Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy.

OBJECTIVE: To compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. STUDY DESIGN: Prospective, randomized, blinded, clinical trial. ANIMALS: A total of 29 female dogs with mammary tumors. METHODS: Premedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 µg kg-1 loading dose (LD) and 1 µg kg-1 hour-1; lidocaine 2 mg kg-1 LD and 3 mg kg-1 hour-1; ketamine 1 mg kg-1 LD and 0.6 mg kg-1 hour-1; n = 14] or FLK (fentanyl 5 µg kg-1 LD and 9 µg kg-1 hour-1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe'Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann-Whitney test. RESULTS: More dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe'Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. CONCLUSIONS AND CLINICAL RELEVANCE: Based on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

Complicaciones anestésicas en pacientes con quimioterapia neoadyuvante por cáncer de mama

Introducción: La quimioterapia previa o en curso puede presentar una amplia gama de interacciones, que aumentan el efecto clínico y la toxicidad de fármacos utilizados en quimioterapia, como los anestésicos. Objetivo: Evaluar la influencia de la anestesia sobre las pacientes con neoplasia de mama que recibieron o no quimioterapia neoadyuvante. Métodos: Se realizó un estudio cuasiexperimental, prospectivo, de corte longitudinal en el Servicio de Anestesiología y Reanimación del Hospital Clínico Quirúrgico Hermanos Ameijeiras, durante el período comprendido de enero de 2021 a enero de 2023. Resultados: La edad promedio fue 53,2 años en el Grupo I y 55,4 años en el II. En ambos grupos predominaron los pacientes ASA II, con 92,0 % en el I y 88,0 % en el II. El 92,0 % de las pacientes del Grupo I y el 96,0 % de los del Grupo II recibieron anestesia balanceada. La arritmia (20 %), seguida de prolongación del segmento QT, (4,0 %), la hipertensión arterial (4,0 %), la oliguria (16,0 %) y el dolor posoperatorio (12,0 %) fueron las complicaciones más frecuentes en los pacientes que recibieron quimioterapia neoadyuvante. En cuanto a la gravedad, en el 56 % de los pacientes fue severa. El 44 % de las complicaciones (arritmias, prolongación QT e hipertensión arterial y oliguria) aparecieron de manera mediata en el posoperatorio. Conclusiones: Se evaluó la influencia de la anestesia sobre las pacientes con neoplasia de mama que recibieron o no quimioterapia neoadyuvante, y se identificaron las complicaciones asociadas a la conducta anestésica.

Introduction: Drugs used for chemotherapy treatment in the cancer patient may increase the clinical effect and toxicity of anesthetics. Objective: To evaluate the clinical response of anesthesia in female patients operated on for breast cancer who received neoadjuvant chemotherapy. Methods: A quasiexperimental, prospective, longitudinal and controlled study was carried out at the anesthesiology and resuscitation service of Hospital Clínico Quirúrgico Hermanos Ameijeiras, during the period from January 2021 to January 2023. Results: Fifty patients were evaluated, whose average ages were 53.2 years in Group I and 55.4 years in Group II. Both groups were dominated by patients with American Society of Anesthesia Grade II criteria (92.0 % vs. 88.0 %). Balanced anesthesia was received by 92.0 % of the patients in Group I and 96.0 % of those in Group II. In terms of safety, arrhythmia (20.0 %), QT segment prolongation (4.0 %), arterial hypertension (4.0 %), oliguria (16.0 %) and postoperative pain (12.0 %) were predominant in relation to previous treatment. 56.0 % were grade IV or severe and 44.0 % (arrhythmias, QT prolongation and arterial hypertension and oliguria) had postoperative mediated onset. Conclusions: Complications due to anesthetic agents in patients with neoadjuvant chemotherapy for breast cancer are more frequent and severe. Complications were identified in relation to the administration of anesthesia.

Influence of Constant Rate Infusions of Fentanyl Alone or in Combination With Lidocaine and Ketamine on the Response to Surgery and Postoperative Pain in Isoflurane Anesthetized Dogs Undergoing Unilateral Mastectomy: A Randomized Clinical Trial.

The aim of this study was to compare the effects of constant rate infusions (CRI) of fentanyl alone or combined with lidocaine and ketamine (FLK), on physiological parameters, isoflurane requirements and the number of postoperative analgesic rescues in dogs undergoing unilateral mastectomy. Twenty-two dogs were premedicated with acepromazine 0.02 mg/kg and morphine 0.5 mg/kg and anesthetized with propofol and isoflurane. Dogs were randomly assigned to 1 of 2 groups: Fentanyl group (fentanyl 5 µg/kg loading dose [LD] and 9 µg/kg/h CRI; n = 11); FLK group (fentanyl [same doses]; lidocaine 2 mg/kg LD and 3 mg/kg/h CRI; ketamine 1.0 mg/kg LD and 0.6 mg/kg/h CRI; = 11). Intraoperative evaluations were performed before the start of surgery and administration of the treatments (T0); three minutes after the LD (T1); during incision and tissue divulsion (T2); during closure of the surgical wound (T3). Meloxicam (0.1 mg/kg) was administered at T3. Blood samples were collected for determination of plasma concentrations of fentanyl, lidocaine and ketamine. Pain scores and the number of postoperative analgesic rescues with morphine (0.5 mg/kg) were evaluated for 24 hours postoperatively using the short form of the Glasgow Composite Measure Pain Scale. Compared to T0, significant decreases in heart rate (from 84 ± 28 to 53 ± 16 bpm in the Fentanyl group and from 93 ± 16 to 63 ± 15 bpm in FLK) and mean arterial pressure (from 61 ± 5 to 49 ± 10 mmHg in Fentanyl and from 59 ± 3 to 38 ± 6 mmHg in FLK) were observed at T1. Arterial hypotension was transient, with normalization of values at T2 and T3. The expired fraction of isoflurane did not differ significantly between the groups. Plasma concentrations of fentanyl, lidocaine and ketamine remained within the therapeutic range. Postoperatively, the number of dogs requiring analgesic rescue was significantly lower in the FLK (0/11, 0%) than in the Fentanyl group (5/11, 45%). In dogs administered morphine and meloxicam as part of the anesthesia protocol, an intraoperative CRI of FLK abolished the requirement for postoperative analgesic rescue for 24 hours in dogs undergoing mastectomy.

Comparison of direct costs associated with the use of balanced general anesthesia and total intravenous anesthesia (TIVA) techniques / Comparación de los costos directos asociados al uso de técnicas de anestesia general balanceada y anestesia total intravenosa (TIVA)

Abstract Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.

