Revista brasileira de anestesiologia最新文献

英文中文

O Anestesiologista e a COVID‐19 麻醉师应对COVID - 19

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-03-21 DOI: 10.1016/j.bjan.2020.03.002

Vinícius Caldeira Quintão , Cláudia Marquez Simões , Laís Helena Navarro e Lima , Guilherme Antônio Moreira de Barros , Marcello Fonseca Salgado‐Filho , Gabriel Magalhães Nunes Guimarães , Rodrigo Leal Alves , Ana Maria Menezes Caetano , André Prato Schmidt , Maria José Carvalho Carmona

引用次数: 9

Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado 视频喉镜与喉管和面罩在肥胖患者气管插管中的比较:一项随机临床研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-05-16 DOI: 10.1016/j.bjan.2020.01.008

Canan Kamile Turna, Zehra Ipek Arslan, Volkan Alparslan, Kamil Okyay, Mine Solak

Background

Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients.

Methods

Eighty patients with ASA physical status I‐III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m^‐2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited.

Results

There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1 s vs. 50.7 ± 21.2 s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1 s vs. 97.4 ± 42.7 s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05).

Conclusions

Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

背景:肥胖导致插管和通气的各种困难，这是由于上呼吸道脂肪组织增加和胸壁顺应性降低所导致的。根据美国麻醉医师协会(ASA)困难气道指南的推荐，视频喉镜和插管喉罩气道(ILMA)是很好的选择。我们的目的是比较ILMA和Airtraq(通道式视频喉镜)在肥胖患者中的应用。方法ASA身体状态为I - III的患者80例，年龄在18 ~ 65岁之间，体重指数大于35 kg。M‐2名接受择期手术需要经口气管插管的患者被纳入研究。患者使用上述设备中的一种进行插管。结果Airtraq和ILMA的插管次数、插入次数和优化操作需求无显著差异。Airtraq插管完成时间较ILMA组短(29.9±22.1 s vs 50.7±21.2 s;p & lt;0.001)。两组总插管时间比较差异有统计学意义(29.9±22.1 s vs 97.4±42.7 s;p & lt;0.001)。ILMA组植入器后平均动脉压升高，差异有统计学意义(p <0.05)。结论airtraq在肥胖患者中优于ILMA，总插管时间小于60秒，平均动脉压变化小。然而，ILMA仍然是一个有用的工具，在整个插管过程中提供通气和插管。

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引用次数: 2

Avaliação de testes à beira leito e proposta de modelo para prever laringoscopia difícil: estudo prospectivo observacional 床边试验的评价和预测困难喉镜检查模型的建议:前瞻性观察研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-05-13 DOI: 10.1016/j.bjan.2020.02.007

Chara Liaskou , Eleftherios Vouzounerakis , Anastasia Trikoupi , Chryssoula Staikou

Background and objectives

The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model.

Methods

This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height‐to‐Thyromental Distance (R‐H/TMD), Neck Circumference (NC), Ratio of Neck Circumference‐to‐Thyromental Distance (R‐NC/TMD), Hyomental Distance with head in Neutral Position (HMD‐NP) and at Maximal Extension (HMD‐HE), Ratio of Hyomental Distance at Maximal head extension‐to‐hyomental distance in neutral position (R‐HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack‐Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models.

Results

A model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed high prognostic accuracy; x²(5) = 109.12, p < 0.001, AUC = 0.86, p < 0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R‐NC/TMD and HMD‐HE) exhibited good prognostic performance; x²(2) = 63.5, p < 0.001, AUC = 0.77, p < 0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%).

Conclusions

A five‐variable model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R‐NC/TMD and HMD‐HE could be useful in incapable patients. The most accurate single predictor was HE.

