Bloqueio contínuo do plexo lombar via posterior bilateral com bomba de infusão descartável: relato de caso

JUSTIFICATIVA E OBJETIVOS: O número de artroplastia total de quadril (ATQ) bilateral tem aumentado a cada ano. Analgesia pós-operatória pela infusão contínua perineural com anestésico local tem se mostrado favorável quando comparada com analgesia sistêmica. O uso de bombas elastoméricas tem aumentado a satisfação do paciente quando em comparação com os modelos eletrônicos. O objetivo deste relato foi descrever um caso de analgesia contínua bilateral do plexo lombar via posterior, com infusão contínua através de bomba elastomérica, em paciente submetido à uma artroplastia bilateral de quadril. RELATO do CASO: Paciente feminina, 46 anos, 65 kg, 162 cm, com artrite reumatoide e hipertensão arterial, estado físico ASA II, escalada para ser submetida a ATQ bilateral em um único estágio. Uso de corticosteroide por 13 anos. Hemoglobina = 10,1 g.dL-1, hematócrito = 32,7%. Monitoração de rotina. Raquianestesia com 15 mg de bupivacaína 0,5% isobárica. Anestesia geral com propofol (PFS) e remifentanil e intubação sem bloqueadores neuromusculares. ATQ direita e no final, bloqueio plexo lombar com estimulador e conjunto agulha 150 mm e injeção de 20 mL bupivacaína 0,2% e passagem de cateter. ATQ esquerda e, no final, mesmo procedimento. Estudado dispersão do anestésico e contraste. Instalado bomba elastomérica com bupivacaína 0,1% (400 mL) em velocidade de 14 mL.h-1. Transferida para Unidade de Cuidados Intensivos (UCI). Vinte e quatro horas após, nova bomba com a mesma solução. Nenhum bolus durante 50 horas. Após remoção de cateter, dor controlada por via oral com cetoprofeno e dipirona. CONCLUSÕES: O bloqueio bilateral contínuo periférico com infusão de bupivacaína a 0,1% com bombas elastoméricas é um procedimento seguro e efetivo em adultos.

Avaliação da associação propofol e de cloridrato de alfentamil na manutenção anestésico por infusão intravenosa contínua em cães após medicação pré-anestésica com acepromazina

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação dos riscos assistenciais relacionados ao uso de equipamentos hospitalares na unidade de terapia intensiva de adultos de um hospital público da cidade de São Paulo, Brasil

Pós-graduação em Bases Gerais da Cirurgia - FMB

Intravitreal injection versus sub-Tenon's infusion of triamcinolone acetonide for refractory diabetic macular edema: A randomized clinical trial

PURPOSE. To compare the effectiveness of posterior sub-Tenon's infusion (STi) and intravitreal injection (IVI) of triamcinolone acetonide (TA) for treatment of refractory diffuse diabetic macular edema.METHODS. Thirty-six phakic diabetic patients with refractory diffuse diabetic macular edema were prospectively enrolled. Patients randomly received either 40 mg STi or 4 mg IVI of TA. Comprehensive ophthalmic evaluation was performed at baseline and 1, 2, 4, 8 +/- 1, 12 +/- 2 and 24 +/- 2 weeks after treatment. Macular morphologic changes detected by optical coherence tomography and visual acuity, intraocular pressure, and lens status were evaluated.RESULTS. Twenty-eight patients (28 eyes) completed the 24-week study. Central macular thickness was significantly reduced in the IVI group when compared with the STi group at 2, 4, 8, 12, and 24 weeks after treatment (P < 0.01). Mean visual acuities (in logarithm of the minimum angle of resolution [logMAR]) at week-4, -8, and -12 follow-up examinations were significantly higher in the IVI group (0.74, 0.75, and 0.82, respectively) when compared with the STi group (0.88, 0.88, and 0.90, respectively; P < 0.01). A significant change from baseline in mean intraocular pressure (mm Hg) was seen at weeks 4 (+/- 3.21) and 8 (+/- 3.35) in STi the group (P < 0.01), and at week 8 (+/- 2.78) in the IVI group (P < 0.05). No patient had cataract progression during the study.CONCLUSIONS. Although the number of patients and length of follow-up in this preliminary study were limited, the changes in central macular thickness and visual acuity observed after treatment suggest that IVI TA may be more effective than STi for the management of refractory diffuse diabetic macular edema. Further studies are needed to confirm these preliminary findings.

