Fluxos de óxido nitroso na interface ar-mar na Baía de Guanabara

In Surface water concentrations of N2O were measured at 37 stations in Guanabara Bay and fluxes estimated across the air-sea interface. Concentrations averaged 8.2 ± 2.2 nmol L-1 and 90% of the stations showed supersaturation averaging 33%. N2O fluxes were estimated using a two-film model which is given by the product of the concentration difference across the film and the gas transfer coefficient (k w). Two parametrizations of k w were used which provided average fluxes of 0.3 and 3.0 µg N m-2 h-1. Flux measurements using floating chambers (not reported here) seem to agree with the upper limit of these estimates.

Studies on Neuromuscular Blocking Agents and Their Antagonists During Anaesthesia

Neuromuscular blocking agents (NMBAs) are widely used in clinical anaesthesia and emergency medicine. Main objectives are to facilitate endotracheal intubation and to allow surgery by reducing muscle tone and eliminating sudden movements, which may otherwise lead to trauma and complications. The most commonly used NMBAs are non-depolarizing agents with a medium duration of action, such as rocuronium and cisatracurium. They bind to the acetylcholine receptors in the neuromuscular junction, thus inhibiting the depolarization of the postsynaptic (muscular) membrane, which is a prerequisite for muscle contraction to take place. Previously, it has been assumed that nitrous oxide (N2O), which is commonly used in combination with volatile or intravenous anaesthetics during general anaesthesia, has no effect on NMBAs. Several studies have since claimed that N2O in fact does increase the effect of NMBAs when using bolus administration of the relaxant. The effect of N2O on the infusion requirements of two NMBAs (rocuronium and cisatracurium) with completely different molecular structure and pharmacological properties was assessed. A closed-loop feedback controlled infusion of NMBA with duration of at least 90 minutes at a 90% level of neuromuscular block was used. All patients received total intravenous anaesthesia (TIVA) with propofol and remifentanil. In both studies the study group (n=35) received N2O/Oxygen and the control group (n=35) Air/Oxygen. There were no significant differences in the mean steady state infusion requirements of NMBA (rocuronium in Study I; cisatracurium in Study II) between the groups in either study. In Study III the duration of the unsafe period of recovery after reversal of rocuronium-induced neuromuscular block by using neostigmine or sugammadex as a reversal agent was analyzed. The unsafe period of recovery was defined as the time elapsed from the moment of no clinical (visual) fade in the train-of-four (TOF) sequence until an objectively measured TOF-ratio of 0.90 was achieved. The duration of these periods were 10.3 ± 5.5 and 0.3 ± 0.3 min after neostigmine and sugammadex, respectively (P < 0.001). Study IV investigated the possible effect of reversal of a rocuronium NMB by sugammadex on depth of anaesthesia as indicated by the bispectral index and entropy levels in thirty patients. Sugammadex did not affect the level of anaesthesia as determined by EEG-derived indices of anaesthetic depth such as the bispectral index and entropy.

Luonnon kasvihuonekaasulähteiden ja -nielujen laskenta maakunnallisella tasolla

Kiihtyvän kasvihuoneilmiön aiheuttama maailmanlaajuinen ilmastonmuutos on yksi aikamme suurimmista haasteista. Kasvihuoneilmiön voimistuminen on ihmistoiminnan seurausta, mutta myös luonnon omat prosessit toimivat kasvihuonekaasujen lähteinä ja nieluina. Tässä työssä on selvitetty luonnon kasvihuonekaasulähteiden ja –nielujen määrää ja merkitystä maakunnallisella tasolla. Lisäksi työssä on esitetty maakunnallisia toimenpide-ehdotuksia kasvihuonekaasunielujen ylläpitämiseksi ja lisäämiseksi. Esimerkkinä työssä on käytetty Keski-Suomen maakuntaa ja laskenta on kohdistettu vuoteen 2008. Keski-Suomessa luonnon prosessit toimivat vuonna 2008 nettonieluna, jonka suuruus oli 1 813 701 tonnia hiilidioksidiekvivalenttia. Eniten kasvihuonekaasuja sitoi puusto 3 019 360 hiilidioksidiekvivalenttitonnin nielulla. Laskennassa huomioitiin hiilidioksidi, metaani ja dityppioksidi. Laskenta suoritettiin soveltuvilta osin kansallisen kasvihuonekaasuraportoinnin periaatteiden mukaisesti sekä tutkimuskirjallisuuteen perustuvien päästö- ja nielukertoimien avulla. Tämä työ osoittaa luonnon nielujen olevan tärkeässä roolissa ilmastonmuutoksen hillitsemisessä. Nielujen säilyttämiseen ja lisäämiseen tähtäävillä toimenpiteillä ilmakehän kasvihuonekaasupitoisuuksiin voidaan vaikuttaa kustannustehokkaasti sekä maailmanlaajuisella että alueellisella tasolla.