背景和目的对喉镜检查困难的预测是基于对面部和颈部解剖特征的评估。我们的目的是确定最准确的测试，并提出一个多变量预测模型。方法前瞻性观察研究纳入1134例患者。甲状腺距离(TMD)、胸骨距离(STMD)、身高与甲状腺距离之比(R‐H/TMD)、颈围(NC)、颈围与甲状腺距离之比(R‐NC/TMD)、头部处于中性位置时的眼神经距离(HMD‐NP)和最大伸展时的眼神经距离(HMD‐HE)、头部处于最大伸展时的眼神经距离与中性位置时的眼神经距离之比(R‐HMD)、Mallampati分级(MLC)、上唇咬合测试(ULBT)、术前评估开口(MO)和头伸(HE)。Cormack‐Lehane分级≥3定义为喉镜检查困难。对所有试验的敏感性、特异性、阳性预测值和阴性预测值进行评估。采用logistic回归多变量分析建立预测模型。结果结合MLC、ULBT、HE、HMD‐HE和R‐NC/TMD的sa模型具有较高的预后准确性;X2 (5) = 109.12, p <0.001, AUC = 0.86, p <0.001)。其敏感性为82.3%，特异性为74.8%，阴性预测值为97.4%。第二个模型包括两项不需要患者配合的测量(R‐NC/TMD和HMD‐HE)显示出良好的预后表现;X2 (2) = 63.5, p <0.001, AUC = 0.77, p <0.001. 在单项检测中，HE的敏感性最高(78.5%)，阴性预测值最高(96%)。结论MLC、ULBT、HE、HMD - HE和R - NC/TMD组成的五变量模型对困难喉镜检查具有较高的预测价值。包括R‐NC/TMD和HMD‐HE的模型可用于无能力患者。最准确的单一预测因子是HE。

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引用次数: 0

Anestesia espinhal em pacientes com COVID‐19, mais pesquisa é necessária COVID - 19患者的脊髓麻醉，需要更多的研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-04-24 DOI: 10.1016/j.bjan.2020.04.002

Masoud Hashemi , Mehrdad Taheri , Reza Aminnejad

引用次数: 0

Anestesiologia pediátrica e o paradoxo da COVID‐19: opinião do Comitê de Anestesia em Pediatria da Sociedade Brasileira de Anestesiologia 儿科麻醉学和COVID - 19悖论:巴西麻醉学学会儿科麻醉委员会的意见

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-05-13 DOI: 10.1016/j.bjan.2020.04.003

Mariana Fontes Lima Neville , Pedro Paulo Vanzillotta , Vinícius Caldeira Quintão

引用次数: 1

Impacto da analgesia pós‐toracotomia com dexmedetomidina e morfina em imunócitos: estudo randomizado 右美托咪定和吗啡开胸后镇痛对免疫细胞的影响:随机研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-05-13 DOI: 10.1016/j.bjan.2019.12.017

Pengfei Lei , Jin Wang , Shan Gao , Bo Du , Hao Wang , Weichun Li , Fei Shi , Aijun Shan

Objective

This study aimed to investigate the impact of post‐thoracotomy analgesia with dexmedetomidine and morphine on immunocytes.

Methods

A total of 118 patients with post‐thoracotomy Patient‐Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg^‐1 body weight] and morphine [0.48 mg.kg^‐1 body weight]) and the Morphine (MOR) Group (61 patients administered with morphine [0.48 mg.kg^‐1]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared.

Results

The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p < 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p < 0.05).

Conclusions

Dexmedetomidine combined with morphine for post‐thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction.

目的探讨右美托咪定联合吗啡开胸后镇痛对免疫细胞的影响。方法随机选取我院2016年3月~ 2018年7月行开胸术后患者自控静脉镇痛(PCIA)的患者118例，分为复方(COM)组(57例患者给予右美托咪定[1.0 μg];Kg‐1体重]和吗啡[0.48 mg。[0.48 mg.kg‐1])和吗啡(MOR)组(61例患者给予吗啡[0.48 mg.kg‐1])。采用FACSCalibur流式细胞术检测两组患者外周血淋巴细胞亚群(CD3+、CD4+、CD8+)和自然杀伤细胞在不同时间点(麻醉诱导前[T0]、气管拔管后立即[T1]、术后12小时[T2]、术后24小时[T3]、术后48小时[T4]、术后72小时[T5]、术后7天[T6])的数值。记录并比较两组患者T3 ~ T5时吗啡剂量及不良反应。结果COM组T2 ~ T5时CD3+水平、CD4+/CD8+比值、T3 ~ T5时CD4+水平、NK细胞均显著高于MOR组(p <0.05)。COM组术后吗啡剂量及术后瘙痒、恶心、呕吐发生率均显著低于MOR组(p <0.05)。结论右美托咪定联合吗啡用于开胸术后PCIA可改善免疫细胞功能，减少吗啡消耗，减少镇痛诱导不良反应。

