ABSTRACT
JUSTIFICATIVA E OBJETIVOS: Exposto aos diversos fatores de riscos ocupacionais, o anestesiologista deve saber como vivenciar as situações relacionadas ao trabalho e à vida cotidiana para que o adoecimento não faça parte da sua realidade. O conhecimento do trabalho através do trabalhador é uma forma de buscar a fundo o universo que cerca o profissional para que soluções eficientes aumentem a satisfação e minimizem os danos. O objetivo desta investigação é traçar um perfil epidemiológico e ocupacional do anestesiologista de Belo Horizonte, Minas Gerais. MÉTODOS: Estudo quantitativo, transversal, aleatório entre os membros da Sociedade de Anestesiologia de Minas Gerais. Dados coletados através de questionário específico, incluindo o CAGE, para avaliação do alcoolismo, e o Self-Report Questionnaire (SRQ-20), para avaliação da prevalência dos transtornos mentais comuns (TMC). RESULTADOS: Houve um predomínio de homens (62,4%) trabalhando em esquema de plantão (91,1%), tanto diurno quanto noturno. A média de plantões noturnos foi de 5,4% nos últimos 30 dias. A maior parte deles (88,3%) em serviços de urgência. A maioria dos profissionais considerase muito cansada e sobrecarregada ou muito sobrecarregada, porém se diz realizada com o trabalho. Houve associação estatística entre CAGE positivo e sobrecarga de trabalho e entre esse e o SRQ-20. CONCLUSÕES: O universo estudado mostra o médico anestesiologista como um profissional bastante sobrecarregado, o que vai de encontro às tendências da profissão médica. Atenção importante deve ser dada a esse profissional, que vive cercado de danosos riscos ocupacionais.
BACKGROUND AND OBJECTIVES: Exposed to many occupational risk factors, the anesthesiologist should know how to experience situations related to work and everyday life, so that illness is not part of his reality. Knowledge of work through the worker himself is one way to look deeper into the universe surrounding health professionals in order to seek effective solutions that increase satisfaction and minimize damage. The objective of this paper was to outline an epidemiological and occupational profile of the anesthesiologist in Belo Horizonte, Minas Gerais. METHODS: Quantitative, cross-sectional randomized study conducted among members of the Society of Anesthesiology of Minas Gerais. Data collected through a questionnaire, including the CAGE, for evaluation of alcoholism and Self-Report Questionnaire (SRQ-20) to evaluate the prevalence of common mental disorders (CMD). RESULTS: There was predominance of male (62.4%) working on-call schedule (91.1%), both day and at night. The average number of night shifts was 5.4% in the last 30 days. Most of them (88.3%) working in emergency departments. Most professionals reported being very tired and overloaded or very overloaded, but satisfied with the work. There was statistical association between CAGE positive and work overload and between CAGE and SRQ-20. CONCLUSIONS: The population studied indicates that the anesthesiologist is a professional rather overloaded, which corroborates trends seen in the medical field. Major attention should be given to these professionals who live surrounded by harmful occupational hazards.
JUSTIFICATIVA Y OBJETIVOS: Estando expuesto a los diversos factores de riesgos ocupacionales, el anestesiólogo debe saber cómo vivir las situaciones relacionadas con el trabajo y con la vida cotidiana para que la enfermedad no forme parte de su realidad. El conocimiento del trabajo por medio del trabajado es una forma de buscar en profundidad el universo que cerca al profesional para que soluciones eficientes aumenten la satisfacción y disminuyan los daños. El objetivo de nuestra investigación es trazar un perfil epidemiológico y ocupacional del anestesiólogo de Belo Horizonte, Minas Gerais. MÉTODOS: Estudio cuantitativo, transversal y randomizado entre los miembros de la Sociedad de Anestesiología de Minas Gerais. Datos recolectados por medio de un cuestionario específico, incluyendo el CAGE, para la evaluación del alcoholismo y el Self-Report Questionnaire (SRQ-20), para la evaluación de la prevalencia de los trastornos mentales comunes (TMC). RESULTADOS: Se registró un predominio de hombres (62,4%) trabajando en un sistema de guardias (91,1%) tanto diurno como nocturno. El promedio de guardias nocturnas fue del 5,4% en los últimos 30 días. La mayor parte de ellas (88,3%) fue en servicios de urgencia. La mayoría de los profesionales se considera muy cansado y con mucha sobrecarga, pero dicen estar realizados con el trabajo. Hubo una asociación estadística entre CAGE positivo y la sobrecarga de trabajo y entre ése y el SRQ-20. CONCLUSIONES: El universo estudiado nos trae una panorámica del médico anestesiólogo como siendo un profesional bastante sobrecargado, lo que se choca con las tendencias de la profesión médica. Una atención importante se le debe dar a ese profesional, que vive rodeado de altos y perjudiciales riesgos ocupacionales.