Brazilian Journal of Anesthesiology (Edicion en Espanol)最新文献_第3页

Influencia del propranolol preoperatorio en el índice cardíaco durante la fase anhepática del trasplante hepático 术前普萘洛尔对肝移植无肝期心脏指数的影响

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.02.013

Emerson Seiberlich , Marcelo D. Sanches , Bruno S. Morais , Jader F. Maciel

Introduction

Liver transplantation (LT) is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from portal hypertension. The effects of propranolol on cardiovascular system of cirrhotic patients during LT are not known.

Objective

Evaluate the influence of propranolol used preoperatively on cardiac index (CI) during the anhepatic phase of LT.

Method

One hundred and one adult patients (73 male [72.2%]) who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clínicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the Meld system, P = .70. The preoperative use of propranolol and the CI outcome were compared during the anhepatic phase of LT in 5 groups (I: increased CI, II: CI reduction < 16%, III: CI reduction ≥ 16% and < 31%, IV: CI reduction ≥ 31% and < 46%, V: CI reduction equal to or greater than 46%).

Results

Patients in group I (46.4%) who received propranolol preoperatively were statistically similar to groups II (60%), III (72.7%), IV (50%) and V (30.8%), P = .57.

Conclusion

The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of CI in anhepatic phase of LT.

肝移植(LT)是终末期肝病的最佳治疗选择。非选择性-受体阻滞剂药物如心得安直接作用于心血管系统，常用于预防门静脉高压症引起的胃肠道出血。心得安对肝移植期间肝硬化患者心血管系统的影响尚不清楚。目的评价术前应用心得安对lt无肝期心脏指数(CI)的影响。方法评价在米纳斯吉拉斯联邦大学Clínicas医院行保存肝后下腔静脉的尸体原位肝移植术的成人患者101例(男性73例[72.2%])。Meld系统各组间的严重程度无差异，P = 0.70。比较5组肝移植无肝期患者术前心得安使用情况及肝移植CI结果(I:肝移植CI升高，II:肝移植CI降低;16%， III: CI降低≥16%和<31%， IV: CI降低≥31%，<46%， V: CI降低等于或大于46%)。结果I组患者术前服用心得安(46.4%)与II组(60%)、III组(72.7%)、IV组(50%)、V组(30.8%)差异有统计学意义，P = 0.57。结论移植前应用心得安预防消化道出血是安全的，与肝移植无肝期CI恶化无关。

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引用次数: 0

¿Qué es lo que falta para el manejo de vía aérea difícil en el siglo xxi? 21世纪艰难的气道管理缺少什么?

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2013.11.005

Pedro Paulo Tanaka , Rafaela Pessoa , Raphaella Fernandes , Jay Brodsky

引用次数: 0

Colonización bacteriana debido al aumento de la carga de trabajo del equipo de enfermería en una unidad de cuidados intensivos 在重症监护病房，由于护理人员工作量增加而导致的细菌定植

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.05.005

Ilker Onguc Aycan , Mustafa Kemal Celen , Ayhan Yilmaz , Mehmet Selim Almaz , Tuba Dal , Yusuf Celik , Esef Bolat

Introduction

The rates of multiresistant bacteria colonization or infection development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit.

Methods

We included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherché en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control.

Results

Of the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9 ± 6.2 years and 63.1 ± 11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4 ± 6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of multiresistant bacteria colonization infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, total Omega, daily PRN, and total PRN (P < .05). There was no correlation between development of multiresistant bacteria colonization infection with gender, age and APACHE-II scores (P > .05).

Conclusion

The risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care-needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged.

