Brazilian Journal of Anesthesiology (Edicion en Espanol)最新文献_第2页

Coloides versus cristaloides en fluidoterapia guiada por objetivos, revisión sistemática y metaanálisis. Demasiado pronto o demasiado tarde para obtener conclusiones 目标导向的液体治疗中的胶体与晶体，系统综述和荟萃分析。得出结论太早或太晚了

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-07-01 DOI: 10.1016/j.bjanes.2014.07.002

Javier Ripollés , Ángel Espinosa , Rubén Casans , Ana Tirado , Alfredo Abad , Cristina Fernández , José Calvo

Introduction

Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to kidney failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids, in GDFT, to determine complications and mortality associated associated.

Methods

A bibliographic research was carried out in MEDLINE Pubmed, EMBASE and Cochrane Library, corroborating randomized clinical trials in those crystalloids are compared to colloids in GDFT for mayor non-cardiac surgery in adults.

Results

One hundred thirty references were found, among those 38 were selected, and 29 analyzed; of these, 6 were included for systematic review and meta-analysis, including 390 patients. It was perceived that the use of colloids it not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% IC] 3.87 [1.121, 13, 38]); I² = 0.0%; P = .635).

Conclusiones

Due to this meta-analysis’ limitations for small number of randomized clinical trials and patients included, the results should be taken cautiously, and it is proposed to carry out new randomized clinical trials, with enough statistical power, comparing balanced and non-balanced colloids to balanced and non-balanced crystalloids, following the protocols of GDFT, respecting current guidelines and suggestions made by groups of experts.

针对目标导向液体疗法(GDFT)进行了几项临床试验，其中许多试验使用胶体来优化预负荷。在欧洲药品管理局做出决定后，关于其使用、益处和可能对肾衰竭的影响存在争议。本系统综述和荟萃分析的目的是比较上一代玉米胶体和晶体在GDFT中的使用，以确定并发症和死亡率。方法在MEDLINE Pubmed、EMBASE和Cochrane图书馆中进行文献研究，证实将这些晶体与胶体在成人非心脏外科手术中进行GDFT的随机临床试验进行比较。结果共检索文献130篇，选取38篇，分析29篇;其中6例纳入系统评价和荟萃分析，包括390例患者。我们认为胶体的使用与并发症的增加无关，而是与更高的死亡率相关(RR [95% IC] 3.87 [1.121, 13,38]);i2 = 0.0%;p = .635)。结论由于本meta分析纳入的随机临床试验和患者数量较少，因此应谨慎对待结果，并建议开展新的随机临床试验，具有足够的统计能力，根据GDFT的方案，尊重现行指南和专家组的建议，比较平衡和不平衡的胶体与平衡和不平衡的晶体。

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引用次数: 1

Efecto de la rotación de la cabeza en la presión intraocular en decúbito ventral: estudio aleatorizado 头部旋转对腹卧位眼压的影响:随机研究

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-07-01 DOI: 10.1016/j.bjanes.2014.02.014

Fabiano Timbó Barbosa , Tatiana Rosa Bezerra Wanderley Barbosa , Rafael Martins da Cunha

引用次数: 0

Concentración mínima efectiva de bupivacaína para el bloqueo del plexo braquial vía axilar guiado por ecografía 超声引导下布比卡因腋窝阻断臂丛的最小有效浓度

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2013.11.004

Alexandre Takeda, Leonardo Henrique Cunha Ferraro, André Hosoi Rezende, Eduardo Jun Sadatsune, Luiz Fernando dos Reis Falcão, Maria Angela Tardelli

Introduction

The use of ultrasound in regional anesthesia allows reducing the dosis of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block.

Methods

Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dosis was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block: a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4 h after the blockade.

Results

MEC90 was 0.241% [R2: 0.978, confidence interval: 0.20-0.34%]. No successful block patient reported pain after 4 h.

Conclusion

This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.

