The Potential of Narrow-Band Imaging as a Novel Light Source for Photodynamic Therapy for Superficial Cancers via Endoscopes.

Background: Photodynamic therapy (PDT) has advanced through the utilization of photosensitizers and specific-wavelength light (≥ 600 nm). However, the widespread adoption of PDT is still impeded by high equipment costs and stringent laser safety requirements. Porphyrins, crucial in PDT, have another absorbance peak of blue light (λ = 380 - 500 nm). This peak corresponds to the wavelength of narrow-band imaging (NBI) (λ = 390 - 445 nm), an image-enhancement technology integrated into endoscopes by Olympus Medical Systems. The study aimed to investigate the potential of widely adopted NBI as a PDT light source for superficial cancers via endoscopes. Methods: Esophageal and biliary cancers were selected for investigation. Human esophageal cancer cell lines (KYSE30, KYSE70, KYSE170) and cholangiocarcinoma cell lines (HuCCT-1, KKU-213) were subjected to verteporfin-mediated PDT under NBI light (λ = 390 - 445 nm). Assessments included spectrometry, crystal violet staining, and fluorescein imaging of singlet oxygen generation and apoptosis. Results: Verteporfin exhibited a peak (λ = 436 nm) consistent with the NBI spectrum, suggesting compatibility with NBI light. NBI light significantly inhibited the growth of esophageal and biliary cancer cells. The half-maximum effective concentration (EC50) values (5 J/cm2) for KYSE30, KYSE70, KYSE170, HuCCT-1, and KKU-213 were calculated as 2.78 ± 0.37µM, 1.76 ± 1.20 µM, 0.77 ± 0.16 µM, 0.65 ± 0.18 µM, and 0.32 ± 0.04 µM, respectively. Verteporfin accumulation in mitochondria, coupled with singlet oxygen generation and observed apoptotic changes, suggests effective PDT under NBI light. Conclusions: NBI is a promising PDT light source for superficial cancers via endoscopes.

Increased likelihood of post-polycythemia vera myelofibrosis in Ph-negative MPN patients with chromosome 12 abnormalities.

Chromosome 12 (Chr12) abnormalities have been described for individual patients with Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-neg MPN), however the frequency, characteristics, and outcomes of such patients as a whole have not been investigated. We reviewed a database of 1787 consecutive Ph-neg MPN patients seen at our institution and determined that 2% of Ph-neg MPN patients harbored an alteration involving Chr12 by cytogenetic evaluation. Retrospective chart review revealed that patients with Chr12 abnormalities had a higher likelihood of having myelofibrosis (MF) compared to patients without a Chr12 abnormality, and were more likely to have post-polycythemia vera MF. The most common alterations in Chr12 in MF patients involved 12q13, 12q15, 12q24, and trisomy 12, and >40% of Chr12 Ph-neg MPN patients had cytogenetic evolution. Chr12 abnormalities did not significantly correlate with JAK2 status, progression to acute myeloid leukemia, or survival, however patients with 12q24 abnormalities trended toward poorer outcomes.

Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

Comorbidities predict worse prognosis in patients with primary myelofibrosis.

BACKGROUND: Comorbidities have been shown to play an important role in the prognostic assessment of several hematologic conditions; however, the role of comorbidities in primary myelofibrosis has not been studied. The objective of the current study was to evaluate the prevalence and impact of comorbidities in patients with primary myelofibrosis (PMF) using the Adult Comorbidity Evaluation-27 (ACE-27). METHODS: In this retrospective observational cohort study, a total of 349 consecutive patients with a confirmed diagnosis of PMF who presented to the study institution from 2000 to 2008 were evaluated. The authors evaluated the frequency and severity of comorbidities in these patients and assessed their impact on survival in a bivariable model that included the ACE-27 and Dynamic International Prognostic Scoring System scores as covariates. RESULTS: Approximately 64% of patients had at least 1 comorbid condition, and diseases of the cardiovascular system (63%) were most common. Comorbidities had a significant negative impact on survival (P < .001). Patients with severe comorbidities had twice the risk of death as those with no comorbidities. When stratified by demographic and clinical characteristics, comorbidities were found to be significantly associated with worse survival in patients aged < 65 years (P < .001) and those with an ECOG performance status < 1 (P < .001). In a multivariable model that included the ACE-27 and Dynamic International Prognostic Scoring System scores, comorbidities retained a significant association with shorter survival (P ≤ .001). CONCLUSIONS: The assessment of comorbid conditions in patients with PMF, particularly those who are younger and with a good performance status, has important implications for overall prognosis and treatment planning.