重症监护病房多重耐药细菌定植或感染发展的比率非常高。本研究的目的是确定医院感染发生的风险与由于重症监护室人手不足而增加的日常护士工作量之间可能存在的关联。方法纳入168例患者。患者的工作量强度和应用程序分别用Project de recherch护理和Omega评分进行评分。感染的标准由疾病控制中心定义。结果168例患者中，女性91例(54.2%)，男性77例(45.8%)。女性平均年龄为64.9±6.2岁，男性平均年龄为63.1±11.9岁。重症监护病房平均住院时间为18.4±6.1天。从39例(23.2%)患者的培养物中分离出多重耐药菌。多耐药菌定植感染的发生与住院时间、欧米伽1、欧米伽2、欧米伽3、总欧米伽、每日PRN和总PRN相关(P <. 05)。多耐药菌定植感染的发生与性别、年龄和APACHE-II评分无相关性(P >. 05)。结论重症监护病房发生院内感染的风险与护士工作量增加、采取干预措施和住院时间长短直接相关。重症监护室人员不足是一个重要的健康问题，尤其影响到需要护理的病人。医院感染的发展给许多国家的经济带来了沉重的负担。为了控制重症监护室院内感染的发展，必须安排护士的工作量、人员配备水平和工作条件。

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引用次数: 0

El efecto analgésico del tramadol no está mediado por receptores opiáceos en el dolor en ratones en el postoperatorio inmediato 曲马多的镇痛作用不受阿片类受体介导的小鼠术后立即疼痛

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.06.004

Angela Maria Sousa, Hazem Adel Ashmawi

Background and objectives

Tramadol is known as a central acting analgesic drug, used for the treatment of moderate to severe pain. Local analgesic effect has been demonstrated, in part due to local anesthetic-like effect, but other mechanisms remain unclear. The role of peripheral opioid receptors in the local analgesic effect is not known. In this study, we examined role of peripheral opioid receptors in the local analgesic effect of tramadol in the plantar incision model.

Methods

Young male Wistar rats were divided into seven groups: control, intraplantar tramadol, intravenous tramadol, intravenous naloxone-intraplantar tramadol, intraplantar naloxone-intraplantar tramadol, intravenous naloxone-intravenous tramadol, and intravenous naloxone. After receiving the assigned drugs (tramadol 5 mg, naloxone 200 μg or 0.9% NaCl), rats were submitted to plantar incision, and withdrawal thresholds after mechanical stimuli with von Frey filaments were assessed at baseline, 10, 15, 30, 45 and 60 min after incision.

Results

Plantar incision led to marked mechanical hyperalgesia during the whole period of observation in the control group, no mechanical hyperalgesia were observed in intraplantar tramadol group, intraplantar naloxone-intraplantar tramadol group and intravenous naloxone-intraplantar tramadol. In the intravenous tramadol group a late increase in withdrawal thresholds (after 45 min) was observed, the intravenous naloxone-intravenous tramadol group and intravenous naloxone remained hyperalgesic during the whole period.

Conclusions

Tramadol presented an early local analgesic effect decreasing mechanical hyperalgesia induced by plantar incision. This analgesic effect was not mediated by peripheral opioid receptors.

背景与目的司马多是一种中枢镇痛药，用于治疗中度至重度疼痛。局部镇痛作用已被证明，部分原因是局部麻醉样作用，但其他机制尚不清楚。外周阿片受体在局部镇痛作用中的作用尚不清楚。在本研究中，我们在足底切口模型中检测了外周阿片受体在曲马多局部镇痛作用中的作用。方法年轻雄性Wistar大鼠分为7组:对照组、曲马多足底注射组、曲马多足底注射组、纳洛酮-曲马多足底注射组、纳洛酮-曲马多足底注射组、纳洛酮-曲马多足底注射组、纳洛酮-曲马多足底注射组、纳洛酮-曲马多足底静脉注射组、纳洛酮静脉注射组。给药(曲马多5 mg、纳洛酮200 μg或0.9% NaCl)后，将大鼠进行足底切开，分别于切开后基线、10、15、30、45和60 min评估von Frey纤维机械刺激后的戒断阈值。结果对照组足底切口在整个观察期间均出现明显的机械性痛觉过敏，足底曲马多组、足底纳洛酮-足底曲马多组和静脉纳洛酮-足底曲马多组均未出现机械性痛觉过敏。曲马多静脉组的停药阈值晚于45min后升高，纳洛酮-曲马多静脉组和纳洛酮静脉组在整个过程中均保持痛觉过敏。结论司马多具有减轻足底切口机械性痛觉的早期局部镇痛作用。这种镇痛作用不是由外周阿片受体介导的。

