Pub Date : 2020-09-01DOI: 10.1016/j.bjan.2020.09.005
Gabriel Magalhães Nunes Guimarães
{"title":"Fatores de risco de NVPO após cesarianas","authors":"Gabriel Magalhães Nunes Guimarães","doi":"10.1016/j.bjan.2020.09.005","DOIUrl":"10.1016/j.bjan.2020.09.005","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38520679","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.04.015
Yavuz Orak , Suleyman Murat Bakacak , Asli Yaylali , Fatma Inanc Tolun , Hakan Kiran , Omer Faruk Boran , Akif Hakan Kurt , Adem Doganer
Background and objective
The aim was to investigate the effects of Turkish classical music on pain and oxidative stress in patients undergoing oocyte pick‐up.
Methods
The study was a randomized, controlled trial. The groups included were Group NM (Non‐Music), control group; Group PM, which comprised patients who listened to music before the operation; and Group CM, which comprised patients who listened to music both before and during the operation. Blood was drawn prior to the operation to measure the oxidative stress values. Pain, hemodynamic parameters, oxidative stress values were assessed postoperatively.
Results
The number of patients requiring additional propofol was higher in Group PM than in Groups NM and CM (p = 0.003). The postoperative Visual Analog Scale (VAS) score were lower in Groups PM and CM than in Group NM (p = 0.001, p = 0.007) in the 1st and 60th minutes. The postoperative VAS score was lower in Group CM than in Group NM (p = 0.045) in the 5th minute. The postoperative additional analgesic requirements were lower in Groups PM and CM than in Group NM (p = 0.045). The postoperative blood glutathione peroxidase values were significantly higher in Groups PM and CM than in Group NM (p = 0.001). The postoperative catalase values were significantly higher in Groups PM and CM than in Group NM (p = 0.008 and p ≤ 0.001). The preoperative malondialdehyde values were significantly lower in Groups PM and CM than in Group NM. The preoperative nitric oxide values were higher in Groups PM and CM than in Group NM (p ≤ 0.001), whereas the postoperative nitric oxide values were lower in Groups PM and CM than in Group NM (p ≤ 0.001).
Conclusion
Turkish classical music has beneficial effects on pain and oxidative stress in oocyte pick‐up patients.
{"title":"Efeitos da musicoterapia sobre dor e estresse oxidativo na aspiração folicular: estudo clínico randomizado","authors":"Yavuz Orak , Suleyman Murat Bakacak , Asli Yaylali , Fatma Inanc Tolun , Hakan Kiran , Omer Faruk Boran , Akif Hakan Kurt , Adem Doganer","doi":"10.1016/j.bjan.2020.04.015","DOIUrl":"10.1016/j.bjan.2020.04.015","url":null,"abstract":"<div><h3>Background and objective</h3><p>The aim was to investigate the effects of Turkish classical music on pain and oxidative stress in patients undergoing oocyte pick‐up.</p></div><div><h3>Methods</h3><p>The study was a randomized, controlled trial. The groups included were Group NM (Non‐Music), control group; Group PM, which comprised patients who listened to music before the operation; and Group CM, which comprised patients who listened to music both before and during the operation. Blood was drawn prior to the operation to measure the oxidative stress values. Pain, hemodynamic parameters, oxidative stress values were assessed postoperatively.</p></div><div><h3>Results</h3><p>The number of patients requiring additional propofol was higher in Group PM than in Groups NM and CM (<em>p</em> <!-->=<!--> <!-->0.003). The postoperative Visual Analog Scale (VAS) score were lower in Groups PM and CM than in Group NM (<em>p</em> <!-->=<!--> <!-->0.001, <em>p</em> <!-->=<!--> <!-->0.007) in the 1<sup>st</sup> and 60<sup>th</sup> minutes. The postoperative VAS score was lower in Group CM than in Group NM (<em>p</em> <!-->=<!--> <!-->0.045) in the 5<sup>th</sup> minute. The postoperative additional analgesic requirements were lower in Groups PM and CM than in Group NM (<em>p</em> <!-->=<!--> <!-->0.045). The postoperative blood glutathione peroxidase values were significantly higher in Groups PM and CM than in Group NM (<em>p<!--> </em>=<!--> <!-->0.001). The postoperative catalase values were significantly higher in Groups PM and CM than in Group NM (<em>p</em> <!-->=<!--> <!-->0.008 and <em>p</em> ≤<!--> <!-->0.001). The preoperative malondialdehyde values were significantly lower in Groups PM and CM than in Group NM. The preoperative nitric oxide values were higher in Groups PM and CM than in Group NM (<em>p</em> ≤<!--> <!-->0.001), whereas the postoperative nitric oxide values were lower in Groups PM and CM than in Group NM (<em>p ≤</em> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>Turkish classical music has beneficial effects on pain and oxidative stress in oocyte pick‐up patients.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38291014","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.04.014
César de Araujo Miranda , José F.A. Meletti , Laís H.N. Lima , Evaldo Marchi
Background
Cardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO2) to Oxygen Consumption (VO2). Central venous oxygen Saturation (ScvO2) is an accessible and indirect measure of DO2/VO2 ratio.