Detection of respiratory compromise by acoustic monitoring, capnography, and brain function monitoring during monitored anesthesia care.

Episodes of apnea in sedated patients represent a risk of respiratory compromise. We hypothesized that acoustic monitoring would be equivalent to capnography for detection of respiratory pauses, with fewer false alarms. In addition, we hypothesized that the patient state index (PSI) would be correlated with the frequency of respiratory pauses and therefore could provide information about the risk of apnea during sedation. Patients undergoing sedation for surgical procedures were monitored for respiration rate using acoustic monitoring and capnography and for depth of sedation using the PSI. A clinician blinded to the acoustic and sedation monitor observed the capnograph and patient to assess sedation and episodes of apnea. Another clinician retrospectively reviewed the capnography and acoustic waveform and sound files to identify true positive and false positive respiratory pauses by each method (reference method). Sensitivity, specificity, and likelihood ratio for detection of respiratory pause was calculated for acoustic monitoring and capnography. The correlation of PSI with respiratory pause events was determined. For the 51 respiratory pauses validated by retrospective analysis, the sensitivity, specificity, and likelihood ratio positive for detection were 16, 96 %, and 3.5 for clinician observation; 88, 7 %, and 1.0 for capnography; and 55, 87 %, and 4.1 for acoustic monitoring. There was no correlation between PSI and respiratory pause events. Acoustic monitoring had the highest likelihood ratio positive for detection of respiratory pause events compared with capnography and clinician observation and, therefore, may provide the best method for respiration rate monitoring during these procedures.

Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Outcomes in patients with acute promyelocytic leukemia (APL) have improved; however, a significant number of patients still relapse despite receiving all-trans-retinoic acid (ATRA) and arsenic-based therapies. PATIENTS AND METHODS: Outcomes of patients with relapsed APL who were treated at our institution (1980-2010) and who received HCT were compared with those who received chemotherapy (CT) only. RESULTS: Among 40 patients, 24 received HCT (autologous [auto] HCT, 7; allogeneic [allo] HCT, 14; both, 3); 16 received CT only. The median age at diagnosis was 36 years (range, 13-50 years), 31 years (range, 16-58 years), and 44 years (range, 24-79 years) for the auto-HCT, allo-HCT, and CT groups, respectively. Ten (100%) patients who received auto-HCT and 12 (71%) who received allo-HCT were in complete remission at the time of the HCT. The median follow-ups in the auto-HCT, allo-HCT, and CT groups were 74 months (range, 26-135 months), 118 months (range, 28-284 months), and 122 months (range, 32-216 months), respectively. Transplantation-related mortality (1 year) after auto-HCT and allo-HCT were 10% and 29%, respectively. The 7-year event-free survival after auto-HCT and allo-HCT was 68.6% and 40.6%, respectively (P = .45). The 7-year overall survival was 85.7%, 49.4%, and 40% in the auto-HCT, allo-HCT, and CT groups, respectively (P = .48). CONCLUSION: Both auto-HCT and allo-HCT are associated with durable remission and prolonged survival. All 3 strategies (auto-HCT, allo-HCT, CT) were found to be feasible in the relapsed APL setting and result in long-term disease control in selected patients. In this retrospective analysis, overall survival for patients who received HCT was not significantly better than patients who received CT only, but a trend toward better outcomes was seen in patients who underwent auto-HCT, although not statistically significant.

Allogeneic hematopoietic stem cell transplantation versus hypomethylating agents in patients with myelodysplastic syndrome: a retrospective case-control study.