Resumen Introducción: Los costos de la atención en salud son crecientes y se enfrentan a un escenario de recursos escasos. La realización de procedimientos quirúrgicos hace parte importante de la atención y del gasto en salud, el costo de las técnicas anestésicas utilizadas es relevante en el costo total de la atención y es un objetivo potencial para la optimización del gasto. Aunque a escala internacional se han reportado diferencias económicas importantes entre las alternativas para anestesia general, en Colombia no se cuenta con publicaciones que comparen los costos actuales y permitan una toma de decisiones informada y responsable económicamente. Objetivo: Cuantificar y comparar los costos directos para Colombia de las diferentes alternativas para anestesia general usadas con más frecuencia en la actualidad. Métodos: Análisis de minimización de costos basado en un modelo teórico de anestesia general balanceada con isoflurano, sevoflurano, desflurano en combinación con remifentanilo y TIVA (propofol y remifentanilo). Se obtuvieron resultados iniciales utilizando una simulación con un método determinista y se realizó un análisis de sensibilidad con una simulación de Montecarlo. Resultados: El costo total promedio por caso para las diferentes técnicas anestésicas fue de COP 126.381 para sevoflurano, COP 97.706 para isoflurano, COP 288.605 para desflurano y COP 222.960 para TIVA. Conclusiones: La anestesia general balanceada con desflurano es la alternativa de mayor costo, es 1,2 veces más costosa que la TIVA, y 2 y 3 veces más que la balanceada con sevoflurano e isoflurano, respectivamente. La TIVA ocupa el segundo lugar con un costo 1,8 veces superior a la balanceada con sevoflurano y 2,5 veces a la balanceada con isoflurano.

Dexmedetomidine-tiletamine-zolazepam followed by inhalant anesthesia in spectacled bears (Tremarctos ornatus)

Background: The spectacled bear (Tremarctos ornatus) is the only bear species inhabiting South America and is classified as vulnerable according to the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. Among the few publications on the use of general anesthesia and advanced monitoring of ursids in veterinary hospital settings, little is described regarding chemical restraint, general anesthesia and monitoring of spectacled bears. This case series describes the use of a dexmedetomidine-tiletamine-zolazepam chemical restraint combination and its effects on cardiorespiratory variables and arterial blood gases observed in two spectacled bears undergoing isoflurane anesthesia for imaging and/or surgical procedures. Cases: Two female, one adult and one senile, all-term captive spectacled bears were referred to the Veterinary Teaching Hospital at the Universidade Estadual Paulista - Unesp, Botucatu campus, both with a presumable history of recent trauma. After immobilization with an intramuscular (IM) administration of tiletamine-zolazepam (3.8 - 4.3 mg/kg) and dexmedetomidine (6.4 - 7.6 µg/kg), induction of anesthesia was achieved by means of intravenous (IV) propofol (1 - 2 mg/kg). After orotracheal intubation animals underwent isoflurane anesthesia under mechanical ventilation through the remainder of the procedures. Initial settings of inspiratory flow rate were adjusted to obtain peak airway pressure (Ppeak ) of 10 cmH2 O and tidal volumes (Vt) of 10 mL/kg, as well as respiratory rates (ƒR) and inspiration-to-expiration (I:E) ratio of 10 breaths/min and 1:2, respectively, and were then adjusted throughout anesthesia to maintain normocapnia (end-tidal carbon dioxide concentrations between 35 and 45 mmHg). One of the individuals was chemically restrained (6.4 mg/kg of tiletaminezolazepam and 7.7 µg/kg of dexmedetomidine) on a second anesthetic event for imaging...

Ventajas de la anestesia intravenosa libre de opioides en cirugía ambulatoria oncológica de mama / Advantages of opioid-free intravenous anesthesia over anesthesia in ambulatory breast cancer surgery

RESUMEN Introducción: la anestesia general libre de opioides surge ante la necesidad de evasión del uso de opioides en el transoperatorio y sus efectos indeseados en el posoperatorio. Objetivo: evaluar el comportamiento hemodinámico y la recuperación anestésica en pacientes intervenidas mediante cirugía ambulatoria por cáncer de mama, en las cuales se administró anestesia general total intravenosa libre de opioides o general balanceada. Métodos: se realizó un estudio cuasiexperimental, prospectivo en pacientes a las que se aplicó anestesia general balanceada (n=34) y total intravenosa libre de opioides (n=34) intervenidas quirúrgicamente por cáncer de mama, en el Hospital General Docente "Abel Santamaría Cuadrado", durante el 2018. Resultados: el grupo de anestesia general balanceada mostró mayor variación intraoperatoria de los parámetros evaluados, con diferencias significativas (p=0,019). El tiempo medio de despertar fue menor en el grupo de anestesia total intravenosa (2,10 ± 0,907 min vs 5,35 ± 1,250 min; p<0,01), al igual que el dolor, con diferencia significativa (p<0,05) y el tiempo de recuperación, donde una hora después de la intervención, el 85 % cumplía los criterios de alta anestésica. El retraso en el alta de la unidad de recuperación ocurrió principalmente por el bajo nivel de actividad motora, con mayor incidencia en el grupo de anestesia general balanceada (71 % vs 26 %; p=0,00). Conclusiones: la anestesia total intravenosa libre de opioides fue superior al método general balanceado, pues mostró mayor estabilidad hemodinámica y analgesia, menor incidencia de complicaciones posoperatorias y menor tiempo de estancia en sala de recuperación posanestésica.

ABSTRACT Introduction: opioid-free general anesthesia arises from the need to avoid the use of opioids in the transoperative period and the undesirable effects in the postoperative period. Objective: to assess the hemodynamic behavior and anesthetic recovery in patients who underwent ambulatory surgery for breast cancer and those who were given either opioid-free intravenous general or balanced general anesthesia. Methods: a quasi-experimental, prospective study was carried out on patients who received balanced general anesthesia (n=34) and total opioid-free intravenous anesthesia (n=34), who underwent breast cancer surgery at Abel Santamaria Cuadrado General Teaching Hospital during 2018. Results: the group of balanced general anesthesia showed greater intraoperative variation of the parameters assessed, with significant differences (p=0.019). The mean time of awakening was lower in the intravenous total anesthesia group (2.10 ± 0,907 min vs. 5,35 ± 1,250 min; p<0.01), as was pain, with significant difference (p<0.05) and the recovery time, where one hour after the surgery, 85 % met the criteria for anesthesia discharge. The delay in discharge from the recovery unit occurred mainly because of the low level of motor activity, with a higher incidence in the group of balanced general anesthesia (71% vs. 26 %; p=0.00). Conclusions: intravenous opioid-free total anesthesia was higher to the balanced general approach because it showed greater hemodynamic and analgesic stability, lower incidence of postoperative complications, and shorter time spent in the post-anesthesia recovery room.

Cumulative incidence and risks factors for postoperative nausea and vomiting in adult patients undergoing cholecystectomy under balanced general anesthesia: a prospective cohort study / Incidencia acumulada y factores de riesgo para náuseas y vómitos posoperatorios en pacientes adultos sometidos a colecistectomía bajo anestesia general balanceada: estudio prospectivo de cohorte

Abstract Introduction: Postoperative nausea and vomiting (PONV) are common issues arising after general anesthesia, for which several independent risk factors (RF) have been described. Objective: To determine the accumulated incidence of PONV during the first 24hours of the postoperative period. Methods: A cohort observational, prospective study was conducted that included all the adults undergoing cholecystectomy under balanced general anesthesia at the EsSalud Talara Hospital from October 2014 until December 2016. The presence of PONV during the first 24hours after surgery was assessed, and univariate, bivariate, and logistic regression analyses were conducted. Results: A total of 244 patients were included, most of them with 2 RFs in the Apfel scale, that represented an accumulated incidence of PONV of 0.51 (95% confidence interval [CI] 0.45-0.57) during the observation period, notwithstanding the fact that 85.25% received antiemetic prophylaxis. The logistic regression analysis identified that being a female (odds ratio [OR] 3.30,95% CI 1.66-6.55, P = 0.0007) and previous PONV or motion sickness (OR 2.67, 95% CI 1.25-5.68, P = 0.011) were independent RFs for PONV. The administration of antiemetic prophylaxis and the presence of PONV (P = 0.92) were found to be independent. Conclusion: The high cumulative incidence of PONV could be the result of the type of surgery, the use of volatile anesthetic agents, and errors in the antiemetic pharmacological prophylaxis.

