Revista brasileira de anestesiologia最新文献

英文中文

Lidocaína em cirurgia oncológica: o papel do bloqueio dos canais de sódio dependentes de voltagem. Revisão narrativa 利多卡因在肿瘤外科中的作用:电压依赖性钠通道阻断的作用。回顾叙述

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.04.018

German Soto , Fernanda Calero , Marusa Naranjo

Background

The current evidence suggests that oncological surgery, which is a therapy used in the treatment of solid tumors, increases the risk of metastasis. In this regard, a wide range of tumor cells express Voltage‐Gated Sodium Channels (VGSC), whose biological roles are not related to the generation of action potentials. In epithelial tumor cells, VGSC are part of cellular structures named invadopodia, involved in cell proliferation, migration, and metastasis. Recent studies showed that lidocaine could decrease cancer recurrence through its direct effects on tumor cells and immunomodulatory properties on the stress response.

Objective

The aim of this narrative review is to highlight the role of VGSC in tumor cells, and to describe the potential antiproliferative effect of lidocaine during the pathogenesis of metastasis.

A critical review of literature from April 2017 to April 2019 was performed. Articles found on PubMed (2000 − 2019) were considered. A free text and MeSH‐lidocaine; voltage‐gated sodium channels; tumor cells; invadopodia; surgical stress; cell proliferation; metastasis; cancer recurrence − for articles in English, Spanish and Portuguese language − was used. A total of 62 were selected.

Conclusion

In animal studies, lidocaine acts by blocking VGSC and other receptors, decreasing migration, invasion, and metastasis. These studies need to be replicated in humans in the context of oncological surgery.

目前的证据表明，肿瘤手术作为治疗实体瘤的一种治疗方法，会增加转移的风险。在这方面，许多肿瘤细胞表达电压门控钠通道(VGSC)，其生物学作用与动作电位的产生无关。在上皮性肿瘤细胞中，VGSC是被称为内adopodia的细胞结构的一部分，参与细胞增殖、迁移和转移。近年来的研究表明，利多卡因可通过其对肿瘤细胞的直接作用和对应激反应的免疫调节作用来降低肿瘤复发。目的综述VGSC在肿瘤细胞中的作用，并探讨利多卡因在肿瘤转移过程中的潜在抗增殖作用。内容对2017年4月至2019年4月的文献进行批判性回顾。考虑了PubMed(2000 - 2019)上的文章。自由文本和MeSH‐利多卡因;电压门控钠通道;肿瘤细胞;invadopodia;手术压力;细胞增殖;转移;在英文、西班牙文和葡萄牙文的文章中使用了癌症复发。共有62人入选。结论在动物实验中，利多卡因通过阻断VGSC等受体，减少VGSC的迁移、侵袭和转移。这些研究需要在肿瘤手术的背景下在人体中复制。

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引用次数: 1

Efeitos da acupuntura para a prevenção de náuseas e vômitos após colecistectomia laparoscópica: estudo clínico randomizado 针灸预防腹腔镜胆囊切除术后恶心呕吐的效果:随机临床研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2019.08.001

Luiz Eduardo Miranda , Luiz de França Maia e Silva Filho , Ana Carolina Brainer de Siqueira , Ana Clara Miranda , Bianca Rodrigues Castelo Branco Rocha , Ian Victor Paiva de Lima , Victor Soares Gomes da Silva , Diego Laurentino de Lima , Holmes Naspollini

Background and objectives

Postoperative nausea and vomiting (PONV) is a common and undesirable complication observed after laparoscopic cholecystectomy (LC). We investigated the effects of auriculoacupuncture (AA) on the prevention of postoperative nausea and vomiting in the immediate postoperative period of uncomplicated laparoscopic cholecystectomy.

Methods

Sixty‐eight patients were randomly divided into two groups, auriculoacupuncture (n = 35) and control (n = 33) and then they were evaluated prospectively. The needle was placed before anaesthesia induction and remained for 20 minutes. Nausea intensity was evaluated using an analogic visual scale and PONV events were registered immediately after anaesthesia care unit admission and in the second, fourth and sixth hours after the surgery.

