864 resultados para Anesthetic techniques
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Background and Objectives: - The effects of associating lipophilic opioids to local anesthetics in epidural anesthesia are not well defined. There are still questions and controversies about opioid doses to be used and their major effects in the epidural block. This study aimed at evaluating the epidural block effects in humans of the association of different fentanyl and sufentanil doses to bupivacaine with 1:200.000 epinephrine. Methods: - A double-blind randomized study was performed in 94 patients of both genders, physical status ASA I, aged between 18 and 60 years, submitted to lower abdomen, perineal or lower limb surgery. Patients without preanesthetic medication were epidurally injected with 100 mg (20 ml) 0.5% bupivacaine, 0.1 mg (0.1 ml) 1%o epinephrine plus a combination of the following drugs: BUPI Group (15 patients): 2 ml of 0.9% saline solution (SS); FENT50 Group (19 patients): 50 μg (1 ml) fentanyl + 1 ml SS; FENT100 Group (20 patients): 100 μg (2 ml) fentanyl; SUF30 Group (20 patients): 30 μg (0.6 ml) sufentanil + SS (1.4 ml); SUF100 Group (20 patients): 50 μg (1 ml) sufentanil + SS (1 ml). The following parameters were studied: onset of sensory block, analgesic block (onset time) in T12, T10 and T8, analgesic block duration in T10 and T12, motor block degree, consciousness degree, need for supplemental perioperative sedation and analgesia, hypotension, bradycardia and peri and post operative side-effects, analgesia duration, proportion of patients needing supplemental analgesia and evaluation of postoperative pain (pain analog visual scale). Results: Groups were demographically uniform. The addition of fentanyl or sufentanil did not alter major characteristics of perioperative epidural block and has not significantly increased postoperative analgesia duration as compared to the use of bupivacaine only. However, the addition of lipophilic opioids has increased the quality of perioperative anesthetic block, translated into a lesser need for supplemental analgesia (p < 0.02). The increased dose of fentanyl and especially of sufentanil has increased the incidence of perioperative drowsiness (p < 0.001) without significant increase in other side effects. Conclusions: In the conditions and doses used, the addition of lipophilic opioids to bupivacaine and the increased dose of lipophilic opioids have improved anesthetic block quality without changes in the epidural block characteristics or a significant increase in side effects, with the exception of drowsiness mainly caused by sufentanil. However, they were not able to provide a significant increase in postoperative analgesia duration.
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Background and Objectives. The analgesic actions of nonsteroidal anti-inflammatory drugs (NSAID) result from the inhibition of the peripheral synthesis of prostaglandins. In spite of the emphasis on the peripheral action, several studies have shown the potential central action of such drugs. In rats, NSAID doses insufficient to block pain when systemically administered were effective when intrathecally injected. This effect could be mediated by interaction with descending serotoninergic ways together with neurotransmission modulation of glycine or N-methyl-D-aspartate receptors. Our goal was to study the effect of different tenoxican doses in the histology of dogs spinal cord and meninges. Methods. Thirty two dogs (7 to 17 kg) were randomly distributed in four groups: G1 - Control with distilled water (DW); G2 - 2 mg tenoxican diluted in DW; G3 - 4 mg tenoxican diluted in DW; G4 - 10 mg tenoxican diluted in DW in a constant volume of 1 ml. Anesthesia was induced with etomidate and fentanyl and dural puncture was performed with a 25G spinal needle in interspace L6-7. Animals were observed for 72 hours and subsequently euthanized by electrocution. Lumbar and sacral spinal cord segments were removed for further histologic examination. Results. All animals were clinically normal during the observation period and there has been no histologic alteration of the nervous system and meninges. Conclusions. In our experimental model intrathecal tenoxican doses up to 10 mg have not triggered nervous tissue or meningeal injuries in dogs.
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Backgrounds and Objectives: Both continuous venous anesthesia with propofol and inhalational anesthesia with sevoflurane propitiate fast arousal with few side effects. The aim of this study was to compare the arousal and post anesthestic recovery times in patients submitted to these two agents. Methods: Forty three patient aged 18 to 50 years, physical status I or II, submitted to gynecological laparoscopy were distributed in two groups: G1 - propofol in continuous infusion of 115 μg.kg -1.min -1 and G2 sevoflurane. All the patients were pre-medicated with 7.5 mg midazolam, sufentanil 0.5 μg.kg -1, propofol 2 mg.kg -1, atracurium 0.5 mg.kg -1, N 2O in 50% of oxygen in a no-rebreathing system. The depth of the anesthesia and arousal time were assessed by the Bispectral index (BIS). The time between end of anesthesia and eye opening, time for command response and time for orientation were also evaluated. Results: The times recorded in minutes were: G1 - eye opening 8.2 ± 2.9, command response 8.6 ± 3.1, orientation 9.8 ± 3.4, recovery 31.6 ± 3.8; G2 - eye opening 4.5 ± 3, command response 4.9 ± 3.4, orientation 6.2 ± 3.4, recovery 66 ± 8. Except the recovery time, all the values were larger in G1. Conclusions: Both intravenous propofol or inhalational sevoflurane were considered excellent anesthetic techniques as to recovery time and recovery room discharge. Sevoflurane provided an earlier arousal with a longer recovery room stay as compared to propofol.