超声在区域麻醉中的应用可以减少周围神经阻滞所用局麻药的剂量。本研究旨在确定布比卡因用于腋窝臂丛神经阻滞的最低有效浓度(MEC90)。方法招募手部手术患者。为了估计MEC90，使用了顺序上下偏置硬币分配方法。布比卡因剂量为每条神经(桡神经、尺神经、正中神经和肌皮神经)5ml。初始浓度为0.35%。这一浓度根据前一个阻断而变化0.05%:阻断失败导致下一个患者的浓度增加;如果成功，下一个患者可以接受或减少(0.1的概率)或相同的浓度(0.9的概率)。根据改良Bromage评分、缺乏热敏性和针刺反应，将手术麻醉定义为驱动力≤2。术后镇痛在恢复室用数值疼痛量表和阻断后4 h内的用药量进行评估。结果smec90为0.241% [R2: 0.978，置信区间:0.20 ~ 0.34%]。结论超声引导腋窝臂丛神经阻滞可以在低浓度局麻药的情况下进行，提高了手术的安全性。应该进行进一步的研究来评估低浓度下的阻断持续时间。

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引用次数: 1

Bases anatómicas para el bloqueo anestésico del nervio isquiático al nivel de la rodilla 膝关节坐骨神经麻醉阻滞的解剖学基础

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.03.011

Fabiano Timbó Barbosa , Tatiana Rosa Bezerra Wanderley Barbosa , Rafael Martins da Cunha , Amanda Karine Barros Rodrigues , Fernando Wagner da Silva Ramos , Célio Fernando de Sousa-Rodrigues

Background and objectives

Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fosa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve.

Method

The study was conducted by dissection of human cadavers’ popliteal fosa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências de la Saúde de Alagoas. Access to the sciatic nerve was obtained.

Results

Fourty four popliteal fosa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fosa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region.

Conclusions

The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%.

背景与目的近年来，由于超声技术的出现对术后镇痛和患者满意度的潜在益处，坐骨神经阻滞的给药方法已被修订。本研究的目的是描述坐骨神经在腘窝的解剖关系，以确定针必须放置的最佳距离，以实现坐骨神经前分支到胫骨和腓骨总神经的阻滞。方法采用10%福尔马林固定的人尸体腘窝解剖标本，由阿拉戈斯联邦大学和Ciências de la Saúde de Alagoas大学人体解剖与形态学实验室提供。进入坐骨神经。结果对44个腘窝进行了分析。观察到坐骨神经在窝尖处的分叉。分岔部位分别为:先端以下67.96%，先端以上15.90%，先端附近11.36%，臀区4.78%。结论坐骨神经分支发生在不同的水平，针刺位置在腘窝上方5 ~ 7cm，成功率为95.22%。

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引用次数: 0

Influencia de diferentes posiciones corporales en la capacidad vital en pacientes en el postoperatorio abdominal superior 不同体位对上腹术后患者肺活量的影响

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.06.001

Bruno Prata Martinez , Joilma Ribeiro Silva , Vanessa Salgado Silva , Mansueto Gomes Neto , Luiz Alberto Forgiarini Júnior

Background

The changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications.

Objective

To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery.

Methods

A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient.

Results

The sample consisted of 30 subjects with a mean age of 45.2 ± 11.2 years, BMI 20.2 ± 1.0 kg/m². The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15 ± 0.03 L, p = 0.001), the supine to 45̊ (average difference: 0.32 ± 0.04 L, p = 0.001) and 0° (0.50 ± 0.05 L, p = 0.001). There was a positive trend between the values of forced VC supine to upright posture (1.68 ± 0.47; 1.86 ± 0.48, 2.02 ± 0.48 and 2.18 ± 0.52 L, respectively).

Conclusion

Body position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.

体位的改变可引起肺功能的改变，有必要了解它们，特别是在术后上腹部手术中，因为这些患者易发生术后肺部并发症。目的评价上腹部手术术后仰卧位(头部0°和45°)、坐位和站立位患者的肺活量。方法2008年8月至2009年1月在萨尔瓦多/BA的一家医院进行横断面研究。测定肺活量(VC)的仪器为模拟肺活量计，体位顺序的选择遵循4个体位的随机顺序。从每位患者的医疗记录中收集辅助数据。结果30例患者，平均年龄45.2±11.2岁，BMI 20.2±1.0 kg/m2。直立体位的CV值在站立时(平均变化为0.15±0.03 L, p = 0.001)、仰卧位为45°(平均变化为0.32±0.04 L, p = 0.001)和0°(0.50±0.05 L, p = 0.001)均较高。强迫VC仰卧位与直立位之间有显著正相关(1.68±0.47;1.86±0.48,2.02±0.48,2.18±0.52 L,分别)。结论体位对术后上腹部手术患者的CV值有影响，胸垂直体位的CV值增加。

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引用次数: 0

¿Existe una correlación entre el volumen ecográfico de la glándula tiroides y la intubación difícil? Un estudio observacional 甲状腺超声体积与困难插管之间是否有相关性?观察性研究

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.06.002

Basak Ceyda Meco , Zekeriyya Alanoglu , Ali Abbas Yilmaz , Cumhur Basaran , Neslihan Alkis , Seher Demirer , Handan Cuhruk

Background and objectives

Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions.