Results

The auriculoacupuncture group had a significantly smaller incidence of nausea and vomiting than the control group throughout the whole postoperative period (16/35 vs. 27/33, p = 0.03 and 4/35 vs. 15/33, p = 0.005, respectively); the AA group had fewer nausea events 2 hours (p = 0.03) and 6 hours (p = 0.001) after surgery and fewer vomiting events 2 hours (p = 0.01) and 6 hours (p = 0.02) after surgery.

Conclusions

Auriculoacupuncture can partially prevent postoperative nausea and vomiting when compared to metoclopramide alone after uncomplicated laparoscopic cholecystectomy. Auriculoacupuncture can be recommended as an adjuvant therapy for postoperative nausea and vomiting prevention in selected patients.

背景与目的术后恶心呕吐(PONV)是腹腔镜胆囊切除术(LC)后常见且不希望出现的并发症。目的探讨耳针对无并发症腹腔镜胆囊切除术术后即刻恶心呕吐的预防作用。方法将68例患者随机分为耳针组(n = 35)和对照组(n = 33)，进行前瞻性评价。针在麻醉诱导前放置并保持20分钟。使用类比视觉量表评估恶心程度，并在麻醉护理病房入院后立即以及手术后第2、4和6小时记录PONV事件。结果耳针组术后恶心呕吐发生率明显低于对照组(16/35 vs. 27/33, p = 0.03; 4/35 vs. 15/33, p = 0.005);AA组术后2小时(p = 0.03)和6小时(p = 0.001)恶心事件较少，术后2小时(p = 0.01)和6小时(p = 0.02)呕吐事件较少。结论与单用甲氧氯普胺相比，针刺对腹腔镜胆囊切除术后恶心呕吐有一定的预防作用。在特定的患者中，耳针可作为预防术后恶心和呕吐的辅助治疗。

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引用次数: 4

Prevenção de náusea e vômito no pós‐operatório: novos pontos de vista no cuidado do paciente 术后恶心呕吐的预防:病人护理的新视角

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.09.004

André P. Schmidt

引用次数: 0

COVID‐19 e a retomada das cirurgias eletivas. Como voltaremos à normalidade? COVID - 19和选择性手术的恢复。我们怎样才能恢复正常?

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.09.001

Florentino Fernandes Mendes

引用次数: 5

O efeito de epinefrina, norepinefrina e fenilefrina no tratamento da hipotensão pós‐raquianestesia: estudo clínico comparativo 肾上腺素、去甲肾上腺素和苯肾上腺素治疗脊髓麻醉后低血压的作用:比较临床研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.04.017

Ebru Biricik , Feride Karacaer , İlker Ünal , Mete Sucu , Hakkı Ünlügenç

Background and objectives

Limited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal‐hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal‐hypotension and ephedrine requirement during cesarean delivery.

Methods

One hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 μg.mL^‐1 (n = 40), epinephrine 5 μg.mL^‐1 (n = 40), phenylephrine 100 μg.mL^‐1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of iv ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded.

Results

There was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p < 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p = 0.001).

Conclusion

There is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered as an alternative agent for management of spinal hypotension.