Allogeneic stem cell transplantation (allo-SCT) is the only potentially curative treatment for myelodysplastic syndrome (MDS). Recently, hypomethylating agents (HMAs) have been shown to improve survival in patients with high-risk MDS. We conducted a retrospective case-control study to compare survival with these treatment modalities in patients with untreated MDS. Controls were identified using a departmental database and transplant patients were matched in at least three of the following five criteria: year of diagnosis, age, blast percentage, International Prognostic Scoring System cytogenetic risk, and time from diagnosis to treatment. Median overall survival (OS) was 26 and 25 months for, respectively, allo-SCT [(n = 53); range, 2-210 months] and HMA [(n = 40); range, 2-98 months] (P = 0.89). Four-year survival rates were 24 and 23% for allo-SCT patients and the nontransplant cohort, respectively. Patients undergoing allo-SCT after 2000 had longer median OS compared with those transplanted before 2000 (41 versus 7 months, P=0.001). These results would suggest that prospective studies are needed to delineate the timing and efficacy of allo-SCT in the HMA era.

Treatment options for chronic myeloid leukemia.

INTRODUCTION: The bcr-abl tyrosine kinase inhibitors (TKIs) are the cornerstone treatment for chronic myeloid leukemia (CML). However, there are many topics related to therapy that remain debated. AREAS COVERED: The aim of this paper is to give the reader a comprehensive review of how to treat CML at diagnosis, how to monitor the disease and a brief read of special populations and case scenarios. It describes the first-line (imatinib) and second-line (nilotinib and dasatinib) TKIs currently used for the treatment of CML, including landmark studies proving their efficacy, side effect profile, dosage and use in special populations. It also reviews the current guidelines regarding treatment and monitoring of the disease while on TKIs, along with an overview of treatment in advanced stages, the role of allogeneic stem cell transplantation and investigational drugs. EXPERT OPINION: Although imatinib represented a mayor therapeutic advancement over conventional chemotherapy, second-generation TKIs offer higher rates of optimal response and should be used as the frontline therapy. Patients with the T315I mutation carry a worse prognosis and should be offered allogeneic stem cell transplantation. The treatment in advanced stages of CML remains suboptimal and bench, translational and clinical research is encouraged.

Diagnosis and management of urothelial carcinoma of the bladder.

Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70,000 new cases of bladder carcinoma (52,000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non-muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive tumors, treatment by cystoscopic resection and intravesical therapy is directed at reducing recurrences and preventing progression to a more advanced stage. The goal in invasive tumors is a combination of radical cystectomy and perioperative cisplatin-based combination chemotherapy to enhance outcomes by reducing the high risk of distant recurrences. Outcomes in metastatic UC are dismal with current cisplatin-based combination chemotherapy, and progressive disease after frontline chemotherapy is characterized by a short survival. Therefore, clinical trials should be the focus for metastatic UC. It is important for primary care physicians to recognize the early signs and symptoms of bladder carcinoma, initiate the proper work-up, and refer promptly to a urologist to evaluate suspicious signs and symptoms.

Estudo comparativo entre soluções a 0,5 por cento de levobupivacaína, bupivacaína em excesso enantiomérico de 50 por cento e bupivacaína racêmica em anestesia peridural para cirurgia de abdômen inferior / Comparative study between 0.5% levobupivacaine solutions, bupivacaine in 50% enantiomeric excess, and racemic bupivacaine in peridural anesthesia for lower abdominal surgery

