Analgesic effect of pregabalin and magnesium sulfate after mastectomy with axillary lymphadenectomy / Efeito analgésico da pregabalina e do sulfato de magnésio no pósoperatório de mastectomia com linfadenectomia axilar

ABSTRACT BACKGROUND AND OBJECTIVES: Mastectomy with lymphadenectomy is a surgery associated with moderate to severe pain in the immediate postoperatory. Several safe adjuvant drugs that provide good analgesia with few adverse effects have been researched. Pregabalin and magnesium sulfate are drugs that promote analgesia with few adverse effects. The objective of the present study was to evaluate the analgesic effect of pregabalin and magnesium sulfate in the postoperatory of mastectomy with axillary lymphadenectomy. METHODS: Double-blinded, randomized study involving 80 patients submitted to mastectomy with axillary lymphadenectomy under general anesthesia. The patients were distributed into 4 groups: Control (CG, did not receive the proposed adjuvant drug); Magnesium+Placebo (MG, received magnesium sulfate during anesthesia); Pregabalin+Magnesium (P+MG, received magnesium added to pregabalin 150 mg before and 12 h after surgery); and Pregabalin+Placebo (PG, received pregabalin). All patients completed the Self-Report Questionnaire 20 (SRQ-20) to screen for possible mental disorders and had their physical status monitored at 1 h, 12 h, and 24 h after surgery, through anamnesis, pain questionnaire, opioid consumption, and presence of complications and/or adverse events such as nausea, vomiting, and sleepiness. Randomization was performed using sealed opaque envelopes without the knowledge of the anesthesiologist (researcher) and the patient. RESULTS: For each group, twenty patients were randomized, which were analyzed at the end of the study. The number of patients presenting absent/mild pain in P+MG was significantly higher than in CG, MG and PG after one hour. After 12 hours, P+MG and PG had more patients with absent/mild pain than CG and MG. At 24 hours postoperatively, all patients in all evaluated groups had no moderate/severe pain. There was no diference in the frequency of patients presenting nausea or vomiting, nor in the scores of the sleep evaluation after surgery in the four groups. CONCLUSION: The combination of magnesium sulfate and pregabalin provided satisfactory analgesia in the first hour after mastectomy with axillary lymphadenectomy. Nevertheless, magnesium sulfate isolated presented no analgesic beneft for the patients, and pregabalin isolated was only slightly effective at the first hour after surgery.

RESUMO JUSTIFICATIVA E OBJETIVOS: Mastectomia com linfadenectomia é uma cirurgia que causa dor moderada ou intensa no pós-operatório imediato. Muitos fármacos adjuvantes, seguros, que promovem boa analgesia e com poucos efeitos adversos têm sido pesquisados. A pregabalina e o sulfato de magnésio são fármacos que promovem analgesia com poucos efeitos adversos. O objetivo deste estudo foi avaliar o efeito analgésico da pregabalina e do sulfato de magnésio no pós-operatório de mastectomia com linfadenectomia axilar. MÉTODOS: Estudo randomizado e duplo-cego envolvendo 80 pacientes submetidas à mastectomia com linfadenectomia axilar sob anestesia geral. As pacientes foram divididas em quatro grupos: Controle (GC, não receberam o fármaco adjuvante proposto); Magnésio+Placebo (GM, receberam sulfato de magnésio durante a anestesia); Pregabalina+Magnésio (GP+M, receberam magnésio adicionado a pregabalina 150 mg antes e 12 h após a cirurgia); e Pregabalina+Placebo (GP, receberam a pregabalina). Todas as pacientes responderam o Self-Report Questionnaire 20 (SRQ-20) para rastrear possível transtorno mental e foram seguidas, monitorando o estado físico 1h, 12h e 24h após a cirurgia, através de anamnese, questionário de dor, consumo de opioides e presença de complicações e/ou eventos adversos como náusea, vômito e sonolência. A randomização foi realizada por meio de envelopes opacos e selados sem o conhecimento do anestesiologista (pesquisador) e do paciente. RESULTADOS: Foram randomizadas 20 pacientes para cada grupo, as quais foram analisadas ao fim do estudo. O número de pacientes apresentando dor ausente/leve no GP+M foi significantemente maior que nos GC, GM e GP após uma hora. Após 12 horas, GP+M e GP apresentaram maior número de pacientes com dor ausente/leve que GC e GM. Em 24 horas do pós-operatório, todos os pacientes de todos os grupos avaliados não apresentaram dor moderada/severa. Não houve diferença na frequência de pacientes apresentando náusea ou vômito, nem nos escores da avaliação do sono após a cirurgia nos quatro grupos. CONCLUSÃO: A associação de sulfato de magnésio e pregabalina causa boa analgesia de mastectomia com linfadenectomia axilar na primeira hora do pós-operatório. No entanto, o uso isolado do sulfato de magnésio não trouxe benefício para analgesia nestas pacientes, assim como a pregabalina sozinha se mostrou pouco efetiva na primeira hora de avaliação.

Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial.

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

Serum cystatin C is a sensitive early marker for changes in the glomerular filtration rate in patients undergoing laparoscopic surgery.

OBJECTIVE: Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery. METHODS: In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels. RESULTS: Serum cystatin C levels increased during the study (T1 = T2T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson's analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate. CONCLUSION: This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal renal function who are undergoing laparoscopic procedures.

Serum cystatin C is a sensitive early marker for changes in the glomerular filtration rate in patients undergoing laparoscopic surgery

OBJECTIVE: Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery. METHODS: In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels. RESULTS: Serum cystatin C levels increased during the study (T1 = T2<T3; p<0.05), whereas serum creatinine levels decreased (T1 = T2>T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson's analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate. CONCLUSION: This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal ...

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia.

OBJECTIVE: Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. METHODS: Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 microg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. RESULTS: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. CONCLUSION: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia / Efeitos maternos e fetais da analgesia de parto pelas técnicas peridural e duplo bloqueio

OBJECTIVE: Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. METHODS: Forty pregnant women received epidural analgesia with 15 mL of 0.125 percent ropivacaine (EA group) and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. RESULTS: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60 percent of CSE group newborns were found to be neurologically healthy at the 24 hour examination. CONCLUSION: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

OBJETIVO: A peridural (AP) e a técnica de duplo bloqueio (DB) são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125 por cento (grupo AP) e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB). Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo para a resolução do parto, hipotensão materna e presença de prurido. Os recém-nascidos foram avaliados pelo índice de Apgar e escore da capacidade adaptativa e neurológica (ECAN), método de Amiel-Tison. RESULTADOS: Não houve diferenças significativas entre os grupos na intensidade da dor, no tempo de latência, no nível do bloqueio sensitivo e no índice de Apgar. O bloqueio motor, a duração da analgesia e o tempo para resolução do parto foram maiores no grupo DB, do qual sete parturientes apresentaram prurido leve. ECAN foi maior no grupo AP após meia hora, duas horas e 24 horas. Noventa e cinco por cento dos recém-nascidos do grupo AP e 60 por cento do grupo DB foram considerados neurologicamente vigorosos ao exame de 24 horas. CONCLUSÃO: As duas técnicas mostraram-se eficazes para analgesia do trabalho de parto. As parturientes do grupo DB apresentaram prurido e trabalho de parto mais prolongado. Recém-nascidos de mães que receberam analgesia de parto via peridural apresentaram melhor ECAN.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial.

CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 microg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. CONCLUSION: Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial / Analgesia de parto com ropivacaína associada à clonidina: pesquisa clínica randomizada

CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125 percent (R group) or 15 ml of ropivacaine 0.0625 percent plus 75 µg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75 percent of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75 percent of the RC group newborns were found to be neurologically healthy...

CONTEXTO E OBJETIVO: A associação entre ropivacaína e clonidina agiria menos que a ropivacaína isolada na mãe e no feto? Foram pesquisados os efeitos materno-fetais de duas técnicas farmacológicas: pequena dose de ropivacaína ou dose menor de ropivacaína mais clonidina na analgesia peridural para parto. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, Departamento de Anestesiologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. MÉTODOS: Trinta e duas parturientes, estado físico de acordo com a American Society of Anesthesiologists I e II, foram aleatoriamente submetidas à analgesia peridural com 15 ml de ropivacaína 0,125 por cento (grupo R) ou 15 ml de ropivacaína 0,0625 por cento mais clonidina, 75 µg (grupo RC). Foram avaliados: intensidade da dor, nível do bloqueio sensitivo, latência, intensidade do bloqueio motor, duração da analgesia de parto e da analgesia peridural. Os neonatos foram avaliados pelo Apgar e método de Amiel-Tison (capacidade neurológica e adaptativa). RESULTADOS: Não houve diferenças significativas entre grupos para dor, nível de bloqueio sensitivo, duração da analgesia peridural e Apgar. Para latência, duração da analgesia de parto e bloqueio motor, grupo R < grupo RC. O escore da capacidade neurológica e adaptativa de meia e duas horas foi maior para o grupo R. Cem por cento dos neonatos do grupo R e 75 por cento dos do grupo RC estavam neurologicamente saudáveis ao exame de 24 horas. CONCLUSÃO: Pequena dose de ropivacaína e dose menor mais clonidina aliviaram a dor materna durante o parto. Neonatos de mães que receberam apenas ropivacaína mostraram melhores escores da capacidade neurológica e adaptativa.

Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2 percent lidocaine plus 8.4 percent sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extubation, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were studied 24 hours after anesthesia. RESULTS: Pressures in Lido cuffs were significantly lower than in Air cuffs (p < 0.05). Tracheal complaints were similar for the two groups, except for lower ET discomfort and sore throat incidence after 24 hours and lower systolic arterial pressure at the time of extubation in the Lido group (p < 0.05). CONCLUSION: ET cuffs filled with alkalinized lidocaine prevented the occurrence of high cuff pressures during N2O anesthesia and reduced ET discomfort and postoperative sore throat incidence. Thus, alkalinized lidocaine-filled ET cuffs seem to be safer than conventional air-filled ET cuffs.

CONTEXTO E OBJETIVO: Os tubos traqueais são dispositivos utilizados para manutenção da ventilação. A hiperinsuflação do balonete do tubo traqueal, causada pela difusão do óxido nitroso (N2O), pode determinar lesões traqueais, que se manifestam clinicamente como odinofagia, rouquidão e tosse. A lidocaína, quando injetada no balonete do tubo traqueal, difunde-se através de sua parede, determinando ação anestésica local na traquéia. O objetivo foi avaliar a efetividade e a segurança do balonete do tubo traqueal preenchido com ar comparado com o balonete preenchido com lidocaína, considerando os desfechos: sintomas cardiovasculatórios (HAS, taquicardia); odinofagia, tosse, rouquidão e tolerância ao tubo traqueal. TIPO DE ESTUDO E LOCAL: Estudo clínico prospectivo, realizado no Departamento de Anestesiologia da Faculdade de Medicina da Unesp, campus de Botucatu. MÉTODOS: A pressão do balonete do tubo traqueal foi medida, entre 50 pacientes, antes, 30, 60, 90 e 120 minutos após o início da inalação de N2O anestésico. As pacientes foram distribuídas aleatoriamente em dois grupos: Air, em que o balonete foi inflado com ar para obtenção de pressão de 20 cm H2O, e Lido, em que o balonete foi preenchido com lidocaína a 2 por cento mais bicarbonato de sódio a 8,4 por cento para obtenção da mesma pressão. O desconforto antes da extubação, e manifestações clínicas como dor de garganta, rouquidão e tosse foram registrados no momento da alta da unidade de cuidados pós-anestésicos, e dor de garganta e rouquidão foram avaliadas também 24 horas após a anestesia. RESULTADOS: Os valores da pressão no balonete em G2 foram significativamente menores do que os de Air em todos os tempos de estudo, a partir de 30 minutos (p < 0,001). A proporção de pacientes que reagiu ao tubo traqueal no momento da desintubação foi significantemente menor em Lido (p < 0,005). A incidência de odinofagia foi significantemente menor em Lido no primeiro dia de pós-operatório...

[Effect of propofol in combination with ephedrine upon the onset time of cisatracurium]. / Efeito do propofol associado à efedrina no tempo de latência do cisatracúrio.

OBJECTIVE: The onset time of neuromuscular blocking drugs is partially determined by circulatory factors, including muscle blood flow and cardiac output. The aim of the present paper was to: 1) compare the haemodynamic effects of adding different doses of ephedrine to an induction dose of propofol and remifentanil. 2) onset time of cisatracurium. METHODS: Sixty patients were randomly allocated into three groups: G1 - 1% propofol; G2 - 1% propofol + 0.5 mg.ml-1 ephedrine and G3 - 1% propofol + 1.0 mg.ml-1 ephedrine. All patients received continuous infusion of remifentanil (0.5 mg.kg-1.min-1). The rate of propofol infusion was 180 ml.h-1 until loss of consciousness and a loading dose of cisatracurium (0.15 mg.kg-1) was then given. After induction of anesthesia, the ulnar nerve was stimulated supramaximally every 10s, and the evoked twitch response of the adductor pollicis was recorded by accelerometry. RESULTS: There was no statistical difference between groups with respect to age, weight, dose of propofol administered and onset time of cisatracurium. Heart rate, SpO2, systolic, diastolic and mean blood pressures were compared at 1 and 3 min post-induction. There were statistical differences in HR, SAP, DAP and MAP, without significant adverse clinical effects. CONCLUSIONS: There were no clinically important decreases in the hemodynamic parameters evaluated in the groups receiving ephedrine or not, and the onset time of cisatracurium was the same for all groups.