Jätteenpolton typenoksidipäästöjen vähentäminen

Työn tavoitteena oli selvittää jätteenpolton typenoksidipäästöjen puhdistusmahdollisuuksia. Työssä käydään läpi typen oksidien muodostuminen poltossa ja typen oksidien poistomenetelmät. Poistomenetelmiä käsiteltäessä painotus on arinapoltossa ja erityisesti selektiivisessä ei-katalyyttimenetelmässä (SNCR). Työn kokeellinen osa tehtiin Ekokem Oy Ab:n jätevoimalassa Riihimäellä. Kokeellisessa osassa selvitettiin ensin ammoniakkiveden massavirran, SNCR-laitteiston veden massavirran ja räjähdysnuohouksen vaikutusta typenoksidipitoisuuteen. Samalla selvitettiin muita typenoksidipitoisuuteen vaikuttavia tekijöitä sekä SNCR-laitteiston puhdistustehokkuus. Sen jälkeen selvitettiin parhaita toiminta-arvoja öljyisen veden massavirralle, SNCR-laitteiston massavirralle ja primääri- ja sekundääri-ilman suhteelle typenoksidipitoisuuden, ammoniakki-slip:n, ilokaasupitoisuuden, ammoniakkiveden kulutuksen ja höyryn tuotannon kannalta. Tulokseksi saatiin, että ammoniakkiveden massavirran lisääminen pienentää typenoksidipitoisuutta, mutta voi aiheuttaa ammoniakkipäästön. Paras SNCR-laitteiston veden massavirta on suurin tutkittu, 800 kg/h, jolloin typenoksidipitoisuus sekä typenoksidipitoisuuden hetkittäinen vaihtelu, ammoniakkiveden kulutus ja ammoniakkipäästö ovat pienimmät. Samalla tosin höyryn virtaama pienenee. SNCR-laitteiston puhdistustehokkuudeksi saatiin 60 %. Räjähdysnuohouksella ei ole havaittavaa, eikä öljyisen veden massavirralla merkittävää vaikutusta typenoksidipitoisuuteen. Ammoniakkiveden kulutuksen kannalta paras öljyisen veden määrä on 600 kg/h, kun taas ammoniakki-slip:n kannalta paras öljyisen veden määrä on 950 kg/h. Primääri-ilman osuuden pienentäminen pienentää ammoniakki-slip:iä ja ammoniakkiveden kulutusta.

Application of thermal ion-molecule reactions in tackling spectroscopic inferences in inductively coupled plasma mass spectrometry

