div><div><h3>Methods</h3><p>Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each: placebo, low dose (bolus 10<!--> <!-->mg.kg^‐1), low dose<!--> <!-->+<!--> <!-->maintenance (bolus 10<!--> <!-->mg.kg^‐1 <!-->+<!--> <!-->maintenance 1<!--> <!-->mg.kg^‐1.hr^‐1), high dose (bolus 30<!--> <!-->mg.kg^‐1) and high dose<!--> <!-->+<!--> <!-->maintenance (bolus 30<!--> <!-->mg.kg^‐1 <!-->+<!--> <!-->maintenance 3<!--> <!-->mg.kg^‐1.hr^‐1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period.</p></div><div><h3>Results</h3><p>The intraoperative blood loss was 440<!--> <!-->±<!--> <!-->207.54<!--> <!-->mL in the placebo group, 412.5<!--> <!-->±<!--> <!-->208.21<!--> <!-->mL in the low dose group, 290<!--> <!-->±<!--> <!-->149.6<!--> <!-->ml in the low dose plus maintenance group, 332.5<!--> <!-->±<!--> <!-->162.33<!--> <!-->mL in the high dose group and 240.7<!--> <!-->±<!--> <!-->88.15<!--> <!-->mL in the high dose maintenance group (<em>p</em> &lt;<!--> <!-->0.001). The reduction in postoperative blood loss in the drain for the first 24<!--> <!-->hours was 80<!--> <!-->±<!--> <!-->44.44<!--> <!-->mL in the placebo group, 89.88<!--> <!-->±<!--> <!-->44.87<!--> <!-->mL in the low dose group, 56.7<!--> <!-->±<!--> <!-->29.12<!--> <!-->mL in the low dose plus maintenance group, 77.9<!--> <!-->±<!--> <!-->35.74<!--> <!-->mL in the high dose group and 46.7<!--> <!-->±<!--> <!-->19.9<!--> <!-->mL in the high dose maintenance group (<em>p</em> &lt;<!--> <!-->0.001). DVT was not encountered in any patient.</p></div><div><h3>Conclusion</h3><p>Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose<!--> <!-->+<!--> <!-->maintenance group.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 311-317"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.03.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38237899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ácido tranexâmico – a escolha da melhor dose","authors":"Rodrigo Leal Alves","doi":"10.1016/j.bjan.2020.07.001","DOIUrl":"10.1016/j.bjan.2020.07.001","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 309-310"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38246267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Em resposta a − “Três bloqueios, incluindo o bloqueio pericapsular (Pericapsular Nerve Block − PENG), para dor em fratura da diáfise femoral” por Onur Koyuncu et al.","authors":"Ashok Jadon","doi":"10.1016/j.bjan.2020.05.003","DOIUrl":"10.1016/j.bjan.2020.05.003","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Page 449"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38206590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uso de videolaringoscópio para intubação traqueal em paciente com massa tumoral na cavidade oral: relato de caso","authors":"Luis Henrique Cangiani,&nbsp;Eduardo Vicensotti,&nbsp;Guilherme Costa Ramos,&nbsp;Guiherme José Souza Oliveira","doi":"10.1016/j.bjan.2020.03.016","DOIUrl":"10.1016/j.bjan.2020.03.016","url":null,"abstract":"<div><h3>Background and objectives</h3><p>When planning the management of a predicted difficult airway, it is important to determine which strategy will be followed. Video laryngoscopy is a major option in scenarios with factors suggesting difficult airway access. It is also indicated in rescue situations, when there is tracheal intubation failure with direct laryngoscopy. The objective of the present report was to show the efficacy of using the video laryngoscope as the first device for a patient with a large tumor that occupied almost the entire anterior portion of the oral cavity.</p></div><div><h3>Case report</h3><p>85 year‐old male patient, 162 cm, 70 kg, physical status ASA II, Mallampati IV classification, was scheduled for resection of an angiosarcoma located in the right maxillary sinus that invaded much of the hard palate and the upper portion of the oropharynx. He was conscious and oriented, with normal blood pressure, heart and respiratory rates and, despite the large tumor in the oral cavity; he showed no signs of respiratory failure or airway obstruction. After intravenous cannulation and monitoring, sedation was performed with 1<!--> <!-->mg of intravenous midazolam, and a nasal cannula was placed to provide oxygen, with a flow of 2 L.min^‐1. Then, the target‐controlled infusion of remifentanil with an effect site concentration of 2 ng.mL^‐1 was initiated, according to Minto's pharmacokinetic model. Ventilation was maintained spontaneously during airway handling. A trans cricothyroid block was performed, with 8 mL of 1% lidocaine solution injected into the tracheal lumen. Slight bleeding did not prevent the use of an optical method for performing tracheal intubation. The entire oral cavity was sprayed with 1% lidocaine. The McGraph video laryngoscope with the difficult intubation blade was used, and an armored tube with a guide wire inside was used for tracheal intubation, performed on the first attempt with appropriate glottis visualization.</p></div><div><h3>Conclusion</h3><p>The video laryngoscope occupies a prominent position in cases in which access to the airway is difficult. In the present case it was useful. It can be used as first choice or as a rescue technique. The video laryngoscope is an appropriate alternative and should be available for facing the ever‐challenging difficult airway patient.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 434-439"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.03.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38213628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SBA 2020: Atualização na diretriz da anestesia regional em uso de anticoagulantes","authors":"Neuber Martins Fonseca ,&nbsp;João Paulo Jordão Pontes ,&nbsp;Marcelo Vaz Perez ,&nbsp;Rodrigo Rodrigues Alves ,&nbsp;Gabriel Gondim Fonseca","doi":"10.1016/j.bjan.2020.02.006","DOIUrl":"10.1016/j.bjan.2020.02.006","url":null,"abstract":"<div><p>The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology (SBA) 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative revision, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique‐associated complications; spinal hematoma‐associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":"70 4","pages":"Pages 364-387"},"PeriodicalIF":1.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.02.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38149852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}