Efeito do propofol associado à efedrina no tempo de latência do cisatracúrio / Effect of propofol in combination with ephedrine upon the onset time of cisatracurium

OBJETIVOS: Este estudo teve por objetivo avaliar a eficácia da efedrina na prevenção dos efeitos hemodinâmicos induzidos pela associação do propofol e do remifentanil, assim como os efeitos sobre o tempo de latência do cisatracúrio. MÉTODOS: Sessenta pacientes com idade entre 18 e 52 anos, estado físico ASA I ou II, foram divididos em três grupos, aleatoriamente: G I - propofol 1 por cento; G II - propofol 1 por cento + efedrina 0,5 mg.ml-1 e G III - propofol 1 por cento + efedrina 1,0 mg.ml-1 (velocidade de infusão igual a 180 ml.h-1), até a perda da consciência. Administrou-se remifentanil (0,5 mg.kg-1.min-1) e cisatracúrio na dose de 0,15 mg.kg-1. Foram registrados os dados demográficos, os sinais vitais (PAS, PAM, PAD, FC e SpO2) e o tempo de latência do cisatracúrio. RESULTADOS: Os grupos foram homogêneos com relação aos dados demográficos. Houve diminuição estatisticamente significativa dos valores de PAS, PAM, PAD e FC, um e três minutos após a administração do propofol, porém sem significado clínico importante e sem diferença entre os grupos. As medianas para os tempos de latência do cisatracúrio foram: 178 s (G2 e G3) e 183 s (G1), mas sem diferença significante entre os grupos. CONCLUSÃO: Não houve diminuição clinicamente importante dos parâmetros hemodinâmicos avaliados nos grupos que receberam ou não a efedrina e o tempo de latência do cisatracúrio foi o mesmo para os diferentes grupos.

OBJECTIVE: The onset time of neuromuscular blocking drugs is partially determined by circulatory factors, including muscle blood flow and cardiac output. The aim of the present paper was to: 1) compare the haemodynamic effects of adding different doses of ephedrine to an induction dose of propofol and remifentanil. 2) onset time of cisatracurium. METHODS: Sixty patients were randomly allocated into three groups: G1 - 1 percent propofol; G2 - 1 percent propofol + 0.5 mg.ml-1 ephedrine and G3 - 1 percent propofol + 1.0 mg.ml-1 ephedrine. All patients received continuous infusion of remifentanil (0.5 mg.kg-1.min-1). The rate of propofol infusion was 180 ml.h-1 until loss of consciousness and a loading dose of cisatracurium (0.15 mg.kg-1) was then given. After induction of anesthesia, the ulnar nerve was stimulated supramaximally every 10s, and the evoked twitch response of the adductor pollicis was recorded by accelerometry. RESULTS: There was no statistical difference between groups with respect to age, weight, dose of propofol administered and onset time of cisatracurium (tables 1, 2). Heart rate, SpO2, systolic, diastolic and mean blood pressures were compared at 1 and 3 min post-induction. There were statistical differences in HR, SAP, DAP and MAP, without significant adverse clinical effects. CONCLUSIONS: There were no clinically important decreases in the hemodynamic parameters evaluated in the groups receiving ephedrine or not, and the onset time of cisatracurium was the same for all groups.

Uso de dexmedetomidina em neurocirurgia / The use of dexmedetomidine in neurosurgery

JUSTIFICATIVA E OBJETIVOS: Os fármacos alfa2-agonistas são a cada dia mais utilizados em Anestesiologia, seja como adjuvantes ou como agentes anestésicos únicos. Atualmente, o emprego da dexmedetomidina vem se popularizando devido à sua maior seletividade aos receptores alfa2 e, também, ao seu perfil farmacocinético. O objetivo desta revisão foi fazer uma análise do emprego da dexmedetomidina em neurocirurgia. CONTEUDO: Além das considerações e revisão da literatura quanto ao emprego da dexmedetomidina especificamente em procedimentos neurocirúrgicos, foi realizada descrição dos efeitos do fármaco nos diversos sistemas do organismo. CONCLUSÕES: A dexmedetomidina tem perfil farmacocinético e farmacodinâmico que favorece seu emprego em diversos procedimentos neurocirúrgicos. A utilização clínica em procedimentos cirúrgicos com craniotomia para pinçamento de aneurisma e remoção de tumores é crescente. Além disso, seu uso em intervenções cirúrgicas funcionais é promissor.