Part I: Ultra-trace determination of vanadium in lake sediments: a performance comparison using O2, N20, and NH3 as reaction gases in ICP-DRC-MS Thermal ion-molecule reactions, targeting removal of specific spectroscopic interference problems, have become a powerful tool for method development in quadrupole based inductively coupled plasma mass spectrometry (ICP-MS) applications. A study was conducted to develop an accurate method for the determination of vanadium in lake sediment samples by ICP-MS, coupled with a dynamic reaction cell (DRC), using two differenvchemical resolution strategies: a) direct removal of interfering C10+ and b) vanadium oxidation to VO+. The performance of three reaction gases that are suitable for handling vanadium interference in the dynamic reaction cell was systematically studied and evaluated: ammonia for C10+ removal and oxygen and nitrous oxide for oxidation. Although it was able to produce comparable results for vanadium to those using oxygen and nitrous oxide, NH3 did not completely eliminate a matrix effect, caused by the presence of chloride, and required large scale dilutions (and a concomitant increase in variance) when the sample and/or the digestion medium contained large amounts of chloride. Among the three candidate reaction gases at their optimized Eonditions, creation of VO+ with oxygen gas delivered the best analyte sensitivity and the lowest detection limit (2.7 ng L-1). Vanadium results obtained from fourteen lake sediment samples and a certified reference material (CRM031-040-1), using two different analytelinterference separation strategies, suggested that the vanadium mono-oxidation offers advantageous performance over the conventional method using NH3 for ultra-trace vanadium determination by ICP-DRC-MS and can be readily employed in relevant environmental chemistry applications that deal with ultra-trace contaminants.Part II: Validation of a modified oxidation approach for the quantification of total arsenic and selenium in complex environmental matrices Spectroscopic interference problems of arsenic and selenium in ICP-MS practices were investigated in detail. Preliminary literature review suggested that oxygen could serve as an effective candidate reaction gas for analysis of the two elements in dynamic reaction cell coupled ICP-MS. An accurate method was developed for the determination of As and Se in complex environmental samples, based on a series of modifications on an oxidation approach for As and Se previously reported. Rhodium was used as internal standard in this study to help minimize non-spectral interferences such as instrumental drift. Using an oxygen gas flow slightly higher than 0.5 mL min-I, arsenic is converted to 75 AS160+ ion in an efficient manner whereas a potentially interfering ion, 91Zr+, is completely removed. Instead of using the most abundant Se isotope, 80Se, selenium was determined by a second most abundant isotope, 78Se, in the form of 78Se160. Upon careful selection of oxygen gas flow rate and optimization ofRPq value, previous isobaric threats caused by Zr and Mo were reduced to background levels whereas another potential atomic isobar, 96Ru+, became completely harmless to the new selenium analyte. The new method underwent a strict validation procedure where the recovery of a suitable certified reference material was examined and the obtained sample data were compared with those produced by a credible external laboratory who analyzed the same set of samples using a standardized HG-ICP-AES method. The validation results were satisfactory. The resultant limits of detection for arsenic and selenium were 5 ng L-1 and 60 ng L-1, respectively.

Existen diferencias farmacocinéticas y tiempos de despertar entre mujeres y hombres con anestesia total intravenosa

Introducción: La anestesia total intravenosa (TIVA) es ampliamente usada y reportada en la literatura como técnica para disminuir la respuesta a la laringoscopia e intubación, en la inducción y mantenimiento de una adecuada anestesia, además de una mejor estabilidad hemodinámica y recuperación pos anestésica; sin embargo no existen un gran número de estudios que comparen el uso de TIVA, determinando si existen diferencias en el perfil farmacocinético según el género del paciente. Objetivo: Describir diferencias farmacocinéticas y de los tiempos de despertar y salida a la unidad de cuidados pos anestésicos (descarga), según el género; en pacientes que reciben TIVA, con remifentanil y propofol, orientado por Stangraf. Metodología: Estudio observacional analítico de corte transversal, en pacientes llevados a cirugía bajo TIVA en el Hospital Occidente de Kennedy en el periodo de junio de 2013 a Enero de 2014.Usando SPSS versión 20 Windows, se analizaron los datos mediante pruebas Kolmogorov-Smirnov y Shapiro-Wilk y U de Mann Withney. Un valor de p menor 0.05 fue aceptado como estadísticamente significativo. Resultados: Se aplicaron pruebas de normalidad y no se encontraron diferencias estadísticamente significativas entre género. El tiempo de despertar fue 9.36 minutos para mujeres y 11.26 minutos para hombres. Los tiempos de descarga fueron 10.71 minutos para mujeres y 12.82 minutos para hombres. Discusión. El tiempo de despertar y descarga no es diferente entre mujeres y hombres en los pacientes analizados. Se requieren estudios adicionales entre grupos poblacionales de diversas condiciones farmacocineticas para corroborar los datos.

