Brazilian Journal of Anesthesiology最新文献

Introduction

Methods

Results

Conclusion

Background

Kidney transplant recipients face complex perioperative challenges due to comorbidities from chronic kidney disease. This study aimed to assess perioperative complications in kidney transplant recipients and evaluate the association between the Charlson Comorbidity Index (CCI) and complication severity using the Clavien-Dindo (CD) classification.

Methods

A prospective cohort study conducted at a tertiary hospital in South Brazil from September 2020 to March 2022, including 230 adult kidney transplant recipients. Data on demographics, comorbidities, and complications were collected. Complications were categorized using the CD scale, and their relationship with CCI was analyzed using univariate and multivariate Cox regression.

Results

Mean age was 49.2 ± 12.7 years, with 58.7% male recipients. The mean CCI score was 3.65 ± 1.5 points. Intraoperative complications occurred in 10.9% of patients, with notable issues including bleeding and airway difficulties. In the immediate postoperative period, 9.1% required urgent dialysis. In the 30-day follow-up, 57.8% had delayed graft function, 21.7% infections, 11.3% had vascular complications, and the mortality was 1.7%. CCI was not a significant predictor of severe complications; however, congestive heart failure was strongly associated with severe complications (HR = 6.6 95% CI 2.6–6.7, p < 0.001).

Conclusions

Despite a low overall comorbidity profile, kidney transplant recipients faced significant perioperative challenges. The lack of a significant association between the CCI score and severe complications suggests that traditional risk assessment tools may not fully capture the risks specific to the early postoperative period in kidney transplantation, and future research should focus on developing more refined risk assessment models for chronic kidney disease patients.

Background

The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.

Methods

The study comprised 222 patients (1...7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg^-1), ibuprofen (10 mg.kg^-1), dexamethason (0.15 mg.kg^-1), and ketanest S (0.1 mg.kg^-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ... 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.

Results

The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%, p = 0.04). The two categories, ..úsleep disturbance..Ñ and ..úseparation anxiety..Ñ, tested within the questionnaire for early postoperative negative behavior, were identified as the most common postoperative negative behavioral changes.

Conclusion

Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.

Trial Registration

DRKS ... German Clinical Trial Register ID: DRKS00013121

Background

We evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy.

Methods

Ninety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg⁻¹ bupivacaine 0.5% combined with either 1 μg.kg⁻¹ of dexmedetomidine (Group D), 30 mg.kg⁻¹ of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively.

Results

FLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026).

Conclusion

Dexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.

Background

We investigated the performance of the Perfusion Index (PI) derived from pulse oximetry waveform as a tool for assessment of anesthetic depth in comparison with A-line Autoregression Index (AAI) derived from analysis of Middle-Latency Auditory Evoked Potentials (MLAEP) waveform integrated by aepEXplus monitor in children receiving sevoflurane anesthesia for tonsillectomy.

Methods

Forty-one patients (4...12 years old) were included in this study. The PI and AAI were recorded simultaneously every minute during different stages of anesthesia delivery. The statistical tests included descriptive analysis, significance tests, correlation tests, and Receiver Operating Characteristic (ROC) curve. The AAI served as a reference.

Results

The PI significantly decreased during light anesthesia and recovery, and significantly increased during deeper planes of anesthesia, with an inverse mirror-image relationship with the AAI. A negative correlation of low to moderate degree was detected between PI and AAI during the study (p.ß>.ß0.05), that reached a statistical significance at the 5th minute during sevoflurane mask induction (r.ß=.ß...0.457, p.ß=.ß0.008). ROC analysis at an AAI < 25 extracted the best cut-off value for PI before intubation as 1.48 (AUC.ß=.ß0.698 [0.537...0.859], 94.4% sensitivity, 44.5% specificity) and at 10-minute intraoperatively as 2.4 (AUC.ß=.ß0.537 [0.354...0.721], 91.7% sensitivity, 31% specificity). During recovery, at an AAI.ß....ß50, the best cutoff was 1.82 (AUC.ß=.ß0.661 [0.46...0.863], 100% sensitivity and 50% specificity) 2 minutes before spontaneous eye opening.

Conclusions

Compared with the AAI, the PI can track changes in depth of anesthesia in pediatric patients undergoing tonsillectomy under sevoflurane anesthesia.

Trial registration

Clinical Trials. Gov. Identifier: NCT03412214.

In the pediatric population, complex regional pain syndrome (CRPS) is a challenging condition that leads to chronic psychosocial dysfunction. This case is of a 12-year-old male patient, 50.ßkg, who, after twisting his right ankle, started to present intense pain. Without adequate diagnosis and treatment, his family sought a pain specialist. During the evaluation, a change in sensitivity and temperature was observed, besides hyperalgesia, allodynia, redness, edema, and motor dysfunction, being diagnosed with CRPS. Ultrasound-guided sciatic blocks were performed on the affected limb, increasing the interval between crises, reducing pain intensity, and promoting a return to daily activities.

Transfusion-Related Acute Lung Injury (TRALI) is an immune-inflammatory lung pathology that manifests within the first 6–72 hours after administration of blood products. However, due to reduced awareness of TRALI, it continues to be an underreported and often underdiagnosed complication of transfusion therapy. We report a case of a 6-year-old girl with myelodysplastic syndrome and TRALI developed in the first hour after platelet transfusion. Diagnosis of TRALI is based on the exclusion of etiologic factors such as volume overload and cardiogenic pulmonary edema following transfusion. Symptoms responded to high-flow oxygen therapy, so intubation was not attempted and full recovery was achieved.

Background

Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy.

Methods

ASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg⁻¹ 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes.

Results

A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10^th, 20^th minutes, 6^th, 16^th, and 24^th hours, especially after the 6^th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001).

Conclusion

Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy.

Clinical Trials Registry

NCT03969316.

Background

The lateral sagittal brachial plexus block is the most used method for pediatric upper extremity surgery, whereas the applications of costoclavicular brachial plexus block are limited. This study aimed to compare the lateral sagittal and costoclavicular approaches for the ultrasound-guided infraclavicular block in pediatric patients.

Methods

Sixty pediatric patients aged 5...15 years undergoing hand or forearm surgery were randomly assigned to two groups. Group LS (n.ß=.ß30) received ultrasound-guided lateral sagittal block, and Group CC (n.ß=.ß30) received ultrasound-guided costoclavicular block. The block performing time, needling time, imaging time, needle visibility, number of passes, sensorial/motor block time, and postoperative pain scores were evaluated.

Results

The needling time (82.90.ß...ß28.17 seconds vs. 64.77.ß...ß28.11 seconds respectively, p.ß=.ß0.004) and total block performance time (109.53 .. 29.75 seconds vs. 89.70 .. 29.98 seconds respectively, p.ß=.ß0.005) were significantly longer in Group LS than in Group CC. However, there was no significant difference between the groups in imaging time, needle visibility, number of passes, sensorial/motor block time, and postoperative pain scores (p > 0.05).

Conclusions

Costoclavicular and lateral sagittal brachial plexus blocks resulted in similar anesthetics effects. Moreover, the costoclavicular method can be a better alternative to lateral sagittal as it has a shorter block performance time.