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anesthesiology , Occupational Health , Occupational Diseases/epidemiology , Brazil , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND AND OBJECTIVES: Exposed to many occupational risk factors, the anesthesiologist should know how to experience situations related to work and everyday life, so that illness is not part of his reality. Knowledge of work through the worker himself is one way to look deeper into the universe surrounding health professionals in order to seek effective solutions that increase satisfaction and minimize damage. The objective of this paper was to outline an epidemiological and occupational profile of the anesthesiologist in Belo Horizonte, Minas Gerais. METHODS: Quantitative, cross-sectional randomized study conducted among members of the Society of Anesthesiology of Minas Gerais. Data collected through a questionnaire, including the CAGE, for evaluation of alcoholism and Self-Report Questionnaire (SRQ-20) to evaluate the prevalence of common mental disorders (CMD). RESULTS: There was predominance of male (62.4%) working on-call schedule (91.1%), both day and at night. The average number of night shifts was 5.4% in the last 30 days. Most of them (88.3%) working in emergency departments. Most professionals reported being very tired and overloaded or very overloaded, but satisfied with the work. There was statistical association between CAGE positive and work overload and between CAGE and SRQ-20. CONCLUSIONS: The population studied indicates that the anesthesiologist is a professional rather overloaded, which corroborates trends seen in the medical field. Major attention should be given to these professionals who live surrounded by harmful occupational hazards.
Subject(s)
Anesthesiology , Occupational Diseases/epidemiology , Occupational Health , Adult , Aged , Brazil , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
BACKGROUND AND OBJECTIVES: Amyotrophic lateral sclerosis starts between the fifth and sixth decades of life, causing degeneration and death of upper and lower motor neurons. When the muscles responsible for ventilation are affected, the patient dies of respiratory failure within a few years. CASE REPORT: This is a 63 years old female with amyotrophic lateral sclerosis who underwent surgical treatment of a transtrochanteric fracture of the femur. The patient presented weakness of upper and lower limbs and dysarthria, and she was awake and oriented. Respiratory function: ineffective cough, decreased strength of the intercostal muscles and diaphragm, and reduction of the breath sounds in both lung bases. Initially, the L3/L4 epidural space was punctured and a silicon catheter was introduced to 5 cm. This was followed by a spinal puncture in the L4/L5 space and the administration of 7.5 mg of hyperbaric bupivacaine. This was followed by the administration of 37 mg of 0.37% ropivacaine through the epidural catheter for a sensitive blockade up to T10. The procedure evolved without complications and the patient was discharged from the hospital after three days. CONCLUSIONS: The evidence has demonstrated that neuroaxis blocks can be safely performed in patients with amyotrophic lateral sclerosis since it avoids manipulation of the airways and respiratory complications.
Subject(s)
Amyotrophic Lateral Sclerosis/complications , Anesthesia, Epidural , Anesthesia, Spinal , Hip Fractures/complications , Hip Fractures/surgery , Female , Humans , Middle Aged , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVES: Moebius sequence (MS) is a rare paralysis of the VI and VII cranial nerves. Craniofacial changes, which can hinder tracheal intubation considerably, are seen in approximately 90% of the patients. CASE REPORT: A male patient, 2 years and 5 months old, with MS, underwent flexible bronchoscopy for evaluation of laryngotracheomalacia. Comorbidities: bronchospasm and interventricular communication. Anesthesia was induced with sevoflurane in 100% O2, followed by venoclysis. A number 2.5 laryngeal AMBU mask was inserted and the fiberbronchoscope scope introduced through the mask. The procedure evolved without complications and bronchoscopy was normal. The patient was discharged home after two hours. CONCLUSIONS: Airways management is a great challenge in those patients with a report of failure or difficult intubation in 13 out of 41 patients. Micrognathia, retrognathia, mandibular hypoplasia, and palatine cleft are some of the manifestations seen in those patients. The use of a laryngeal mask was reported in one patient in a large series with 106 anesthesias in patients with MS. There does not seem to be contraindications to perform the procedure in an outpatient setting. Pulmonary aspiration and respiratory obstruction in the recovery room due to difficulty swallowing and eliminating mouth secretions have been reported, and the use of anti-sialagogues recommended.
