Pub Date : 2015-03-01DOI: 10.1016/j.bjanes.2014.12.001
Ricardo Francisco Simoni , Luiz Eduardo de Paula Gomes Miziara , Luis Otávio Esteves , Diógenes de Oliveira Silva , Cristina Alves Ribeiro , Mariana Oki Smith , Leonardo Ferreira de Paula , Luis Henrique Cangiani
Background and objective
Studies have shown that rate of propofol infusion may influence the predicted propofol concentration at the effect site (Es). The aim of this study was to evaluate the Es predicted by the Marsh pharmacokinetic model (ke0 0.26 min−1) in loss of consciousness during fast or slow induction.
Method
The study included 28 patients randomly divided into 2 equal groups. In slow induction group, target-controlled infusion of propofol with plasma, Marsh pharmacokinetic model (ke0 0.26 min−1) with target concentration (Tc) at 2.0 μg.mL−1 were administered. When the predicted propofol concentration at the Es reached half of Es value, Es was increased to previous Es +1 μg.mL−1, successively, until loss of consciousness. In rapid induction group, patients were induced with target-controlled infusion of propofol with plasma (6.0 μg.ml−1) at Es, and waited until loss of consciousness.
Results
In rapid induction group, Es for loss of consciousness was significantly lower compared to slow induction group (1.67 ± 0.76 and 2.50 ± 0.56 μg.mL−1, respectively, P = 0.004).
Conclusion
The predicted propofol concentration at the Es for loss of consciousness is different for rapid induction and slow induction, even with the same pharmacokinetic model of propofol and the same balance constant between plasma and effect site.
{"title":"Estudio comparativo entre inducción rápida y lenta de propofol en infusión objetivo-controlada: concentración de propofol prevista en la región de acción. Ensayo clínico aleatorizado","authors":"Ricardo Francisco Simoni , Luiz Eduardo de Paula Gomes Miziara , Luis Otávio Esteves , Diógenes de Oliveira Silva , Cristina Alves Ribeiro , Mariana Oki Smith , Leonardo Ferreira de Paula , Luis Henrique Cangiani","doi":"10.1016/j.bjanes.2014.12.001","DOIUrl":"10.1016/j.bjanes.2014.12.001","url":null,"abstract":"<div><h3>Background and objective</h3><p>Studies have shown that rate of propofol infusion may influence the predicted propofol concentration at the effect site (Es). The aim of this study was to evaluate the Es predicted by the Marsh pharmacokinetic model (ke0 0.26<!--> <!-->min<sup>−1</sup>) in loss of consciousness during fast or slow induction.</p></div><div><h3>Method</h3><p>The study included 28 patients randomly divided into 2 equal groups. In slow induction group, target-controlled infusion of propofol with plasma, Marsh pharmacokinetic model (ke0 0.26<!--> <!-->min<sup>−1</sup>) with target concentration (Tc) at 2.0<!--> <!-->μg.mL<sup>−1</sup> were administered. When the predicted propofol concentration at the Es reached half of Es value, Es was increased to previous Es +1<!--> <!-->μg.mL<sup>−1</sup>, successively, until loss of consciousness. In rapid induction group, patients were induced with target-controlled infusion of propofol with plasma (6.0<!--> <!-->μg.ml<sup>−1</sup>) at Es, and waited until loss of consciousness.</p></div><div><h3>Results</h3><p>In rapid induction group, Es for loss of consciousness was significantly lower compared to slow induction group (1.67<!--> <!-->±<!--> <!-->0.76 and 2.50<!--> <!-->±<!--> <!-->0.56<!--> <!-->μg.mL<sup>−1</sup>, respectively, <em>P</em> <!-->=<!--> <!-->0.004).</p></div><div><h3>Conclusion</h3><p>The predicted propofol concentration at the Es for loss of consciousness is different for rapid induction and slow induction, even with the same pharmacokinetic model of propofol and the same balance constant between plasma and effect site.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 99-103"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54235653","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}
Pub Date : 2015-03-01DOI: 10.1016/j.bjanes.2013.10.019
Letícia Baltieri, Laisa Antonela dos Santos, Irineu Rasera-Junior, Maria Imaculada de Lima Montebelo, Eli Maria Pazzianotto-Forti
Background and objective
To investigate the influence of intraoperative and preoperative airway positive pressure in the time of extubation in patients undergoing bariatric surgery.