Objective
To monitor perioperative ScvO2 and assess its correlation with mortality during cardiac surgery.
Methods
This prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO2 at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24 hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO2.
Results
Of the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO2 in both survivors (T0 = 78% ± 8.1%, T1 = 75.4% ± 7.5%, and T2 = 68.5% ± 9%; p < 0.001) and nonsurvivors (T0 = 74.4% ± 8.7%, T1 = 75.4% ± 7.7%, and T2 = 66.7% ± 13.1%; p < 0.001). At T0, the percentage of patients with ScvO2 < 70% was greater in the nonsurvivor group (31.8% vs. 13.1%; p = 0.046) and the multiple logistic regression showed that ScvO2 is an independent risk factor associated with death, OR = 2.94 (95% CI 1.10 − 7.89) (p = 0.032). The length of ICU and LOS were 3.6 ± 3.1 and 7.4 ± 6.0 days respectively and was not significantly associated with ScvO2.
Conclusions
Early intraoperative ScvO2 < 70% indicated a higher risk of death. A perioperative reduction of ScvO2 was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.
{"title":"Correlação entre saturação venosa central de oxigênio perioperatória e mortalidade em cirurgia cardíaca: estudo prospectivo observacional","authors":"César de Araujo Miranda , José F.A. Meletti , Laís H.N. Lima , Evaldo Marchi","doi":"10.1016/j.bjan.2020.04.014","DOIUrl":"10.1016/j.bjan.2020.04.014","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO<sub>2</sub>) to Oxygen Consumption (VO<sub>2</sub>). Central venous oxygen Saturation (ScvO<sub>2</sub>) is an accessible and indirect measure of DO<sub>2</sub>/VO<sub>2</sub> ratio.</p></div><div><h3>Objective</h3><p>To monitor perioperative ScvO<sub>2</sub> and assess its correlation with mortality during cardiac surgery.</p></div><div><h3>Methods</h3><p>This prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO<sub>2</sub> at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24<!--> <!-->hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO<sub>2</sub>.</p></div><div><h3>Results</h3><p>Of the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO<sub>2</sub> in both survivors (T0<!--> <!-->=<!--> <!-->78%<!--> <!-->± 8.1%, T1<!--> <!-->=<!--> <!-->75.4%<!--> <!-->±<!--> <!-->7.5%, and T2<!--> <!-->=<!--> <!-->68.5%<!--> <!-->±<!--> <!-->9%; <em>p</em> <!--><<!--> <!-->0.001) and nonsurvivors (T0<!--> <!-->=<!--> <!-->74.4%<!--> <!-->±<!--> <!-->8.7%, T1<!--> <!-->=<!--> <!-->75.4%<!--> <!-->±<!--> <!-->7.7%, and T2<!--> <!-->=<!--> <!-->66.7%<!--> <!-->±<!--> <!-->13.1%; <em>p</em> <<!--> <!-->0.001). At T0, the percentage of patients with ScvO<sub>2</sub> <<!--> <!-->70% was greater in the nonsurvivor group (31.8% vs. 13.1%; <em>p</em> <!-->=<!--> <!-->0.046) and the multiple logistic regression showed that ScvO<sub>2</sub> is an independent risk factor associated with death, OR<!--> <!-->=<!--> <!-->2.94 (95% CI 1.10<!--> <!-->−<!--> <!-->7.89) (<em>p</em> <!-->=<!--> <!-->0.032). The length of ICU and LOS were 3.6<!--> <!-->±<!--> <!-->3.1 and 7.4<!--> <!-->±<!--> <!-->6.0 days respectively and was not significantly associated with ScvO<sub>2</sub>.</p></div><div><h3>Conclusions</h3><p>Early intraoperative ScvO<sub>2</sub> <<!--> <!-->70% indicated a higher risk of death. A perioperative reduction of ScvO<sub>2</sub> was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38425418","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}
Náusea e Vômito no Pós‐Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5‐Hidroxitriptamina3 (5‐HT3) e antagonistas do receptor da Neurocinina‐1 (NK‐1), têm sido utilizados para tratar a NVPO.