Subject(s)
Anesthesia , Bronchoscopy , Mobius Syndrome , Anesthesia/methods , Child, Preschool , Humans , Male , Risk FactorsABSTRACT
JUSTIFICATIVA E OBJETIVOS: A sequência de Moebius (SM) é uma rara paralisia do VI e VII nervos cranianos. Alterações craniofaciais estão presentes em aproximadamente 90% destes pacientes, o que pode tornar a intubação traqueal muito difícil. RELATO DO CASO: Paciente do sexo masculino, 2 anos e 5 meses, portador de SM, submetido à broncoscopia flexível para avaliação de laringotraqueomalácia. Comorbidades: crises de broncoespasmo e comunicação interventricular. Realizou-se indução anestésica com sevoflurano em O2 a 100% e venóclise. Introduziu-se máscara laríngea AMBU® número 2,5 e o fibrobroncoscópio foi introduzido através da mesma. O procedimento foi realizado sem complicações e a broncoscopia revelou-se normal. O paciente recebeu alta para casa após duas horas. CONCLUSÕES: O controle das vias aéreas é o grande desafio nestes pacientes, havendo relato de falha ou dificuldade de intubação em 13 pacientes de uma série de 41 casos analisados. Micrognatia, retrognatia, hipoplasia mandibular e fenda palatina são algumas características destes pacientes. Em outra grande série com 106 anestesias em pacientes com SM há descrição do uso da máscara laríngea em um caso. Parece não haver contra-indicação a realizar o procedimento em regime ambulatorial. Há relato de aspiração pulmonar e obstrução respiratória na sala de recuperação devido à dificuldade em deglutir e eliminar as secreções da boca e recomenda-se administrar antisialogogos.
BACKGROUND AND OBJECTIVES: Moebius sequence (MS) is a rare paralysis of the VI and VII cranial nerves. Craniofacial changes, which can hinder tracheal intubation considerably, are seen in approximately 90% of the patients. CASE REPORT: A male patient, 2 years and 5 months old, with MS, underwent flexible bronchoscopy for evaluation of laryngotracheomalacia. Comorbidities: bronchospasm and interventricular communication. Anesthesia was induced with sevoflurane in 100% O2, followed by venoclysis. A number 2.5 laryngeal AMBU mask was inserted and the fiberbronchoscope scope introduced through the mask. The procedure evolved without complications and bronchoscopy was normal. The patient was discharged home after two hours. CONCLUSIONS: Airways management is a great challenge in those patients with a report of failure or difficult intubation in 13 out of 41 patients. Micrognathia, retrognathia, mandibular hypoplasia, and palatine cleft are some of the manifestations seen in those patients. The use of a laryngeal mask was reported in one patient in a large series with 106 anesthesias in patients with MS. There does not seem to be contraindications to perform the procedure in an outpatient setting. Pulmonary aspiration and respiratory obstruction in the recovery room due to difficulty swallowing and eliminating mouth secretions have been reported, and the use of anti-sialagogues recommended.
JUSTIFICATIVA Y OBJETIVOS: La secuencia de Moebius (SM) es una rara parálisis del VI y VII nervios cranianos. Las alteraciones craneofaciales están presentes en aproximadamente un 90% de esos pacientes, lo que puede hacer con que la intubación traqueal sea muy difícil. RELATO DEL CASO: Paciente del sexo masculino, 2 años y 5 meses, portador de SM, sometido a la broncoscopia flexible para la evaluación de laringotraqueomalacia. Comorbidades: crisis de broncoespasmo y comunicación interventricular. Se realizó la inducción anestésica con sevoflurano en O2 a 100% y venoclisis. Se introdujo la máscara laríngea AMBU® número 2,5 y el fibrobroncoscopio fue introducido a través de ella. El procedimiento fue realizado sin complicaciones y la broncoscopia fue normal. El paciente recibió alta después de dos horas. CONCLUSIONES: El control de las vías aéreas es el gran reto para esos pacientes, habiendo relatos de falla o de dificultad de intubación en 13 pacientes de una serie de 41 casos analizados. Micrognatia, retrognatia, hipoplasia mandibular y la hendidura palatina, son algunas de las características de esos pacientes. En otra gran serie con 106 anestesias en pacientes con SM, hay una descripción del uso de la máscara laríngea en un caso. En régimen ambulatorial, parece no haber contraindicación para realizar el procedimiento. Existe un relato de aspiración pulmonar y obstrucción respiratoria en la sala de recuperación, a causa de la dificultad de deglutir y eliminar las secreciones de la boca y para ese caso se recomienda administrar antisialogogos.