Comparación de la anestesia espinal con anestesia general endovenosa para legrado uterino obstétrico

Introducción: La elección de la técnica anestésica para cualquier procedimiento quirúrgico debe estar basada en su seguridad, la rapidez para su aplicación, la recuperación óptima para el paciente y minimización de los efectos secundarios, la anestesia raquídea es una técnica anestésica que puede ser utilizada con buenos resultados clínicos y minimas complicaciones . Materiales y métodos: Se realizó un estudio observacional con recolección prospectiva en mujeres clasificadas como ASA I - II y que posteriormente fueron llevadas a la realización de legrado uterino obstétrico por embarazo no viable durante las primeras 12 semanas de gestación, las técnicas anestésicas fueron anestesia espinal o anestesia general endovenosa dependiendo de la elección hecha por el anestesiólogo previo al procedimiento. Se midieron variables hemodinámicas, control del dolor postoperatorio, tiempo de recuperación y complicaciones perioperatorias con el fin de determinar si se presentaban diferencias significativas entre estas dos técnicas anestésicas. Resultados: Se incluyeron un total de 110 pacientes, 63.6% (n=70) con anestesia general y 36.4% (n40) con anestesia espinal. Ambas poblaciones fueron comparables. Se presentaron menos efectos secundarios con la técnica espinal, hay una diferencia estadísticamente significativa en cuanto al dolor a favor de la anestesia espinal (p0,000) Discusión: La anestesia raquídea es una opción viable, sencilla , fácil y eficaz para la realización de legrados obstétricos, se puede realizar con monitorización básica y las complicaciones son mínimas. Se requieren estudios más amplios para determinar el papel de cual es la mejor técnica. Palabras claves: legrado uterino instrumentado, anestesia espinal, anestesia general endovenosa

Variación en la resistencia al flujo de los tubos endotraqueales pediátricos modificando su longitud

Introducción: Se conocen los beneficios del uso de los tubos endotraqueales con neumotaponador, aunque dicha práctica tiene un impacto sobre el trabajo respiratorio durante el acto anestésico sin embargo se propone estudiar las consecuencias físicas de la variación en la longitud de los tubos para compensar dicha perdida de flujo, con base en la ley de Hagen-Poiseuille. Metodología: Se realizó un estudio experimental in vitro, en el cual se realizaron mediciones repetidas de flujo, variando la longitud y diámetro de diferentes tubos endotraqueales pediátricos (desde calibre 3.5mm hasta 6.5mm), con longitudes de 20cm, 15 cm, 10 cm y manteniendo su longitud original. Se analizaron los datos con el fin de medir el impacto sobre el flujo. Resultados: A pesar que los resultados muestran diferencias estadísticamente significativas (p0,000), la variación en la longitud de los tubos endotraqueales pediátricos tiene mucho menor impacto sobre la variación en el flujo, que la modificación del diámetro. Discusión: Si bien la práctica de acortar la longitud de un tubo endotraqueal pediátrico puede ayudar a reducir el espacio muerto y la retención de CO2, el impacto que tiene sobre el flujo es poco. Cuando se trata de disminuir el trabajo respiratorio de un niño en ventilación espontánea durante el acto anestésico, se debe escoger de forma apropiada el calibre de tubo correspondiente para la edad.