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引用次数: 1

Evaluación de la implicación de los fascículos del plexo braquial en el bloqueo por vía infraclavicular: estudio en cadáveres no fijos 臂丛束在锁骨下阻滞中的作用评价:非固定尸体的研究

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-05-01 DOI: 10.1016/j.bjanes.2014.06.005

Luiz Carlos Buarque de Gusmão , Jacqueline Silva Brito Lima , Jeane da Rosa Oiticica Ramalho , Amanda Lira dos Santos Leite , Alberson Maylson Ramos da Silva

Background and objectives

This study shows how occurs the diffusion of the anesthetic into the sheath through the axiliary infraclavicular space and hence prove the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia.

Materials and methods

33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length.

Results and discussion

Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, and 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue.

Conclusions

The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

背景和目的本研究显示了麻醉剂是如何通过锁骨下间隙扩散到鞘内的，从而证明了臂丛麻醉阻滞的有效性，并可能因此巩固这一通路，减少了先前麻醉的并发症。材料与方法对33具成人尸体腋窝进行了分析和整理。我们根据gusm等人提倡的技术，在锁骨下间隙注射含有乳胶染料的氯丁橡胶溶液，并将尸体放入冰箱三周。随后，标本被解冻和解剖，暴露腋窝鞘沿其整个长度。结果:51.46%的患者受累于臂丛的所有束。部分受累占30.30%，丙烯酸酯位于辅助鞘外的病例占18.24%，无问题。结论锁骨下注入的溶液在腋窝鞘内注射时，有81.76%的溶液部分或全部累及臂丛，是一种简便有效的进入臂丛的方法。我们认为，只有在实践中使用这一途径才能证明其有效性。

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引用次数: 0

Prevalencia del síndrome de burnout entre los anestesistas del Distrito Federal 联邦地区麻醉师中倦怠综合征的患病率

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-03-01 DOI: 10.1016/j.bjanes.2013.07.017

Edno Magalhães , Áurea Carolina Machado de Sousa Oliveira , Catia Sousa Govêia , Luis Cláudio Araújo Ladeira , Daniel Moser Queiroz , Camila Viana Vieira

Background

Burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference

Objective

Evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District.

Method

Cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data.

Results

Of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of 3 criteria to develop the syndrome and only 8.2% have a low risk to manifest it.

Conclusion

The prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.

职业倦怠综合症是一种慢性压力的结果，以情绪衰竭、人格解体和低职业成就感为特征。它影响承担极端责任的工作人员或那些照顾有风险个体的工作人员，包括那些远离工作的麻醉师、病人和同事，因为他们觉得保持冷漠更安全。目的评估倦怠综合征的患病率及其组成部分的强度，并确定联邦区麻醉师中患有该综合征的人的特征。方法对联邦区麻醉学会注册的241名麻醉师进行横断面研究。使用了一份自我管理的问卷，其中包括马斯拉克倦怠量表、人口统计、专业和休闲数据。结果134份完整问卷中，男性占55.8%，占65.6%，年龄在30 ~ 50岁之间占67.9%。工作满意度(47.7%)、人格解体(28.3%)和情绪耗竭(23.1%)显著降低。职业倦怠综合征患病率为10.4%，主要发生在男性(64.2%)，年龄在30-50岁(64.2%)，工作经验在10年以上(64.2%)，夜班(71.4%)，久坐(57.1%)，未参加与医学无关的课程(78.5%)。在参与者中，50.7%的人至少有三项标准中的一项来发展为综合征，只有8.2%的人表现为低风险。结论联邦区麻醉医师职业倦怠发生率较高。为减少压力因素和工作动力的丧失，提高工作满意度，寻求劳动结构调整的策略是可取的。