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引用次数: 1

O manejo do absorvedor de CO2 durante o uso do aparelho de anestesia como respirador mecânico em pacientes com COVID‐19 COVID - 19患者麻醉装置作为机械呼吸器使用时CO2吸收器的管理

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-04-21 DOI: 10.1016/j.bjan.2020.04.001

Marcelo Luis Abramides Torres, Fernando Augusto Tavares Canhisares, Vinícius Caldeira Quintão

引用次数: 2

Anestesia geral associada a bloqueio do plano do músculo eretor da espinha para encerramento de persistência de canal arterial: dois relatos de caso 全身麻醉与脊柱勃起肌平面阻滞以持续关闭动脉管:两例报告

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-02-20 DOI: 10.1016/j.bjan.2020.01.001

Erica Viviana Guimarães Carvalho, Joana Luísa Borges Marques, Maria João Falle Gomes dos Santos

Background

Failure of ductus arteriosus closure in preterm neonates results in a left‐to‐right shunt that leads to variable severities of hemodynamic and respiratory distress. When medical therapy fails, surgical ligation via left lateral thoracotomy remains an alternative approach and can be performed in the operating room or at the bedside with a low mortality rate. Opioid‐based anesthesia is a frequent choice among anesthesiologists who manage patent ductus arteriosus cases based on the suppression of the stress response and maintenance of hemodynamic stability. This rationale suggests that regional anesthesia may also be an advantageous technique and may benefit earlier weaning from ventilation. Blocking afferent signals before incision may also modulate the long‐term consequences of altered sensory perception and pain responses.

Case report

We present two cases of general anesthesia combined with erector spinae plane block as part of multimodal anesthesia in premature twins undergoing patent ductus arteriosus closure.

Discussion

In these cases, the use of erector spinae plane block combined with general anesthesia was efficient to minimize the negative impact of surgery and allowed a reduction in the amount of intraoperative opioid use for patent ductus arteriosus closure.

背景:早产儿动脉导管关闭失败导致左向右分流，导致不同程度的血液动力学和呼吸窘迫。当药物治疗失败时，通过左侧开胸手术结扎仍然是一种替代方法，可在手术室或床边进行，死亡率低。基于阿片类药物的麻醉是麻醉医师在处理基于抑制应激反应和维持血流动力学稳定性的动脉导管未闭病例时经常选择的麻醉方法。这一理论基础表明，区域麻醉也是一种有利的技术，可能有利于早期脱离通气。在切开之前阻断传入信号也可以调节感觉知觉和疼痛反应改变的长期后果。病例报告我们报告了两例全麻联合竖脊肌平面阻滞作为多模式麻醉的一部分，用于早产儿动脉导管未闭闭合。在这些病例中，使用竖脊肌平面阻滞联合全身麻醉可以有效地减少手术的负面影响，并减少术中阿片类药物用于动脉导管未闭闭合的量。

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引用次数: 2

Nova cânula orofaríongea de duplo lúmen para sedação em ecocardiografia transesofágica: série de casos 经食管超声心动图中新型双腔口咽导管镇静作用:病例系列

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-03-01 Epub Date: 2020-05-13 DOI: 10.1016/j.bjan.2020.03.005

Caetano Nigro Neto , Francisco José Lucena Bezerra , Rodrigo Bellio de Mattos Barreto , Davi Costa de Souza Le Bihan , Vinicius Tadeu Nogueira da Silva do Nascimento , Ingrid Caroline Baia de Souza

Introduction

Currently, transesophageal echodopplercardiography (TEE) is frequently performed under sedation on an outpatient basis. Sedation is related with increase in incidents on airways. Bearing in mind this scenario, we developed a new double lumen oropharyngeal cannula aimed at keeping airway patency, in addition to reducing risks to patients during endoscopy procedures performed under sedation. The main objective of our study was to assess the incidence of oxygen desaturation in a series of cases of adult patients submitted to outpatient TEE exam, under sedation and using the oropharyngeal cannula.

