Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

Antimicrobial and mechanical properties of acrylic resins with incorporated silver-zinc zeolite - part I

Objective: The purpose of this in vitro study was to evaluate the antimicrobial activity of acrylic resins containing different percentages of silver and zinc zeolite, and to assess whether the addition of zeolite alters the flexural and impact strength of the resins. Background: The characteristics of acrylic resins support microorganism development that can threaten the health of the dentures user. Material and methods: A microwave-polymerised (Onda-Cryl) and two heat-polymerised (QC20 and Lucitone 550) acrylic resins were used. The materials were handled according to the manufacturers` instructions. Fifty rectangular-shaped specimens (8 x 10 x 4mm) were fabricated from each resin and assigned to 5 groups (n = 10) according to their percentage of Irgaguard B5000 silver-zinc zeolite (0%- control, 2.5%, 5.0%, 7.5% and 10%). Flexural strength and Izod impact strength were evaluated. The antimicrobial activity against two strains of Candida albicans and two strains of Streptococcus mutans was assessed by agar diffusion method. Data were analysed statistically by one-way ANOVA and Tukey`s test at 5% significance level. Results: The addition of 2.5% of Irgaguard B5000 to the materials resulted in antimicrobial activity against all strains. Flexural strength decreased significantly with the addition of 2.5% (QC20 and Lucitone 550) and 5.0% (Onda-Cryl) of Irgaguard B5000. The impact strength decreased significantly with the addition of 2.5% (Lucitone 550) and 5.0% (QC20 and Onda-Cryl) of zeolite. Conclusion: The addition of silver-zinc zeolite to acrylic resins yields antimicrobial activity, but may affect negatively the mechanical properties, depending on the percentage of zeolite.

Vivência de mulheres no puerpério : significado atribuído à revisão pósparto

The consultation for women during the postpartum period should occur between the seventh and tenth days, and 42 days after childbirth, to decrease the incidence of maternal and neonatal morbidity and mortality. However, the effectiveness of such assistance in primary health care has not been achieved, especially in the forty-second day of puerperium. Facing this reality, the research aimed to understand the views of women about postpartum consultation. This is an exploratory and descriptive research with qualitative approach, developed in the municipality of Lajes/RN, Brazil, with women inscribed on the four teams that make up the Family Health Strategy. Data were collected through semistructured interviews with 15 women who met the following criteria: be enrolled in ESF; have health mental preserved, have been entered in the Humanization Program of Prenatal and Birth, and that was, at maximum, 60 days postpartum. The data were organized according to the precepts of content analysis according to Bardin, generating three categories: prevention of puerperal complications, feelings related to life changes after childbirth, and postpartum care. This process of coding and categorizing a central theme emerged: the experience of women in the postpartum period. The data were analyzed according to the principles of symbolic interactionism, according to Blumer. The study revealed that the meanings attributed to the postpartum period for prevention of complications were directly related to home, to the consultation and postpartum care provided by family members and health professionals. The interviewees strictly complied with the rest under the influence of the context in which they were entered. But that has not happened with the postpartum revision because few mothers underwent this procedure. Therefore, the interaction of the interviewed people in their living standard as well as the feelings that permeated the post-partum were crucial to consider whether or not the post-partum visit as significant. According to the results, it was noted that disability guidelines and counter-references has impaired the access of women to postpartum review. Thus, further studies are needed on the subject, as well as a reorientation of health care activities in view of the consolidation of postpartum consultation in primary care

Cardiovascular changes under normoxic and hypoxic conditions in the air-breathing teleost Synbranchus marmoratus: importance of the venous system