Resumen Introducción: Las náuseas y vómitos posoperatorios (NVPO) son problemas comunes que aparecen luego de la anestesia general, para los que se han descrito varios factores independientes de riesgo. Objetivo: Determinar la incidencia acumulada de NVPO durante las primeras 24 horas del periodo posoperatorio. Métodos: Se realizó un estudio observacional prospectivo de cohorte que incluyó a todos los adultos sometidos a colecistectomía bajo anestesia general balanceada en el Hospital EsSalud Talara desde octubre de 2014 hasta diciembre de 2016. Se evaluó la presencia de NVPO durante las primeras 24 horas posoperatorias y se ejecutaron análisis univariado, bivariado y de regresión logística. Resultados: Se incluyeron 244 pacientes, la mayoría con dos factores de riesgo en la escala de Apfel, que presentaron una incidencia acumulada de NVPO de 0.51 (IC 95% 0.45-0.57) en el periodo de observación, a pesar de que el 85.25% recibió profilaxis antiemética. El análisis de regresión logística identificó la presencia de sexo femenino (OR 3.30, IC 95% 1.66-6.55, p = 0.0007) y la historia de NVPO previos o cinetosis (OR 2.67, IC 95% 1.25-5.68, p = 0.011) como factores de riesgo independientes para NVPO. Se halló independencia entre la presencia de profilaxis antiemética y la presencia de NVPO (p=0.92). Conclusiones: La alta incidencia acumulada de NVPO pudiera ser ocasionada por el tipo de cirugía, uso de anestésicos volátiles y falencias en la profilaxis farmacológica antiemética.

Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en Bucaramanga (Santander, Colombia) en el año 2017 / Postoperative cognitive dysfunction incidence for regional and general anesthesia in a level four institution in Bucaramanga (Santander, Colombia) during 2017 / Incidência do déficit cognitivo pós-operatório em anestesia regional e geral em uma instituição de quarto nível em Bucaramanga (Santander, Colômbia) em 2017

Introducción. En el proceso de envejecimiento, la mayoría de los sistemas orgánicos mantienen su funcionamiento basal, pero existe una reducción de la reserva funcional y de la capacidad para compensar el estrés fisiológico, lo que hace que los pacientes de mayor edad sean más propensos a complicaciones postoperatorias. Se realizó un estudio en instituciones de Bucaramanga para determinar la incidencia de déficit cognitivo postoperatorio y los factores de riesgo asociados. Metodología. Estudio observacional analítico de cohorte prospectivo realizado en instituciones de salud de Bucaramanga durante 2017 con pacientes mayores de 55 años intervenidos bajo anestesia regional, general balanceada o anestesia total intravenosa. Resultados. Se estudiaron 173 pacientes, 112 mujeres (64.74%) y 61 hombres (35.26%) operados. Las técnicas anestésicas más empleadas fueron: Regional (46.24%) y General balanceada (44.51%). La incidencia de Déficit Cognitivo Postoperatorio a corto plazo fue 6.36% en pacientes previamente sanos, con valor P significativo (0.001) ajustado. Se detectó deterioro cognitivo del 51.41% con alteraciones en los dominios de lenguaje, atención y memoria; con aumento en la evaluación a largo plazo. Durante el seguimiento de pacientes a largo plazo resultó en un 11.55%, determinando la incidencia de Déficit Cognitivo Postoperatorio tardío en un 17.91%. La técnica anestésica con mayor proporción de déficit a largo plazo fue la anestesia mixta, comparada con anestesia regional. Discusión. En la actualidad no existe una definición estandarizada de Déficit Cognitivo Postoperatorio, se ha observado mayor frecuencia y mayor prolongación en pacientes de edad avanzada. El estudio demostró una incidencia temprana significativamente menor, comparándolo con artículos internacionales, pero una incidencia mayor en déficit postoperatorio tardío, resultado de mayores complicaciones intraoperatorias, comparado con otros estudios. Conclusiones. El Déficit Cognitivo Postoperatorio involucra múltiples factores de riesgo; en el estudio se encontró mayor asociación con la edad, la escolaridad, la hipotensión y la anestesia general. No hubo asociación entre comorbilidades y el Déficit Cognitivo Postoperatorio. Se determinó la presencia de hipotensión para desarrollo de este déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introduction. Within the aging process, most organic systems maintain their basal functions. However, there is a reduction in functional reserve and the capacity to compensate physiological stress, which makes older patients more prone to postoperative complications. A study was performed in institutions in Bucaramanga to determine the incidence of postoperative cognitive dysfunction and the associated risk factors. Methodology. This was a analytical observational prospective cohort study performed in healthcare institutions in Bucaramanga in 2017 with patients older than 55 years of age under regional, balanced general or total intravenous anesthesia. Results. One hundred and seventy-three operated patients were studied, among which 112 (64.74%) were women and 61 (35.26%) were men. The most commonly used anesthetic techniques were: regional (46.24%) and balanced general (44.51%). Short-term Postoperative Cognitive Dysfunction incidence was 6.36% in previously healthy patients, with an adjusted significant P value (0.001). Cognitive deterioration was detected in 51.41% of patients, with alterations in their mastery of language, attention and memory. This increased for the long-term evaluation. During long-term patient follow-up, it resulted in 11.55%, determining the incidence of delayed Postoperative Cognitive Dysfunction at 17.91%. The anesthetic technique with the highest proportion of long- term dysfunction was mixed anesthesia, compared to regional anesthesia. Discussion. There is currently no standardized definition for Postoperative Cognitive Dysfunction. It has been observed more frequently and for longer extensions in older patients. The study demonstrated a significantly lower early incidence when compared to international articles, but a greater incidence of delayed postoperative dysfunction as a result of more intraoperative complications compared to other studies. Conclusions. Postoperative Cognitive Dysfunction involves multiple risk factors. The study observed a greater association with age, level of education, hypotension and general anesthesia. There was no association between comorbidities and Postoperative Cognitive Dysfunction. The presence of hypotension was determined for developing this dysfunction. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introdução. No processo de envelhecimento, a maioria dos sistemas orgânicos mantém seu funcionamento basal, mas há uma diminuição da reserva funcional e da capacidade de compensar o estresse fisiológico que torna os pacientes idosos mais sujeitos a complicações pós-operatórias. Foi realizado um estudo em instituições da cidade de Bucaramanga para determinar a incidência de déficit cognitivo pós-operatório e os fatores de risco associados. Métodos. Estudo observacional analítico de coorte prospectivo realizado em instituições de saúde em Bucaramanga durante o ano de 2017 em pacientes com idade superior a 65 anos operados sob anestesia regional, geral balanceada ou anestesia geral intravenosa. Resultados. Foram estudados 173 pacientes, 112 mulheres (64.74%) e 61 homens (35.26%) operados. As técnicas anestésicas mais utilizadas foram: regional (46.24%) e geral balanceada (44.51%). A incidência de déficit cognitivo pós-operatório de curto prazo foi de 6.36% em pacientes previamente saudáveis, com um valor P significativo (0.001) ajustado. Detectou- se deterioração cognitiva de 51.41% com alterações nos domínios da linguagem, atenção e memória; com aumento na avaliação de longo prazo. No seguimento a longo prazo dos pacientes resultou em 11.55%, determinando a incidência de déficit cognitivo pós-operatório tardio em 17.91%. A técnica anestésica com maior proporção de déficit no longo prazo foi a anestesia mista, em comparação com a anestesia regional. Discussão. Atualmente não existe uma definição padronizada de Déficit Cognitivo Pós-operatório, a qual observa-se com maior frequência e por mais tempo em pacientes idosos. O estudo demonstrou incidência precoce significativamente menor, em comparação com resultados de artigos internacionais, mas maior incidência de déficit pós-operatório tardio, resultado de maiores complicações intraoperatórias, em comparação com outros estudos. Conclusões. O Déficit Cognitivo Pós-operatório envolve múltiplos fatores de risco; o estudo encontrou maior associação com idade, escolaridade, hipotensão e anestesia geral. Não houve associação entre comorbidades e Déficit Cognitivo Pós-operatório. Determinou-se a presença de hipotensão para o desenvolvimento desse déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Anestesia em filhote de Veado-Catingueiro submetido a osteossíntese de Rádio e Ulna: relato de caso / Anesthesia in stag cathedral puppy submitted to osteosinthesis of radio and ulna: case report / Anestesia en cachorro de venado-catingueiro sometido a osteosíntesis de radio y ulna: relato de caso