Objetivo
Comparar o efeito antiemético dos antagonistas do receptor NK‐1, incluindo o fosaprepitanto.
Fontes de dados
Foram utilizadas bases de dados on‐line (PubMed, MEDLINE, Scopus, The Cochrane Library).
Critérios de elegibilidade do estudo, participantes e intervenções
Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK‐1 e antagonistas do receptor 5‐HT3, e que comparassem a incidência de NVPO.
Métodos de avaliação e síntese do estudo
Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%.
Resultados
As doses de 40 mg e 80 mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós‐operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30‐0,54; p < 0,001 e OR = 0,32; 95% IC 0,19‐0,56; p < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0‐24 horas como no período de 0‐48 horas pós‐operatórias (OR = 0,07; 95% IC 0,02‐0,24; p < 0,001 e OR = 0,07; 95% IC 0,02‐0,23; p < 0,001).
Limitações
Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés.
Conclusões e implicações dos principais achados
Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós‐operatório. No entanto, são necessários mais estudos para elaboração de meta‐análises de melhor qualidade.
Número de registro da revisão sistemática
CRD42019120188.
Background
Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5‐Hydroxytryptamine3 (5‐HT3) receptor antagonists and Neurokinin‐1 (NK‐1) receptor antagonists, have been used to treat PONV.
Objectives
To compare the antiemetic effect of NK‐1 receptor antagonists, including fosaprepitant.
Data sources
Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.
Study eligibility criteria, participants, and interventions
Randomized
术后病史和呕吐是全身麻醉常见的不良事件。几种止吐药物，包括5‐羟色胺受体拮抗剂(5‐HT3)和神经激肽受体1拮抗剂(NK‐1)，已被用于治疗NVPO。目的比较NK - 1受体拮抗剂的止吐作用，包括福萨普吡坦。数据来源使用在线数据库(PubMed, MEDLINE, Scopus, The Cochrane Library)。合格标准的研究,参与者和intervençõesForam包括随机临床试验(ECR)大于18岁病人进行分类(翼第三,以评估治疗的有效性包括NK受体1、受体拮抗剂5‐‐HT3 ponv发生率比较是否。评价方法和研究综合所有统计评价均采用随机效应法，计算优势比和95%置信区间。结果40 mg和80 mg阿瑞吡坦剂量可显著降低术后0 - 24小时内呕吐发生率(几率[OR = 0.40];95%置信区间[95% ci] 0.30 - 0.54;p <0.001, OR = 0.32;95% ci 0.19‐0.56;p <0.001)。福萨prepitanto还可显著降低术后0 - 24小时和0 - 48小时的呕吐发生率(或= 0.07;95% ci 0.02 - 0.24;p <0.001, OR = 0.07;95% ci 0.02 - 0.23;p <0.001)。局限性未分析NVPO的危险因素，包括使用多种止吐剂的rcs，鼻前皮质的rcs样本小，可能存在一些偏差。结论和主要发现的意义:术前和术后呕吐可能是有效的预防性止吐药物。然而，还需要更多的研究来发展更好质量的荟萃分析。系统修订注册编号acrd42019120188。BackgroundPostoperative恶心和Vomiting (PONV)是通用的共同语言complication麻醉。几种类型的抗吐药物，包括5 -羟色胺- 3 (5 - HT3)受体拮抗剂和神经激酶- 1 (NK - 1)受体拮抗剂，已被用于治疗PONV。目的比较包括fosaprepitant在内的NK‐1受体拮抗剂的止吐作用。使用了在线数据来源数据库(PubMed, MEDLINE, Scopus, Cochrane图书馆数据库)。研究资格标准、参与者和干预对照试验(rct)在18年以上ASA - PS I - III患者中进行，旨在评估包括NK - 1受体拮抗剂和5 - HT3受体拮抗剂在内的抗吐药物的有效性，并比较PONV的发生率。研究评估和综合方法采用随机效应法进行统计评估，计算优势比和95%置信区间。结果prepitant 40mg和80mg显著降低术后0 - 24小时呕吐发生率(比值比[OR = 0.40];95%置信区间[95% CI 0.30 - 0.54];p <0.001，或= 0.32;95% CI 0.19 - 0.56;p <0001)。Fosaprepitant还可显著降低术后0 - 24小时和0 - 48小时的呕吐发生率(或= 0.07;95% CI 0.02 - 0.24;p <0.001和或= 0.07;95% CI 0.02 - 0.23;p <0001)。没有考虑PONV的限制因素，包括使用多种抗吐药的rct，用于fosaprepitant的rct很小，可能存在一些偏见。关键发现前药和福萨前药可有效预防术后呕吐的结论和意义。然而，需要更多的研究来进行更高质量的荟萃分析。系统评审注册编号crd42019120188
