Principais preocupações dos pacientes sobre as complicações mais frequentes na sala de recuperação pós-anestésica

JUSTIFICATIVA E OBJETIVOS: Eventos considerados menores têm assumido papel fundamental na determinação da qualidade do serviço prestado na área da Anestesiologia. O objetivo do presente estudo foi avaliar as principais preocupações dos pacientes em relação ao período pós-anestésico e testar a hipótese de que os efeitos mais indesejados podem ser influenciados por características demográficas. MÉTODO: Um questionário foi respondido por 440 pacientes imediatamente antes da avaliação pré-anestésica. Foram listados os possíveis efeitos indesejáveis no período pós-operatório imediato, baseados em levantamento a partir de dados disponíveis na literatura e considerando o critério de frequência, mas não o de gravidade. Foram avaliados os dados demográficos e pesquisadas as nove preocupações mais frequentemente citadas. As informações coletadas a partir da análise dos questionários preenchidos pelos entrevistados foram relacionadas com seus dados antropométricos, socioeconômicos e educacionais, com o objetivo de avaliar a influência dessas variáveis no perfil das respostas. RESULTADOS: Entre os efeitos indesejados, o temor de acordar intubado foi o mais frequentemente citado como o mais importante, seguido de dor forte no local da cirurgia e acordar durante a cirurgia. A análise dos três efeitos mais indesejados em relação aos dados demográficos não evidenciou diferença estatística significativa, com exceção do item dor no local da cirurgia (menos citada entre pacientes do sexo masculino). CONCLUSÕES: As principais preocupações dos pacientes em relação ao período pós-anestésico são: acordar com um tubo na garganta, dor forte no local da cirurgia e a lembrança de estar acordado durante a cirurgia. A idade, o grau de escolaridade e a renda familiar não determinaram diferenças nas preocupações dos pacientes.

Tricobezoar gástrico: relato de caso e revisão da literatura

Bezoar é a impactação de material estranho no interior do trato digestivo, originado a partir da ingestão de diversas substâncias, incluindo cabelos ou pêlos, fibras vegetais e outros. No presente estudo relata-se caso de um volumoso tricobezoar gástrico observado em uma adolescente de 16 anos, com queixa de dor e tumoração palpável na região epigástrica, diagnosticado através da endoscopia digestiva alta. Dada às proporções do bezoar, a paciente foi submetida à gastrotomia anterior com retirada de uma massa sólida de cabelos, com 1200 g, a qual moldava todo o estômago, desde o fundo até o piloro. Uma grande úlcera de pressão também foi detectada em região antral, cujas biópsias revelaram- se negativas para neoplasia. Após a alta, sem intercorrências, a paciente foi encaminhada ao Serviço de Neuropsiquiatria para o tratamento da tricofagia e prevenção da recorrência, objetivo final, ao nosso ver, de todo o tratamento.

Representação do corpo na relação consigo mesma após mastectomia

Esta pesquisa objetivou compreender como a mulher mastectomizada representa o seu corpo nas relações consigo mesma. O referencial teórico-metodológico foram as representações sociais. Foram entrevistadas, no domicílio, dez mulheres mastectomizadas, no sétimo dia pós-alta e uma vez por mês, durante quatro meses de pós-operatório. Os conteúdos da representação do corpo consigo mesma convergiram para quatro unidades de significação: a) corpos mutilados, cuja percepção foi demonstrada de diferentes formas; b) sensação de impotência em diversos momentos do período pós-operatório; c) dor e limitação, principalmente no início de sua recuperação; d) cuidado com o corpo. Foi possível entender que o princípio do cuidado de si para as mulheres tomou a forma de uma atitude, desenvolvida em práticas que foram refletidas e ensinadas como um processo contínuo após a cirurgia. A percepção da relação de corpo/físico/mente/espírito permearam, todos os momentos, sua vivência. Os resultados oferecem importantes elementos para reflexão quanto à assistência às mulheres mastectomizadas.