Synbranchus marmoratus is a facultative air-breathing fish, which uses its buccal cavity as well as its gills for air-breathing. S. marmoratus shows a very pronounced tachycardia when it surfaces to air-breathe. An elevation of heart rate decreases cardiac filling time and therefore may cause a decline in stroke volume (VS), but this can be compensated for by an increase in venous tone to maintain stroke volume. Thus, the study on S. marmoratus was undertaken to investigate how stroke volume and venous function are affected during air-breathing. To this end we measured cardiac output (Q), heart rate (fH), central venous blood pressure (PCV), mean circulatory filling pressure (MCFP), and dorsal aortic blood pressures (PDA) in S. marmoratus. Measurements were performed in aerated water (P-O2 > 130 mmHg), when the fish alternated between gill ventilation and prolonged periods of apnoeas, as well as during hypoxia (P-O2 <= 50 mmHg), when the fish changed from gill ventilation to air-breathing. Q increased significantly during gill ventilation compared to apnoea in aerated water through a significant increase in both fH and VS. PCV and MCFP also increased significantly. During hypoxia, when the animals surface to ventilate air, we found a marked rise in fH, PCV, MCFP, Q and VS, whereas PDA decreased significantly. Simultaneous increases in PCV and MCFP in aerated, as well as in hypoxic water, suggests that the venous system plays an important regulatory role for cardiac filling and VS in this species. In addition, we investigated adrenergic regulation of the venous system through bolus infusions of adrenergic agonists (adrenaline, phenylephrine and isoproterenol; 2 mu g kg(-1)). Adrenaline and phenylephrine caused a marked rise in PCV and MCFP, whereas isoproterenol led to a marked decrease in PCV, and tended to decrease MCFP. Thus, it is evident that stimulation of both alpha- and beta-adrenoreceptors affects venous tone in S. marmoratus.

Venous tone and cardiac function in the South American rattlesnake Crotalus durissus: mean circulatory filling pressure during adrenergic stimulation in anaesthetised and fully recovered animals

The effects of adrenergic stimulation on mean circulatory filling pressure (MCFP), central venous pressure (P-CV) and stroke volume (Vs), as well as the effects of altered MCFP through changes of blood volume were investigated in rattlesnakes (Crotalus durissus). MCFP is an estimate of the upstream pressure driving blood towards the heart and is determined by blood volume and the activity of the smooth muscle cells in the veins (venous tone). MCFP can be determined as the plateau in P-CV during a total occlusion of blood flow from the heart.Vs decreased significantly when MCFP was lowered by reducing blood volume in anaesthetised snakes, whereas increased MCFP through infusion of blood (up to 3 ml kg(-1)) only led to a small rise in Vs. Thus, it seems that end-diastolic volume is not affected by an elevated MCFP in rattlesnakes. To investigate adrenergic regulation on venous tone, adrenaline as well as phenylephrine and isoproterenol (alpha- and beta-adrenergic agonists, respectively) were infused as bolus injections (2 and 10 mu g kg(-1)). Adrenaline and phenylephrine caused large increases in MCFP and P-CV, whereas isoproterenol decreased both parameters. This was also the case in fully recovered snakes. Therefore, adrenaline affects venous tone through both alpha- and beta-adrenergic receptors, but the alpha-adrenergic receptor dominates at the dosages used in the present study. Injection of the nitric oxide donor SNP caused a significant decrease in P-CV and MCFP. Thus, nitric oxide seems to affect venous tone.

Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

Objectives: Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period. Aim: Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population. Background: Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences. Methods/Materials: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis. Results: After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm) and those who died (2.93 vs 1.40 mm). For surgeries with CPB, the same association was observed for cardiovascular (2.90 mm x 2.06 mm), renal (3.34 vs 2.33 mm), respiratory (2.98 vs 2.12 mm) and hematological complications (2.99 vs 1.95 mm), and death (3.38 vs 2.40 mm). Conclusion: Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low- and medium-risk procedures, with or without CPB, in pediatric cardiac surgery.

Comportamento hemodinâmico e metabólico do choque hemorrágico: estudo experimental no cão