Os estudos aplicados à anestesiologia em cervídeos no Brasil atualmente é exíguo, devido ao fato de existirem poucas espécies mantidas em cativeiro, o manejo ser de difícil acesso com elevadas taxas de mortalidade e aos altos custos para realização de estudos in situ. Contudo, o manejo de cervídeos vem sendo uma prática cada vez mais comum tanto ex situ como in situ. Em consequência disso, a utilização de protocolos anestésicos se torna indispensável para a realização de contenções químicas e procedimentos cirúrgicos. Neste último, muitas vezes se faz necessário a anestesia geral ou a anestesia balanceada. Este trabalho tem por objetivo relatar a anestesia de um filhote de veado-catingueiro (Mazama gouazoubira) submetido a osteossíntese de rádio e ulna, no qual foi administrada uma anestesia com a associação de agentes hipnóticos, opióides e bloqueio locorregional. O animal se manteve estável ao longo do trans e pós-anestésico,indicando sucesso ao protocolo de escolha.

The studies applied to anesthesiology in cervids in Brazil are currently very small, due to the fact that there are few species kept in captivity, management is difficult to access with high mortality rates and high costs for in situ studies. However, the management of cervids has become an increasingly common practice both ex situ and in situ. As a consequence, the use of anesthetic protocols becomes indispensable for the accomplishment of chemical restraints and surgical procedures. In the latter, general anesthesia or balanced anesthesia is often necessary. The objective of this study was to report the anesthesia of a young deer-catingueiro(Mazama gouazoubira) submitted to radio and ulna osteosynthesis, in which anesthesia was administered with the association of hypnotic agents, opioids and locoregional block. The animal remained stable throughout the trans and post-anesthetic, indicating success to the protocol of choice.

Los estudios aplicados a la anestesiología en cérvidos en Brasil actualmente son exiguos, debido al hecho de que existen pocas especies mantenidas en cautiverio, el manejo es de difícil acceso con altas tasas de mortalidad y los altos costos para realización de estudios in situ. Sin embargo, el manejo de los cérvidos es una práctica cada vez más común tanto ex situ como in situ. En consecuencia, la utilización de protocolos anestésicos se vuelve indispensable para la realización de contenciones químicas y procedimientos quirúrgicos. En este último, muchas veces se hace necesario la anestesia general o la anestesia balanceada. Este trabajo tiene por objetivo relatar la anestesia de un cachorro de venado-catingueiro (Mazama gouazoubira) sometido a osteosíntesis de radio y ulna, en el cual se administró una anestesia con la asociación de agentes hipnóticos, opioides y bloqueo locorregional. El animal se mantuvo estable a lo largo del trans y post-anestésico,indicando éxito al protocolo de elección.

Anestesia em filhote de Veado-Catingueiro submetido a osteossíntese de Rádio e Ulna: relato de caso / Anesthesia in stag cathedral puppy submitted to osteosinthesis of radio and ulna: case report / Anestesia en cachorro de venado-catingueiro sometido a osteosíntesis de radio y ulna: relato de caso

Os estudos aplicados à anestesiologia em cervídeos no Brasil atualmente é exíguo, devido ao fato de existirem poucas espécies mantidas em cativeiro, o manejo ser de difícil acesso com elevadas taxas de mortalidade e aos altos custos para realização de estudos in situ. Contudo, o manejo de cervídeos vem sendo uma prática cada vez mais comum tanto ex situ como in situ. Em consequência disso, a utilização de protocolos anestésicos se torna indispensável para a realização de contenções químicas e procedimentos cirúrgicos. Neste último, muitas vezes se faz necessário a anestesia geral ou a anestesia balanceada. Este trabalho tem por objetivo relatar a anestesia de um filhote de veado-catingueiro (Mazama gouazoubira) submetido a osteossíntese de rádio e ulna, no qual foi administrada uma anestesia com a associação de agentes hipnóticos, opióides e bloqueio locorregional. O animal se manteve estável ao longo do trans e pós-anestésico,indicando sucesso ao protocolo de escolha.(AU)

The studies applied to anesthesiology in cervids in Brazil are currently very small, due to the fact that there are few species kept in captivity, management is difficult to access with high mortality rates and high costs for in situ studies. However, the management of cervids has become an increasingly common practice both ex situ and in situ. As a consequence, the use of anesthetic protocols becomes indispensable for the accomplishment of chemical restraints and surgical procedures. In the latter, general anesthesia or balanced anesthesia is often necessary. The objective of this study was to report the anesthesia of a young deer-catingueiro(Mazama gouazoubira) submitted to radio and ulna osteosynthesis, in which anesthesia was administered with the association of hypnotic agents, opioids and locoregional block. The animal remained stable throughout the trans and post-anesthetic, indicating success to the protocol of choice.(AU)

Los estudios aplicados a la anestesiología en cérvidos en Brasil actualmente son exiguos, debido al hecho de que existen pocas especies mantenidas en cautiverio, el manejo es de difícil acceso con altas tasas de mortalidad y los altos costos para realización de estudios in situ. Sin embargo, el manejo de los cérvidos es una práctica cada vez más común tanto ex situ como in situ. En consecuencia, la utilización de protocolos anestésicos se vuelve indispensable para la realización de contenciones químicas y procedimientos quirúrgicos. En este último, muchas veces se hace necesario la anestesia general o la anestesia balanceada. Este trabajo tiene por objetivo relatar la anestesia de un cachorro de venado-catingueiro (Mazama gouazoubira) sometido a osteosíntesis de radio y ulna, en el cual se administró una anestesia con la asociación de agentes hipnóticos, opioides y bloqueo locorregional. El animal se mantuvo estable a lo largo del trans y post-anestésico,indicando éxito al protocolo de elección.(AU)

De la farmacocinética a la farmacodinámica, ¿estamos listos para los software 3D? / From pharmacokinetics to pharmacodynamics -Are we ready for 3D software?