Continuous infusion of ketamine in hypovolemic dogs anesthetized with desflurane

Objective: To evaluate the cardiorespiratory effects of continuous infusion of ketamine in hypovolemic dogs anesthetized with desflurane.Design: A prospective experimental study.Animals: Twelve mixed breed dogs allocated into 2 groups: saline (n=6) and ketamine (n=6).Interventions: After obtaining baseline measurements (time [T] 0) in awake dogs, hypovolemia was induced by the removal of 40 mL of blood/kg over 30 minutes. Anesthesia was induced and maintained with desflurane (1.5 minimal alveolar concentration) and 30 minutes later (T75) a continuous intravenous (IV) infusion of saline or ketamine (100 mu g/kg/min) was initiated. Cardiorespiratory evaluations were obtained 15 minutes after hemorrhage (T45), 30 minutes after desflurane anesthesia, and immediately before initiating the infusion (T75), and 5 (T80), 15 (T90), 30 (T105) and 45 (T120) minutes after beginning the infusion.Measurements and main results: Hypovolemia (T45) reduced the arterial blood pressures (systolic arterial pressure, diastolic arterial pressure [DAP] and mean arterial pressure [MAP]), cardiac (CI) and systolic (SI) indexes, and mean pulmonary arterial pressure (PAP) in both groups. After 30 minutes of desflurane anesthesia (T75), an additional decrease of MAP in both groups was observed, heart rate was higher than T0 at T75, T80, T90 and T105 in saline-treated dogs only, and the CI was higher in the ketamine group than in the saline group at T75. Five minutes after starting the infusion (T80), respiratory rate (RR) was lower and the end-tidal CO(2) (ETCO(2)) was higher compared with values at T45 in ketamine-treated dogs. Mean values of ETCO(2) were higher in ketamine than in saline dogs between T75 and T120. The systemic vascular resistance index (SVRI) was decreased between T80 and T120 in ketamine when compared with T45.Conclusions: Continuous IV infusion of ketamine in hypovolemic dogs anesthetized with desflurane induced an increase in ETCO(2), but other cardiorespiratory alterations did not differ from those observed when the same concentration of desflurane was used as the sole anesthetic agent. However, this study did not evaluate the effectiveness of ketamine infusion in reducing desflurane dose requirements in hypovolemic dogs or the cardiorespiratory effects of ketamine-desflurane balanced anesthesia.

Bispectral index in dogs at three intravenous infusion rates of propofol

Objective To establish the correlation between the bispectral index (BIS) and different rates of infusion of propofol in dogs.Study design Prospective experimental trial.Animals Eight adult dogs weighing 6-20 kg.Methods Eight animals underwent three treatments at intervals of 20 days. Propofol was used for induction of anesthesia (10 mg kg(-1) IV), followed by a continuous rate infusion (CRI) at 0.2 mg kg(-1) minute(-1) (P2), 0.4 mg kg(-1) minute(-1) (P4) or 0.8 mg kg(-1) minute(-1) (P8) for 55 minutes. The BIS values were measured at 10, 20, 30, 40, and 50 minutes (T10, T20, T30, T40, and T50, respectively) after the CRI of propofol was started. Numeric data were submitted to analysis of variance followed by Tukey test (p < 0.05).Results The BIS differed significantly among groups at T40, when P8 was lower than P2 and P4. At T50, P8 was lower than P2. The electromyographic activity (EMG) in P2 and P4 was higher than P8 at T40 and T50.Conclusion An increase in propofol infusion rates decreases the BIS values and EMG.

Portable smart films for ultrasensitive detection and chemical analysis using SERS and SERRS

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

Effects of intra-hippocampal infusion of WAY-100635 on plus-maze behavior in mice - Influence of site of injection and prior test experience

The positive profile of systemically-administered 5-HT(1A) receptor antagonists in several rodent models of anxiolytic activity suggests an important role for postsynaptic 5-HT(1A) receptor mechanisms in anxiety. To test this hypothesis, we investigated the effects of WAY-100635 microinfusions (0, 0.1, 1.0 or 3.0 mug in 0.2 mul) into the dorsal (DH) or ventral (VH) hippocampus an behaviours displayed by male Swiss-Webster mice in the elevated plus-maze. As prior experience is known to modify pharmacological responses in this test, the effects of intra-hippocampal infusions were examined both in maze-naive and maze-experienced subjects. Test videotapes were scored for conventional indices of anxiety (% open arm entries/time) and locomotor activity (closed arm entries), as well as a range of ethological measures (e.g. risk assessment). In maze-naive mice, intra-VH (but not intra-M) infusions of WAY-100635 (3.0 mug but not lower doses) increased open arm exploration and reduced risk assessment. These effects were observed in the absence of significant changes in locomotor activity. In contrast, neither intra-VH nor intra-DH infusions of WAY-100635 altered the behaviour of maze-experienced mice. These Findings suggest that postsynaptic 5-HT(1A) receptors in the ventral (but not dorsal) hippocampus play a significant role both in the mediation of plus-maze anxiety in mice and in experientially-induced alterations in responses to this test. (C) 2002 Elsevier B.V. BY All rights reserved.