Bubble-included chocolate: relating structure with sensory response

Bubbles impart a very unique texture, chew, and mouth feel to foods. However, little is known about the relationship between structure of such products and consumer response in terms of mouth-feel and eating experience. The objective of this article is to investigate the sensory properties of 4 types of bubble-containing chocolates, produced by using different gases: carbon dioxide, nitrogen, nitrous oxide, and argon. The structure of these chocolates were characterized in terms of (1) gas hold-up values determined by density measurements and (2) bubble size distribution which was measured by undertaking an image analysis of X-ray microtomograph sections. Bubble size distributions were obtained by measuring bubble volumes after reconstructing 3D images from the tomographic sections. A sensory study was undertaken by a nonexpert panel of 20 panelists and their responses were analyzed using qualitative descriptive analysis (QDA). The results show that chocolates made from the 4 gases could be divided into 2 groups on the basis of bubble volume and gas hold-up: the samples produced using carbon dioxide and nitrous oxide had a distinctly higher gas hold-up containing larger bubbles in comparison with those produced using argon and nitrogen. The sensory study also demonstrated that chocolates made with the latter were perceived to be harder, less aerated, slow to melt in the mouth, and having overall flavor intensity. These products were further found to be creamier than the chocolates made by using carbon dioxide and nitrous oxide; the latter sample also showed a higher intensity of cocoa flavor.

Chemical and aerosol characterisation of the troposphere over West Africa during the monsoon period as part of AMMA

During June, July and August 2006 five aircraft took part in a campaign over West Africa to observe the aerosol content and chemical composition of the troposphere and lower stratosphere as part of the African Monsoon Multidisciplinary Analysis (AMMA) project. These are the first such measurements in this region during the monsoon period. In addition to providing an overview of the tropospheric composition, this paper provides a description of the measurement strategy (flights performed, instrumental payloads, wing-tip to wing-tip comparisons) and points to some of the important findings discussed in more detail in other papers in this special issue. The ozone data exhibits an "S" shaped vertical profile which appears to result from significant losses in the lower troposphere due to rapid deposition to forested areas and photochemical destruction in the moist monsoon air, and convective uplift of ozone-poor air to the upper troposphere. This profile is disturbed, particularly in the south of the region, by the intrusions in the lower and middle troposphere of air from the southern hemisphere impacted by biomass burning. Comparisons with longer term data sets suggest the impact of these intrusions on West Africa in 2006 was greater than in other recent wet seasons. There is evidence for net photochemical production of ozone in these biomass burning plumes as well as in urban plumes, in particular that from Lagos, convective outflow in the upper troposphere and in boundary layer air affected by nitrogen oxide emissions from recently wetted soils. This latter effect, along with enhanced deposition to the forested areas, contributes to a latitudinal gradient of ozone in the lower troposphere. Biogenic volatile organic compounds are also important in defining the composition both for the boundary layer and upper tropospheric convective outflow. Mineral dust was found to be the most abundant and ubiquitous aerosol type in the atmosphere over Western Africa. Data collected within AMMA indicate that injection of dust to altitudes favourable for long-range transport (i.e. in the upper Sahelian planetary boundary layer) can occur behind the leading edge of mesoscale convective system (MCS) cold-pools. Research within AMMA also provides the first estimates of secondary organic aerosols across the West African Sahel and have shown that organic mass loadings vary between 0 and 2 μg m−3 with a median concentration of 1.07 μg m−3. The vertical distribution of nucleation mode particle concentrations reveals that significant and fairly strong particle formation events did occur for a considerable fraction of measurement time above 8 km (and only there). Very low concentrations were observed in general in the fresh outflow of active MCSs, likely as the result of efficient wet removal of aerosol particles due to heavy precipitation inside the convective cells of the MCSs. This wet removal initially affects all particle size ranges as clearly shown by all measurements in the vicinity of MCSs.

Normal mode Rossby waves and their effects on chemical composition in the late summer stratosphere

During past MANTRA campaigns, ground-based measurements of several long-lived chemical species have revealed quasi-periodic fluctuations on time scales of several days. These fluctuations could confound efforts to detect long-term trends from MANTRA, and need to be understood and accounted for. Using the Canadian Middle Atmosphere Model, we investigate the role of dynamical variability in the late summer stratosphere due to normal mode Rossby waves and the impact of this variability on fluctuations in chemical species. Zonal wavenumber 1, westward travelling waves are considered with average periods of 5, 10 and 16 days. Time-lagged correlations between the temperature and nitrous oxide, methane and ozone fields are calculated in order to assess the possible impact of these waves on the chemical species. Using Fourier-wavelet decomposition and correlating the fluctuations between the temperature and chemical fields, we determine that variations in the chemical species are well-correlated with the 5- and 10-day waves between 30 and 60 km, although the nature of the correlations depend strongly on altitude. Interannual variability of the waves is also examined.