Abstract The relationship between the dose and plasma concentration of a drug is determined by pharmacokinetics. However, difficulties arise when more than one drug is administered simultaneously. There is currently a gap in the teaching model when trying to convey the significance of pharmacodynamic interactions. In this article the authors reflect on the importance of developing a software that simplifies the pharmacokinetic concepts of two drugs, turning them into one single variable in space as a function of time. Together with depth of anesthesia monitoring and the pain control variables, this model will bring pharmacokinetics and pharmacodynamics together and provide a teaching tool for improved understanding of these concepts.

Resumen La relación entre la dosis y la concentración plasmática de un fármaco está determinada por la farmacocinética. Sin embargo, se presentan dificultades cuando hay más de un medicamento administrado de forma simultánea. En la actualidad hay un vacío en el modelo de enseñanza cuando se pretende difundir la importancia de las interacciones farmacodinámicas. En el presente artículo los autores hacen una reflexión sobre la importancia de poder construir un software que simplifique los conceptos farmacocinéticos de dos medicamentos, convirtiéndolos en una sola variable de espacio en función del tiempo. Este modelo permitiría, junto con la monitorización de la profundidad anestésica y las variables de control del dolor, acoplar la farmacocinética a la farmacodinámica, y brindaría una herramienta de educación para la comprensión de estos conceptos.

Bispectral index assessment in calves subjected to the continuous infusion of propofol combined with fentanyl administration / Indice biespectral em bezerros submetidos à infusão contínua de propofol associado ao fentanil

ABSTRACT: The aim of this study was to evaluate the bispectral index (BIS) effects in calves through continuous infusion of propofol with or without fentanyl. Eight Holstein male calves (ages from six to twelve months old) with an average weight of 123±18kg were used. All animals participated in both groups, always keeping a minimum interval of one week between the anesthetic procedures; the calves were randomly distributed between groups. Anesthesia was induced with an intravenous (IV) dose of propofol of 5mg kg-1 in control group (GP) or with propofol (4mg kg-1) associated with IV fentanyl 0.001mg kg-1(GF). All the calves were positioned in right lateral recumbency and were allowed to spontaneously breathe room air. Subsequently, the anesthesia was maintained by continuous infusion of propofol at the rate of 0.6mg kg-1 min-1 IV in GP, and associated with the infusion of fentanyl 0.001mg kg-1 hour-1 in GF. Measurements of BIS, signal quality index (SQI) and electromyography (EMG) were evaluated before anesthesia induction (TB), and at 15, 30, 45 and 60 minutes after the beginning of continuous drugs infusion (T15, T30, T45 and T60, respectively). The heart rate (HR), respiratory rate (f), end-tidal carbon dioxide tension (ETCO2) and recovery times were evaluated as well. No significant differences were observed between the groups in the BIS variables and the recovery time was longer in GF. Co-administration of propofol and fentanyl infusions, at the doses reported here, did not change the values of BIS in cattle, but delayed the recovery time.

RESUMO: O estudo teve por objetivo avaliar o índice biespectral (BIS) durante a infusão contínua de propofol associado ou não ao fentanil em bezerros. Foram utilizados oito animais machos entre seis e doze meses de idade, holandeses, com massa corporal média de 123±18kg. Todos os animais participaram de ambos os grupos, respeitando-se sempre um intervalo mínimo de uma semana entre uma anestesia e outra, sendo aleatoriamente distribuídos entre os grupos. A anestesia nos bezerros foi induzida com propofol na dose de 5mg kg-1; intravenoso (IV), grupo controle (GP) ou propofol 4mg kg-1 associado ao fentanil 0,001mg kg-1; IV, grupo fentanil (GF) e posicionados em decúbito lateral direito, onde permaneceram respirando espontaneamente ar ambiente. Ato contínuo, a manutenção anestésica foi realizada pela infusão contínua de propofol na taxa de 0,6mg kg-1 min-1; IV GP, associado ou não à infusão de fentanil 0.001mg kg-1 hora-1 GF. A mensuração das variáveis do BIS, índice de qualidade de sinal (IQS) eletromiografia (EMG), frequência cardíaca (FC), frequência respiratória (f) e dióxido de carbono ao final da expiração (ETCO2) foram avaliadas antes da indução anestésica no momento basal (MB), e 15, 30, 45 e 60 minutos após o início da infusão contínua dos fármacos (M15, M30, M45 e M60, respectivamente); o tempo de recuperação também foi avaliado. Não foram observadas diferenças significativas entre os grupos nas variáveis do BIS e o tempo de recuperação foi maior no GF. A co-administração das infusões de propofol e fentanil, nas doses utilizadas nesse estudo, não alterou os valores do BIS em bezerros, porém, prolongou o tempo de recuperação.

Bispectral index assessment in calves subjected to the continuous infusion of propofol combined with fentanyl administration / Indice biespectral em bezerros submetidos à infusão contínua de propofol associado ao fentanil

The aim of this study was to evaluate the bispectral index (BIS) effects in calves through continuous infusion of propofol with or without fentanyl. Eight Holstein male calves (ages from six to twelve months old) with an average weight of 123±18kg were used. All animals participated in both groups, always keeping a minimum interval of one week between the anesthetic procedures; the calves were randomly distributed between groups. Anesthesia was induced with an intravenous (IV) dose of propofol of 5mg kg-1 in control group (GP) or with propofol (4mg kg-1) associated with IV fentanyl 0.001mg kg-1(GF). All the calves were positioned in right lateral recumbency and were allowed to spontaneously breathe room air. Subsequently, the anesthesia was maintained by continuous infusion of propofol at the rate of 0.6mg kg-1 min-1 IV in GP, and associated with the infusion of fentanyl 0.001mg kg-1 hour-1 in GF. Measurements of BIS, signal quality index (SQI) and electromyography (EMG) were evaluated before anesthesia induction (TB), and at 15, 30, 45 and 60 minutes after the beginning of continuous drugs infusion (T15, T30, T45 and T60, respectively). The heart rate (HR), respiratory rate (f), end-tidal carbon dioxide tension (ETCO2) and recovery times were evaluated as well. No significant differences were observed between the groups in the BIS variables and the recovery time was longer in GF. Co-administration of propofol and fentanyl infusions, at the doses reported here, did not change the values of BIS in cattle, but delayed the recovery time.(AU)