Blockade of fear-induced antinociception with intra-amygdala infusion of midazolam: Influence of prior test experience

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

High-performance liquid chromatographic separation and identification of polyphenolic compounds from the infusion of Davilla elliptica St. Hill

The isolation of polyphenolic compounds from an infusion of the Brazilian plant Davilla elliptica (Dilleniaceae), used as tea by virtue of its digestive properties, is described. An improved preparative HPLC method was used in order to isolate pure polyphenols from the complex mixture. Liquid-liquid extraction and solid-phase extraction were employed to minimise the interference of polymeric compounds and to provide an enriched fraction of the compounds of interest. The identification of the isolated compounds was performed using analytical HPLC as well as direct injection electrospray ionisation ion trap tandem mass spectrometry (ESI-IT-MS/MS). The high flavonoid content suggests that D. elliptica may be a promising source of compounds to produce natural phytomedicines. Copyright (C) 2007 John Wiley & Sons, Ltd.

Open and Standardized Resources for Smart Transducer Networking

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Structural integrity identification based on smart materials and neural networks

This paper presents a non-model based technique to detect, locate, and characterize structural damage by combining the impedance-based structural health monitoring technique with an artificial neural network. The impedance-based structural health monitoring technique, which utilizes the electromechanical coupling property of piezoelectric materials, has shown engineering feasibility in a variety of practical field applications. Relying on high frequency structural excitations (typically>30 kHz), this technique is very sensitive to minor structural changes in the near field of the piezoelectric sensors. In order to quantitatively assess the state of structures, two sets of artificial neural networks, which utilize measured electrical impedance signals for input patterns, were developed. By employing high frequency ranges and by incorporating neural network features, this technique is able to detect the damage in its early stage and to estimate the nature of damage without prior knowledge of the model of structures. The paper concludes with an experimental example, an investigation on a massive quarter scale model of a steel bridge section, in order to verify the performance of this proposed methodology.

Optimal design of smart structures using bonded plezoelectrics for vibration control

Smart material technology has become an area of increasing interest for the development of lighter and stronger structures which are able to incorporate actuator and sensor capabilities for collocated control. In the design of actively controlled structures, the determination of the actuator locations and the controller gains, is a very important issue. For that purpose, smart material modelling, modal analysis methods, control and optimization techniques are the most important ingredients to be taken into account. The optimization problem to be solved in this context presents two interdependent aspects. The first one is related to the discrete optimal actuator location selection problem which is solved in this paper using genetic algorithms. The second is represented by a continuous variable optimization problem, through which the control gains are determined using classical techniques. A cantilever Euler-Bernoulli beam is used to illustrate the presented methodology.

Optimal placement of piezoelectric sensor/actuators for smart structures vibration control

Smart material technology has become an area of increasing interest for the development of lighter and stronger structures that are able to incorporate actuator and sensor capabilities for collocated control. In the design of actively controlled structures, the determination of the actuator locations and the controller gains is a very important issue. For that purpose, smart material modeling, modal analysis methods, and control and optimization techniques are the most important ingredients to be taken into account. The optimization problem to be solved in this context presents two interdependent aspects. The first is related to the discrete optimal actuator location selection problem, which is solved in this paper using genetic algorithms. The second is represented by a continuous variable optimization problem, through which the control gains are determined using classical techniques. A cantilever Euler-Bernoulli beam is used to illustrate the presented methodology.

Observer-based state-feedback versus H-infinity output feedback control solved by LMI approach for applications in smart structures

This paper aims with the use of linear matrix inequalities approach (LMIs) for application in active vibration control problems in smart strutures. A robust controller for active damping in a panel was designed with piezoelectrical actuators in optimal locations for illustration of the main proposal. It was considered, in the simulations of the closed-loop, a model identified by eigensystem realization algorithm (ERA) and reduced by modal decomposition. We tested two differents techniques to solve the problem. The first one uses LMI approach by state-feedback based in an observer design, considering several simultaneous constraints as: a decay rate, limited input on the actuators, bounded output peak (output energy) and robustness to parametic uncertainties. The results demonstrated the vibration attenuation in the structure by controlling only the first modes and the increased damping in the bandwidth of interest. However, it is possible to occur spillover effects, because the design has not been done considering the dynamic uncertainties related with high frequencies modes. In this sense, the second technique uses the classical H. output feedback control, also solved by LMI approach, considering robustness to residual dynamic to overcome the problem found in the first test. The results are compared and discussed. The responses shown the robust performance of the system and the good reduction of the vibration level, without increase mass.