背景和目的目前关于肾上腺素预防和治疗脊柱低血压的安全性和有效性的数据有限。本研究旨在比较肾上腺素、去甲肾上腺素和苯肾上腺素对剖宫产患者脊柱低血压和麻黄素需要量的影响。方法选取160例无并发症的孕妇在脊髓麻醉下择期剖宫产。随机给予去甲肾上腺素5 μg。mL‐1 (n = 40)，肾上腺素5 μg。mL‐1 (n = 40)，苯肾上腺素100 μg。脊髓麻醉诱导后立即输注mL‐1 (n = 40)或0.9%生理盐水(n = 40)。当收缩压降至低于基线的80%时，给予5毫克静脉麻黄碱作为救助性血管加压药。记录低血压发生率、低血压总发作次数、麻黄素需要量、麻黄素平均用量及不良反应。结果两组产妇低血压发生率比较，差异无统计学意义。生理盐水组需要麻黄碱的患者数量明显多于苯肾上腺素组(p <0.001)。然而，在苯肾上腺素、去甲肾上腺素和肾上腺素组之间是相似的。生理盐水组的平均麻黄素消耗量显著高于去甲肾上腺素、肾上腺素和苯肾上腺素组(p = 0.001)。结论腰麻剖宫产术中使用肾上腺素与去甲肾上腺素、苯肾上腺素相比，低血压发生率及麻黄素用量差异无统计学意义。肾上腺素可作为治疗脊柱低血压的替代药物。

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引用次数: 1

Fatores de risco para náusea e vômitos após cesariana: estudo prognóstico prospectivo 剖宫产后恶心呕吐的危险因素:前瞻性预后研究

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.08.003

Gabriel Magalhães Nunes Guimarães , Helga Bezerra Gomes da Silva , Hazem Adel Ashmawi

Background

Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia.

Methods

One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi‐squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV.

Results

Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4‐inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV.

Conclusions

Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self‐reported nausea during the first trimester was a protective factor for post‐cesarean nausea and vomiting.

背景:产科患者术后恶心和呕吐(PONV)的危险因素尚未明确。在这项研究中，我们的目的是确定脊髓麻醉下剖宫产术后PONV的潜在危险因素。方法采用一组腰麻剖宫产术患者，探讨其发生PONV的潜在危险因素。采用卡方方法对最佳数值危险因素进行二分类。采用条件独立(增量关联法)随机网络选择最佳预测因子。结果260例患者中有250例留在了研究中。年轻产妇PONV的优势比(<25岁:2.9[1.49−5.96])，脊髓布比卡因剂量降低(<13 mg, inf[2.4‐inf])，降低脊髓吗啡剂量(<80 mg, 0.03[0−0.97])，晕动病史(2.5[1.27−5.25])，妊娠早期明显恶心(0.3[0.16−0.64])，术中恶心呕吐(8.2[3.67−20.47])，低胎龄(<38周，2.0[1.01−4.08])，差异有统计学意义。因果网络选择妊娠前三个月无明显恶心、术中恶心和胎龄;38周是PONV的主要直接危险因素。结论术中恶心与产妇年龄有关;25岁是腰麻下剖宫产术后PONV的主要危险因素。在前三个月没有自我报告的恶心是剖宫产后恶心和呕吐的保护因素。

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引用次数: 4

A saga do anestesiologista: guerreiro da linha de frente da COVID‐19 麻醉师的传奇:COVID - 19前线战士

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.09.002

Rashmi Syal, Kamlesh Kumari, Rakesh Kumar, Kriti Chaudhary, Bharat Paliwal

引用次数: 1

Efeito da palonosetrona, ondansetrona e dexametasona na prevenção de náusea e vômito pós‐operatório em videocolecistectomia com anestesia venosa total com propofol‐remifentanil – ensaio clínico randomizado duplo cego 帕洛诺司琼、恩丹司琼和地塞米松在异丙酚-瑞芬太尼全静脉麻醉视频胆囊切除术术后恶心和呕吐预防中的作用-双盲随机临床试验

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.08.001

Neuber Martins Fonseca , Ludmila Ribeiro Pedrosa , Natália Melo , Ricardo de Ávila Oliveira

Introduction and objectives

The incidence of Postoperative Nausea and Vomiting (PONV) after video cholecystectomy is high. Progress in pharmacological PONV prophylaxis includes a new generation of 5‐HT₃ antagonists. This study aims to assess the effect of the 5‐HT₃ antagonist in postanesthetic antiemetic management of patients submitted to laparoscopic cholecystectomy with total intravenous anesthesia.