{"title":"Prevalencia del síndrome de burnout entre los anestesistas del Distrito Federal","authors":"Edno Magalhães , Áurea Carolina Machado de Sousa Oliveira , Catia Sousa Govêia , Luis Cláudio Araújo Ladeira , Daniel Moser Queiroz , Camila Viana Vieira","doi":"10.1016/j.bjanes.2013.07.017","DOIUrl":"10.1016/j.bjanes.2013.07.017","url":null,"abstract":"<div><h3>Background</h3><p>Burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference</p></div><div><h3>Objective</h3><p>Evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District.</p></div><div><h3>Method</h3><p>Cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data.</p></div><div><h3>Results</h3><p>Of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of 3 criteria to develop the syndrome and only 8.2% have a low risk to manifest it.</p></div><div><h3>Conclusion</h3><p>The prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 104-110"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.07.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225287","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: 8

Aplicación clínica del bloqueo anestésico paravertebral torácico en operaciones de mama 胸椎旁麻醉阻滞在乳房手术中的临床应用

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-03-01 DOI: 10.1016/j.bjanes.2013.07.019

Sara Socorro Faria , Renato Santiago Gomez

Introduction

Optimum treatment for postoperative pain has been of fundamental importance in surgical patient care. Among the analgesic techniques aimed at this group of patients, thoracic paravertebral block combined with general anesthesia stands out for the good results and favorable risk-benefit ratio. Many local anesthetics and other adjuvant drugs are being investigated for use in this technique, in order to improve the quality of analgesia and reduce adverse effects.

Objective

Evaluate the effectiveness and safety of paravertebral block compared to other analgesic and anesthetic regimens in women undergoing breast cancer surgeries.

Methods

Integrative literature review from 1966 to 2012, using specific terms in computerized databases of articles investigating the clinical characteristics, adverse effects, and beneficial effects of thoracic paravertebral block.

Results

On the selected date, 16 randomized studies that met the selection criteria established for this literature review were identified. Thoracic paravertebral block showed a significant reduction of post-operative pain, as well as decreased pain during arm movement after surgery.

Conclusion

Thoracic paravertebral block reduced postoperative analgesic requirement compared to placebo group, markedly within the first 24 h. The use of this technique could ensure postoperative analgesia of clinical relevance. Further studies with larger populations are necessary, as paravertebral block seems to be promising for preemptive analgesia in breast cancer surgery.

术后疼痛的最佳治疗一直是外科病人护理的基础。在针对这组患者的镇痛技术中，胸椎旁阻滞联合全身麻醉效果较好，风险-效益比较好。为了提高镇痛质量和减少不良反应，许多局部麻醉剂和其他辅助药物正在研究中。目的评价椎旁阻滞与其他镇痛麻醉方案在乳腺癌手术中的有效性和安全性。方法采用计算机数据库中的相关术语，对1966年至2012年的文献进行综合分析，探讨胸椎旁阻滞的临床特点、不良反应和有益作用。结果在选择的日期，16个随机研究符合本文献综述的选择标准。胸椎旁阻滞能显著减轻术后疼痛，也能减轻术后手臂运动时的疼痛。结论与安慰剂组相比，胸椎旁阻滞可明显减少术后镇痛需求，且在术后24 h内效果显著，可确保术后镇痛具有临床意义。进一步研究更大的人群是必要的，因为椎旁阻滞似乎有希望在乳腺癌手术中先发制人的镇痛。

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引用次数: 1

La disminución del tiempo de ayuno mejora el bienestar y la satisfacción con la anestesia en pacientes ancianos con fractura de cadera 减少禁食时间可提高老年髋部骨折患者的幸福感和麻醉满意度

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-03-01 DOI: 10.1016/j.bjanes.2013.10.017

Luiz Eduardo Imbelloni , Illova Anaya Nasiane Pombo , Geraldo Borges de Morais Filho

Background and objectives

Patient's satisfaction is a standard indicator of care quality. The aim of this study was to evaluate whether a preoperative oral ingestion of 200 mL of a carbohydrate drink can improve comfort and satisfaction with anesthesia in elderly patients with hip fracture.