Methods

Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale (IDS). Statistical analyses were done with SPSS 15.0 software.

Results

The mean thyroid volume of the patients was 26.38 ± 14 mL. The median IDS 1 (0-2). Thyromental distance (P = .011; r = 0.36; 95% CI 0.582-0.088), Mallampati score (P = .041; r = 0.29; 95% CI 0.013-0.526), compression or invasion signs (P = 0.041; r = 0.28; 95% CI 0.006-0.521) and tracheal deviation on chest X-ray (P = 0.041; r = 0.52; 95% CI 0.268-0.702) were correlated with IDS. Also patients were classified into 2 groups related to their IDS (group I, n = 19: IDS = 0; group II, n = 31: 1 < IDS ≤ 5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (P = .025).

Conclusion

The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.

背景和目的术前甲状腺超声检查可以让我们预测气道管理的挑战。本观察性研究的目的是评估术前外科医生通过超声和胸片评估的甲状腺相关参数对插管条件的影响。方法选取50例甲状腺手术患者。术前评估甲状腺距离、Mallampati评分、颈围、颈部活动范围。甲状腺体积，侵犯或压迫的迹象和胸片气管偏离也被注意。采用Cormack和Lehane评分和插管困难量表(IDS)评估插管情况。采用SPSS 15.0软件进行统计学分析。结果患者甲状腺体积平均值为26.38±14 mL, IDS中位数为1(0 ~ 2)。甲状腺距离(P = 0.011;r = 0.36;95% CI 0.582-0.088)， Mallampati评分(P = 0.041;r = 0.29;95% CI 0.013-0.526)，压迫或侵袭迹象(P = 0.041;r = 0.28;95% CI 0.006-0.521)和胸片上气管偏曲(P = 0.041;r = 0.52;95% CI 0.268 ~ 0.702)与IDS相关。根据患者的IDS情况将患者分为2组(I组，n = 19, IDS = 0;第二组，n = 31: 1 <比较IDS≤5)和插管困难的预测指标及甲状腺相关参数。仅Mallampati评分组间差异有统计学意义(P = 0.025)。结论甲状腺体积与插管困难无关。然而，临床评估参数可能预测插管困难。

{"title":"¿Existe una correlación entre el volumen ecográfico de la glándula tiroides y la intubación difícil? Un estudio observacional","authors":"Basak Ceyda Meco , Zekeriyya Alanoglu , Ali Abbas Yilmaz , Cumhur Basaran , Neslihan Alkis , Seher Demirer , Handan Cuhruk","doi":"10.1016/j.bjanes.2014.06.002","DOIUrl":"10.1016/j.bjanes.2014.06.002","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions.</p></div><div><h3>Methods</h3><p>Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale (IDS). Statistical analyses were done with SPSS 15.0 software.</p></div><div><h3>Results</h3><p>The mean thyroid volume of the patients was 26.38±14mL. The median IDS 1 (0-2). Thyromental distance (<em>P</em>  =0.36; 95% CI 0.582-0.088), Mallampati score (<em>P</em>  =0.29; 95% CI 0.013-0.526), compression or invasion signs (<em>P</em>  =0.28; 95% CI 0.006-0.521) and tracheal deviation on chest X-ray (<em>P</em>  =0.52; 95% CI 0.268-0.702) were correlated with IDS. Also patients were classified into 2 groups related to their IDS (group <span>I</span>, <em>n</em>    =31: 1<IDS≤5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (<em>P</em>  <!-->.025).</p></div><div><h3>Conclusion</h3><p>The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 3","pages":"Pages 230-234"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54235010","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}

引用次数: 0

Comparación de bloqueo del plexo braquial por vía interescalénica y administración de anestésico local intraarticular en el manejo del dolor en el postoperatorio de cirugía artroscópica del hombro 关节镜肩关节手术术后疼痛管理中关节间路臂丛阻滞与关节内局部麻醉的比较

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.06.003

Recep Aksu , Cihangir Biçer , Ayşe Ülgey , Adnan Bayram , Işın Güneş , Ahmet Güney , Mustafa Denizhan Yıldırım , Günhan Gökahmetoğlu , Karamehmet Yıldız

Background and objectives

In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intraarticular bupivacaine carried out with bupivacaine.