Method

Thirty patients under sedation with intravenous midazolam and propofol were assessed. After loss of consciousness, the cannula was placed and patients were maintained on spontaneous breathing. Oxygen saturation, capnometry, heart rate and non‐invasive arterial blood pressure, in addition to subjective data: airway patency, handling of cannula insertion, and comfort of examiner were analyzed.

Results

The incidence of mild desaturation was 23.3%, and there was no severe desaturation in any of the cases. The insertion of the oropharyngeal cannula was considered easy for 29 patients (96.6%), and TEE probe handling was appropriate in 93.33% of exams performed.

Conclusions

TEE exams under sedation aided by the double‐lumen oropharyngeal cannula presented a low incidence of desaturation in patients assessed, and allowed analysis of expired CO₂ during the exams.

目前，经食管超声心动图(TEE)经常在镇静下在门诊进行。镇静与气道事故的增加有关。考虑到这种情况，我们开发了一种新的双腔口咽插管，旨在保持气道通畅，同时降低患者在镇静下进行内窥镜检查时的风险。我们研究的主要目的是评估一系列接受门诊TEE检查、镇静和使用口咽插管的成年患者的氧去饱和发生率。方法对30例静脉注射咪达唑仑和异丙酚镇静患者进行评价。意识丧失后插管，维持患者自主呼吸。分析了血氧饱和度、血液计量、心率和无创动脉血压，以及主观数据:气道通畅、插管处理和检查者的舒适度。结果轻度脱饱和发生率为23.3%，无严重脱饱和病例。29例(96.6%)患者认为口咽插管容易插入，93.33%的患者认为TEE探头处理合适。结论:在双腔口咽插管辅助下镇静下的e检查显示，被评估患者的去饱和发生率较低，并且可以在检查期间分析过期的CO2。

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引用次数: 0

Conduta em obstrução por coágulo em cânula de duplo lúmen bicaval após diagnóstico guiado por ETE: relato de caso ETE引导诊断后双腔双腔插管血栓阻塞的治疗:病例报告

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-01-01 Epub Date: 2020-02-19 DOI: 10.1016/j.bjan.2019.12.007

Raffael Pereira Cezar Zamper , Daniel Bainbridge , Dave Nagpal , Satoru Fujii

Background

Veno‐venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno‐venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot‐obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography.

Case report

A 39 year‐old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno‐venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus‐like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later.

Discussion

The diagnosis of veno‐venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno‐venous extracorporeal membrane oxygenation.

背景:静脉-静脉体外膜氧合是治疗难治性急性呼吸窘迫综合征(ARDS)的一种成熟的治疗方法。使用静脉-静脉体外膜氧合的一个并发症是血栓形成，尽管适当抗凝。我们报告了在经食管超声心动图指导下，通过颈内静脉放置单部位插管的血栓阻塞的诊断和处理。病例报告一名39岁男性在ICU发生肺误吸后出现急性呼吸窘迫综合征和血流动力学不稳定。放置单部位静脉-静脉体外膜氧合8小时后，灌注师突然注意到血流减少。TEE显示血栓样肿块阻塞SVC的流入口，而IVC的流入口是完整的。在重新放置套管的尝试失败后，团队决定通过下腔静脉插入额外的股流套管。然后拔出单点导管，直到其尖端位于右心房，导管的三个端口都切换到输液端口。在此之后，血流和氧合明显改善。不幸的是，尽管做了所有的努力，病人还是在2天后去世了。静脉-静脉体外膜氧合插管梗阻的诊断是基于流入率降低、血流动力学不稳定和血液氧合不良。TEE可以评估插管内的血流，在这种情况下，发现了阻塞。所提出的治疗方法指出，在血块引起导管阻塞的情况下，有一个可行的替代方案，以确保静脉-静脉体外膜氧合提供的血流动力学支持的最小中断。

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引用次数: 0

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