O estudo teve por objetivo avaliar o índice biespectral (BIS) durante a infusão contínua de propofol associado ou não ao fentanil em bezerros. Foram utilizados oito animais machos entre seis e doze meses de idade, holandeses, com massa corporal média de 123±18kg. Todos os animais participaram de ambos os grupos, respeitando-se sempre um intervalo mínimo de uma semana entre uma anestesia e outra, sendo aleatoriamente distribuídos entre os grupos. A anestesia nos bezerros foi induzida com propofol na dose de 5mg kg-1; intravenoso (IV), grupo controle (GP) ou propofol 4mg kg-1 associado ao fentanil 0,001mg kg-1; IV, grupo fentanil (GF) e posicionados em decúbito lateral direito, onde permaneceram respirando espontaneamente ar ambiente. Ato contínuo, a manutenção anestésica foi realizada pela infusão contínua de propofol na taxa de 0,6mg kg-1 min-1; IV GP, associado ou não à infusão de fentanil 0.001mg kg-1 hora-1 GF. A mensuração das variáveis do BIS, índice de qualidade de sinal (IQS) eletromiografia (EMG), frequência cardíaca (FC), frequência respiratória (f) e dióxido de carbono ao final da expiração (ETCO2)foram avaliadas antes da indução anestésica no momento basal (MB), e 15, 30, 45 e 60 minutos após o início da infusão contínua dos fármacos (M15, M30, M45 e M60, respectivamente); o tempo de recuperação também foi avaliado. Não foram observadas diferenças significativas entre os grupos nas variáveis do BIS e o tempo de recuperação foi maior no GF. A co-administração das infusões de propofol e fentanil, nas doses utilizadas nesse estudo, não alterou os valores do BIS em bezerros, porém, prolongou o tempo de recuperação.(AU)

Anesthesia recovery comparison between remifentanil-propofol and remifentanil-desflurane guided by Bispectral Index® monitoring / Comparação da recuperação pós-anestésica entre remifentanil-propofol e remifentanil-desflurano guiada pela monitoração do Índice Bispectral®

Abstract Background and objectives There is a strong demand for fast and predictable anesthesia recovery with few side effects. Choice of the hypnotic agent could impact on that. This study investigated the differences between recoveries after remifentanil-propofol and remifentanil-desflurane anesthesias guided by bispectral index (BIS®). Methods Forty patients were randomly assigned into 2 groups according to the anesthesia technique applied: remifentanil-propofol (REM-PRO) and remifentanil-desflurane (REM-DES). After the discontinuation of the anesthetics, the times to extubation, to obey commands and to recover the airway protection reflex were recorted. In the post-anesthetic recovery room (PACU) it was recorded the occurrence of nausea and vomiting (PONV), scores of Ramsay sedation scale and of numeric pain scale (NPS), morphine dose and length of stay in the unit. Results Data from 38 patients were analyzed: 18 from REM-PRO and 20 from REM-DES group. Anesthesia times were similar (REM-PRO = 193 min, SD 79.9 vs. 175.7 min, SD 87.9 REM-DES; p = 0.5). REM-DES had shorter times than REM-PRO group: time to follow command (8.5 min; SD 3.0 vs. 5.6 min; SD 2.5; p = 0.0) and extubation time (6.2 min; 3.1-8.5 vs. 9.5 min; 4.9-14.4; p = 0.0). Times to recover airway protective reflex were similar: 16 patients from REM-PRO (88.9%) restored the airway protective reflex 2 min after extubation vs. 17 from REM-DES (89.5%); and 2 patients from REM-PRO (11.1%) vs. 2 from REM-DES (10.5%) 6 min after extubation, p = 1. Ramsay sedation score, NPS, PONV incidents, morphine dose and PACU stay of length PACU were also similar. Conclusion Remifentanil-desflurane-based anesthesia has a faster extubation time and to follow command than remifentanil-propofol-based anesthesia when both guided by BIS®.

Resumo Justificativa e objetivos Há uma forte demanda por recuperação pós-anestésica rápida e previsível com poucos efeitos adversos. A escolha do agente hipnótico pode influenciar isso. Este estudo investigou as diferenças da recuperação no pós-operatório entre as técnicas anestésicas com remifentanil-propofol e com remifentanil-desflurano ambas com monitoração guiada pelo índice bispectral (BIS ®). Métodos Foram randomicamente distribuídos 40 pacientes em dois grupos de acordo com a técnica anestésica aplicada: remifentanil-propofol (REM-PRO) e remifentanil-desflurano (REM-DES). Após a descontinuação dos anestésicos foram registrados os tempos para extubação, obedecer a comandos e recuperar o reflexo de proteção das vias aéreas. Na sala de recuperação pós-anestésica (SRPA) foi registrado a ocorrência de náuseas e vômitos (NVPO), os escores na escala de sedação de Ramsay e na escala numérica de dor (END), a dose de morfina utilizada e o tempo de permanência nesta unidade. Resultados Os dados de 38 pacientes foram analisados: 18 do grupo REM-PRO e 20 do grupo REM-DES. Os tempos de anestesia foram semelhantes (REM-PRO = 193 minutos, DP 79,9 vs. 175,7 minutos, DP 87,9 REM-DES; p = 0,5). O grupo REM-DES apresentou tempos mais curtos do que o grupo REM-PRO: tempo para obedecer a comandos (8,5 minutos; DP 3,0 vs. 5,6 minutos; DP 2,5; p = 0,0) e tempo de extubação (6,2 minutos; 3,1-8,5 vs. 9,5 minutos; 4,9-14,4; p = 0,0). Os tempos para recuperação do reflexo de proteção das vias aéreas foram semelhantes: 16 pacientes do grupo REM-PRO (88,9%) recuperaram o reflexo de proteção das vias aéreas dois minutos após a extubação vs. 17 do grupo REM-DES (89,5%) e dois pacientes do grupo REM-PRO (11,1%) vs. dois do REM-DES (10,5%) seis minutos após a extubação, p = 1. Os escores de Ramsay, NPS, a incidência de NVPO, a dose de morfina e o tempo de permanência na SRPA também foram semelhantes. Conclusão A anestesia com remifentanil-desflurano tem um perfil de recuperação da anestesia pós-anestésica mais rápido do que o da anestesia com remifentanil-propofol quando ambas guiadas pelo BIS®.