JUSTIFICATIVA E OBJETIVOS: Com a finalidade de encontrar um anestésico local mais seguro que a bupivacaína, vários estudos em animais foram realizados com seus isômeros. Este estudo teve como objetivo avaliar a eficácia da bupivacaína em excesso enantiomérico de 50 por cento, comparada à levobupivacaína e à bupivacaína racêmica, na anestesia peridural em pacientes submetidos à cirurgia de abdômen inferior, pelo período de uma hora após a injeção das soluções. MÉTODO: Após aprovação pelo Comitê de Ética em Pesquisa, participaram deste estudo, aleatório e duplamente encoberto, 87 pacientes com idade entre 18 e 65 anos, estado físico ASA I e II submetidos à cirurgia de abdômen inferior. Foram distribuídos em três grupos que receberam fracionadamente solução contendo 27 mL (incluindo a dose-teste) de anestésico local com adrenalina (1:200.000) e fentanil (100 æg). O grupo I recebeu solução de levobupivacaína a 0,5 por cento, o grupo II recebeu solução de bupivacaína em excesso enantiomérico de 50 por cento a 0,5 por cento e o grupo III recebeu solução de bupivacaína a 0,5 por cento. Os pacientes foram monitorizados por meio de oxímetro de pulso, cardioscópio e pressão arterial não-invasiva. Foram investigadas as características motoras e sensitivas do bloqueio anestésico, bem como a incidência de efeitos colaterais. Os frascos de anestésico local foram preparados sem identificação, numerados e somente ao final do estudo a lista de distribuição aleatória foi aberta. RESULTADOS: Não foram observadas diferenças significativas com relação à altura e estado físico. Diferença demográfica significativa foi encontrada em relação à idade no grupo I. Os parâmetros hemodinâmicos foram semelhantes entre os grupos. Houve diferença significativa em relação à intensidade do bloqueio motor relatado entre os grupos estudados (menor intensidade no grupo I comparada aos grupos II e III). CONCLUSÕES: Foram observados adequados bloqueios motor e sensitivo para a realização da cirurgia nos grupos estudados com poucos efeitos colaterais, sugerindo que as soluções são eficazes na anestesia peridural para cirurgia de abdômen inferior. A levobupivacaína apresentou menor bloqueio motor que os outros dois grupos.

Levobupivacaine 0.5%, 50% enantiomeric excess bupivacaine and racemic bupivacaine in epidural anesthesia for lower abdominal procedures. Comparative study.

BACKGROUND AND OBJECTIVES: With the purpose of finding a local anesthetic agent safer than racemic bupivacaine, several animal studies have been performed with its isomers. This study aimed at evaluating, for one hour after injection, the efficacy of 50% enantiomeric excess bupivacaine as compared to levobupivacaine and racemic bupivacaine for epidural anesthesia in patients submitted to lower abdominal procedures. METHODS: After the Research Ethics Committee approval, 87 patients aged 18 to 65 years, physical status ASA I and II, undergoing lower abdominal procedures were included in this randomized double-blind study. Patients were distributed in three groups which received 27 mL (including test dose) of local anesthetics with epinephrine (1:200,000) and fentanyl (100 microg) solutions. Group I was given 0.5% levobupivacaine, group II received 50% enantiomeric excess 0.5% bupivacaine, and group III received 0.5% bupivacaine. Monitoring consisted of pulse oximetry, cardioscopy and noninvasive blood pressure. Motor and sensory block profiles were evaluated, in addition to the incidence of side effects. Unidentified local anesthetic vials were numbered, and the randomized distribution list was opened only at the end of the experiment. RESULTS: There were no significant differences regarding height and physical status between groups. There was a significant age difference in group I. Hemodynamic parameters were similar between groups. Motor block intensity was significantly lower in group I as compared to groups II and III. CONCLUSIONS: All groups presented adequate motor and sensory block for surgery, with few side effects, suggesting that these solutions are effective for epidural anesthesia for lower abdominal procedures. Levobupivacaine produced less motor block as compared to the other compounds.

Sintomas neurológicos transitórios após raquianestesia: [revisão] / Transient neurological symptoms after spinal anesthesia: [review]

JUSTIFICATIVA E OBJETIVOS: Os sintomas neurológicos transitórios têm sido descritos em pacientes submetidos à raquianestesia sem outras complicações, após completa recuperação do bloqueio espinhal. Este estudo tem por objetivo apresentar uma revisão sobre o assunto. CONTEUDO: São apresentados a história, incidência, possíveis etiologias, fatores de risco e tratamento dos sintomas neurológicos transitórios. CONCLUSÕES: A raquianestesia é bastante segura e a incidência destes sintomas é relativamente baixa, não justificando o abandono da técnica anestésica, bem como o uso da lidocaína.