Methods

Sixty individuals who underwent video cholecystectomy were randomized into three groups of 20 individuals according to the treatment administered: 0.125 mg of palonosetron (Group 1); 4 mg of ondansetron associated with 4 mg of dexamethasone (Group 2); 4 mg of dexamethasone (Group 3). General intravenous anesthesia was performed with propofol, remifentanil and rocuronium. The group to which the participant belonged was concealed from the investigator who assessed drug effect. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. Rescue medication was 0.655 to 1.5 mg of droperidol.

Results

Group 1 presented a lower incidence of PONV and required less rescue medication in the first postoperative hour. There was no significant difference among the three groups regarding PONV incidence in the first 12 postoperative hours. Groups 1 and 2 were superior to Group 3 regarding the control of PONV from 12 to 24 hours, and after rescue medication from 12 to 24 hours. Group 1 showed significantly superior nausea control in the first 12 postoperative hours.

Conclusions

The present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea.

简介与目的胆囊切除术后恶心呕吐的发生率较高。药物预防PONV的进展包括新一代5‐HT3拮抗剂。本研究旨在评估5‐HT3拮抗剂在全静脉麻醉腹腔镜胆囊切除术患者麻醉后止吐管理中的作用。方法60例胆囊切除术患者随机分为3组，每组20人:帕洛诺司琼0.125 mg(第一组);昂丹西琼4mg联合地塞米松4mg(第2组);地塞米松4mg(第三组)。静脉全身麻醉:异丙酚、瑞芬太尼、罗库溴铵。参与者所属的组对评估药物效果的研究者是隐藏的。在术后12小时和24小时使用Rhodes量表评估PONV。抢救用药为氟哌啶醇0.655 ~ 1.5 mg。结果组1术后1小时PONV发生率较低，所需抢救药物较少。术后前12小时，三组间PONV发生率无显著差异。在12 ~ 24 h及抢救用药后12 ~ 24 h的PONV控制方面，1、2组优于3组。组1术后前12小时恶心控制明显优于对照组。结论帕洛诺司琼的止吐效果较持久，对抢救药物的需求较少，这主要与帕洛诺司琼能完全抑制恶心等不适症状有关。

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引用次数: 4

Lombalgia crônica: devemos adotar as novas técnicas de analgesia? 慢性腰痛:我们应该采用新的镇痛技术吗?

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.09.003

Inês Gonçalves Morais, Ana Martin

引用次数: 0

Bloqueio do gânglio esfenopalatino autoaplicado para cefaleia pós‐punção dural: relato de quatro casos 硬膜穿刺后头痛的自我应用蝶腭神经节阻塞:4例报告

IF 1 Q3 Medicine

Revista brasileira de anestesiologia

Pub Date : 2020-09-01 DOI: 10.1016/j.bjan.2020.07.002

Andrés Rocha-Romero , Priodarshi Roychoudhury , Rodrigo Benavides Cordero , Maynor Lopez Mendoza

Background and objectives

The Sphenopalatine Ganglion Block (SGB) is an effective, low‐risk treatment option for Postdural Puncture Headache (PDPH) refractory to conservative management.

Case report

This report presents four complex cases of patients with headache related to low cerebrospinal fluid pressure. Three of them were successfully treated with the application of local anesthetic topical drops through the nasal cavity.

Conclusion

The novel approach described in this report has minimal risks of discomfort or injury to the nasal mucosa. It is quick to apply and can be administered by the patient himself.

背景和目的蝶腭神经节阻滞(SGB)是硬脊膜后穿刺头痛(PDPH)的一种有效、低风险的治疗选择。病例报告:本文报告了4例脑脊液低压所致头痛的复杂病例。其中3例通过鼻腔局部麻醉滴剂成功治疗。结论本报告所述的新入路对鼻黏膜的不适或损伤风险最小。它可以快速应用，并可以由病人自己管理。

引用次数: 2

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