Subject(s)
Child, Preschool , Humans , Male , Anesthesia , Bronchoscopy , Mobius Syndrome , Anesthesia/methods , Risk FactorsABSTRACT
JUSTIFICATIVA E OBJETIVOS: A esclerose lateral amiotrófica é uma doença que se inicia entre a quinta e a sexta década de vida e provoca a degeneração e morte dos neurônios motores superiores e inferiores. Quando os músculos responsáveis pela ventilação são acometidos, o paciente evolui para o óbito em alguns anos em decorrência da insuficiência respiratória. RELATO DO CASO: Sexo feminino, 63 anos, esclerose lateral amiotrófica, submetida a tratamento cirúrgico de fratura transtrocantérica de fêmur. Quadro de fraqueza em membros superiores e inferiores, disartria, consciente e orientada. Aparelho respiratório: tosse ineficaz, diminuição da força dos músculos intercostais e diafragma e redução do murmúrio vesicular em bases pulmonares. Primeiramente, a punção peridural foi realizada em L3/L4, onde um cateter de silicone foi introduzido 5 cm. A seguir, a punção raquidiana foi feita em L4/L5 com administração de 7,5 mg de bupivacaína hiperbárica. Mais 37 mg de ropivacaína a 0,37% foram administrados pelo cateter peridural para que o bloqueio sensitivo alcançasse o dermátomo T10. O procedimento transcorreu sem complicações e a paciente recebeu alta hospitalar após três dias. CONCLUSÕES: As evidências têm demonstrado que a administração de bloqueios no neuroeixo parece ser segura em pacientes com esclerose lateral amiotrófica, pois evita a manipulação das vias aéreas e as complicações ventilatórias.
BACKGROUND AND OBJECTIVES: Amyotrophic lateral sclerosis starts between the fifth and sixth decades of life, causing degeneration and death of upper and lower motor neurons. When the muscles responsible for ventilation are affected, the patient dies of respiratory failure within a few years. CASE REPORT: This is a 63 years old female with amyotrophic lateral sclerosis who underwent surgical treatment of a transtrochanteric fracture of the femur. The patient presented weakness of upper and lower limbs and dysarthria, and she was awake and oriented. Respiratory function: ineffective cough, decreased strength of the intercostal muscles and diaphragm, and reduction of the breath sounds in both lung bases. Initially, the L3/L4 epidural space was punctured and a silicon catheter was introduced to 5 cm. This was followed by a spinal puncture in the L4/L5 space and the administration of 7.5 mg of hyperbaric bupivacaine. This was followed by the administration of 37 mg of 0.37% ropivacaine through the epidural catheter for a sensitive blockade up to T10. The procedure evolved without complications and the patient was discharged from the hospital after three days. CONCLUSIONS: The evidence has demonstrated that neuroaxis blocks can be safely performed in patients with amyotrophic lateral sclerosis since it avoids manipulation of the airways and respiratory complications.
JUSTIFICATIVA Y OBJETIVOS: La esclerosis lateral amiotrófica es una enfermedad que empieza entre la quinta y la sexta década de vida y que provoca la degeneración y la muerte de las neuronas motoras superiores e inferiores. Cuando los músculos responsables de la ventilación son acometidos, el paciente evoluciona a óbito en algunos años debido a la insuficiencia respiratoria. RELATO DEL CASO: Sexo femenino, 63 años, esclerosis lateral amiotrófica, sometida a tratamiento quirúrgico de fractura transtrocantérica de fémur. Cuadro de debilidad en los miembros superiores e inferiores, disartria, consciente y orientada. Aparato respiratorio: tos ineficaz, reducción de la fuerza de los músculos intercostales y diafragma y reducción del murmurio vesicular en bases pulmonares. Primeramente, la punción epidural fue realizada en L3/L4, donde un catéter de silicona fue introducido 5 cm. A continuación, la punción raquídea se hizo en L4/L5 con administración de 7.5 mg de bupivacaína hiperbárica. Más 37 mg de ropivacaína a 0,37% se administraron por el catéter epidural para que el bloqueo sensitivo llegase al dermatomo T10. El procedimiento transcurrió sin complicaciones y la paciente recibió alta tres días después. CONCLUSIONES: Las evidencias han demostrado que la administración de bloqueos de neuro eje, parece ser segura en pacientes con esclerosis lateral amiotrófica, pues evita la manipulación de las vías aéreas y las complicaciones ventilatorias.