BACKGROUND AND OBJECTIVES: Transient neurological symptoms have been described in patients submitted to spinal anesthesia without other complications, after total spinal block recovery. This study aimed at reviewing this subject. CONTENTS: Transient neurological symptoms history, incidence, possible etiologies, risk factors and treatment are presented. CONCLUSIONS: Spinal anesthesia is a very safe procedure with a low incidence of these symptoms, not justifying abandoning the technique as well as lidocaine.

JUSTIFICATIVA Y OBJETIVOS: Los síntomas neurológicos transitorios han sido descritos en pacientes sometidos a raquianestesia sin más complicaciones, después de la completa recuperación del bloqueo espinal. Este estudio tiene por objetivo presentar una revisión sobre el asunto. CONTENIDO: Son presentados la historia, incidencia, posibles etiologías, factores de riesgo y tratamiento de los síntomas neurológicos transitorios. CONCLUSIONES: La raquianestesia es bastante segura y la incidencia de estos síntomas es relativamente baja, no justificando el abandono de la técnica anestésica, bien como el uso de la lidocaína.

Transient neurological symptoms after spinal anesthesia.

BACKGROUND AND OBJECTIVES: Transient neurological symptoms have been described in patients submitted to spinal anesthesia without other complications, after total spinal block recovery. This study aimed at reviewing this subject. CONTENTS: Transient neurological symptoms history, incidence, possible etiologies, risk factors and treatment are presented. CONCLUSIONS: Spinal anesthesia is a very safe procedure with a low incidence of these symptoms, not justifying abandoning the technique as well as lidocaine.

Substâncias carreadoras de oxigênio à base de hemoglobina: situação atual e perspectivas / Hemoglobin-based blood substitutes: current status and perspectives

JUSTIFICATIVA E OBJETIVOS: Soluções alternativas à transfusäo de sangue têm sido estudadas desde a década de 50. O objetivo deste estudo é apresentar a situaçäo atual e as perspectivas futuras das substâncias carreadoras de oxigênio à base de hemoglobina. CONTEUDO: São apresentadas as potenciais áreas de aplicaçäo, bem como estudos clínicos envolvendo as principais moléculas de hemoglobina desenvolvidas, suas vantagens e limitações. CONCLUSÕES: Vários estudos aleatórios demonstraram eficácia com o propósito de evitar ou reduzir a transfusäo sangüínea; entretanto, algumas limitações existem, sendo que o futuro substituto sangüíneo deverá, no mínimo, retratar a segurança e a eficácia do sangue em si

Estudo comparativo entre a Bupivacaína a 0, 5% e a mistura enantiomérica de Bupivacaína (S75-R25) a 0,5% em anestesia peridural em pacientes submetidos a cirurgia ortopédica de membros inferiores / Comparative study of 0.5% Bupivacaine versus 0.5% Bupivacaine enantiomeric mixture (S75-R25) in epidural anesthesia for orthopedic surgery

JUSTIFICATIVA E OBJETIVOS: Com a finalidade de encontrar uma droga mais segura que a bupivacaína, vários estudos em animais foram realizados com seus isômeros. Este estudo tem como objetivo avaliar a eficácia da mistura enantiomérica de bupivacaína (S75-R25) a 0,5 por cento comparada a bupivacaína a 0,5 por cento na anestesia peridural em pacientes submetidos à cirurgia ortopédica de membros inferiores. MÉTODO: Participaram deste estudo, aleatório e duplamente encoberto, 38 pacientes, com idades entre 17 e 69 anos, estado físico ASA I e II, submetidos à cirurgia ortopédica de membros inferiores, distribuídos em dois grupos: Grupo B, que recebeu 30 ml de uma soluçäo de bupivacaína a 0,5 por cento, e Grupo MEB, que recebeu 30 ml de uma soluçäo da mistura enantiomérica de bupivacaína (S75-R25) a 0,5 por cento. Foram investigadas as características motoras e sensoriais do bloqueio anestésico, bem como a incidência de efeitos colaterais. RESULTADOS: Houve diferença significativa em relaçäo ao peso no grupo MEB. Os parâmetros hemodinâmicos foram semelhantes entre os grupos. Näo houve diferença significativa em relaçäo ao tempo necessário para atingir a maior intensidade de bloqueio motor e a altura do bloqueio sensitivo. O tempo de regressäo do bloqueio motor foi semelhante entre os dois grupos. A intensidade do bloqueio motor na escala de Bromage 2 foi maior no grupo MEB. CONCLUSÕES: Foram observados adequados bloqueios motor e sensitivo para a realizaçäo da cirurgia em ambos os grupos, com poucos efeitos colaterais, sugerindo que as soluções säo seguras na anestesia peridural para cirurgia ortopédica