Method
Randomized clinical trial, in which 40 individuals with a BMI between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10): individuals who received treatment with noninvasive positive pressure before surgery for one hour, G-intra (n = 10): individuals who received PEEP of 10 cm H2O throughout the surgical procedure and G-control (n = 20): not received any pre or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery.
Results
There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of PEEP of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect.
Conclusion
The use of PEEP of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.
背景与目的探讨减肥手术患者术中、术前气道正压对拔管时间的影响。方法选取40例体重指数在40 ~ 55 kg/m2之间、年龄在25 ~ 55岁、不吸烟、经剖腹Roux-en-Y型胃旁路手术且术前肺功能正常的患者，随机分为以下组:G-pre组(n = 10):术前接受无创正压治疗1小时的G-intra组(n = 10):在整个手术过程中接受10 cm H2O PEEP和g控制的个体(n = 20):未接受任何术前或术中干预。记录:麻醉诱导至拔管时间、麻醉结束至拔管时间、机械通气时间、拔管至麻醉后恢复出院时间。结果两组间差异无统计学意义。然而，当应用于Cohen系数时，术中使用10 cm H2O的PEEP对麻醉结束至拔管时间的影响较大。大约在同一时间，术前治疗显示出中等效果。结论术中使用10 cm H2O正压通气和术前正压通气对减肥手术患者拔管时间有影响。
{"title":"Utilización de la presión positiva en el pre- y en el intraoperatorio de cirugía bariátrica y sus efectos sobre el tiempo de extubación","authors":"Letícia Baltieri, Laisa Antonela dos Santos, Irineu Rasera-Junior, Maria Imaculada de Lima Montebelo, Eli Maria Pazzianotto-Forti","doi":"10.1016/j.bjanes.2013.10.019","DOIUrl":"10.1016/j.bjanes.2013.10.019","url":null,"abstract":"<div><h3>Background and objective</h3><p>To investigate the influence of intraoperative and preoperative airway positive pressure in the time of extubation in patients undergoing bariatric surgery.</p></div><div><h3>Method</h3><p>Randomized clinical trial, in which 40 individuals with a BMI between 40 and 55<!--> <!-->kg/m<sup>2</sup>, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n<!--> <!-->=<!--> <!-->10): individuals who received treatment with noninvasive positive pressure before surgery for one hour, G-intra (n<!--> <!-->=<!--> <!-->10): individuals who received PEEP of 10<!--> <!-->cm H<sub>2</sub>O throughout the surgical procedure and G-control (n<!--> <!-->=<!--> <!-->20): not received any pre or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery.</p></div><div><h3>Results</h3><p>There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of PEEP of 10<!--> <!-->cm H<sub>2</sub>O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect.</p></div><div><h3>Conclusion</h3><p>The use of PEEP of 10<!--> <!-->cm H<sub>2</sub>O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 130-135"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.10.019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233211","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}
Evaluate the antinociceptive effects of subarachnoid meloxicam on the mechanical hypernociception induced by carrageenan in rats.
Methods
Randomized controlled trial. Eighteen adult male Wistar rats underwent a cannula implantation into the subarachnoid space and were randomly divided into two groups: group i received saline solution 5 μL, while group ii received meloxicam 30 μg. The mechanical hypernociception was induced by intraplantar injection of carrageenan and evaluated using a digital analgesymeter every 30 min during a 4 h period. The results were recorded as the Δ withdrawal threshold (in g), calculated by subtracting the measurement value after.
Results
The Δ withdrawal threshold mean values were lower in the group of patients treated with meloxicam over all time points between 45 and 165 min, however, there was no statistical significance (P = .835) for this difference.
Conclusion
Subarachnoid meloxicam at a dose of 30 μg.animal–1 did not suppress the mechanical hypernociception in a model of inflammatory pain induced by intraplantar administration of carrageenan in rats. The data suggest that other dosages should be investigated the drug effect is discarded.
