Revista brasileira de anestesiologia最新文献

Since the beginning of the COVID‐19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID‐19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra‐indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID‐19 and offer practical recommendations for safe and efficient performance.

Introduction and objectives

The association pneumoperitoneum and obesity in video laparoscopy can contribute to pulmonary complications, but has not been well defined in specific groups of obese individuals. We assessed the effects of pneumoperitoneum in respiratory mechanics in Grade I obese compared to non‐obese.

Methods

Prospective study including 20 patients submitted to video laparoscopic cholecystectomy, normal spirometry, divided into non‐obese (BMI ≤ 25 kg.m^–2) and obese (BMI > 30 kg.mg^–2), excluding Grade II and III obese. We measured pulmonary ventilation mechanics data before pneumoperitoneum (baseline), and five, fifteen and thirty minutes after peritoneal insufflation, and fifteen minutes after disinflation (final).

Results

Mean BMI of non‐obese was 22.72 ± 1.43 kg.m^–2 and of the obese 31.78 ± 1.09 kg.m^–2, p < 0.01. Duration of anesthesia and of peritoneal insufflation was similar between groups. Baseline pulmonary compliance (Crs) of the obese (38.3 ± 8.3 mL.cm H₂O^–1) was lower than of the non‐obese (47.4 ± 5.7 mL.cm H₂O^–1), p = 0.01. After insufflation, Crs decreased in both groups and remained even lower in the obese at all moments assessed (GLM p < 0.01). Respiratory system peak pressure and plateau pressure were higher in the obese, albeit variations were similar at moments analyzed (GLM p > 0.05). The same occurred with elastic pressure, higher in the obese at all times (GLM p = 0.04), and resistive pressure showed differences in variations between groups during pneumoperitoneum (GLM p = 0,05).

Conclusions

Grade I obese presented more changes in pulmonary mechanics than the non‐obese during video laparoscopies and the fact requires mechanical ventilation‐related care.

Objective

The limited number of bibliometric studies in the literature have generally focused on the top‐cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods.

Methods

The articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword “Anesthesiology” in the “Research Area” category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis.

Results

A review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971‐5,849) articles for the year 2019. There was a high‐level, positive significant correlation between the number of publications and Gross Domestic Product (r = 0.776, p < 0.001).

Conclusion

The findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.

Background and objectives

Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail.

Methods

This study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients’ data was evaluated retrospectively.

Results

The mean age of the patients was 31.0 ± 17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi‐organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post‐operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9 ± 1.1 days in patients requiring ICU. Recurrence during the 40 ± 17 months follow‐up occurred in 8.4% patients.

Conclusions

Anesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi‐organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.

Background and objectives

Sugammadex is a modified gamma‐cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway oedema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium‐induced moderate neuromuscular blockade in those who received intraoperative 1 mg.kg^‐1 methylprednisolone or saline.

Method

This single‐centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear‐nose‐throat procedures (aged from 18‐65, an ASA physical status I‐II, a BMI less than 30 kg.m^‐2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg.kg^‐1 of methylprednisolone in 5 mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg.kg^‐1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study.

Results

Median time to TOFr = 0.9 was for 130.00 s (range of 29‐330) for Group C and 181.00 s (100‐420) for Group M (p < 0.001). The differences between the two groups were statistically significant.

Conclusion

When using 2 mg.kg^‐1 of sugammadex to reverse rocuronium‐induced neuromuscular blockade in patients who received 1 mg.kg^‐1 of intraoperative methylprednisolone, demonstrated delayed recovery times.

Background

Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients.

Methods

In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique.

Results

Sensory distribution of the block in the four patients studied was found to cover the area between the T11‐12 and L4‐5 dermatomes. Spread of the injectate was confirmed via an A‐P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases.

Conclusions

The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.

Background and objectives

The perioperative cardiac arrest (CA) and mortality rates in Brazil, a developing country, are higher than in developed countries. The hypothesis of this review was that knowledge of the epidemiology of perioperative CA and mortality in Brazil enables the comparison with developed countries. The systematic review aimed to verify, in studies conducted in Brazil, the epidemiology of perioperative CA and mortality.

Method and results

A search strategy was carried out on different databases (PubMed, EMBASE, SciELO and LILACS) to identify observational studies that reported perioperative CA and/or mortality up to 48 hours postoperatively in Brazil. The primary outcomes were data on epidemiology of perioperative CA and mortality. In 8 Brazilian studies, there was a higher occurrence of perioperative CA and mortality in males; in extremes of age; in patients in worse physical status according to the American Society of Anesthesiologists (ASA); in emergency surgeries; in general anesthesia; and in cardiac, thoracic, vascular, abdominal and neurological surgeries. The patient's disease/condition was the main triggering factor, with sepsis and trauma as the main causes.

Conclusions

The epidemiology of both perioperative CA and mortality events reported in Brazilian studies does not show important differences and, in general, is similar to studies in developed countries. However, sepsis represents one of the major causes of perioperative CA and mortality in Brazilian studies, contrasting with studies in developed countries in which sepsis is a secondary cause.

The 2020 pandemic caused by the novel coronavirus, COVID‐19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator‐dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year‐old male COVID‐19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

Background

The Argon Beam Coagulator (ABC) achieves hemostasis but has potential complications in the form of argon gas embolisms. Risk factors for embolisms have been identified and ABC manufacturers have developed guidelines for usage of the device to prevent embolism development.

Case report

A 49 year‐old male with history of recurrent cholangiocarcinoma status post resection presented for resection of a cutaneous biliary fistula. Shortly after initial use of the ABC, the patient underwent cardiac arrest. After resuscitation, air bubbles were observed in the left ventricle via Transesophageal Echo (TEE).

Conclusion

Although argon embolisms have been described more commonly during laparoscopies, this patient most likely experienced an argon gas embolism during an open resection of a cutaneous biliary fistula via the biliary tract or vein with possible transpulmonary passage of the embolism. Consequently, a high degree of suspicion should be maintained for an argon gas embolism during ABC use in laparoscopic, open, and cutaneous surgeries.