Mastopexia associada à inclusão de próptese mamária / Mastopexy associated with inclusion of mammary protheses

The authors describe the association of mastopexy and inclusion of silicone implants in l7 patients. The major indication is for hypoplastic breasts with slight or moderate ptoses, and adequate skin texture, The authors describe the surgical technique emphasizing access routes. They review the advantages and disavantages of the association and conclude that although periareolar mastopexy scar retouching may be necessary, result are generally gratifying

[Comparative study of 0.5% bupivacaine versus 0.5% bupivacaine enantiomeric mixture (S75-R25) in epidural anesthesia for orthopedic surgery]. / Estudo Comparativo entre a bupivacaína a 0,5% e a mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural em pacientes submetidos a cirurgia ortopédica de membros inferiores.

BACKGROUND AND OBJECTIVES: With the objective of finding a safer drug than racemic bupivacaine, several animal studies were performed with its enantiomers. This study aimed at evaluating the efficacy of 0.5% bupivacaine enantiomeric mixture (S75-R25) as compared to 0.5% bupivacaine in lumbar epidural anesthesia for lower limb orthopedic surgery. METHODS: Participated in this randomized double-blind study 38 adult patients, aged 17 to 69 years, physical status ASA I and II submitted to lower limb orthopedic surgery, who were distributed in two groups: Group B - 30 ml of 0.5% bupivacaine and Group BEM - 30 ml of 0.5% bupivacaine enantiomeric mixture (S75-R25). Sensory and motor block characteristics were investigated, in addition to the incidence of side effects. RESULTS: There have been significant weight differences in group BEM. Hemodynamic parameters were similar in both groups. There were no differences in time to reach Bromage score and peak block height. Also time to total motor block regression was similar between groups. There has been a significant difference in Bromage 2 score between groups, which was higher in group BEM. CONCLUSIONS: Adequate sensory and motor block for surgery was achieved in both groups with few side effects, suggesting that both solutions are safe in lumbar epidural anesthesia for orthopedic surgery.

[Hemoglobin-based blood substitutes: current status and perspectives]. / Substâncias carreadoras de oxigênio à base de hemoglobina: situação atual e perspectivas.

BACKGROUND AND OBJECTIVES: Alternatives to red blood cells transfusion have been studied since the fifties. This study aimed at presenting current status and perspectives of hemoglobin-based blood substitutes. CONTENTS: Potential application areas are presented, in addition to clinical studies involving major hemoglobin molecules developed, their advantages and limitations. CONCLUSIONS: Several randomized trials have shown efficacy in avoiding or decreasing red blood cells transfusions, however there are some limitations and the future blood substitute shall at least have the same safety and efficacy of blood itself.