{"title":"El meloxicam subaracnoideo no inhibe la hipernocicepción mecánica en el test de la carragenina en ratones","authors":"Lanucha Fidelis da Luz Moura , Silvana Bellini Vidor , Anelise Bonilla Trindade , Priscilla Domingues Mörschbächer , Nilson Oleskovicz , Emerson Antonio Contesini","doi":"10.1016/j.bjanes.2013.10.018","DOIUrl":"10.1016/j.bjanes.2013.10.018","url":null,"abstract":"<div><h3>Background and objective</h3><p>Evaluate the antinociceptive effects of subarachnoid meloxicam on the mechanical hypernociception induced by carrageenan in rats.</p></div><div><h3>Methods</h3><p>Randomized controlled trial. Eighteen adult male Wistar rats underwent a cannula implantation into the subarachnoid space and were randomly divided into two groups: group <span>i</span> received saline solution 5<!--> <!-->μL, while group <span>ii</span> received meloxicam 30<!--> <!-->μg. The mechanical hypernociception was induced by intraplantar injection of carrageenan and evaluated using a digital analgesymeter every 30<!--> <!-->min during a 4<!--> <!-->h period. The results were recorded as the Δ withdrawal threshold (in g), calculated by subtracting the measurement value after.</p></div><div><h3>Results</h3><p>The Δ withdrawal threshold mean values were lower in the group of patients treated with meloxicam over all time points between 45 and 165<!--> <!-->min, however, there was no statistical significance (<em>P</em> <!-->=<!--> <!-->.835) for this difference.</p></div><div><h3>Conclusion</h3><p>Subarachnoid meloxicam at a dose of 30<!--> <!-->μg.animal<sup>–1</sup> did not suppress the mechanical hypernociception in a model of inflammatory pain induced by intraplantar administration of carrageenan in rats. The data suggest that other dosages should be investigated the drug effect is discarded.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 124-129"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.10.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54226561","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}
Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV.
Methods
Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; i – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), ii – Only propofol and remifentanil was used during maintenance, iii – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), iv – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale scores for pain was also been evaluated.
Results
Visual analog scale scores were significantly lowest in group i (P = 0.001-0.028). PNV incidence was significantly lowest in group i (P = 0.026). PNV incidence was also lower in group iii compared to group IV (P = 0.032). Analgesic requirements were significantly lower in group I and was lower in group iii compared to group iv (P = 0.005). Heart rates were significantly lower in esmolol groups (group i and iii) compared to their controls (P = 0.001) however blood pressures were similar in all groups (P = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (P = 0.024-0.03).
Conclusion
Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.
{"title":"Efecto de la infusión de esmolol sobre la necesidad de anestesia en el intraoperatorio y analgesia, náuseas y vómito en el postoperatorio en un grupo de pacientes sometidos a la colecistectomía laparoscópica","authors":"Necla Dereli, Zehra Baykal Tutal, Munire Babayigit, Aysun Kurtay, Mehmet Sahap, Eyup Horasanli","doi":"10.1016/j.bjanes.2014.08.001","DOIUrl":"10.1016/j.bjanes.2014.08.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV.</p></div><div><h3>Methods</h3><p>Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; <span>i</span> – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), <span>ii</span> – Only propofol and remifentanil was used during maintenance, <span>iii</span> – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), <span>iv</span> – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24<!--> <!-->h for PNV and analgesic requirements. Visual analog scale scores for pain was also been evaluated.</p></div><div><h3>Results</h3><p>Visual analog scale scores were significantly lowest in group <span>i</span> (<em>P</em> <!-->=<!--> <!-->0.001-0.028). PNV incidence was significantly lowest in group <span>i</span> (<em>P</em> <!-->=<!--> <!-->0.026). PNV incidence was also lower in group <span>iii</span> compared to group <span>IV</span> (<em>P</em> <!-->=<!--> <!-->0.032). Analgesic requirements were significantly lower in group <span>I</span> and was lower in group <span>iii</span> compared to group <span>iv</span> (<em>P</em> <!-->=<!--> <!-->0.005). Heart rates were significantly lower in esmolol groups (group <span>i</span> and <span>iii</span>) compared to their controls (<em>P</em> <!-->=<!--> <!-->0.001) however blood pressures were similar in all groups (<em>P</em> <!-->=<!--> <!-->0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (<em>P</em> <!-->=<!--> <!-->0.024-0.03).</p></div><div><h3>Conclusion</h3><p>Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 141-146"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54234800","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}
Pub Date : 2015-03-01DOI: 10.1016/j.bjanes.2014.12.003
Angélica de Fátima Braga , Vanessa Henriques Carvalho , Franklin Sarmento Braga , Gloria Maria Braga Potério , Filipe Nadir Caparica Santos
Background and objectives
The local anesthetic effects on neuromuscular junction and its influence on blockade produced by nondepolarizing neuromuscular blockers are still under-investigated; however, this interaction has been described in experimental studies and in humans. The aim of this study was to evaluate in vitro the interaction between ropivacaine and pancuronium, the influence on transmission and neuromuscular blockade, and the effectiveness of neostigmine and 4-aminopyridine to reverse the blockade.