{"title":"Antagonistas do receptor da neurocinina‐1 no tratamento de náusea e vômito no pós‐operatório: Revisão sistemática e meta‐análise","authors":"Chiaki Murakami , Nami Kakuta , Shiho Satomi , Ryuji Nakamura , Hirotsugu Miyoshi , Atsushi Morio , Noboru Saeki , Takahiro Kato , Naohiro Ohshita , Katsuya Tanaka , Yasuo M. Tsutsumi","doi":"10.1016/j.bjan.2020.04.005","DOIUrl":"10.1016/j.bjan.2020.04.005","url":null,"abstract":"<div><h3>Histórico</h3><p>Náusea e Vômito no Pós‐Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5‐Hidroxitriptamina3 (5‐HT3) e antagonistas do receptor da Neurocinina‐1 (NK‐1), têm sido utilizados para tratar a NVPO.</p></div><div><h3>Objetivo</h3><p>Comparar o efeito antiemético dos antagonistas do receptor NK‐1, incluindo o fosaprepitanto.</p></div><div><h3>Fontes de dados</h3><p>Foram utilizadas bases de dados <em>on‐line</em> (PubMed, MEDLINE, Scopus, The Cochrane Library).</p></div><div><h3>Critérios de elegibilidade do estudo, participantes e intervenções</h3><p>Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK‐1 e antagonistas do receptor 5‐HT3, e que comparassem a incidência de NVPO.</p></div><div><h3>Métodos de avaliação e síntese do estudo</h3><p>Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%.</p></div><div><h3>Resultados</h3><p>As doses de 40<!--> <!-->mg e 80<!--> <!-->mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós‐operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30‐0,54; <em>p</em> < 0,001 e OR = 0,32; 95% IC 0,19‐0,56; <em>p</em> < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0‐24<!--> <!-->horas como no período de 0‐48 horas pós‐operatórias (OR = 0,07; 95% IC 0,02‐0,24; <em>p</em> < 0,001 e OR = 0,07; 95% IC 0,02‐0,23; <em>p</em> < 0,001).</p></div><div><h3>Limitações</h3><p>Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés.</p></div><div><h3>Conclusões e implicações dos principais achados</h3><p>Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós‐operatório. No entanto, são necessários mais estudos para elaboração de meta‐análises de melhor qualidade.</p></div><div><h3>Número de registro da revisão sistemática</h3><p>CRD42019120188.</p></div><div><h3>Background</h3><p>Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5‐Hydroxytryptamine3 (5‐HT3) receptor antagonists and Neurokinin‐1 (NK‐1) receptor antagonists, have been used to treat PONV.</p></div><div><h3>Objectives</h3><p>To compare the antiemetic effect of NK‐1 receptor antagonists, including fosaprepitant.</p></div><div><h3>Data sources</h3><p>Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.</p></div><div><h3>Study eligibility criteria, participants, and interventions</h3><p>Randomized","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38237893","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.05.004
Atish Pal, Vikas Gogia, Chetan Mehra
Myasthenia Gravis (MG) is an autoimmune disease characterized by weakness and fatigability of skeletal muscles, with improvement following rest. It is a disease of great significance to the anesthesiologist because it affects the neuromuscular junction. Robotic thymectomy has come up in recent times due to the minimally invasive nature and its advantages. This presents a new set of challenges for the anesthesia team, and here we present the various anesthesia considerations and perioperative management in a series of 20 patients who underwent robotic thymectomy. As it is a recent upcoming procedure, there is a paucity of literature on this topic, and most of the available literature talks about One‐Lung Ventilation (OLV) and thoracic epidurals. To our notice, this is the first literature without the use of OLV and thoracic epidural for the management of robotic thymectomy.
