Spinal anesthesia in children with isobaric local anesthetics: report on 307 patients under 13 years of age.

BACKGROUND: Spinal anesthesia in expert hands is an excellent method for children for appropriate surgery. The aim of this study was to evaluate the effects of spinal anesthesia with isobaric solutions in 307 consecutive cases from May 2001 to August 2002. METHODS: In this prospective study, 307 patients from 0 to 12 years of age were scheduled for spinal anesthesia with enantiomeric mixture of bupivacaine (S75 : 25R) 0.5% or racemic bupivacaine 0.5% or lidocaine 2% without glucose, for surgery compatible with the technique. The following were assessed: latency of analgesia, motor block, maximum length and duration of sensory blockade, cardiovascular changes, incidence of headache or transient neurological symptoms and cost. RESULTS: The onset of sensory block occurred at 2.36 +/- 0.95 min. Duration of surgery was 1.29 +/- 0.83 h and the duration of stay in the postanesthesia care unit was 39.72 +/- 26.84 min. The highest level of analgesia ranged from T(9) to T(4) (mean T(6)). Onset of motor block was <2 min in all children and each had a modified Bromage score of 3 at the beginning of the surgery. At the end of the surgery 9% had score 3, 16%, score 2, 46%, score 1 and 29%, zero. Seventy five percent of all patients recovered from motor block 1 or zero at the end of the surgery. Patients older than 1 year were able to walk in 3.79 +/- 0.73 h. There was no case of oxygen desaturation. Hypotension and bradycardia occurred in one patient. Spinal anesthesia failed in five patients. Three children developed postdural puncture headache (PDPH), the youngest aged 2 years. PDPH in all three was mild or moderate. Transient radicular symptoms were not observed. The final cost of the spinal anesthesia was R dollars 49.00 compared with a mean cost of general anesthesia of R dollars 105.00. CONCLUSIONS: Spinal anesthesia continues to gain acceptance as an alternative to general anesthesia in children. There has also been an increased use of spinal anesthesia for other surgical procedures including lower extremity orthopedic procedures as well as specific surgery procedures above the umbilicus and in patients past the neonatal period. Spinal anesthesia in children is a special method suitable for use only by anesthesiologists, expert in administering spinal anesthesia for adults. It was 54% less than the cost of general anesthesia.

Monitores automáticos de pressão arterial: avaliação de três modelos em voluntárias / Automatic blood pressure monitors: evaluation of three models in volunteers

JUSTIFICATIVA E OBJETIVOS: Desde 1903 a monitorização da pressão arterial tem sido realizada por método não invasivo, com esfigmomanômetro ou aparelhos automáticos não invasivos. Um dos problemas da medida da pressão arterial não invasiva é considerar a variação da pressão arterial com o método utilizado. O método oscilométrico de medida da pressão arterial avalia a pressão arterial durante a deflação do manguito. Dificuldades da medida da pressão arterial pelo método oscilométrico podem acontecer por: tamanho inadequado do manguito, incorreta aplicação do manguito, faltas não detectadas pelo manguito e conectores, movimento do braço, estado de choque e compressão vascular proximal ao manguito. Este estudo avaliou a confiabilidade dos aparelhos nas medidas da pressão arterial pelo método não invasivo em cinco medidas com três aparelhos diferentes. MÉTODO: Foi avaliada a pressão arterial em 60 voluntárias com idades entre 20 e 40 anos no período das 7 às 11 horas da manhã, na posição sentada de um dia normal de trabalho. A medida da pressão arterial constou de cinco aferições com intervalo de 2 minutos. Foram estudados três aparelhos automáticos de medida da pressão arterial. Nenhuma paciente era obesa, hipertensa ou sofria de doença cardíaca ou disritmias cardíacas. A medida indireta da pressão arterial era feita de acordo com as instruções dos fabricantes. RESULTADOS: Não há diferença entre os três grupos estudados em relação aos parâmetros demográficos. A variação média intrapessoal na PAS, de uma medida para outra, foi de até 6,7 mmHg, na PAM de até 4,9 mmHg e na PAD de até 3,3 mmHg, todas com intervalo de confiança de 95 por cento. A diferença máxima entre as medidas na mesma voluntária foi de 49 mmHg na PAS, 46 mmHg na PAM e 28 mmHg na PAD. CONCLUSÕES: Este trabalho mostrou que há variação significativa entre as medidas das PAS, PAM e PAD e que a PAD é o parâmetro mais fidedigno para verificar alterações da pressão arterial em voluntárias.