BACKGROUND AND OBJECTIVES: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery. CONTENTS: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described. CONCLUSIONS: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

JUSTIFICATIVA Y OBJETIVOS: Los fármacos alfa2-agonistas son cada día más utilizados en Anestesiología, sea como adyuvantes o como agentes anestésicos únicos. Actualmente, el empleo de la dexmedetomidina se ha venido popularizando debido a su mayor selectividad a los receptores alfa2 y, también, a su perfil farmacocinético. El objetivo de esta revisión fue hacer una análisis del empleo de la dexmedetomidina en Neurocirugía. CONTENIDO: Además de las consideraciones y de la revisión de la literatura en cuanto al empleo de la dexmedetomidina específicamente en procedimientos neuro-quirúrgicos, fue realizada una descripción de los efectos del fármaco en los diversos sistemas del organismo. CONCLUSIONES: La dexmedetomidina tiene un perfil farmacocinético y farmacodinámico que favorece su empleo en diversos procedimientos neuro-quirúrgicos. La utilización clínica en procedimientos quirúrgicos con craneotomia para el pinzamiento de aneurisma y la retirada de tumores va en aumento. Además, su uso en intervenciones quirúrgicas funcionales es promisorio.

Efeitos adversos do sufentanil associado ao anestésico local pelas vias subaracnóidea e peridural em pacientes submetidas à analgesia de parto / Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia

JUSTIFICATIVA E OBJETIVOS: A associação do opióide ao anestésico local melhora a qualidade da analgesia de parto e reduz o risco de toxicidade sistêmica pelo anestésico local. Os opióides, entretanto, podem determinar efeitos colaterais. O objetivo desta pesquisa foi comparar os efeitos adversos determinados pelo sufentanil, administrado por via subaracnóidea, associado à bupivacaína, com aquele determinado pelo sufentanil por via peridural, associado à ropivacaína, nas doses utilizadas no Serviço de Anestesia, em gestantes submetidas à analgesia de parto. MÉTODO: Participaram do estudo 60 pacientes, estado físico ASA I e II, com idade entre 15 e 42 anos, com gestação a termo e fetos saudáveis, submetidas à analgesia de parto. Foram distribuídas de forma aleatória em dois grupos: G1 - Duplo bloqueio - bupivacaína a 0,5 por cento (2,5 mg) e sufentanil (5 µg) pela via subaracnóidea, G2 - Peridural - ropivacaína a 0,2 por cento (20 mg) e sufentanil (10 µg) pela via peridural. Para doses complementares foi administrada ropivacaína a 0,2 por cento (12 mg) e para resolução do parto, ropivacaína a 1 por cento (50 mg). As pacientes foram avaliadas após analgesia (M1) com relação a hipotensão arterial, bradicardia materna, prurido, náusea, vômito, depressão respiratória e sedação. No pós-operatório (M2), quanto à presença de náusea, vômito, prurido, sedação, retenção urinária e dor. Os recém-nascidos foram avaliados pelo índice de Apgar. Para análise estatística, foram utilizados teste t de Student, Mann-Whitney e Qui-quadrado. RESULTADOS: Os grupos foram similares com relação à idade, ao peso, à altura, à duração do período de trabalho de parto após analgesia, ao Apgar dos recém-nascidos, à ocorrência de hipotensão arterial, bradicardia, náusea, vômito, prurido e retenção urinária. A sedação foi mais freqüente nas pacientes de G2, em M1 (50 por cento) com diferença estatística significativa. CONCLUSÕES: O sufentanil nas doses utilizadas, administrado...