{"title":"Desafios perioperatórios e pontos de atenção no bloqueio neuromuscular durante timectomia robótica para miastenia gravis","authors":"Atish Pal, Vikas Gogia, Chetan Mehra","doi":"10.1016/j.bjan.2020.05.004","DOIUrl":"10.1016/j.bjan.2020.05.004","url":null,"abstract":"<div><p>Myasthenia Gravis (MG) is an autoimmune disease characterized by weakness and fatigability of skeletal muscles, with improvement following rest. It is a disease of great significance to the anesthesiologist because it affects the neuromuscular junction. Robotic thymectomy has come up in recent times due to the minimally invasive nature and its advantages. This presents a new set of challenges for the anesthesia team, and here we present the various anesthesia considerations and perioperative management in a series of 20 patients who underwent robotic thymectomy. As it is a recent upcoming procedure, there is a paucity of literature on this topic, and most of the available literature talks about One‐Lung Ventilation (OLV) and thoracic epidurals. To our notice, this is the first literature without the use of OLV and thoracic epidural for the management of robotic thymectomy.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.05.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38471352","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}
Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life‐threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low‐dose ketamine‐propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.
{"title":"Cisto hidático na medula cervical complicada por via aérea difícil com potencial risco de vida: relato de caso","authors":"Dmitriy Viderman , Aisa Nurpeisov , Omirzhan Balabayev , Yermek Urunbayev , Guilherme de Almeida , Federico Bilotta","doi":"10.1016/j.bjan.2020.08.004","DOIUrl":"10.1016/j.bjan.2020.08.004","url":null,"abstract":"<div><p>Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life‐threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low‐dose ketamine‐propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38544944","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.04.019
Amir Ahmadzadeh Amiri , Kasra Karvandian , Mohammad Ashouri , Mojgan Rahimi , Ali Ahmadzadeh Amiri
Background
Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients’ characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV.
Methods
A single‐blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated.
Results
Fifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p = 0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043).
Conclusion
The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.
{"title":"Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós‐operatórios em laparotomia: estudo clínico randomizado","authors":"Amir Ahmadzadeh Amiri , Kasra Karvandian , Mohammad Ashouri , Mojgan Rahimi , Ali Ahmadzadeh Amiri","doi":"10.1016/j.bjan.2020.04.019","DOIUrl":"10.1016/j.bjan.2020.04.019","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients’ characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV.</p></div><div><h3>Methods</h3><p>A single‐blinded prospective randomized clinical trial on 105 patients aged 18<!--> <!-->−<!--> <!-->65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24<!--> <!-->hours after the surgery. The use of a rescue antiemetic was also evaluated.</p></div><div><h3>Results</h3><p>Fifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (<em>p</em> <<!--> <!-->0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (<em>p</em> <!-->=<!--> <!-->0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (<em>p</em> <!-->=<!--> <!-->0.043).</p></div><div><h3>Conclusion</h3><p>The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38468771","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 nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60−80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron‐dexamethasone and ondansetron‐dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery.