Comments on some recent measurements of anomalously steep N2O and O3tracer spectra in the stratospheric surf zone

Recent aircraft measurements, primarily in the extratropics, of the horizontal variance of nitrous oxide (N2O) and ozone (O3) in the middle stratosphere indicate that horizontal spectra of the tracer variance scale nearly as k−2, where k is the spatial wavenumber along the aircraft flight track [Strahan and Mahlman, 1994; Bacmeister et al., 1996]. This spectral scaling has been regarded as inconsistent with the accepted picture of stratospheric tracer motion; large-scale quasi-two-dimensional tracer advection typically yields a k−1 scaling (i.e., the classical Batchelor spectrum). In this paper it is argued that the nearly k−2 scaling seen in the measurements is a natural outcome of quasi-two-dimensional filamentation of the polar vortex edge. The accepted picture of stratospheric tracer motion can thus be retained: no additional physical processes are needed to account for deviations from the Batchelor spectrum. Our argument is based on the finite lifetime of tracer filaments and on the “singularity spectrum” associated with a one-dimensional field composed of randomly spaced jumps in concentration.

Umidificação e aquecimento do gás inalado durante ventilação artificial com baixo fluxo e fluxo mínimo de gases frescos

JUSTIFICATIVA E OBJETIVOS: em pacientes sob intubação traqueal ou traqueostomia, a umidificação e o aquecimento do gás inalado são necessários para a prevenção de lesões no sistema respiratório, conseqüentes ao contato do gás frio e seco com as vias aéreas. O objetivo da pesquisa foi avaliar o efeito do sistema respiratório circular com absorvedor de dióxido de carbono do aparelho de anestesia Cícero da Dräger, quanto à capacidade de aquecimento e umidificação dos gases inalados, utilizando-se fluxo baixo (1 L.min-1) ou mínimo (0,5 L.min-1) de gases frescos. MÉTODO: O estudo aleatório foi realizado em 24 pacientes, estado físico ASA I, com idades entre 18 e 65 anos, submetidos à anestesia geral, utilizando-se a Estação de Trabalho Cícero da Dräger (Alemanha), para realização de cirurgias abdominais, os quais foram distribuídos aleatoriamente em dois grupos: grupo de Baixo Fluxo (BF), no qual foi administrado 0,5 L.min-1 de oxigênio e 0,5 L.min-1 de óxido nitroso e fluxo mínimo (FM), administrando-se somente oxigênio a 0,5 L.min-1. Os atributos estudados foram temperatura, umidade relativa e absoluta da sala de operação e do gás no sistema inspiratório. RESULTADOS: Os valores da temperatura, umidade relativa e umidade absoluta no sistema inspiratório na saída do aparelho de anestesia e junto ao tubo traqueal não apresentaram diferença significante entre os grupos, mas aumentaram ao longo do tempo nos dois grupos (BF e FM), havendo influência da temperatura da sala de operação sobre a temperatura do gás inalado, nos dois grupos estudados. Níveis de umidade e temperatura próximos dos ideais foram alcançados, nos dois grupos, a partir de 90 minutos. CONCLUSÕES: Não há diferença significante da umidade e temperatura do gás inalado utilizando-se baixo fluxo e fluxo mínimo de gases frescos.