BACKGROUND AND OBJECTIVES: The association of an opioid with a local anesthetic improves the quality of labor analgesia and reduces the risk of systemic toxicity of the local anesthetic. However, opioids are not devoid of side effects. The aim of this study was to compare the side effects of subarachnoid sufentanil associated with bupivacaine to those caused by epidural sufentanil associated with ropivacaine in the doses used in the Anesthesiology Department in pregnant women undergoing labor analgesia. METHODS: Sixty pregnant women, ASA physical status I and II, ages between 15 and 42 years, at term and with healthy fetuses, undergoing labor analgesia were enrolled in this study. They were randomly divided in two groups: G1 - combined spinal epidural anesthesia - 0.5 percent bupivacaine (2.5 mg) and subarachnoid sufentanil (5 µg); G2 - Epidural Block - 0.2 percent ropivacaine (20 mg), and epidural sufentanil (10 µg). Complementary doses of 0.2 percent ropivacaine (12 mg) were administered whenever necessary, and 1 percent ropivacaine (50 mg) was administered for labor resolution. Patients were evaluated after analgesia (M1) regarding the presence of hypotension, maternal bradycardia, pruritus, nausea, vomiting, respiratory depression, and sedation. They were also evaluated postoperatively (M2) regarding the presence of nausea, vomiting, pruritus, sedation, urinary retention, and pain. Newborns were evaluated by the Apgar score. The test t Student, Mann-Whitney test, and Chi-Square test were used for the statistical analysis. RESULTS: Both groups were similar regarding age, weight, height, duration of labor after analgesia, Apgar score of the newborns, hypotension, maternal bradycardia, nausea, vomiting, pruritus, and urinary retention. Sedation was more frequent in patients in G2 at M1 (50 percent), which was statistically significant. CONCLUSION: Subarachnoid or epidural sufentanil, in the doses used in this study, associated...

JUSTIFICATIVA Y OBJETIVOS: La asociación del opioide con el anestésico local mejora la calidad de la analgesia de parto y reduce el riesgo de toxicidad sistémica por el anestésico local. Los opioides, sin embargo, pueden determinar efectos colaterales. El objetivo de esta investigación fue comparar los efectos adversos determinados por el sufentanil, administrado por vía subaracnoidea, asociado a la bupivacaína, con aquel determinado por el sufentanil por vía peridural, asociado a la ropivacaína, en las dosis utilizadas en el Servicio de Anestesia, en embarazadas sometidas a la analgesia de parto. MÉTODO: Participaron del estudio 60 pacientes, estado físico ASA I y II, con edad entre los 15 y los 42 años, con embarazo en tiempo y fetos saludables, sometidas a la analgesia de parto. Se distribuyeron aleatoriamente en de los grupos: G1 Doble bloqueo bupivacaína a 0,5 por ciento (2,5 mg) y sufentanil (5 µg) por vía subaracnoidea, G2 Peridural ropivacaína a 0,2 por ciento (20 mg) y sufentanil (10 µg) por vía peridural. Para dosis complementarias fue administrada ropivacaína a 0,2 por ciento (12 mg) y para resolución del parto, ropivacaína a 1 por ciento (50 mg). Las pacientes se evaluaron después de la analgesia (M1) con relación a la hipotensión arterial, bradicardia materna, prurito, náusea, vómito, depresión respiratoria y sedación. En el postoperatorio (M2), en cuanto a la presencia de náusea, vómito, prurito, sedación, retención urinaria y dolor. Los recién nacidos se evaluaron por el índice de Apgar. Para análisis estadístico, se utilizaron la prueba t de Student, Mann-Whitney y Qui-cuadrado. RESULTADOS: Los grupos fueron similares con relación a la edad, al peso, a la altura, a la duración del período de trabajo de parto después de la analgesia, al Apgar de los recién nacidos, a la existencia de hipotensión arterial, bradicardia, náusea, vómito, prurito y retención urinaria. La sedación fue más frecuente en las pacientes...

[Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia.]. / Efeitos adversos do sufentanil associado ao anestésico local pelas vias subaracnóidea e peridural em pacientes submetidas à analgesia de parto.

BACKGROUND AND OBJECTIVES: The association of an opioid with a local anesthetic improves the quality of labor analgesia and reduces the risk of systemic toxicity of the local anesthetic. However, opioids are not devoid of side effects. The aim of this study was to compare the side effects of subarachnoid sufentanil associated with bupivacaine to those caused by epidural sufentanil associated with ropivacaine in the doses used in the Anesthesiology Department in pregnant women undergoing labor analgesia. METHODS: Sixty pregnant women, ASA physical status I and II, ages between 15 and 42 years, at term and with healthy fetuses, undergoing labor analgesia were enrolled in this study. They were randomly divided in two groups: G1 - combined spinal epidural anesthesia - 0.5% bupivacaine (2.5 mg) and subarachnoid sufentanil (5 microg); G2 - Epidural Block - 0.2% ropivacaine (20 mg), and epidural sufentanil (10 microg). Complementary doses of 0.2% ropivacaine (12 mg) were administered whenever necessary, and 1% ropivacaine (50 mg) was administered for labor resolution. Patients were evaluated after analgesia (M1) regarding the presence of hypotension, maternal bradycardia, pruritus, nausea, vomiting, respiratory depression, and sedation. They were also evaluated postoperatively (M2) regarding the presence of nausea, vomiting, pruritus, sedation, urinary retention, and pain. Newborns were evaluated by the Apgar score. The test t Student, Mann-Whitney test, and Chi-Square test were used for the statistical analysis. RESULTS: Both groups were similar regarding age, weight, height, duration of labor after analgesia, Apgar score of the newborns, hypotension, maternal bradycardia, nausea, vomiting, pruritus, and urinary retention. Sedation was more frequent in patients in G2 at M1 (50%), which was statistically significant. CONCLUSION: Subarachnoid or epidural sufentanil, in the doses used in this study, associated with local anesthetics, had the same effect on the duration of labor after analgesia and in the Apgar score of newborns. Sedation was the most frequent side effect in patients receiving epidural sufentanil.