Methods
Sixty‐four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron‐dexamethasone and ondansetron‐dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded.
Results
Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2−6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0−24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron‐dexamethasone was 28%, the relative risk reduction was 75%, and the number‐needed‐to‐treat was 4. The patient's satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026).
Conclusion
The combination of palonosetron‐dexamethasone is superior to ondansetron‐dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.
{"title":"Comparação entre palonosetrona‐dexametasona e ondansetrona‐dexametasona na prevenção de náuseas e vômitos no pós‐operatório de cirurgia do ouvido médio: estudo clínico randomizado","authors":"Vinit Kumar Srivastava , Saima Khan , Sanjay Agrawal , Sweta Anil Deshmukh , Pooja Shree , Partha Pratim Misra","doi":"10.1016/j.bjan.2020.04.016","DOIUrl":"10.1016/j.bjan.2020.04.016","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60−80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron‐dexamethasone and ondansetron‐dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery.</p></div><div><h3>Methods</h3><p>Sixty‐four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron‐dexamethasone and ondansetron‐dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded.</p></div><div><h3>Results</h3><p>Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2−6<!--> <!-->hours only (<em>p</em> <!-->=<!--> <!-->0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0−24<!--> <!-->hours postoperatively) was 37.5% in group O and 9.4% in group P (<em>p</em> <!-->=<!--> <!-->0.016). Absolute risk reduction with palonosetron‐dexamethasone was 28%, the relative risk reduction was 75%, and the number‐needed‐to‐treat was 4. The patient's satisfaction score was higher in group P than group O (<em>p</em> <!-->=<!--> <!-->0.016). The frequency of rescue medication was more common in group O than in group P patients (<em>p</em> <!-->=<!--> <!-->0.026).</p></div><div><h3>Conclusion</h3><p>The combination of palonosetron‐dexamethasone is superior to ondansetron‐dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38526792","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.06.004
Maria Anita Costa Spindola , Dirceu Solé , Marcelo Vivolo Aun , Liana Maria Tôrres de Araújo Azi , Luiz Antonio Guerra Bernd , Daniela Bianchi Garcia , Albertina Varandas Capelo , Débora de Oliveira Cumino , Alex Eustáquio Lacerda , Luciana Cavalcanti Lima , Edelton Flávio Morato , Rogean Rodrigues Nunes , Norma de Paula Motta Rubini , Jane da Silva , Maria Ângela Tardelli , Alexandra Sayuri Watanabe , Erick Freitas Curi , Flávio Sano
Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
{"title":"Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) – Parte I: tratamento e orientação pós‐crise","authors":"Maria Anita Costa Spindola , Dirceu Solé , Marcelo Vivolo Aun , Liana Maria Tôrres de Araújo Azi , Luiz Antonio Guerra Bernd , Daniela Bianchi Garcia , Albertina Varandas Capelo , Débora de Oliveira Cumino , Alex Eustáquio Lacerda , Luciana Cavalcanti Lima , Edelton Flávio Morato , Rogean Rodrigues Nunes , Norma de Paula Motta Rubini , Jane da Silva , Maria Ângela Tardelli , Alexandra Sayuri Watanabe , Erick Freitas Curi , Flávio Sano","doi":"10.1016/j.bjan.2020.06.004","DOIUrl":"10.1016/j.bjan.2020.06.004","url":null,"abstract":"<div><p>Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237025","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 : 2020-09-01DOI: 10.1016/j.bjan.2020.08.002
Antoine Abi Lutfallah , Khalil Jabbour , Afrida Gergess , Gemma Hayeck , Nayla Matar , Samia Madi‐Jebara
Introdução
O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo‐sedação leve e intermitente.