Avaliação do uso do Hylano GF-20 no pós-operatório de artroscopia de joelho por artrose

O presente estudo avaliou os benefícios do uso do Hylano GF-20 no pós-operatório de artroscopias do joelho para lavagem e desbridamento por artrose.Foram estudados 20 pacientes submetidos à artroscopia em 20 joelhos que apresentavam artrose até grau 3 da classificação com sintomas de dor e bloqueio no referido joelho e não obtiveram melhora ao tratamento conservador, sendo então realizada lavagem associada a desbridamento leve condral e meniscal de acordo com a necessidade de cada caso.Os pacientes foram divididos em 2 grupos sendo que em um dos grupos foi feita apenas a artroscopia e noutro grupo artroscopia associada ao uso de 3 infiltrações realizadas semanalmente de Hylano GF-20.Os pacientes foram avaliados nas variáveis dor em repouso noturna, dor durante movimento com sobrecarga de 10% do peso corporal, dor durante o movimento mais doloroso do joelho afetado com escala visual e a variável quantidade diária de diclofenaco potássico ingerida para alívio da dor no joelho afetado. Os resultados estatísticos mostraram melhora significativa em todas as variáveis estudadas nos pacientes do grupo submetidos ao uso de infiltrações com o Hylano GF-20 no pós-operatório de artroscopias do joelho por artrose no período de 6 meses.

Carprofen and buprenorphine prevent hyperalgesia in a model of inflammatory pain in cats

A model of nociceptive threshold determination was developed for evaluation of NSAID analgesia in cats. In a crossover study, eight cats received carprofen (4 mg/kg), buprenorphine (0.01 mg/kg) or saline (0.3 ml) subcutaneously before intradermal kaolin injection on the antebrachium to induce mild inflammation. Pressure thresholds were measured at the injected site using blunt-ended pins advanced by manual inflation of a bladder within a bracelet. Bladder pressure was recorded as threshold (PT) at the behavioural end point. Baseline PT were recorded before kaolin injection (time 0). PT was measured at 2-10 h intervals for 52 h. PT below the lower 95% confidence interval (CI) of baseline values indicated hyperalgesia. After saline, hyperalgesia was detected from 2-6 h, 22-26 h, and at 30 and 36 h. After carprofen, PT remained within the 95% CI. After buprenorphine, PT remained within the 95% CI except at 2 h. Carprofen and to some extent buprenorphine, prevented inflammatory hyperalgesia. (C) 2007 Elsevier Ltd. All rights reserved.

Anti-inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide versus prednisolone acetate 1% eyedrops after pars plana vitrectomy

Purpose: To compare the safety and anti-inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide (TA) with prednisolone acetate 1% eyedrops after pars plana vitrectomy (PPV).Methods: the study included 40 consecutive phakic eyes of 40 patients undergoing PPV for non-clearing vitreous haemorrhage with attached retina (verified by echography), epiretinal membrane or macular hole. At the end of the surgical procedure, eyes were randomized to receive either a single posterior subtenon injection of TA (40 mg in 1 ml) plus sham eyedrops (prednisolone acetate 1% vehicle) postoperatively (group TA), or a posterior subtenon sham injection (1 ml balanced salt solution) plus prednisolone acetate 1% eyedrops postoperatively (group ED).Results: There was no difference in the severity of anterior chamber cell and flare between the two groups at any time-point during the study period (p > 0.05). Separate within-group analysis revealed a significant decrease in anterior chamber cell and flare from postoperative day 1 to postoperative days 7, 14 and 28 in both groups (p < 0.05). There was no difference in pain, photophobia, conjunctival erythema, ciliary flush or chemosis scores between the two groups at any time-point during the study period (p > 0.05). Steroid-induced intraocular hypertension was not observed in either group.Conclusions: A single posterior subtenon injection of TA can be as effective and safe as a 4-week regimen of prednisolone acetate 1% eyedrops in controlling intraocular inflammation after PPV.

Sympathetic hyperactivity, respiratory failure, pruritus, and anesthesia after unintentional epidural injection of potassium chloride: Case report

Background and Objectives. A combination of epidural and general anesthesia has been widely used to attenuate the surgical stress response and to provide postoperative analgesia. This case report illustrates the use of this anesthetic technique. Analgesia was induced with local anesthetic in the immediate postoperative period using unintentional 19.1% potassium chloride (KCI) as diluent. Methods. An ASA I male patient was scheduled for surgical correction of idiopathic megaesophagus under continuous epidural anesthesia combined with general anesthesia. In the postoperative period, while preparing 10 mt 0.125% bupivacaine to be administered through the epidural catheter for pain control, 5 mt 19.1% KCI was unintentionally used as diluent, resulting in a 9.55% potassium solution concentration. Results. The patient developed warmness of the lower limbs, tachycardia, hypertension, intense pruritus on the chest, agitation, exacerbation of sensory and motor blocks, and respiratory failure secondary to pulmonary edema, requiring ventilatory support. Total recovery was observed after 24 hours. Conclusions. Epidurally injected potassium leads to severe clinical manifestations caused by autonomic dysfunction, spinal cord irritation, and possible release of histamine. Despite continuous recommendations, ampule misidentification still happens in hospitals, frequently leading to serious accidents.