BACKGROUND AND OBJECTIVES: Since 1903, blood pressure has been noninvasively monitored (NIBP), either with manual sphygmomanometer or automated noninvasive devices. One NIBP measurement problem is the considerable variance in blood pressure data, both within and between available techniques. The oscillometric method for NIBP monitoring evaluates blood pressure during cuff deflation. Difficulties in blood pressure measurement by oscillometry may arise from: inadequate cuff size, inadequate cuff application, undetected fails in cuff, hoses, or connectors, arm movement, shock and vascular compression proximal to the cuff. This study aimed at evaluating the reliability of three noninvasive blood pressure monitoring devices during five measurements. METHODS: Blood pressure of 60 healthy female volunteers aged 20 to 40 years was evaluated from 7 am to 11 am, in the sitting position during a normal workday. Five measures were taken with each device at 2-minute intervals. Three automatic blood pressure monitors were studied. No patient was obese, hypertensive or suffering from cardiac disease and cardiac arrhythmia. Indirect measurements were made according to manufacturers' instructions. RESULTS: There were no differences in demographics among the three studied groups. Mean intrapersonal variation from one measurement to the other was up to 6.7 mmHg for systolic blood pressure (SBP), 4.9 mmHg for mean blood pressure (MBP) and 3.3 mmHg for diastolic blood pressure (DBP) with 95% confidence interval. The highest difference between measures in the same volunteer was 49 mmHg for SBP, 46 mmHg for MBP and 28 mmHg for DBP. CONCLUSIONS: This study has shown significant variations in SBP, MBP and DBP and that SBP is the most reliable parameter to check blood pressure changes in volunteers.

JUSTIFICATIVA Y OBJETIVOS: Desde 1903 la monitorización de la presión arterial ha sido realizada por método no invasor, con esfigmomanómetro o aparatos automáticos no invasores. Uno de los problemas de la medida de la presión arterial no invasora es considerar la variación de la presión arterial con el método utilizado. El método oscilométrico de medida de la presión arterial evalúa la presión arterial durante la deflación del manguito. Dificultades de la medida de la presión arterial por el método oscilométrico pueden acontecer por: tamaño inadecuado del manguito, incorrecta aplicación del manguito, faltas no detectadas por el manguito y conectores, movimiento del brazo, estado de choque y compresión vascular proximal al manguito. Este estudio evaluó la confianza de los aparatos en las medidas de la presión arterial por el método no invasor en cinco medidas con tres aparatos diferentes. MÉTODO: Fue evaluada la presión arterial en 60 voluntarias con edades entre 20 y 40 años en el período de las 7 a las 11 horas de la mañana, en la posición sentada de un día normal de trabajo. La medida de la presión arterial constató de cinco afericiones con intervalo de 2 minutos. Fueron estudiados tres aparatos automáticos de medida de la presión arterial. Ninguna paciente era obesa, hipertensa o sofría de enfermedad cardíaca o disritmias cardíacas. La medida indirecta de la presión arterial era hecha de acuerdo con las instrucciones de los fabricantes. RESULTADOS: No hay diferencia entre los tres grupos estudiados en relación a los parámetros demográficos. La variación media intrapersonal en la PAS, de una medida para otra, fue de hasta 6,7 mmHg, en la PAM de hasta 4,9 mmHg y en la PAD de hasta 3,3 mmHg, todas con intervalo de confianza 95%. La diferencia máxima entre las medidas en la misma voluntaria fue de 49 mmHg en la PAS, 46 mmHg en la PAM y 28 mmHg en la PAD. CONCLUSIONES: Este trabajo mostró que hay variación significativa entre as medidas de las PAS, PAM y PAD y...

Automatic blood pressure monitors. Evaluation of three models in volunteers.

BACKGROUND AND OBJECTIVES: Since 1903, blood pressure has been noninvasively monitored (NIBP), either with manual sphygmomanometer or automated noninvasive devices. One NIBP measurement problem is the considerable variance in blood pressure data, both within and between available techniques. The oscillometric method for NIBP monitoring evaluates blood pressure during cuff deflation. Difficulties in blood pressure measurement by oscillometry may arise from: inadequate cuff size, inadequate cuff application, undetected fails in cuff, hoses, or connectors, arm movement, shock and vascular compression proximal to the cuff. This study aimed at evaluating the reliability of three noninvasive blood pressure monitoring devices during five measurements. METHODS: Blood pressure of 60 healthy female volunteers aged 20 to 40 years was evaluated from 7 am to 11 am, in the sitting position during a normal workday. Five measures were taken with each device at 2-minute intervals. Three automatic blood pressure monitors were studied. No patient was obese, hypertensive or suffering from cardiac disease and cardiac arrhythmia. Indirect measurements were made according to manufacturers' instructions. RESULTS: There were no differences in demographics among the three studied groups. Mean intrapersonal variation from one measurement to the other was up to 6.7 mmHg for systolic blood pressure (SBP), 4.9 mmHg for mean blood pressure (MBP) and 3.3 mmHg for diastolic blood pressure (DBP) with 95% confidence interval. The highest difference between measures in the same volunteer was 49 mmHg for SBP, 46 mmHg for MBP and 28 mmHg for DBP. CONCLUSIONS: This study has shown significant variations in SBP, MBP and DBP and that SBP is the most reliable parameter to check blood pressure changes in volunteers.