Relato de caso
Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo‐sedação intermitente com infusão alvo‐controlada de remifentanil (alvo de 0,5 ng.mL‐1) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente.
Conclusões
O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.
Background
The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia.
Case report
A 51‐year‐old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound‐guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia. An intermittent sedation analgesia with a target‐controlled infusion of remifentanyl (target 0.5 ng.mL‐1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort.
Conclusion
The use of regional technique is a promising method for the anesthetic management in TIP, espe
I型甲状腺成形术(ipt)在声带瘫痪后声门功能不全的治疗中的作用已得到证实，但ipt的最佳麻醉处理仍有争议。我们描述了一种新的ipt麻醉技术，使用颈部神经丛阻滞(BPC)浅表和相关的中间BPC，在analgo -轻度和间歇镇静的存在下。一名51岁的左声带瘫痪和阻塞性睡眠呼吸暂停患者被安排在ipt。超声引导的中间BPC采用后入路，在胸锁乳突肌与椎前筋膜之间的颈后间隙注射15ml 0.5%罗哌卡因。然后，对于浅表BPC，在胸锁乳突肌后缘附近的皮下注射10ml 0.5%罗哌卡因，而不移植膜筋膜。间歇性镇静，靶向控制瑞芬太尼输注(靶向0.5 ng.mL‐1)，以促进假体插入和光纤喉镜检查。该技术在麻醉过程中提供了安全的气道，为外科医生提供了良好的条件，监测声音的可能性，以及极大的患者舒适度。结论区域麻醉的使用是一种很有前途的技术，在ipt期间的麻醉护理，特别是在气道受损的患者。在此背景下，I型甲状腺成形术(TIP)作为治疗声带瘫痪引起的声门功能不全的一种方法已得到很好的证实，但对这种手术的最佳麻醉管理仍有广泛的讨论。我们介绍了一种新型的颈部麻醉方法，采用中间和浅表颈神经丛阻滞(CPB)和间歇性轻度镇静镇痛。病例报告51岁，左声带折叠瘫痪和阻塞性睡眠呼吸暂停，计划进行TIP。超声引导的中间CPB采用后入法，15 mL 0.5%罗哌卡因注射到胸锁乳突肌和椎前筋膜之间的颈椎后间隙。然后，对于表面CPB，共注射10ml 0.5%罗匹卡因，靠近胸骨cleidomastoid肌肉的后边界，而不穿过投资筋膜。间歇性镇静镇痛与目标控制注射瑞芬太尼(目标0.5 ng.mL‐1)用于促进假体插入和光纤喉镜检查。该技术为外科医生提供了安全的麻醉气道和良好的手术条件，以及可行的声音监测和最佳的患者舒适。结论区域技术的应用是一种很有前途的针头麻醉管理方法，特别是对气道受损患者。
{"title":"Bloqueio do plexo cervical como técnica anestésica alternativa para tireoplastia tipo I: relato de caso","authors":"Antoine Abi Lutfallah , Khalil Jabbour , Afrida Gergess , Gemma Hayeck , Nayla Matar , Samia Madi‐Jebara","doi":"10.1016/j.bjan.2020.08.002","DOIUrl":"10.1016/j.bjan.2020.08.002","url":null,"abstract":"<div><h3>Introdução</h3><p>O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo‐sedação leve e intermitente.</p></div><div><h3>Relato de caso</h3><p>Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo‐sedação intermitente com infusão alvo‐controlada de remifentanil (alvo de 0,5 ng.mL<sup>‐1</sup>) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente.</p></div><div><h3>Conclusões</h3><p>O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.</p></div><div><h3>Background</h3><p>The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia.</p></div><div><h3>Case report</h3><p>A 51‐year‐old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound‐guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia. An intermittent sedation analgesia with a target‐controlled infusion of remifentanyl (target 0.5 ng.mL<sup>‐1</sup>) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort.</p></div><div><h3>Conclusion</h3><p>The use of regional technique is a promising method for the anesthetic management in TIP, espe","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38451932","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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