Does occupational exposure to anesthetic gases lead to increase of pro-inflammatory cytokines?

There is great concern about the possible harmful effects of exposure to volatile anesthetics. The current study aimed at evaluating, for the first time, the effects of occupational exposure to anesthetic gases on physicians who work in operating rooms, by determining several inflammatory cytokines. Plasma inflammatory cytokines (IL-1β, -6, -8, -10, -12, TNF-α) were investigated in 30 individuals who were allocated into two groups of 15: the exposed group, consisting of operating room medical personnel exposed to a mixture of anesthetic gases for 3 years, and a control group composed of medical personnel not exposed to anesthetic gases. The concentrations of volatile anesthetics were measured in the operating room by means of an infrared portable analyzer Our findings suggest an increase of the pro-inflammatory IL-8 (p < 0.05) in medical personnel exposed to high concentrations of anesthetic gases, even for a relatively short period.

Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study

We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.

Myocardial contractility impairment with racemic bupivacaine, non-racemic bupivacaine and ropivacaine. A comparative study

To study racemic bupivacaine, non-racemic bupivacaine and ropivacaine on myocardial contractility. Isolated Wistar papillary muscles were submitted to 50 and 100 mM racemic bupivacaine (B50 and B100), non-racemic bupivacaine (NR50 and NR100) and ropivacaine (R50 and R100) intoxication. Isometric contraction data were obtained in basal condition (0.2 Hz), after increasing the frequency of stimulation to 1.0 Hz and after 5, 10 and 15 min of local anesthetic intoxication. Data were analyzed as relative changes of variation. Developed tension was higher with R100 than B100 at D1 (4.3 ± 41.1 vs -57.9 ± 48.1). Resting tension was altered with B50 (-10.6 ± 23.8 vs -4.7 ± 5.0) and R50 (-14.0 ± 20.5 vs -0.5 ± 7.1) between D1 and D3. Maximum rate of tension development was lower with B100 (-56.6 ± 38.0) than R50 (-6.3 ± 37.9) and R100 (-1.9 ± 37.2) in D1. B50, B100 and NR100 modified the maximum rate of tension decline from D1 through D2. Time to peak tension was changed with NR50 between D1 and D2. Racemic bupivacaine depressed myocardial contractile force more than non-racemic bupivacaine and ropivacaine. Non-racemic and racemic bupivacaine caused myocardial relaxation impairment more than ropivacaine.

Anesthesia-related and perioperative cardiac arrest in low- and high-income countries: a systematic review with meta-regression and proportional meta-analysis

The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5-1.0] in the 1990s-2010s, P < 0.001; and 8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P < 0.001, respectively). In low-HDI countries, anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P = 0.14), whereas perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P = 0.03).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the 2 time periods.

Eficácia e efeitos hemodinâmicos da anestesia raquidiana com ropivacaína isobárica, hipobárica ou hiperbárica seletiva em cães anestesiados com isofluorano

Pós-graduação em Ciência Animal - FMVA

Anestesia total intravenosa (ATI) para herniorrafias umbilicais em bezerros

The total intravenous anesthesia (TIVA) is an option for some surgeries in bovines for fields. The aim of this study was to evaluate blood gases effects, cardiorespiratory and glycemia on calves submitted the umbilical herniorraphy. We used eight calves aged from 9 ± 4 months, weighting 111 ± 43 kg. The animals were pre-treated with xylazine (0.05 mg/kg IV) and after 15 minutes was administered ketamine (2.0 mg/kg IV) followed by the continuous infusion of xylazine (0.05 mg/ml), guaifenesin (50 mg/mL) and ketamine (1mg/ml) at a rate of infusion of 2mL/kg/hour. The blood gases and glucose samples were collected immediately before the MPA (MB) and the 5, 40 and 80 after the starting of TIVA (M5, M40 e M80). The other variables were measured in MB, 15 minutes after the MPA (Mx) and every 10 minutes after the starting of TIVA, entiring 80 minutes. The heart rate was higher in MB than in the other stages (p <0.05) and respiratory rate increased in M20 and M50 compared to MB and Mx (p <0.05). The PvCO2 increased while PaO2 decreased in M40 and M80, for MB (p <0.05), PVCO2 in M80 was lower than in MB (p <0.05). The pHv was smaller in M80 than M5 and MB (p <0.05), and HCO3 was lower in MB (p <0.05) compared to the others. The glucose was higher in M40 and M80 and M5 for MB (p <0.05). The recovery time was 152 ± 60 minutes after the end of the administration of the infusion of anesthetics. It was conclude that the anesthetic technique employed promoted respiratory depression, increased blood glucose and prolonged period of anesthetic recovery in calves.

Physico-chemical characterization and analytical development for sodium azumolene, a potential drug designed to fight malignant hyperthermia

Sodium azumolene is a drug designed to fight Malignant Hyperthermia (MH), which is characterized by genetic predisposition and triggered by the use of inhalational anesthetics. This drug is shown as a water-soluble analogue of dantrolene sodium, 30-folds more water soluble, which gives advantages for its emergency use. To our knowledge there is no analytical method for sodium zaumolene raw material or dosage form published so far. The objective of the present investigation was to develop and validate analytical methods to achieve sodium azumolene chemical identification and quantification. The sodium azumolene was characterized regarding its thermal behavior, by differential thermal analysis and thermogravimetric analysis; Visible, UV and infrared absorption. To accurately assess the sodium Azumolene content three different analytical methods (visible and UV spectrophotometry and high performance liquid chromatography) were developed and validated. All methods showed to be linear, accurate, precise and reliable. Azumolene has shown to be equipotent to dantrolene in the treatment and prevention of an MH crisis and the great advantage compared to dantrolene is better water solubility. This study has characterized the sodium azumolene and presents new analytical methods which have not been reported so far.

Efeitos da infusão contínua de Cetamina s(+) em equinos anestesiados pelo Halotano

The horse’s blood pressure is susceptible to changes induced by volatile anesthetics. Because of that, the use of anesthesic techniques which keep stable the horse´s blood pressure is essencial. Ketamine is an important induction and maintenance anesthetic agent used in the horse anesthesia practice mainly to improve the blood pressure. S(+)-ketamine provides the same effects on the blood pressure, with greater analgesic results and less side effects than the normal ketamine. Although some studies have been conducted with ketamine continuous rate infusion during the halothane anesthetized horses, the S(+)-ketamine has not been evaluated yet. Considering the increased use of ketamine, it is important to evaluate its cardiovascular and respiratory effects in halothane anesthetized horses. To conclude, S(+)-ketamine 0.01mg/kg/min. continuous rate infusion did not induce additive cardiovascular and respiratory depression in halothane anesthetized horses.

Parada cardíaca perioperatória e relacionada à anestesia: revisão sistemática com meta-análise proporcional e análise de metarregressão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Parada cardíaca perioperatória e por fator anestésico em pacientes geriátricos: revisão sistemática com meta-análise e análise de metarregressão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da administração de fentanil na concentração anestésica mínima e nas variáveis cardiorrespiratórias de galinhas (Gallus gallus domesticus) anestesiadas com isofluorano

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos hemodinâmicos da ventilação monopulmonar em cães anestesiados com isofluorano ou infusão contínua de propofol

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação de danos no material genético em anestesiologistas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Anestesia no transplante de rim de doador vivo no Hospital das Clínicas de Botucatu: fatores de influência para o desfecho

Pós-graduação em Anestesiologia - FMB