Methods
Rats were divided into groups (n = 5) according to the study drug: ropivacaine (5 μg.mL−1); pancuronium (2 μg.mL–1); ropivacaine + pancuronium. Neostigmine and 4-aminopyridine were used at concentrations of 2 μg.mL−1 and 20 μg.mL−1, respectively. The effects of ropivacaine on membrane potential) and miniature end-plate potential, the amplitude of diaphragm responses before and 60 min after the addition of ropivacaine (degree of neuromuscular blockade with pancuronium and with the association of pancuronium-ropivacaine), and the effectiveness of neostigmine and 4-aminopyridine on neuromuscular block reversal were evaluated.
Results
Ropivacaine did not alter the amplitude of muscle response (the membrane potential), but decreased the frequency and amplitude of the miniature end-plate potential. Pancuronium blockade was potentiated by ropivacaine, and partially and fully reversed by neostigmine and 4-aminopyridine, respectively.
Conclusions
Ropivacaine increased the neuromuscular block produced by pancuronium. The complete antagonism with 4-aminopyridine suggests presynaptic action of ropivacaine.
{"title":"Efecto de la asociación ropivacaína-pancuronio en la transmisión neuromuscular. Eficacia de la neostigmina y 4-aminopiridina en la reversión del bloqueo. Estudio experimental","authors":"Angélica de Fátima Braga , Vanessa Henriques Carvalho , Franklin Sarmento Braga , Gloria Maria Braga Potério , Filipe Nadir Caparica Santos","doi":"10.1016/j.bjanes.2014.12.003","DOIUrl":"10.1016/j.bjanes.2014.12.003","url":null,"abstract":"<div><h3>Background and objectives</h3><p>The local anesthetic effects on neuromuscular junction and its influence on blockade produced by nondepolarizing neuromuscular blockers are still under-investigated; however, this interaction has been described in experimental studies and in humans. The aim of this study was to evaluate in vitro the interaction between ropivacaine and pancuronium, the influence on transmission and neuromuscular blockade, and the effectiveness of neostigmine and 4-aminopyridine to reverse the blockade.</p></div><div><h3>Methods</h3><p>Rats were divided into groups (n<!--> <!-->=<!--> <!-->5) according to the study drug: ropivacaine (5<!--> <!-->μg.mL<sup>−1</sup>); pancuronium (2<!--> <!-->μg.mL<sup>–1</sup>); ropivacaine<!--> <!-->+<!--> <!-->pancuronium. Neostigmine and 4-aminopyridine were used at concentrations of 2<!--> <!-->μg.mL<sup>−1</sup> and 20<!--> <!-->μg.mL<sup>−1</sup>, respectively. The effects of ropivacaine on membrane potential) and miniature end-plate potential, the amplitude of diaphragm responses before and 60<!--> <!-->min after the addition of ropivacaine (degree of neuromuscular blockade with pancuronium and with the association of pancuronium-ropivacaine), and the effectiveness of neostigmine and 4-aminopyridine on neuromuscular block reversal were evaluated.</p></div><div><h3>Results</h3><p>Ropivacaine did not alter the amplitude of muscle response (the membrane potential), but decreased the frequency and amplitude of the miniature end-plate potential. Pancuronium blockade was potentiated by ropivacaine, and partially and fully reversed by neostigmine and 4-aminopyridine, respectively.</p></div><div><h3>Conclusions</h3><p>Ropivacaine increased the neuromuscular block produced by pancuronium. The complete antagonism with 4-aminopyridine suggests presynaptic action of ropivacaine.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 136-140"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54235232","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}
Pub Date : 2015-03-01DOI: 10.1016/j.bjanes.2013.07.018
Caio Marcio Barros de Oliveira , Rioko Kimiko Sakata , Alexandre Slullitel , Reinaldo Salomão , Vera Lucia Lanchote , Adriana Machado Issy
Background and objectives
Interleukin-6 (IL-6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy.