Thermography and ultrasonography in back pain diagnosis of equine athletes

The object of the current study was to evaluate the efficacy of thermography and ultrasonography in the diagnosis of thoracolumbar lesions in Quarter Horse athletes and associate the different types of lesions found with the athletic modality practiced. Twenty-four horses were admitted to the Surgery Service for Large Animals of the Veterinary and Animal Science Faculty, UNESP, Botucatu, Brazil, with complaints of back problems. All the horses were submitted for physical examinations to confirm the existence of thoracolumbar alterations and then for thermography and ultrasonography Thermography was used to map the lesioned areas of this region and ultrasonography for lesion characterization. The lesions found were supraspinous desmitis, interspinous desmitis, dorsal intervertebral osteoarthritis, and impingement of the spinous processes or kissing spines. The existence of a relation between the type of event practiced by the horse and the type of lesion found was determined. In horses that competed in the barrel race, a predominance of lesions in the thoracic caudal, thoracolumbar, and cranial lumbar regions occurred, with intervertebral osteoarthritis and interspinous desmitis being the most common. In cutting horses, most of the lesions were observed in the caudal lumbar region, whereas horses competing in reining showed a preferential location for lesions in the middle lumbar, with a predominance of supraspinous desmitis and myositis. Thermography associated with ultrasonography was shown to be efficient in the diagnosis of the thoracolumbar lesions of these horses.

Multidisciplinary approach to chronic pain from myofascial pain dysfunction syndrome: A four-year experience at a Brazilian center

Chronic pain is the major complaint of myofascial pain dysfunction syndrome (MPDS) and is a complex problem which involves physical, psychological and social aspects, the etiology of MPDS is multifactorial and the multidisciplinary approach is essential for differential diagnosis and for comprehensive treatment planning, In 1993, the Dental School of Piracicaba-UNICAMP, Brazil, opened a Center for Pain Studies (CPS), staffed by health care providers including, dentists, psychologists, physicians, physiotherapists and phonoaudiologists. The major aims of the CPS are to provide clinical care and to develop basic and applied research, Sixty-two MPDS patients had been admitted to the CPS by 1997, There were 60 females and 2 males, mean age -32.5 years, the mean duration of chronic pain was 48 months. Pain intensity and unpleasantness were measured employing the Visual Analogue Scale, the tendency to develop stress-related diseases was assessed by the Social Readjustment de Scale, There was a mean reduction of chronic pain of 69.89% and 71.78% relative to intensity and unpleasantness, respectively, the experience of clinical attendance at a multidisciplinary center showed the relevance of a team consisting of health care providers from different specialties with well-established aims, completely integrated and sensitive enough to understand the painful complaints of MPDS patients.

The newborn pain cry: Descriptive acoustic spectrographic analysis

Introduction: Study the characteristics of pain vocal emission of newborns during venepuncture through acoustic analysis and relate it to NIPS pain scale and some variables of the newborns.Methods: Emissions of 111 healthy term newborns were recorded, whose lifetime varied from 24 to 72 h. The acoustic analysis was realized with GRAM 5.7 software verifying the occurrence of tense strangled voice quality, sounds, concentration of acoustic energy, breaks, double harmonic breaks and frequency instability, type of phonation, vocal attack and cough. The NIPS scale was realized during venepuncture and descriptive statistical analysis and correlation through Spearman test.Results: Hundred percent of the emissions had guttural sounds, vowels, hard vocal attack, frequency, breaks, double harmonic breaks and tense strangled voice quality; 34.2% higher fundamental frequency; 62.2% periods of emission absence and 100% occurrence of tracing instability, concentration of acoustic energy, inspiratory and expiratory phonation. The cough occurred in 14.4%. The signs of vocal tract constriction associated with all. The parameters. There was a negative correlation between the higher fundamental frequencies and the weight of newborns and positive correlation between cough and NIPS score.Conclusions: the newborn pain emission is tense and strident, the modifications of frequency and spectrographic tracing and the presence of sounds show laryngeal and vocal tract participation. The smaller the newborn weight, the bigger the presence of higher fundamental frequency with tense strangled voice quality and the bigger the NIPS score, the more frequent the cough. Such characteristics make pain crying peculiar, helping in the evaluation of pain during a procedure. (c) 2006 Elsevier B.V.. All rights reserved.

Open elevated plus maze-induced antinociception in rats: A non-opioid type of pain inhibition?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sufentanil-2-hydroxypropyl-beta-cyclodextrin inclusion complex for pain treatment: Physicochemical, cytotoxicity, and pharmacological evaluation

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