[The use of dexmedetomidine in neurosurgery.]. / Uso de dexmedetomidina em neurocirurgia.

BACKGROUND AND OBJECTIVES: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery. CONTENTS: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described. CONCLUSIONS: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial.

CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2% lidocaine plus 8.4% sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extubation, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were studied 24 hours after anesthesia. RESULTS: Pressures in Lido cuffs were significantly lower than in Air cuffs (p < 0.05). Tracheal complaints were similar for the two groups, except for lower ET discomfort and sore throat incidence after 24 hours and lower systolic arterial pressure at the time of extubation in the Lido group (p < 0.05). CONCLUSION: ET cuffs filled with alkalinized lidocaine prevented the occurrence of high cuff pressures during N2O anesthesia and reduced ET discomfort and postoperative sore throat incidence. Thus, alkalinized lidocaine-filled ET cuffs seem to be safer than conventional air-filled ET cuffs.

Interação entre a analgesia de parto e o seu resultado: avaliação pelo peso e índice de Apgar do recém-nascido / The interaction between labor analgesia and its results: assessment using the newbornïs weight and Apgar score

JUSTIFICATIVA E OBJETIVOS: Existem controvérsias quanto à possibilidade de a analgesia de parto interferir no andamento do trabalho de parto e na vitalidade do recém-nascido. O objetivo deste estudo foi a interação entre analgesia do parto pelas técnicas peridural contínua e duplo bloqueio, com pequena dose de anestésico local, e o tipo de parto ocorrido, pela análise do peso e índice de Apgar do recém-nascido. MÉTODO: Analisaram-se, prospectivamente, os resultados de 168 analgesias de parto (janeiro de 2002 a janeiro de 2003), divididas em quatro grupos: G1 (n = 58) peridural contínua e evolução para parto vaginal; G2 (n = 69) duplo bloqueio e evolução para parto vaginal; G3 (n = 25) peridural contínua e evolução para cesariana; G4 (n = 16) duplo bloqueio e evolução para cesariana. Para G1 foi administrada ropivacaína a 0,125 por cento (12 a 15 mL), para G2, bupivacaína a 0,5 por cento (0,5 a 1 mL), sufentanil (10 mg), por via subaracnóidea. Administrou-se ropivacaína a 0,5 por cento, por via peridural, para o parto vaginal (8 mL) e para cesariana (20 mL). Avaliaram-se idade, peso, altura, índice de massa corpórea (IMC), idade gestacional (IG), paridade e complicações (hipotensão arterial, bradicardia e hipóxia), e, do recém-nascido, peso e índice de Apgar (1°, 5° e 10° min). RESULTADOS: A maioria das parturientes era primigesta, com gestação de termo (uma IG de 28 semanas e nenhum pós-datismo), com peso, G2 < G4, e, IMC, G2 £ G4. Para o peso do RN, G1 < G3 e G2 < G4, e o Apgar do 1° min, G1 > G3. CONCLUSÕES: As técnicas de analgesia, peridural contínua e duplo bloqueio, com pequenas doses de anestésico local, não apresentaram interação com o resultado do parto, se a análise estiver focalizada no peso e no índice de Apgar do recém-nascido.