Method
A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2 mg.kg−1.h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24 hours), first analgesic request, and dose of morphine in 24 hours were evaluated. IL-6 was measured before starting surgery (T0), 5 hours after the start (T5), and 24 hours after the end of surgery (T24).
Results
There was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0 ± 104.4 min) than in G1 (26.7 ± 23.3 min). There was no difference in supplemental dose of morphine between G1 (23.5 ± 12.6 mg) and G2 (18.7 ± 11.3 mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5 ± 364.1 ng.ml−1 in T5 and 30.1 ± 14.2 ng.ml−1 in T24.
Conclusion
Intravenous lidocaine (2 mg.kg−1.h−1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.
{"title":"Efecto de la lidocaína venosa intraoperatoria sobre el dolor e interleucina-6 plasmática en pacientes sometidas a histerectomía","authors":"Caio Marcio Barros de Oliveira , Rioko Kimiko Sakata , Alexandre Slullitel , Reinaldo Salomão , Vera Lucia Lanchote , Adriana Machado Issy","doi":"10.1016/j.bjanes.2013.07.018","DOIUrl":"10.1016/j.bjanes.2013.07.018","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Interleukin-6 (IL-6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy.</p></div><div><h3>Method</h3><p>A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2<!--> <!-->mg.kg<sup>−1</sup>.h<sup>−1</sup>) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O<sub>2</sub>/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24<!--> <!-->hours), first analgesic request, and dose of morphine in 24<!--> <!-->hours were evaluated. IL-6 was measured before starting surgery (T0), 5<!--> <!-->hours after the start (T5), and 24<!--> <!-->hours after the end of surgery (T24).</p></div><div><h3>Results</h3><p>There was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0<!--> <!-->±<!--> <!-->104.4<!--> <!-->min) than in G1 (26.7<!--> <!-->±<!--> <!-->23.3<!--> <!-->min). There was no difference in supplemental dose of morphine between G1 (23.5<!--> <!-->±<!--> <!-->12.6<!--> <!-->mg) and G2 (18.7<!--> <!-->±<!--> <!-->11.3<!--> <!-->mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5<!--> <!-->±<!--> <!-->364.1<!--> <!-->ng.ml<sup>−1</sup> in T5 and 30.1<!--> <!-->±<!--> <!-->14.2<!--> <!-->ng.ml<sup>−1</sup> in T24.</p></div><div><h3>Conclusion</h3><p>Intravenous lidocaine (2<!--> <!-->mg.kg<sup>−1</sup>.h<sup>−1</sup>) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 92-98"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.07.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225448","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}
Pub Date : 2015-03-01DOI: 10.1016/j.bjanes.2013.08.006
Cláudia Regina Fernandes , Rafael Queiroz de Sousa , Francisco Sávio Alves Arcanjo , Gerardo Cristino de Menezes Neto , Josenília Maria Alves Gomes , Renata Rocha Barreto Giaxa
Background and objectives
Understand, through the theory of social representations, the influence exerted by the establishment a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil.
Method
Qualitative methodology. The theoretical framework comprised the phenomenology and the social representation theory. Five multidisciplinary focus groups were formed with 17 health professionals (5 surgeons, 5 anesthesiologists, 2 nurses, and 5 nursing technicians), who work in operating rooms and post-anesthesia care units, all with prior and posterior experience to the establishment of residency.
Results
From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, recognition of weaknesses in the perioperative process. It was evident upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed.
Conclusion
The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries.