JUSTIFICATIVA E OBJETIVOS: Diversos modelos experimentais têm sido utilizados para ilustrar as alterações hemodinâmicas e metabólicas que ocorrem durante o choque hemorrágico. O objetivo da pesquisa é o de observar os comportamentos hemodinâmicos e metabólicos que acontecem em um modelo seqüencial e progressivo de choque hemorrágico no cão, verificando quais índices alteram-se mais precocemente. MÉTODO: O estudo foi realizado em 13 cães sob anestesia venosa total com pentobarbital sódico, em normoventilação e previamente esplenectomizados. Os animais não foram hidratados e a velocidade do sangramento foi ditada pela pressão arterial em que o animal se encontrava. Os atributos estudados foram divididos em hemodinâmicos (freqüência cardíaca - FC, pressão arterial média - PAM, índice de resistência vascular sistêmica - IRVS, índice sistólico - IS, índice cardíaco - IC, índice de choque - I.choque, índice de trabalho sistólico do ventrículo esquerdo - ITSVE, pressão capilar pulmonar - PCP, pressão venosa central - PVC) e metabólicos (saturação venosa mista - SvO2, pressão venosa de oxigênio - PvO2, transporte de oxigênio - DO2, consumo de oxigênio - VO2, extração de oxigênio - TEO2, lactato sérico). A coleta de dados e os atributos foram estudados em 6 momentos distintos, sendo M1, o momento controle e os outros momentos correspondentes a decréscimos gradativos de 10% da volemia calculada para cada animal. RESULTADOS: A hemorragia determinou diminuição significativa da FC somente em M6; queda da PAM, IC, IS e ITSVE a cada momento estudado; discreta alteração da PVC e PCP em cada momento; diminuição da PvO2 e da SvO2 nos momentos estudados; redução do DO2, estabilização do VO2 e elevação da TEO2 nos momentos; o índice de choque apresentou elevação até M3, diminuição em M4 e nova elevação até M6; o IRVS elevou-se até M6, ficou inalterado em M5 e apresentou diminuição significativa em M6; o lactato apresentou elevações a partir de M5 e M6. CONCLUSÕES: Considerou-se que a pressão arterial média, freqüência cardíaca, pressão venosa central e pressão capilar pulmonar não refletem o real estado volêmico dos cães no nosso modelo experimental e que o transporte, consumo e a taxa de extração de oxigênio são parâmetros úteis na determinação da reversibilidade e prognóstico do choque hemorrágico.

Utilization of peritoneal dialysis in the acute setting

Peritoneal dialysis (PD), although classically described and utilized in the treatment of patients with end-stage renal disease, can also be utilized in the acute setting in different clinical situations. Recent studies showed that, in patients with acute renal failure, it is possible to obtain reasonable dialysis doses with adequate metabolic and etectrolytic control and tow incidence of complications by utilizing continuous PD through a cycler at high volume. In patients with congestive heart failure without end-stage renal disease, PD is capable of promoting clinical improvement with slow removal of liquids, becoming an attractive alternative for situations of rapidly or slowly worsening cardiac function. In patients submitted to chronic hemodialysis but who have vascular access difficulties, PD can also be utilized as a bridge, thereby avoiding the use of central venous catheters, which can be associated with infectious complications such as bacterial endocarditis. New studies must be realized showing other indications for PD.

Metabolic acidosis in healthy mules under general anaesthesia with halothane

Objective To report the severe metabolic acidosis identified in a group of 11 healthy mules anaesthetized with halothane for castration.Study design Data generated from a prospective study.Animals Eleven mules aged 2.5-8 years, weighing 230-315 kg and 11 horses aged 1.5-3.5 years, weighing 315-480 kg.Methods Animals were anaesthetized for castration as part of an electroencephalographic study. Preanaesthetic medication was acepromazine (0.03 mg kg(-1)) administered through a preplaced jugular venous catheter. Anaesthesia was induced 30-90 minutes later with intravenous thiopental (10 mg kg(-1)). After orotracheal intubation, anaesthesia was maintained with halothane vaporised in oxygen. The animals' lungs were ventilated to maintain the end-tidal CO(2) concentration between 3.9 and 4.5 kPa (29-34 mmHg). Anaesthetic monitoring included invasive blood pressure measurement via the auricular artery (mules) and submandibular branch of the facial artery (horses). Arterial blood gas samples were drawn from these catheters at three time points during surgery and pH, PaCO(2), base excess (ecf) and HCO(3)(-) were measured. Values were compared between groups using a Mann-Whitney test. p was taken as <0.05. Results are reported as median (range).Results PaCO(2) did not differ between groups but pH was significantly lower in mules [7.178 (7.00-7.29)] compared to horses [7.367 (7.24-7.43)] (p = 0.0002). HCO(3)(-) values were significantly lower in the mules [16.6 (13.0-22.3) mM] compared to horses [23.7 (20.9-23.7) mM] (p = 0.0001), whilst base excess (ecf) was significantly more negative in the mules [-11.4 (-1.27 to -16) mM] compared to horses [-1.3 (-5.8 to +2.4) mM] (p = 0.0004).Conclusion and clinical relevance This study demonstrated severe metabolic acidosis in healthy mules, which may have prompted intervention with drug therapies in a clinical arena. It is probable that the acidosis existed prior to anaesthesia and caused by diet, but other possible causes are considered.