Effects of nitrous oxide on cardiovascular parameters in pigs anesthetized with propofol and subjected to pressure-controlled ventilation / Efeitos do óxido nitroso sobre parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação controlada à pressão

This paper evaluated the effects of the ratio of nitrous oxide to oxygen (50% of each) on cardiovascular parameters in pigs anesthetized with propofol and maintained in ventilation with intermittent positive pressure. Sixteen Large White pigs, weighing between 15 and 20 kg, were divided into two groups of eight animals, and designated as follows: GPN (propofol/nitrous oxide) and GPA (propofol/compressed air). In order to allow endotracheal intubation, the animals received azaperone (2 mg kg-1, IM) followed, after 20 minutes, by intravenous propofol. After successful intubation, continuous infusion of propofol was initiated at a dose of 0.4 mg kg-1minute-1. From this point, the GPN group received N2O (diluted in 50% oxygen), while the GPA group received compressed air (diluted in 50% oxygen). Rocuronium was then administered by continuous intravenous infusion at 0.6 mg kg-1h-1. Pressure-controlled ventilation (PCV) was started and adjusted to 15 cmH2O, and the respiratory rate was set to reach capnometry readings between 35-45 mmHg. The measurement of parameters (heart rate, mean arterial pressure, cardiac index, systemic vascular resistance index, stroke index) begun 15 minutes after the administration of rocuronium, and was repeated in 15-minute intervals for 60 minutes. Data were statistically analyzed by ANOVA followed by Bonferroni test. The results showed that the 1:1 ratio combination of nitrous oxide to oxygen (50% each) did not alter the mentioned parameters in pigsanesthetized with propofol and maintained at pressure-controlled ventilation, indicating that it is a safeprotocol for the cardiovascular system.(AU)

Objetivou-se com este trabalho avaliar os efeitos da associação de óxido nitroso (N2O) ao oxigênio, na proporção de 50% cada, sobre os parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação com pressão positiva intermitente. Para isso, foram utilizados 16 suínos da raça Large White com pesos entre 15 e 20 kg, distribuídos em dois grupos de oito animais cada, assim nomeados: GPN (GrupoPropofol/Óxidonitroso) e GPA (GrupoPropofol/Arcomprimido). Os animais receberam azaperona (2mgkg-1,IM) e após 20 minutos, administrou-se propofol por via intravenosa, em doses suficientes para permitir a intubação traqueal. Após intubação, iniciou-se a infusão contínua de propofol na dose de 0,4mgkg-1minuto-1. A partir deste momento, os animais do GPN receberam N2O diluído em 50% de oxigênio e os do GPA, ar comprimido diluído em 50% de oxigênio. Ato contínuo, administrou-se, por infusão intravenosa contínua, rocurônio a 0,6mgkg-1h-1. A ventilação controlada a pressão (VCP) foi iniciada e ajustada a 15cmH2O e a freqüência respiratória foi regulada para alcançar valores de capnometria entre 35-45mmHg. A medição dos parâmetros (freqüência cardíaca, pressão arterial média, índice cardíaco, índice da resistência periférica total, índice sistólico) iniciou-se após 15 minutos da administração de rocurônio, repetindo-se a cada 15 minutos, durante um intervalo de 60 minutos. Os dados foram submetidos à análise estatística pela ANOVA seguida pelo teste de Bonferroni.Os resultados mostraram que a associação do óxido nitroso ao oxigênio na proporção de 50% cada emsuíno anestesiado com propofol e mantido em ventilação controlada à pressão não provoca alteraçõescardiovasculares clinicamente relevantes.(AU)

Principles of anesthesia for craniotomy in awake patients / Principios de la anestesia para craneotomía en paciente vigil

La realización de una craneotomía con el paciente despierto se está utilizando cada vez más en diversas situaciones, como en neurocirugía funcional sobre la estimulación cerebral para tratar la enfermedad de Parkinson y la cirugía para tratar la epilepsia, así como los procedimientos neuroquirúrgicos destinadas a resección de tumores cerebrales en áreas elocuentes. Los principios anestésicos para realizar la craneotomía despierta tienen el objetivo de realización de una analgesia adecuada,sedación, la estabilidad hemodinámica sistémica y la permeabilidad de la vía aérea con el tipo de procedimiento neuroquirúrgico a realizar. El objetivo de este estudio es revisar los principios que rigen la conducta de la anestesia para la neurocirugía que es necesario para lograr la craneotomía con el paciente despierto.

Craniotomy in awake patients is becoming more widely used in a range of situations, such as functional neurology, brain stimulation for treatment of Parkinson disease, surgery for treating epilepsy, as well as in neurological procedures to resect brain tumors in eloquent area. The main anesthesia regimen for craniotomy in the awake patient is chosen to provide the appropriate analgesia, sedation, systemic hemodynamic stability and airway patency for the type of neurosurgical procedure being carried out. The objective of the present study was to conduct a review of the principles governing anesthesia for neurosurgeries involving craniotomy in awake patients.

[Anesthesia recovery comparison between remifentanil-propofol and remifentanil-desflurane guided by Bispectral Index® monitoring]. / Comparação da recuperação pós-anestésica entre remifentanil­propofol e remifentanil­desflurano guiada pela monitoração do Índice Bispectral®.

BACKGROUND AND OBJECTIVES: There is a strong demand for fast and predictable anesthesia recovery with few side effects. Choice of the hypnotic agent could impact on that. This study investigated the differences between recoveries after remifentanil-propofol and remifentanil-desflurane anesthesias guided by bispectral index (BIS®). METHODS: Forty patients were randomly assigned into 2 groups according to the anesthesia technique applied: remifentanil-propofol (REM-PRO) and remifentanil-desflurane (REM-DES). After the discontinuation of the anesthetics, the times to extubation, to obey commands and to recover the airway protection reflex were recorted. In the post-anesthetic recovery room (PACU) it was recorded the occurrence of nausea and vomiting (PONV), scores of Ramsay sedation scale and of numeric pain scale (NPS), morphine dose and length of stay in the unit. RESULTS: Data from 38 patients were analyzed: 18 from REM-PRO and 20 from REM-DES group. Anesthesia times were similar (REM-PRO=193min, SD 79.9 vs. 175.7min, SD 87.9 REM-DES; p=0.5). REM-DES had shorter times than REM-PRO group: time to follow command (8.5min; SD 3.0 vs. 5.6min; SD 2.5; p=0.0) and extubation time (6.2 minutes; 3.1-8.5 vs. 9.5 minutes; 4.9-14.4; p=0.0). Times to recover airway protective reflex were similar: 16 patients from REM-PRO (88.9%) restored the airway protective reflex 2min after extubation vs. 17 from REM-DES (89.5%); and 2 patients from REM-PRO (11.1%) vs. 2 from REM-DES (10.5%) 6min after extubation, p=1. Ramsay sedation score, NPS, PONV incidents, morphine dose and PACU stay of length PACU were also similar. CONCLUSION: Remifentanil-desflurane-based anesthesia has a faster extubation time and to follow command than remifentanil-propofol-based anesthesia when both guided by BIS®.

Effects of a single intravenous bolus of fentanyl on the minimum anesthetic concentration of isoflurane in chickens (Gallus gallus domesticus).