{"title":"Implantación de residencia en anestesiología en el interior del nordeste de Brasil: impacto en los procesos de trabajo y en la motivación profesional","authors":"Cláudia Regina Fernandes , Rafael Queiroz de Sousa , Francisco Sávio Alves Arcanjo , Gerardo Cristino de Menezes Neto , Josenília Maria Alves Gomes , Renata Rocha Barreto Giaxa","doi":"10.1016/j.bjanes.2013.08.006","DOIUrl":"10.1016/j.bjanes.2013.08.006","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Understand, through the theory of social representations, the influence exerted by the establishment a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil.</p></div><div><h3>Method</h3><p>Qualitative methodology. The theoretical framework comprised the phenomenology and the social representation theory. Five multidisciplinary focus groups were formed with 17 health professionals (5 surgeons, 5 anesthesiologists, 2 nurses, and 5 nursing technicians), who work in operating rooms and post-anesthesia care units, all with prior and posterior experience to the establishment of residency.</p></div><div><h3>Results</h3><p>From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, recognition of weaknesses in the perioperative process. It was evident upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed.</p></div><div><h3>Conclusion</h3><p>The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 2","pages":"Pages 155-161"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54225708","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":"Cefalea pospunción dural para cesárea: ¿las estrategias preventivas son peores que la curación?","authors":"Prakhar Gyanesh , Radhika K. , Manju Sinha , Rudrashish Haldar","doi":"10.1016/j.bjanes.2014.04.003","DOIUrl":"10.1016/j.bjanes.2014.04.003","url":null,"abstract":"","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 1","pages":"Pages 82-83"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233940","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}
Pub Date : 2015-01-01DOI: 10.1016/j.bjanes.2014.04.002
Adnan Bayram , Ayşe Ülgey , Işın Güneş , İbrahim Ketenci , Ayşe Çapar , Aliye Esmaoğlu , Adem Boyacı
Background and objectives
It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site.
Methods
60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (group M), patients were administered 40 mg/kg magnesium sulfate in 100 mL saline solution over 10 min as the intravenous loading dose 10 min before induction, with a subsequent 10–15 μg/kg/h infusion during surgery. In the dexmedetomidine group (group D), patients were administered 1 μg/kg dexmedetomidine in 100 mL saline solution as the loading dose 10 min before surgery and 0.5–1 μg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60–70 mmHg.
Results
Bleeding score was significantly decreased in group D (P = .002). Mean arterial pressure values were significantly decreased in group D compared to that in group M, except for the initial stage, after induction and 5 min after intubation (P < .05). The number of patients who required nitroglycerine was significantly lower in group D (P = .01) and surgeon satisfaction was significantly increased in the same group (P = .001). Aldrete recovery score ≥ 9 duration was significantly shorter in group D (P = .001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale.
Conclusions
Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.
{"title":"Comparación entre el sulfato de magnesio y la dexmedetomidina en hipotensión controlada durante cirugía funcional endoscópica de los senos paranasales","authors":"Adnan Bayram , Ayşe Ülgey , Işın Güneş , İbrahim Ketenci , Ayşe Çapar , Aliye Esmaoğlu , Adem Boyacı","doi":"10.1016/j.bjanes.2014.04.002","DOIUrl":"10.1016/j.bjanes.2014.04.002","url":null,"abstract":"<div><h3>Background and objectives</h3><p>It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site.</p></div><div><h3>Methods</h3><p>60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (group M), patients were administered 40<!--> <!-->mg/kg magnesium sulfate in 100<!--> <!-->mL saline solution over 10<!--> <!-->min as the intravenous loading dose 10<!--> <!-->min before induction, with a subsequent 10–15<!--> <!-->μg/kg/h infusion during surgery. In the dexmedetomidine group (group D), patients were administered 1<!--> <!-->μg/kg dexmedetomidine in 100<!--> <!-->mL saline solution as the loading dose 10<!--> <!-->min before surgery and 0.5–1<!--> <!-->μg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60–70<!--> <!-->mmHg.</p></div><div><h3>Results</h3><p>Bleeding score was significantly decreased in group D (<em>P</em> <!-->=<!--> <!-->.002). Mean arterial pressure values were significantly decreased in group D compared to that in group M, except for the initial stage, after induction and 5<!--> <!-->min after intubation (<em>P</em> <!--><<!--> <!-->.05). The number of patients who required nitroglycerine was significantly lower in group D (<em>P</em> <!-->=<!--> <!-->.01) and surgeon satisfaction was significantly increased in the same group (<em>P</em> <!-->=<!--> <!-->.001). Aldrete recovery score<!--> <!-->≥<!--> <!-->9 duration was significantly shorter in group D (<em>P</em> <!-->=<!--> <!-->.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale.</p></div><div><h3>Conclusions</h3><p>Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 1","pages":"Pages 61-67"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2014.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233834","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}
Pub Date : 2015-01-01DOI: 10.1016/j.bjanes.2013.07.008
Gisele Alborghetti Nai , Mariliza Casanova de Oliveira , Graziela de Oliveira Tavares , Laís Fabrício Fonseca Pereira , Nádia Derli Salvador Lemes Soares , Patrícia Gatti Silva
Background and objective
Previous studies regarding the effects of some local anesthetics have suggested these agents may cause genetic damage. However, they have not been tested for genotoxicity related to repetitive administration. The aim of this study was to evaluate the genotoxic potential of local anesthetics upon repetitive administration.