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Background and Objectives - It is essential to reduce health care costs without impairing the quality of care. Propofol is associated to faster recovery and it is known that post-anesthesia care unit (PACU) costs are high. The aim of this study was to evaluate the advantages of two anesthesia regimens - propofol continuous infusion or isoflurane - taking into account the cost of both techniques on PACU stay. Methods - Forty seven patients, physical status ASA I, II and III, undergoing laparoscopic cholecystectomy were divided into 2 groups according to the anesthetic agent: G1, conventional propofol continuous infusion (100-150 μg.kg-1.min-1) and G2, isoflurane. All patients were induced with sufentanil (1 μg.kg-1) and propofol (2 mg.kg-1) and were kept in a re-inhalation circuit (2 L.min-1 of fresh gas flow) with 50% N2O in O2, sufentanil (0.01 μg.kg-1.min-1) and atracurium (0.5 mg.kg-1), or pancuronium (0.1 mg.kg-1) for asthma patients. All patients received atropine and neostigmine at the end of the surgery. Prophylactic ondansetron, dipyrone and tenoxican were administered and, when necessary, tramadol and N-butylscopolamine. Costs of anesthetic drugs (COST), total PACU stay (t-PACU), and PACU stay after extubation (t-EXT) were computed for both groups. Results - Costs were significantly lower in the isoflurane group but t-PACU was 26 minutes longer and t-EXT G1
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BACKGROUND. This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. METHODS. Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 μg.kg -1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. RESULTS. Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, 1 (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO 2 < 90%) was low and similar between groups (p > 0.05). CONCLUSION. There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.
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Neurosurgeries are frequent in the routine of veterinary hospitals and, therefore, knowledge of the different anesthetic protocols to be used for each patient is necessary to prevent the morbity and mortality in the after and trans-surgical period. The objectives of this study were to evaluate the anesthetic protocols used in patients undergoing neurosurgeries; the results of those protocols; the rate of complications, and if those complications are related to the duration of the anesthesia time. We studied the anesthetical data of 52 dogs and two cats submitted to neurosurgery between January of 2003 and December of 2006, in the Veterinary Hospital of UEL. Findings showed that the main protocols used were propofol for induction and halothane or isofluorane for maintenance of the anesthesia. These protocols induced adequate anesthesia for the surgical procedure and did not occur complications during the anesthetic period in 37/54 (68,5%) of the cases. 7/19 (36.8%) of the complications observed occurred in patients submitted to anesthesia with halothane and 8/32 (25.2%) in patients with isofluorane. The complication most observed in this study was bradicardy, which occurred in 15/54 (27.8%) of the patients. Two deaths occurred in patients submitted to slot cervical. Good knowledge of the neurological disease and of surgical and anesthetic techniques are essential to prevent alterations in the central nervous system caused by the drugs, disease or association of these factors.
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BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate catheters the technique has been used more often and gaining acceptance among anesthesiologists. The objective of this report was to demonstrate the usefulness of the technique as a viable alternative for medium and major size surgeries. CASE REPORT: This is a 58 years old female patient, weighing 62 kg, physical status ASA I, with a history of migraines, low back pain, and prior surgeries under spinal block without intercurrence. The patient was scheduled for exploratory laparotomy for a probable pelvic tumor. After venoclysis with an 18G catheter, monitoring with cardioscope, non-invasive blood pressure and pulse oximetry was instituted; she was sedated with 2 mg of midazolam and 100 μg of fentanyl, and placed in left lateral decubitus. The patient underwent continuous spinal block through the median approach in L 3-L 4; 9 mg of 0.5% hyperbaric bupivacaine and 120 μ g of morphine sulfate were administered. Inspection of the abdominal cavity revealed a gastric stromal tumor that required an increase in the incision for a partial gastrectomy. A small dose of hyperbaric solution was required for the entire procedure, which was associated with complete hemodynamic stability. Postoperative admission to the ICU was not necessary; the patient presented a good evolution without complaints and with a high degree of satisfaction. She was discharged from the hospital after 72 hours without intercurrence. CONCLUSIONS: Intermediate catheters used in continuous spinal blocks have shown the potential to turn it an attractive and useful technique in medium and large size surgeries and it can even be an effective alternative in the management of critical patients to whom hemodynamic repercussions can be harmful.