Methods

In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20 mL 0.25% bupivacaine was given vía intraarticular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia with morphine was used in all three groups for postoperative analgesia.

Results

In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other 2 groups. Morphine consumption in the IA group was lower than in the control group in the period from 0-6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th h (P < .05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th h were lower than in the control group (P < .05).

Conclusion

ISPBl plexus block was found to be more effective than intraarticular local anesthetic injection for postoperative analgesia.

背景与目的本研究旨在比较超声引导下斜角肌间臂丛阻滞与布比卡因关节内阻滞的术后镇痛效果。方法第一组患者术后给予0.25%布比卡因20 mL，超声引导下斜角肌间臂丛阻滞(ISPB)，第二组患者术后给予0.25%布比卡因20 mL vía关节内(IA)给药。第三组为对照组，不进行阻滞治疗。三组患者术后均采用吗啡自控镇痛。结果ISPB组术后0 ~ 4、6 ~ 12、12 ~ 24 h吗啡用量及24 h内吗啡总用量均低于其他2组。IA组0 ~ 6 h吗啡用量低于对照组，24 h吗啡总用量低于对照组。ISPB组术后VASr评分在前2 h低于其他两组，在第4、6 h低于对照组(P <. 05)。IA组第2、4、6 h VASr、VASm评分均低于对照组(P <. 05)。结论ispbl神经丛阻滞比关节内局麻注射更有效。

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引用次数: 0

Anestesia venosa total libre de opiáceos, con infusiones de propofol, dexmedetomidina y lidocaína para la colecistectomía laparoscópica: estudio prospectivo, aleatorizado y doble ciego 腹腔镜胆囊切除术全静脉麻醉无阿片类药物，异丙酚、右美托咪定和利多卡因输注:前瞻性、随机、双盲研究

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.05.008

Mefkur Bakan , Tarik Umutoglu , Ufuk Topuz , Harun Uysal , Mehmet Bayram , Huseyin Kadioglu , Ziya Salihoglu

Background and objectives

Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting.

Methods

Eighty ASA I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into 2 groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver intravenous fentanyl for 6 h after surgery. The primary outcome variable was postoperative fentanyl consumption.

Results

Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 μg and 120 ± 94 μg respectively, while it was comparable at postoperative 6 th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need.

Conclusion

Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

背景与目的术中使用阿片类药物可能与术后痛觉过敏和镇痛药消耗增加有关。由于围手术期使用阿片类药物的副作用，如术后恶心和呕吐可能延迟出院。我们假设，由利多卡因和右美托咪定组成的全静脉麻醉作为阿片类药物的替代品可能是腹腔镜胆囊切除术的一种替代技术，并且可以降低术后对芬太尼的需求，减少术后恶心和呕吐的发生率。方法选择80例ASA I-II级成人行择期腹腔镜胆囊切除术。患者被随机分为两组，分别采用右美托咪定、利多卡因和异丙酚输注的无阿片类麻醉(DL组)或瑞芬太尼和异丙酚输注的阿片类麻醉(RF组)。所有患者均接受标准的多模式镇痛方案。术后设置患者自控镇痛装置，静脉注射芬太尼6小时。主要结局变量为术后芬太尼用量。结果DL组术后2 h芬太尼用量(75±59 μg)显著低于RF组(120±94 μg);术后6 h芬太尼用量(120±94 μg)显著低于RF组(75±59 μg)。麻醉期间，RF组低血压事件较多，DL组高血压事件较多，差异均有统计学意义。尽管恢复时间较长，但DL组的疼痛评分、救援镇痛药和昂丹司琼需求均显著降低。结论右美托咪定、利多卡因和异丙酚输注无阿片类药物麻醉可作为腹腔镜胆囊切除术的替代麻醉方法，尤其适用于术后恶心、呕吐高危患者。

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引用次数: 1

Frecuencia de colonización y bacterias aisladas de punta de catéter epidural implantado para analgesia postoperatoria 植入硬膜外导管用于术后镇痛的定植频率和分离细菌

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.05.006

Débora Miranda Diogo Stabille , Augusto Diogo Filho , Beatriz Lemos da Silva Mandim , Lúcio Borges de Araújo , Priscila Miranda Diogo Mesquita , Miguel Tanús Jorge

Objectives

The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization.

