Pediatras e os distúrbios respiratórios do sono na criança

OBJECTIVES. assessment of opinions and practices of pediatricians concerning sleep-disordered breathing (SDB) in children. Methods. randomly 516 pediatricians were selected in the state of São Paulo, Brazil. A survey mailed to them included questions regarding: their professional profile, knowledge about SDB in childhood, opinions and practices for diagnosis and treatment of these diseases. RESULTS. 112 anonymous completed surveys were returned (21.7%). The teaching of SDB during medical school and pediatric residency training was considered unsatisfactory respectively by 65.2% and 34.8% of the pediatricians. Forty-nine respondents (43.8%) rated their knowledge about SDB in children as regular, 39 (34.8%) as good and 17 (15.2%) as unsatisfactory. The most important sleep-related questions were: mouth breathing, breathing pauses, sleep amount, excessive daytime sleepiness and nocturnal wheezing. Clinical aspects regarded as the most significant for suspecting obstructive sleep apnea syndrome (OSAS) were: breathing pauses, adenoid hypertrophy, mouth breathing, craniofacial anomaly and snoring. The most frequent practices for evaluation of OSAS in children were: cavum radiography with referral to an otorhinolarnygologist (25%) and nocturnal pulse oximetry (14.2%). Only 11.6% of pediatricians recommended overnight polysomnography and 4.5%, nap polysomnography. The most effective practices for SDB were considered to be: adenoidectomy and adenotonsillectomy, parents counseling, weight loss and sleep hygiene. CONCLUSIONS. there is a gap between research on SDB in childhood and pediatric practice. © 2006 Associação Médica Brasileira.

Raquianestesia contínua em paciente submetido à gastrectomia parcial. Relato de caso

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.

Pneumonias

Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). In this paper will be presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

Anestesia para colecistectomía videolaparoscópica en paciente portador de enfermedad de Steinert. Relato de caso y revisiõn de la literatura

BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.

Estudo cardiorrespiratório comparativo da anestesia geral inalatória com o sevofluorano em cadela não-gestantes e no terço final da gestação, pré-tratados com acepromazina e propofol

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

Avaliação do retinol no escarro e no soro de tabagistas e pacientes com doença pulmonar obstrutiva crônica e sua relação com o processo inflamatório

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da frequência de síndrome metabólica e sua associação na sobrevida de pacientes com doença pulmonar obstrutiva crônica (DPOC)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estado inflamatório sistêmico e gravidade da doença pulmonar obstrutiva crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo da remodelação cardíaca em pacientes com doença pulmonar obstrutiva crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cetamina S(+) como adjuvante na anestesia e no tratamento da dor pós-operatória de pacientes queimados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Uso do Airtraq® em cirurgias bariátricas: influência do posicionamento

Pós-graduação em Anestesiologia - FMB

Determinação da concentração alveolar mínima(CAM) de sevofluorano em filhotes de cães (neonatos e pediátricos)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da aplicação intravenosa do cloridrato sobre a concentração alveolar mínima do sevofluorano em cães

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