Intensidade da dor à injeçäo subcutânea de lidocaína isoladamente ou associada ao bicarbonato de sódio / Pain intensity after subcutaneous injection of lidocaines or lidocaine bicarbonate association

Justificativa e Objetivos: Em muitas instituiçöes é rotina para o anestesiologista a realizaçäo de anestesia subcutânea antes da inserçäo do cateter venoso. Os anestésicos locais podem causar dor à infiltraçäo. O objetivo deste estudo visa determinar à injeçäo subcutânea de lidocaína a 1 por cento, com bicarbonato de sódio e soluçäo fisiológica. Método: participaram deste estudo, aletório e duplamente encoberto, quinze pacientes, com idades entre 22 e 51 anos, pesos entre 42 e 94 kg, estado físico ASA I e II. Foram excluídos os pacientes portaddores de neuropatia periférica, reaçäo de hipersensibilidade à lidocaína e gestantes. Com seringas previamente numeradas, cada paciente recebeu três injeçöes de lidocaína a 1 por cento, lidocaína a 1 por cento com bicarbonato e soluçäo fisiológica na camada subcutânea da face anterior do antebraço näo dominante, quatro centímetros abaixo da prega do cotovelo, utilizando-se agulha 27g. Após cada aplicaçäo, a dor foi avaliada por meio de escala visual analógica. Resultados: Näo foram observados diferenças significativas com relaçäo ao peso, idade, sexo e estado físico. A classificaçäo média da dor apresentada após a aplicaçäo de soluçäo fisiológica foi de 14,5 mm; lidocaína 1 por cento com bicarbonato foi de 16,8 mm e após lidocaína 1 por cento de 27,3 mm. Quando se comparam os três grupos os resultados säo estatisticamente significantes. Conclusöes: Os resultados encontrados sugerem que a lidocaína associada ao bicarbonato de sódio é um efetivo método de reduçäo da dor durante a infiltraçäo subcutânea de anestésico local

Determinaçäo da liberaçäo de histamina após uso de mivacúrio e rocurônio / Assessment of histamine release after rocuronium and mivacurium

Justificativa e objetivos: reaçöes que ocorrem durante a anestesia podem ser caracterizadas como anafiláticas ou anafilactóides. Os bloqueadores neuromusculares säo responsáveis por parte dessas reaçöes. O objetivo deste estudo visa determinar a evidência de liberaçäo de histamina, através da avaliaçäo hemodinâmica e laboratorial, após administraçäo de mivacúrio ou rocurônio, em doses utilizadas na prática clínica para intubaçäo traqueal. Método: paeticiparam do estudo trinta pacientes, com idades entre 18 e 70 anos, estado físico ASA I e II, distribuídos em dois grupos: grupo M (mivacúrio); grupo R (rocurônio). Os foram monitorados por meio de oximetria de pulso, cardioscopia e pressäo arterial invasiva. Foram avaliados os parâmetros cardiovasculares e a concentraçäo plasmática de histamina nos seguintes momentos: pré-induçäo anestésica (MO); após administraçäo de etomidato (M2); dois (M4) e quatro minutos (M6) após a injeçäo do bloqueador neurosmuscular (mivacúrio ou rocurônio). As amostras foram colhidas em seringas resfriadas e centrifugadas por 10 minutos à 1.500 rotaçöes por minuto em centrífuga à 4ºC. As alíquotas foram analisadas pelo método Elisa para determinaçäo da concentraçäo de histamina plasmática. Resultados: os dados hemodinâmicos: pressäo arterial sistólica, diastólica, média e frequencia cardíaca foram semelhantes entre os grupos estudados. Os níveis plasmáticos de histamina (nanomolar) nos diversos momentos foram: grupo R (MO=4,1 ñ1,05; M2=3,85 ñ1; M4=4,39 ñ1,93; M6=6,04ñ4,04) e grupo M (MO=3,95ñ1,47; M2=4,48ñ3,85; M4=11,09ñ15,6; M6=7,81ñ8,38), sem diferenças significativas entre os grupos. Quatro pacientes do grupo M e três do grupo R apresentaram aumento da concentraçäo plasmática de histamina em momentos diferentes do estudo, näo relacionados com a variaçäo hemodinâmica. Conclusöes: os resultados encontrados sugerem que é baixo o índice de liberaçäo de histamina após administraçäo, de rocurônio e mivacúrio, em um minuto, nas doses preconizadas para intubaçäo traqueal. Näo houve evidência de correlaçäo entre a liberaçäo de histamina e alteraçöes hemodinâmicas