Profilaxia do prurido causado pela administração subaracnóidea de sufentanil: efeitos do droperidol, da nalbufina, do ondansetron e da combinação deles / Prophylaxis of pruritus caused by subarachnoid administration of sufentanil: effects of droperidol, nalbuphine, ondansetron and their combination

JUSTIFICATIVA E OBJETIVOS: O uso espinhal de opióides pode causar alguns efeitos indesejáveis, dentre os quais, o mais freqüente é o prurido que, apesar de sua baixa morbidade, pode proporcionar desconforto intenso ao paciente e prolongar o período de internação. O objetivo deste estudo foi avaliar diversas opções terapêuticas no tratamento profilático do prurido após administração de sufentanil por via subaracnóidea. MÉTODO: Foram distribuídos de maneira aleatória, por sorteio, 100 pacientes a serem submetidos à intervenção cirúrgica não-obstétricas em cinco grupos, de acordo com o tratamento utilizado: controle (ausência de tratamento - C); droperidol 2,5 mg (D); nalbufina 10 mg (N); associação dos medicamentos anteriores (DN) e ondansetron 8 mg (O). O prurido foi avaliado quantitativamente 30 minutos, 1, 2, e 3 horas após a administração subaracnóidea de sufentanil. RESULTADOS: Os grupos C e O apresentaram incidência significativamente maior de prurido em relação aos grupos D, N e DN. Entretanto, não houve diferença significativa na necessidade de tratamento específico com naloxona entre os grupos tratados. CONCLUSÕES: O tratamento profilático do prurido neste estudo, independentemente do fármaco utilizado, diminuiu sua intensidade e limitou a necessidade de tratamento específico com naloxona.

[Prevention of itching after spinal sufentanil: effects of droperidol, nalbuphine, ondansetron and the association of them.]. / Profilaxia do prurido causado pela administração subaracnóidea de sufentanil: efeitos do droperidol, da nalbufina, do ondansetron e da combinação deles.

BACKGROUND AND OBJECTIVES: Spinal opioids may cause some undesirable effects, the most frequent of which is itching. In spite of its low morbidity rate, itching may cause severe discomfort to patients in addition to prolonging hospital stay. This study aimed at evaluating different therapeutic options to prevent itching after spinal sufentanil. METHODS: Participated in these study 100 patients scheduled for non-obstetric procedures, who were randomly distributed in five groups: control (no treatment - C); 2.5 mg droperidol (D); 10 mg nalbuphine (N); association of previous drugs (DN); and 8 mg ondansetron (O). Pruritus was quantitatively evaluated at 30 minutes, 1, 2 and 3 hours after spinal sufentanil. RESULTS: Groups C and O had significantly higher incidence of itching as compared to groups D, N and DN. However, there has been no significant difference in the need for specific treatment with naloxone among groups. CONCLUSIONS: Itching prevention in our study, regardless of the drug used, has decreased its severity and has limited the need for specific treatment with naloxone.

[The interaction between labor analgesia and its results: assessment using the newborn s weight and Apgar score.]. / Interação entre a analgesia de parto e o seu resultado: avaliação pelo peso e índice de Apgar do recém-nascido.

BACKGROUND AND OBJECTIVES: There are controversies regarding whether labor analgesia can interfere with labor and the vitality of the newborn. The objective of this study was the interaction between labor analgesia, using the continuous epidural and combined spinal-epidural techniques with a small dose of local anesthetic, and the type of delivery analyzing the newborn's weight and Apgar score. METHODS: The results of 168 labor analgesias (from January 2002 to January 2003) were analyzed. They were divided in 4 groups: G1 (n = 58), continuous epidural and evolution to vaginal delivery; G2 (n = 69), combined spinal-epidural and evolution to vaginal delivery; G3 (n = 25), continuous epidural and evolution to cesarean; G4 (n = 16), combined spinal-epidural and evolution to cesarean. G1 received 0.125% ropivacaine (12 to 15 mL), G2 received subarachnoid 0.5% bupivacaine (0.5 to 1 mL) and sufentanil (10 mg). Epidural ropivacaine 0.5% for the vaginal delivery (8 mL) and for cesarean (20 mL). The patient's age, weight, height, body mass index (BMI), gestational age, number of prior pregnancies, and complications (arterial hypotension, bradycardia, and hypoxia) and the newborn's weight and Apgar score (at 1, 5, and 10 minutes) were evaluated. RESULTS: The majority of pregnant women were primiparous and presented with a term pregnancy (one with gestational age of 28 weeks and none post-term pregnancy); weight, G2 < G4; and MBI, G2 pound G4. For the weight of the newborn, G1 < G3 and G2 < G4, and for the Apgar score at 1st minute, G1 > G3. CONCLUSIONS: If the analysis focuses the newborn's weight and Apgar score, the techniques of analgesia, continuous epidural and combined spinal-epidural with small doses of local anesthetic, do not interfere with the result of the delivery.