Method

Prospective randomized clinical trial conducted in a Brazilian public hospital, with patients ASA I-III undergoing surgery for hip fracture. The control group received nothing by mouth after 9:00 p.m. the night before, while patients in the experimental group received 200 mL of a carbohydrate drink 2-4 hours before the operation. Patients’ characteristics, subjective perceptions, thirst and hunger and satisfaction were determined in four steps. Mann-Whitney U-test and Fisher exact test were used for comparison of control and experimental groups. A P-value < .05 was considered significant.

Results

A total of 100 patients were included in one of two regimens of preoperative fasting. Fasting time decreased significantly in the study group. Patients drank 200 mL 2:59 h before surgery and showed no hunger (P < .00) and thirsty on arrival to OR (P < .00), resulting in increased satisfaction with the perioperative anesthesia care (P < .00).

Conclusions

The satisfaction questionnaire for surgical patient could become a useful tool in assessing the quality of care. In conclusion, carbohydrate drink significantly reduces preoperative discomfort and increases satisfaction with anesthesia care.

背景与目的患者满意度是衡量护理质量的标准指标。本研究的目的是评估术前口服200毫升碳水化合物饮料是否可以提高老年髋部骨折患者的麻醉舒适度和满意度。方法在巴西一家公立医院进行前瞻性随机临床试验，ASA I-III型患者接受髋部骨折手术。对照组术前1晚9点后不口服，实验组术前2 ~ 4小时口服200 mL碳水化合物饮料。分四步确定患者的特征、主观感受、口渴、饥饿和满意度。对照组与试验组比较采用Mann-Whitney u检验和Fisher精确检验。A p值<.05被认为是显著的。结果共有100例患者被纳入术前禁食两种方案之一。研究组空腹时间明显缩短。患者在手术前2:59 h饮用200 mL，无饥饿感(P <.00)到达OR时口渴(P <.00)，从而提高围手术期麻醉护理的满意度(P <美元)。结论外科病人满意度问卷可作为评价护理质量的有效工具。综上所述，碳水化合物饮料可显著减少术前不适，提高麻醉护理满意度。

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引用次数: 1

Efecto hiperalgésico de la fentolamina por vía subaracnoidea en ratones 芬托拉明蛛网膜下腔对小鼠的过敏反应

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-03-01 DOI: 10.1016/j.bjanes.2014.12.002

Desiré Carlos Callegari , João Antônio Correa , Oscar César Pires , Renan Batista Corrêa Braga , Ana Flávia Marques Gimbo , Adriana Aparecida de Souza , Marta Helena Rovani Pires , Elton Constantino , Irimar de Paula Posso

Background and objectives

Painful phenomenon is one of the most important and complex experiences. Phentolamine is a non-selective alpha-adrenergic antagonist. The objective of this study was to compare the effect of increasing doses of phentolamine into subarachnoid space in rats in the modulation of painful phenomenon.

Methods

Eighty four male Wistar rats were divided into formalin and plantar incision groups, subdivided into six subgroups (n = 7). Control group (CG) received only saline (10 μL); active subgroups received phentolamine 10 μg (GF10), 20 μg (GF20), 30 μg (GF30), 40 μg (GF40), and 50 μg (GF50). In formalin group, pain was induced by injection of 50 μL of 2% formalin in dorsal region of right posterior paw. In plantar incision group, pain was induced by plantar incision and evaluated using Von Frey filaments. Induction and maintenance of anesthesia were performed with 3% halothane for catheter placement into subarachnoid space and plantar incision. Statistical analysis was performed using the JMP® program from SAS with 5% significance level.