Eficácia analgésica da dexmedetomidina comparada ao sufentanil em cirurgias intraperitoneais: estudo comparativo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina, agonista alfa2-adrenérgico com especificidade alfa1:alfa2 1:1620, não determina depressão respiratória, sendo utilizada no intra-operatório como sedativo e analgésico. Esse fármaco tem sido empregado com os opióides em anestesia de procedimentos com elevado estímulo doloroso, como os abdominais intraperitoneais, não havendo referências sobre seu uso como analgésico único. Comparou-se a dexmedetomidina ao sufentanil em procedimentos intraperitoneais, de pacientes com mais de 60 anos de idade. MÉTODO: Foram estudados 41 pacientes divididos aleatoriamente em dois grupos: GS (n = 21), que recebeu sufentanil, e GD (n = 20), dexmedetomidina, ambos na indução e manutenção da anestesia. Os pacientes receberam etomidato (GS e GD) com midazolam (GD) na indução, isoflurano e óxido nitroso na manutenção da anestesia. Foram avaliados os atributos hemodinâmicos (pressão arterial média e freqüência cardíaca), tempos de despertar e de extubação ao final da anestesia, locais onde os pacientes foram extubados - sala de operação (SO) ou sala de recuperação pós-anestésica (SRPA), tempo de permanência na SRPA, necessidade de analgesia suplementar e antiemético na SRPA, complicações apresentadas na SO e SRPA, índice de Aldrete-Kroulik na alta da SRPA e a necessidade de máscara de oxigênio na alta da SRPA. RESULTADOS: Não houve diferença quanto à estabilidade hemodinâmica e GD apresentou menor tempo de permanência na SRPA e menor necessidade de máscara de oxigênio na alta da SRPA. CONCLUSÕES: A dexmedetomidina pode ser utilizada como analgésico isolado em operações intraperitoneais em pacientes com mais de 60 anos, determinando estabilidade hemodinâmica semelhante à do sufentanil, com melhores características de recuperação.

Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

CONTEXTO E OBJETIVO: Os tubos traqueais são dispositivos utilizados para manutenção da ventilação. A hiperinsuflação do balonete do tubo traqueal, causada pela difusão do óxido nitroso (N2O), pode determinar lesões traqueais, que se manifestam clinicamente como odinofagia, rouquidão e tosse. A lidocaína, quando injetada no balonete do tubo traqueal, difunde-se através de sua parede, determinando ação anestésica local na traquéia. O objetivo foi avaliar a efetividade e a segurança do balonete do tubo traqueal preenchido com ar comparado com o balonete preenchido com lidocaína, considerando os desfechos: sintomas cardiovasculatórios (HAS, taquicardia); odinofagia, tosse, rouquidão e tolerância ao tubo traqueal. TIPO DE ESTUDO E LOCAL: Estudo clínico prospectivo, realizado no Departamento de Anestesiologia da Faculdade de Medicina da Unesp, campus de Botucatu. MÉTODOS: A pressão do balonete do tubo traqueal foi medida, entre 50 pacientes, antes, 30, 60, 90 e 120 minutos após o início da inalação de N2O anestésico. As pacientes foram distribuídas aleatoriamente em dois grupos: Air, em que o balonete foi inflado com ar para obtenção de pressão de 20 cm H2O, e Lido, em que o balonete foi preenchido com lidocaína a 2% mais bicarbonato de sódio a 8,4% para obtenção da mesma pressão. O desconforto antes da extubação, e manifestações clínicas como dor de garganta, rouquidão e tosse foram registrados no momento da alta da unidade de cuidados pós-anestésicos, e dor de garganta e rouquidão foram avaliadas também 24 horas após a anestesia. RESULTADOS: Os valores da pressão no balonete em G2 foram significativamente menores do que os de Air em todos os tempos de estudo, a partir de 30 minutos (p < 0,001). A proporção de pacientes que reagiu ao tubo traqueal no momento da desintubação foi significantemente menor em Lido (p < 0,005). A incidência de odinofagia foi significantemente menor em Lido no primeiro dia de pós-operatório (p < 0,05). A incidência de tosse e rouquidão não diferiu entre os grupos. CONCLUSÕES: Durante ventilação artificial, empregando-se a mistura de oxigênio e N2O, a insuflação do balonete com lidocaína 2% alcalinizada impede que ocorra aumento significante da pressão no balonete e determina maior tolerância ao tubo traqueal e menor incidência de odinofagia no pós-operatório, podendo então ser considerada mais segura e com maior efetividade.