Sedoanalgesia with midazolam and fentanyl citrate controls probe pain during prostate biopsy by transrectal ultrasound

To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy. This was a study in patients with different indications for prostate biopsy in whom 5 mg of midazolam and 50 µg of fentanyl citrate was administered intravenously 3 minutes before the procedure. After biopsy, pain was assessed by use of a visual analogue scale (VAS) in three stages: VAS 1, during probe introduction; VAS 2, during needle penetration into prostate tissue; and VAS 3, in the weeks following the exam. Pain intensity at these different times was tested with stratification by age, race, education, prostate volume, rebiopsy, and anxiety before biopsy. Pain was ranked according to the following scores: 0 (no pain), 1-3 (mild pain), 4-7 (moderate pain), and 8-10 (severe pain). Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon two-tailed tests with a significance of 5%. Pain intensity was not influenced by any risk factors. The mean VAS 1 score was 1.95±1.98, the mean VAS 2 score was 2.73±2.55, and the mean VAS 3 score was 0.3±0.9, showing greater pain at the time of needle penetration than in other situations (VAS 2>VAS 1>VAS 3, p=0.0013, p=0.0001, respectively). Seventy-five percent of patients reported a VAS pain scale of less than 3.1 or mild pain. Intravenous sedation and analgesia with midazolam and fentanyl citrate is a good method for reducing pain caused by prostate biopsy, even during probe insertion.

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.

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.

Avaliação do desempenho de dois monitores oscilométricos portáteis na estimativa da pressão arterial direta em gatos anestesiados com isofluorano

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Concordância entre o débito cardíaco estimado através das técnicas de termodiluição transpulmonar e de análise de contorno de pulso e a técnica de termodiluição de artéria pulmonar em cães anestesiados com isoflurano

Pós-graduação em Anestesiologia - FMB

Aplicação pré-operatória imediata de antimicrobianos e repercussão cardiorrespiratória e hemodinâmica em cadelas e gatas anestesiadas com isoflurano

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos do atipamezol e da ioimbina isolados ou em associação com a naloxona nda reversão anestésica de macacos bugios (Aloautta guariba clamitans) (CABRERA, 1940) anestesiados com metadona, dexmedetomidina e cetaminha S(+)

Pós-graduação em Biotecnologia Animal - FMVZ

Pharmacokinetic Profile of Liposome-Encapsulated Ropivacaine after Maxillary Infiltration Anaesthesia

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

Cytogenotoxicity biomarkers in fat snook Centropomus parallelus from Cananeia and Sao Vicente estuaries, SP, Brazil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mentol como anestésico para dourado (Salminus brasiliensis)

Different levels of menthol as an anesthetic for dourado (Salminus brasiliensis) were evaluated in this study. Fish (n=32) with average weight of 194.13 +/- 9.06 g and total mean length of 25.30 +/- 0.90 cm were separated in four groups composed of 8 individuals. Each group was submitted to different menthol concentrations: 60, 90, 120 and 150 mg L(-1). Total induction time was analyzed by polynomial regression and other parameters by Tukey's test. All experimental fish exposed to different concentrations of menthol reached deep anesthesia stage without mortality. It was observed a negative linear effect (P<0.05) for total induction time. The longest recovery time (172.60 s) was observed for dourado treated with 120 mg. L(-1), which differed (P<0.05) from the 90 mg.L(-1) treatment (122.03 s). All levels evaluated in this study were safe and effective. A concentration of 60 mg L(-1) for dourado is suggested based on lower cost and adequate induction and recovery time responses.

Eugenol em juvenis de tilápia do nilo: concentrações e administrações sucessivas

Several anesthetics are used in aquaculture to reduce the stress caused by management. In the field, the most common anesthetic is benzocaine, but several authors are researching about eugenol. The objective of this study were to compare the action of these drugs on the anesthetics stages and measure the effects of successive administration of eugenol on the anesthetics stages in Oreochromis niloticus. In the first test, fish (47.73 +/- 8.73 g and 14.23 +/- 0.81 cm) were subjected to five concentrations of eugenol (40, 60, 80, 100 and 120 mg L-1) and one of benzocaine (100 mg L-1). All the anesthetic concentrations tested were able to induce fish to all stages of anesthesia, and revealed an inverse relationship between the induction times and increased concentrations. The minimum concentration of eugenol to induce anesthesia was 100 mg L-1. In the second test, the juveniles (38.07 +/- 5.00 g and 12.70 +/- 0.54 cm) were exposed to concentrations of 60, 80, 100 mg L-1 of eugenol, as determined in the first test. Evaluating the differences between successive days, there was no significant difference (P > 0.05) between anesthetics stages in the concentrations of eugenol tested, suggesting that the residue of eugenol was removed from the fish in less than 24 hours.

Benzocaine and eugenol as anesthetics for Brycon hilarii

A utilização de produtos anestésicos durante práticas de manejo é frequentemente empregada, porém doses corretas de diferentes fármacos e para espécies distintas ainda estão em fases de pesquisa. O objetivo do estudo foi determinar a melhor concentração de benzocaína e eugenol para juvenis de piraputanga (B. hilarii). Foram utilizados 104 juvenis de piraputanga com peso médio de 50,04 ± 20,80 g e comprimento total médio de 16,30 ± 12,32 cm adquiridos em uma piscicultura comercial localizada na região Oeste do Estado do Paraná. O trabalho foi conduzido no Laboratório de Aquicultura do Grupo de Estudos de Manejo na Aquicultura - GEMAq da Universidade Estadual do Oeste do Paraná (UNIOESTE). Os animais foram submetidos a cinco concentrações de benzocaína (50,0; 100,0; 150,0; 200,0 e 250,0 mg L-1) e sete concentrações de eugenol (50,0; 100,0; 150,0; 200,0; 250,0; 300,0 e 350 mg L-1), para a aferição dos tempos referentes à letargia. Para a recuperação, os animais foram mantidos em aquários livre do anestésico e observado o tempo em que retornaram às atividades normais. A melhor dose de benzocaína verificada foi de 100 mg L-1, enquanto a melhor dose de eugenol foi entre 100 e 150 mg L-1.