Methods
80 male Wistar rats were allocated into: group A - 16 rats injected intraperitoneally (IP) with lidocaine hydrochloride 2%; group B - 16 rats IP injected with mepivacaine 2%; group C - 16 rats IP injected with articaine 4%; group D - 16 rats IP injected with prilocaine 3% (6.0 mg.kg–1); group E - 8 rats subcutaneously injected with a single dose of cyclophosphamide; and group F - 8 rats IP injected with saline. Eight rats from groups A to D received a single dose of anaesthetic on day 1 of the experiment; the remaining rats were injected once a day for 5 days.
Results
The median number of micronuclei in the local anesthetics groups exposed for one or 5 days ranged from 0.00 to 1.00, in the cyclophosphamide-exposed group was 10.00, and the negative control group for 1 and 5 days was 1.00 and 0.00, respectively (p < 0.0001). A significant difference in the number of micronuclei was observed between the cyclophosphamide group and all local anesthetic groups (p = 0.0001), but not between the negative control group and the local anesthetic groups (p > 0.05).
Conclusion
No genotoxicity effect was observed upon repetitive exposure to any of the local anesthetics evaluated.
{"title":"Evaluación de la genotoxicidad inducida por la administración repetida de anestésicos locales: un estudio experimental en ratones","authors":"Gisele Alborghetti Nai , Mariliza Casanova de Oliveira , Graziela de Oliveira Tavares , Laís Fabrício Fonseca Pereira , Nádia Derli Salvador Lemes Soares , Patrícia Gatti Silva","doi":"10.1016/j.bjanes.2013.07.008","DOIUrl":"10.1016/j.bjanes.2013.07.008","url":null,"abstract":"<div><h3>Background and objective</h3><p>Previous studies regarding the effects of some local anesthetics have suggested these agents may cause genetic damage. However, they have not been tested for genotoxicity related to repetitive administration. The aim of this study was to evaluate the genotoxic potential of local anesthetics upon repetitive administration.</p></div><div><h3>Methods</h3><p>80 male Wistar rats were allocated into: group A - 16 rats injected intraperitoneally (IP) with lidocaine hydrochloride 2%; group B - 16 rats IP injected with mepivacaine 2%; group C - 16 rats IP injected with articaine 4%; group D - 16 rats IP injected with prilocaine 3% (6.0<!--> <!-->mg.kg<sup>–1</sup>); group E - 8 rats subcutaneously injected with a single dose of cyclophosphamide; and group F - 8 rats IP injected with saline. Eight rats from groups A to D received a single dose of anaesthetic on day 1 of the experiment; the remaining rats were injected once a day for 5 days.</p></div><div><h3>Results</h3><p>The median number of micronuclei in the local anesthetics groups exposed for one or 5 days ranged from 0.00 to 1.00, in the cyclophosphamide-exposed group was 10.00, and the negative control group for 1 and 5 days was 1.00 and 0.00, respectively (<em>p</em> <!--><<!--> <!-->0.0001). A significant difference in the number of micronuclei was observed between the cyclophosphamide group and all local anesthetic groups (<em>p</em> <!-->=<!--> <!-->0.0001), but not between the negative control group and the local anesthetic groups (<em>p</em> <!-->><!--> <!-->0.05).</p></div><div><h3>Conclusion</h3><p>No genotoxicity effect was observed upon repetitive exposure to any of the local anesthetics evaluated.</p></div>","PeriodicalId":100199,"journal":{"name":"Brazilian Journal of Anesthesiology (Edicion en Espanol)","volume":"65 1","pages":"Pages 21-26"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjanes.2013.07.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54224876","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}
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