OBJECTIVE: To assess the temporal effects of a single fentanyl intravenous (IV) bolus on the minimum anesthetic concentration (MAC) of isoflurane in chickens and to evaluate the effects of this combination on heart rate (HR) and rhythm, systemic arterial pressures (sAP) and ventilation. STUDY DESIGN: Prospective experimental trial. ANIMALS: Seventeen adult chickens weighing 1.8±0.2 kg. METHODS: Individual isoflurane MAC for 17 chickens was previously determined using the bracketing method. Chickens were anesthetized with isoflurane to evaluate the effects of a single IV fentanyl bolus (10 or 30 µg kg-1) on isoflurane MAC over time using the up-and-down method. Ventilation was controlled. The isoflurane MAC reduction was estimated by logistic regression at 5 and 15 minutes after fentanyl administration. In the second phase, seven chickens were anesthetized with isoflurane, and fentanyl was administered (30 µg kg-1) IV over 1 minute during spontaneous ventilation and HR and rhythm, sAP and ventilation variables were measured. RESULTS: At 5 minutes after IV administration of fentanyl (10 or 30 µg kg-1), isoflurane MAC was significantly reduced by 17.6% (6.1-29.1%) [logistic regression estimate (95% Wald confidence interval)] and 42.6% (13.3-71.9%), respectively. Isoflurane MAC reduction at 15 minutes after IV administration of fentanyl (10 or 30 µg kg-1) was 6.2% (-0.6 to 12.9%) and 13.2% (-0.9 to 27.3%), respectively; however, this reduction was not significant. No clinically significant cardiopulmonary changes or arrhythmias were detected after the administration of fentanyl (30 µg kg-1). CONCLUSIONS AND CLINICAL RELEVANCE: Administration of a single fentanyl bolus induced a dose-dependent and short-lasting reduction in isoflurane MAC. The higher dose induced no significant cardiopulmonary depression in isoflurane-anesthetized chickens during spontaneous ventilation. In chickens anesthetized with isoflurane, the clinical usefulness of a single fentanyl bolus is limited by its short duration of effect.

Reincidencia intraoperatoria de probable reacción alérgica al remifentanilo. Informe de caso / Intraoperative recurrence of probable allergic reaction to remifentanil. Case report

Introduction: Although rare, intraoperative anaphylaxis may be life-threatening. Opioids, including remifentanil, have the lowest rates of association with allergic reactions during anaesthesia. Recurrence of anaphylactic reaction after continuation of a remifentanil infusion creates the suspicion of a causal relationship between this agent and the reaction. Case description. Case presentation of anaphylactic reaction during balanced anaesthesia in a 19 year-old female patient. At the start of the surgical procedure, the patient developed refractory hypotension and generalized erythema, which responded to vasopressors, antihistamines and the discontinuation of the anaesthetic agents. The remifentanil infusion was reinitiated later in response to the need of increasing the depth of the anaesthesia, and the anaphylactic reaction recurred. Conclusion: Any medication or potential allergen to which a patient is exposed during the perioperative period may cause anaphylaxis; the usual culprits are neuromuscular blocking agents (NMBA). In 80% of cases of hypersensitivity to medications, the origin is not immunological; the only way to confirm anaphylaxis is by means of biological and skin testing performed in a unit specializing in allergy and anaesthesia. In this case, confirmation was not possible because, in Colombia, the specific technological and biological resources are lacking.

Introducción: La aparición de anafilaxia intraoperatoria es rara pero amenaza la vida de los pacientes. Los opioides son los agentes que menos producen reacciones alérgicas en anestesia, entre ellos el remifentanilo. La reincidencia de la reacción anafiláctica al continuar la infusión de remifentanilo hace particularmente sospechoso este agente como causante de la reacción. Descripción del caso: Se presenta el caso de una reacción anafiláctica durante anestesia balanceada en una paciente de 19 años. Al inicio del acto quirúrgico la paciente presenta hipotensión refractaria y eritema generalizado, que responde al manejo con vasopresores, antihistamínicos y suspensión de los anestésicos. Posteriormente se requiere aumentar la profundidad de la anestesia por lo cual se reinicia infusión de remifentanilo y la reacción anafiláctica reaparece. Conclusión: Cualquier medicamento o posible alérgeno al cual sea expuesto un paciente en el perioperatorio puede ocasionar anafilaxia; los medicamentos más involucrados son los bloqueantes neuromusculares (BNM). El 80% de los eventos de hipersensibilidad a medicamentos no es de origen inmunológico; la única manera de confirmar una anafilaxia es mediante pruebas biológicas y pruebas cutáneas realizadas en una unidad especializada en alergia y anestesia. Este caso no pudo confirmarse debido a que en Colombia no existe este recurso técnico y biológico específico.

Effects of nitrous oxide on cardiovascular parameters in pigs anesthetized with propofol and subjected to pressure-controlled ventilation / Efeitos do óxido nitroso sobre parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação controlada à pressão

This paper evaluated the effects of the ratio of nitrous oxide to oxygen (50% of each) on cardiovascular parameters in pigs anesthetized with propofol and maintained in ventilation with intermittent positive pressure. Sixteen Large White pigs, weighing between 15 and 20 kg, were divided into two groups of eight animals, and designated as follows: GPN (propofol/nitrous oxide) and GPA (propofol/compressed air). In order to allow endotracheal intubation, the animals received azaperone (2 mg kg-1, IM) followed, after 20 minutes, by intravenous propofol. After successful intubation, continuous infusion of propofol was initiated at a dose of 0.4 mg kg-1minute-1. From this point, the GPN group received N2O (diluted in 50% oxygen), while the GPA group received compressed air (diluted in 50% oxygen). Rocuronium was then administered by continuous intravenous infusion at 0.6 mg kg-1h-1. Pressure-controlled ventilation (PCV) was started and adjusted to 15 cmH2O, and the respiratory rate was set to reach capnometry readings between 35-45 mmHg. The measurement of parameters (heart rate, mean arterial pressure, cardiac index, systemic vascular resistance index, stroke index) begun 15 minutes after the administration of rocuronium, and was repeated in 15-minute intervals for 60 minutes. Data were statistically analyzed by ANOVA followed by Bonferroni test. The results showed that the 1:1 rati

Objetivou-se com este trabalho avaliar os efeitos da associação de óxido nitroso (N2O) ao oxigênio, na proporção de 50% cada, sobre os parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação com pressão positiva intermitente. Para isso, foram utilizados 16 suínos da raça Large White com pesos entre 15 e 20 kg, distribuídos em dois grupos de oito animais cada, assim nomeados: GPN (GrupoPropofol/Óxidonitroso) e GPA (GrupoPropofol/Arcomprimido). Os animais receberam azaperona (2mgkg-1,IM) e após 20 minutos, administrou-se propofol por via intravenosa, em doses suficientes para permitir a intubação traqueal. Após intubação, iniciou-se a infusão contínua de propofol na dose de 0,4mgkg-1minuto-1. A partir deste momento, os animais do GPN receberam N2O diluído em 50% de oxigênio e os do GPA, ar comprimido diluído em 50% de oxigênio. Ato contínuo, administrou-se, por infusão intravenosa contínua, rocurônio a 0,6mgkg-1h-1. A ventilação controlada a pressão (VCP) foi iniciada e ajustada a 15cmH2O e a freqüência respiratória foi regulada para alcançar valores de capnometria entre 35-45mmHg. A medição dos parâmetros (freqüência cardíaca, pressão arterial média, índice cardíaco, índice da resistência periférica total, índice sistólico) iniciou-se após 15 minutos da administração de rocurônio, repetindo-se a cada 15 minutos, durante um intervalo de 60 minutos