Effect of passive pneumoperitoneum on oesophageal pressure, cardiovascular parameters and blood gas analysis in horses

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perioperative evaluation of tumescent anaesthesia technique in bitches submitted to unilateral mastectomy

Background: Tumescent anaesthesia (TA) is a widely used technique in oncologic surgeries necessitating large resection margins. This technique produces transoperative and postoperative analgesia, reduces surgical bleeding, and facilitates tissue divulsion. This prospective, randomised, blind study evaluated the use of TA in bitches submitted to mastectomy and compared the effect of TA with an intravenous fentanyl bolus. A 2.5-mcg/kg intravenous fentanyl bolus (n = 10) was compared with TA using 0.275% lidocaine (n = 10) in bitches submitted to unilateral mastectomy. Sedation was performed by intramuscular (IM) injection of 0.05 mg/kg of acepromazine combined with 2 mg/kg of meperidine. Anaesthesia was induced with 5 mg/kg of intravenous propofol and maintained with isoflurane/O2. Heart and respiratory rates; systolic, mean, and diastolic arterial blood pressures; central venous pressure; SpO2; ETCO2; inspired and expired isoflurane concentrations; and temperature were measured transoperatively. Visual analogue scales for sedation and pain and the Glasgow composite and Melbourne pain scales were used for postoperative assessment. The surgeon investigated the quality of the surgical approach, considering bleeding and resection ability, and the incidence of postoperative wound complications.Results: The heart rate was lower and the end-tidal isoflurane concentration was higher in dogs treated with fentanyl than in dogs treated with TA. A fentanyl bolus was administered to 8 of 10 dogs treated with fentanyl and to none treated with TA. Intraoperative bleeding and the mammary gland excision time were lower in dogs treated with TA. The maximal mean and individual plasma lidocaine concentrations were 1426 ± 502 ng/ml and 2443 ng/ml at 90 minutes after infiltration, respectively. The Glasgow Composite Pain Scale scores were higher in dogs treated with fentanyl than in dogs treated with TA until 2 hours after extubation.Conclusions: Compared with intravenous fentanyl, TA in bitches: may be easily performed in non-inflamed, ulcerated, adhered mammary tumours; has an isoflurane-sparing effect; improves transoperative and immediate postoperative analgesia; is apparently safe for use in clinical conditions as evidenced by the fact that it did not produce any adverse signs or lidocaine plasma concentrations compatible with toxicity; does not modify the recovery time; and facilitates the surgical procedure without interfering with wound healing. © 2013 Credie et al.; licensee BioMed Central Ltd.

Infusão alvo-controlada com propofol e remifentanil: estudo experimental em cães

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

Efeitos das catecolaminas sobre a reposição volêmica com solução fisiológica. Repercussão sobre a variabilidade da frequência cardíaca de coelhos submetidos à hemorragia: estudo por análise espectral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação perioperatória da técnica de anestesia por tumescência em cadelas submetidas à mastectomia unilateral

Pós-graduação em Anestesiologia - FMB

Ovariohisterectomia por videocirurgia (via NOTES vaginal híbrida), celiotomia ou miniceliotomia em cadelas

The elective ovariohysterectomy (OH) is the most frequent procedures performed in dogs. In this study was used three groups of seven animals each (GI, GII, and GIII) that was undergone to three elective OH techniques: (i) mini-celiotomy (Snook-hook technique), (ii) hybrid Natural Orifice Translumenal Endoscopic Surgery (NOTES), and (iii) celiotomy (conventional surgery). The surgical techniques were compared considering the surgery time, trans and postoperative complications, technical difficulties, postoperative pain, surgical bleedind and some vital parameters as: heart rate (FC), respiratory rate (), rectal temperature, invasive blood pressure (PVI) and central venous pressure (PVC). The OH by hybrid vaginal NOTES was the technique with the lowest post-surgical discomfort score and the lowest surgical bleeding, although its surgical time was higher compared to the conventional and the hook (mini-celiotomy) modalities.