Results

Phentolamine at doses of 20 and 30 μg increased the algesic response in the intermediate phase of the formalin test. In plantar incision test, it had hyperalgic effect on first, third, fifth, and seventh days at a dose of 10 μg and on first, third, and fifth days at a dose of 20 μg and on fifth day at a dose of 30 μg.

Conclusion

Subarachnoid administration of phentolamine showed hyperalgesic effect, possibly due to the involvement of different subclasses of alpha-adrenergic receptors in modulating pain pathways.

背景与目的疼痛现象是最重要、最复杂的体验之一。酚妥拉明是一种非选择性α -肾上腺素能拮抗剂。本研究的目的是比较增加剂量的酚妥拉明进入大鼠蛛网膜下腔对疼痛现象的调节作用。方法84只雄性Wistar大鼠随机分为福尔马林组和足底切开组，再分为6个亚组(n = 7)，对照组(CG)仅给予生理盐水(10 μL);活性亚组给予酚妥拉明10 μg (GF10)、20 μg (GF20)、30 μg (GF30)、40 μg (GF40)、50 μg (GF50)。福尔马林组右后足背区注射2%福尔马林50 μL致痛。足底切开组经足底切开致痛，采用Von Frey纤维法评价疼痛。采用3%氟烷诱导和维持麻醉，将导管置入蛛网膜下腔和足底切口。采用SAS的JMP®程序进行统计学分析，显著性水平为5%。结果20、30 μg剂量的酚妥拉明对福尔马林试验中期的镇痛反应有增强作用。足底切开试验中，第1、3、5、7天剂量为10 μg，第1、3、5天剂量为20 μg，第5天剂量为30 μg，均有过敏作用。结论酚妥拉明蛛网膜下腔给药可能与α -肾上腺素能受体不同亚类参与疼痛通路调节有关。

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引用次数: 0

Valor predictivo de los test preoperatorios para estimar la intubación difícil en pacientes sometidos a la laringoscopia directa para la cirugía de oído, nariz y garganta 耳、鼻、喉手术直接喉镜检查患者难以插管的术前试验的预测价值

Brazilian Journal of Anesthesiology (Edicion en Espanol)

Pub Date : 2015-03-01 DOI: 10.1016/j.bjanes.2014.05.004

Osman Karakus , Cengiz Kaya , Faik Emre Ustun , Ersin Koksal , Yasemin Burcu Ustun

Background and objectives

Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated.

Methods

Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened.

Results

A total of 2.611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system class 4 (50%), Cormack–Lehane classification grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical range of motion) (75.8%), short thyromental distance (81.6%), vocal cord mass (849.5%) as indicated in parentheses (P < .0001). MS had a low sensitivity, while restricted cervical range of motion, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in Cormack–Lehane classification grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases.

Conclusion

Test results predicting difficult intubations in cases with direct laryngoscopy had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

背景与目的术前检查对困难插管的预测价值可能因喉部病变而异。回顾了接受直接喉镜检查的患者，并研究了术前检查对估计插管困难的预测价值。方法对手术前、术中麻醉记录表格及医院计算机系统进行筛选。结果共评估2.611例患者。7.4%的患者发现插管困难。在Mallampati评分(MS)系统4级(50%)，Cormack-Lehane分类4级(95.7%)，既往气道困难(86.2%)，颈部活动受限(颈椎活动范围)(75.8%)，甲状腺距离短(81.6%)，声带肿块(849.5%)的患者中遇到插管困难(P <。)。MS的敏感性较低，而颈椎活动范围受限、声带肿块存在、甲状腺距离短和MS均具有相对较高的阳性预测值。Cormack-Lehane分级和MS分级每增加一级，插管困难发生率分别增加6.159倍和1.736倍。当综合考虑所有测试时，96.3%的病例可以准确分类插管困难。结论预测直接喉镜下插管困难的测试结果与文献中一般患者群体的结果有明显的重叠。与一般人群相比，某些测试结果的差异可能源于插管困难患者人群中伴随的潜在喉部病理状况。

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