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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
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Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Pós-graduação em Bases Gerais da Cirurgia - FMB
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Background. Postoperative cognitive dysfunction (POCD) after coronary artery bypass graft surgery is a common complication for which, despite many clinical investigations, no definitive etiology has been found. The current use of both high and low-dose fentanyl as anesthetic techniques allowed us to investigate the effect of fentanyl on the incidence of POCD. Methods. Three hundred fifty patients scheduled to undergo elective coronary artery bypass graft surgery were randomized to receive either high-dose fentanyl (50 mu g/kg) or low-dose fentanyl (10 mu g/kg) as the basis of the anesthetic. All patients underwent neuropsychological testing before surgery and at 1 week, 3 months, and 12 months after surgery. Results. One hundred sixty-eight patients in the low-dose group and 158 patients in the high-dose group were included in the final analysis. Neuropsychological testing was performed on 88%, 93%, and 92% of patients at 1 week, 3 months, and 12 months, respectively. There was no difference between group mean scores at any of the three testing times. Analysis of individual patients by the 20% rule did not detect any differences between groups. The one SD rule, which has fewer false-positive results, detected significantly more patients with POCD in the low-dose group than in the high-dose group at 1 week (23.6% vs. 13.7%; P = 0.03) but not at the other testing times. Patients with POCD spent an average of 1.2 days longer in the hospital than those without POCD (P = 0.021). Conclusions: High-dose fentanyl is not associated with a difference in the incidence of POCD at 3 or 12 months after surgery. Low-dose fentanyl leads to shorter postoperative ventilation times and may be associated with a greater incidence of POCD 1 week after surgery. Early POCD is associated with an increased duration of stay in the hospital.
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Introducción: La anestesia epidural como la anestesia raquídea son técnicas anestésicas similares que disminuye la percepción sensitiva y dolorosa. La anestesia raquídea y epidural aunque siendo ambas anestesia regional, presentan distinto comportamiento y por tanto distinto manejo, eficacia y riesgos. Objetivo General: Determinar la prevalencia de anestesia epidural y raquídea en pacientes que se sometieron a cesárea en el hospital José Carrasco Arteaga. Cuenca – Ecuador. Julio a diciembre 2014 Metodología: Se realizó un estudio descriptivo analítico de corte transversal, utilizando la base de datos elaborada de 450 mujeres sometidas a cesárea en el año 2014 en el Hospital José Carrasco Arteaga. La información se recolectó en formularios, los mismos que fueron elaborados por las autoras, se elaboró una base de datos, para lo cual se utilizó Excel 2010, se creó tablas, analizándolas mediante valor de p, frecuencia y porcentaje(%).La información se analizó por medio del software SPSS versión 22. Resultados: De las 441 pacientes encontramos que las mujeres entre los 20-39 años fueron la población de mayor prevalencia sometida a anestesia raquídea y epidural con un 92,1% (164) y un 85,9% (226) correspondientemente, la anestesia epidural se uso más en las pacientes con sobrepeso 38.8% (102) y obesidad 35.0% (92), las mujeres con peso normal en el 37,6% (67) se utilizó la anestesia raquídea mayormente y de las mujeres con sobrepeso en el 36,5 (65) se utilizó la anestesia raquídea principalmente, la mayor prevalencia fue en la población casada bajo anestesia epidural con el 60% (153), la anestesia epidural se utilizó más en las pacientes de la zona urbana un 58.8% (204) y en zona rural un 62.8% (59), la escolaridad superior con el tipo de anestesia raquídea con un 47,2% (84) y con anestesia raquídea con un 35,0% (92) fue el nivel de escolaridad más prevalente, la anestesia epidural se utilizó mas en las pacientes procedentes de la zona urbana 58.8% (204) como de la zona rural 62.8% (59)
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Introdução: Em Endodontia, a anestesia local é o método de controlo de dor mais utilizado, no entanto vários estudos revelaram que as técnicas anestésicas convencionais apresentam uma eficácia reduzida em casos sintomáticos. Existem várias alternativas às técnicas e anestésicos convencionais, assim como anestesias suplementares que podem ser utilizadas para aumentar a profundidade da anestesia pulpar, e que devem fazer parte do arsenal clínico de modo a possibilitar um tratamento indolor ao paciente. Objetivo: O presente trabalho visou reunir e analisar bibliografia sobre anestesia local em Endodontia e fatores que podem influenciar a sua administração. Foram abordadas técnicas e anestésicos utilizados atualmente, assim como outros métodos estudados recentemente, sendo destacada a eficácia destes na anestesia de pacientes diagnosticados com pulpite irreversível. Materiais e métodos: Foi realizada uma pesquisa bibliográfica no motor de busca Pubmed, tendo sido utilizadas as seguintes palavras chave: “Anesthesia”, “Local anesthesia”, “Anesthesia Technique”, “Anesthetic efficacy”, “Endodontics”, “Lidocaine”, “Articaine”, “Pulpitis”. Estabeleceu-se uma limitação temporal de 2005 a 2016, tendo sido incluídos 54 artigos com ênfase em estudos do tipo meta-análise, revisões bibliográficas e estudos clínicos controlados e randomizados. Conclusão: Em pacientes sintomáticos, de modo a controlar a dor pré-operatória, torna-se muitas vezes necessária a utilização de anestésicos de maior potência e de técnicas suplementares. Aconselham-se, por isso, técnicas como a injeção intraligamentar, intraóssea e infiltrações suplementares para assegurar a anestesia pulpar após técnicas primárias falhadas. Deve-se, ainda, ter em consideração a sensibilidade que alguns pacientes apresentam a determinados componentes presentes nos anestésicos locais, exigindo-se um especial cuidado na seleção e administração destes agentes.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)