Methods

From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis.

Results

Of 68 cultured catheters, 6 tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (P = .0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis.

Conclusion

Postoperative epidural catheter analgesia, under this study conditions, was found to be low risk for bacterial colonization in patients at surgical wards.

目的:随着硬膜外置管镇痛使用的增加，需要证明这种方法的安全性，并了解硬膜外置管术后定殖的发生率，以及导致这种定殖的细菌。方法对2011年11月至2012年4月择期硬膜外置管维持患者术后镇痛进行评价。收集导管尖端进行半定量和定性微生物学分析。结果68根培养导管中6根(8.8%)培养阳性。无患者发生浅表或深部感染。平均导管使用时间为43.45 h (18-118) (P = .0894)。手术类型(污染或未污染)、患者身体状况和手术时间与导管定植无关。从导管尖端分离到的微生物有金黄色葡萄球菌、铜绿假单胞菌和少动鞘单胞菌。结论在本研究条件下，外科病房患者术后硬膜外导管镇痛的细菌定植风险较低。

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引用次数: 0

Lidocaína intravenosa en el tratamiento del dolor posmastectomía: ensayo clínico aleatorizado, encubierto, placebo controlado 静脉注射利多卡因治疗乳房切除术后疼痛:随机、隐蔽、安慰剂对照临床试验

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.05.007

Tania Cursino de Menezes Couceiro , Luciana Cavalcanti Lima , Léa Menezes Couceiro Burle , Marcelo Moraes Valença

Background and objective

Postoperative pain treatment in mastectomy remains a major challenge despite the multimodal approach. The aim of this study was to investigate the analgesic effect of intravenous lidocaine in patients undergoing mastectomy, as well as the postoperative consumption of opioids.

Methods

After approval by the Human Research Ethics Committee of the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, a randomized, blind, controlled trial was conducted with intravenous lidocaine at a dose of 3 mg/kg infused over one hour in 45 women undergoing mastectomy under general anesthesia. One patient from placebo group was

Results

Groups were similar in age, body mass index, type of surgery, and postoperative need for opioids. Two of 22 patients in lidocaine group and 3 of 22 patients in placebo group requested opioid (P = .50). Pain on awakening was identified in 4/22 of lidocaine group and 5/22 of placebo group (P = .50); in the post-anesthetic recovery room in 14/22 and 12/22 (P = .37) of lidocaine and placebo groups, respectively. Pain evaluation 24 h after surgery showed that 2/22 and 3/22 patients (P = .50) of lidocaine and placebo groups, respectively, complained of pain.

Conclusion

Intravenous lidocaine at a dose of 3 mg/kg administered over a period of an hour during mastectomy did not promote additional analgesia compared to placebo in the first 24 h, and has not decreased opioid consumption. However, a beneficial effect of intravenous lidocaine in selected and/or other therapeutic regimens patients can not be ruled out.

背景与目的尽管采用了多模式手术方法，但乳房切除术后疼痛的治疗仍然是一个主要的挑战。本研究的目的是探讨静脉注射利多卡因对乳房切除术患者的镇痛作用，以及术后阿片类药物的使用情况。方法经Pernambuco累西腓综合医学研究所Fernando Figueira教授的人类研究伦理委员会批准，对45名接受乳房切除术的妇女进行了一项随机、盲、对照试验，以3mg /kg的剂量静脉注射利多卡因，持续1小时。结果两组患者在年龄、体重指数、手术类型和术后对阿片类药物的需求方面相似。利多卡因组22例患者中有2例需要阿片类药物，安慰剂组22例中有3例需要阿片类药物(P = 0.50)。利多卡因组觉醒时疼痛发生率为4/22，安慰剂组为5/22 (P = 0.50);利多卡因组和安慰剂组分别于14/22和12/22麻醉后恢复室的死亡率(P = 0.37)。术后24 h疼痛评估显示，利多卡因组和安慰剂组分别有2/22和3/22患者主诉疼痛(P = 0.50)。结论:与安慰剂相比，在乳房切除术前24小时内静脉注射3mg /kg利多卡因并没有促进额外的镇痛作用，也没有减少阿片类药物的消耗。然而，不能排除静脉注射利多卡因在选定和/或其他治疗方案中的有益作用。

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