Construction of a tool to measure perceptions about the use of the World Health Organization Safe Surgery Checklist Program / Construção de uma ferramenta para medida de percepções sobre o uso do checklist do Programa de Cirurgia Segura da Organização Mundial da Saúde

Abstract Background: The World Health Organization (WHO) has recommended greater attention to patient safety, particularly regarding preventable adverse events. The Safe Surgery Saves Lives (CSSV) program was released recommending the application of a surgical checklist for items on the safety of procedures. The checklist implementation reduced the hospital mortality rate in the first 30 days. In Brazil, we found no studies of anesthesiologists’ adherence to the practice of the checklist. Objective: The main objective was to develop a tool to measure the attitude of anesthesiologists and residents regarding the use of checklist in the perioperative period. Method: This was a cross-sectional study performed during the 59th CBA in BH/MG, whose participants were enrolled physicians who responded to the questionnaire with quantitative epidemiological approach. Results: From the sample of 459 participants who answered the questionnaire, 55% were male, 44.2% under 10 years of practice, and 15.5% with over 30 years of medical school completion. Seven items with 78% reliability coefficient were selected. There was a statistically significant difference between the groups of anesthesiologists who reported using the instrument in less or more than 70% of patients, indicating that the attitude questionnaire discriminates between these two groups of professionals. Conclusions: The seven items questionnaire showed adequate internal consistency and a well-defined factor structure, and can be used as a tool to measure the anesthesiologists’ perceptions about the checklist usefulness and applicability.

Resumo Introdução: A Organização Mundial da Saúde (OMS) tem recomendado uma maior atenção com a segurança do paciente, mais especificamente em relação aos eventos adversos evitáveis. Foi lançado o programa “Cirurgia Segura Salva Vidas (CSSV)”, que recomenda a aplicação da lista de verificação cirúrgica (checklist) para a conferência de itens relacionados à segurança do procedimento. A implantação do checklist reduziu a mortalidade hospitalar nos primeiros 30 dias. No Brasil, não foram identificados estudos sobre adesão dos anestesiologistas à prática do checklist. Objetivo: Desenvolvimento de uma ferramenta para mensuração da atitude dos anestesiologistas e residentes em relação ao uso do checklist no período perioperatório. Método: Estudo transversal feito durante o 59° Congresso Brasileiro de Anestesiologia (CBA), em Belo Horizonte (MG), cujos participantes foram médicos inscritos e que responderam ao questionário com abordagem epidemiológica quantitativa. Resultados: A amostra constou de 459 participantes que responderam ao questionário, 55% do sexo masculino, 44,2% com menos de 10 anos e 15,5% acima de 30 anos de conclusão do curso médico. Foram selecionados sete itens com coeficiente de confiabilidade de 78%. Houve diferença estatisticamente significativa entre os grupos de anestesiologistas que referiram usar o instrumento em menos ou mais de 70% dos pacientes assistidos. Isso indica que o questionário de atitudes discrimina entre esses dois grupos de profissionais. Conclusões: O questionário de sete itens mostrou adequada consistência interna e uma estrutura fatorial bem delimitada. Pode ser usado como ferramenta para medida das percepções de anestesiologistas quanto à utilidade e a aplicabilidade do checklist.

Construction of a tool to measure perceptions about the use of the World Health Organization Safe Surgery Checklist Program.

BACKGROUND: The World Health Organization (WHO) has recommended greater attention to patient safety, particularly regarding preventable adverse events. The Safe Surgery Saves Lives (CSSV) program was released recommending the application of a surgical checklist for items on the safety of procedures. The checklist implementation reduced the hospital mortality rate in the first 30 days. In Brazil, we found no studies of anesthesiologists' adherence to the practice of the checklist. OBJECTIVE: The main objective was to develop a tool to measure the attitude of anesthesiologists and residents regarding the use of checklist in the perioperative period. METHOD: This was a cross-sectional study performed during the 59th CBA in BH/MG, whose participants were enrolled physicians who responded to the questionnaire with quantitative epidemiological approach. RESULTS: From the sample of 459 participants who answered the questionnaire, 55% were male, 44.2% under 10 years of practice, and 15.5% with over 30 years of medical school completion. Seven items with 78% reliability coefficient were selected. There was a statistically significant difference between the groups of anesthesiologists who reported using the instrument in less or more than 70% of patients, indicating that the attitude questionnaire discriminates between these two groups of professionals. CONCLUSIONS: The seven items questionnaire showed adequate internal consistency and a well-defined factor structure, and can be used as a tool to measure the anesthesiologists' perceptions about the checklist usefulness and applicability.

[Construction of a tool to measure perceptions about the use of the World Health Organization Safe Surgery Checklist Program]. / Construção de uma ferramenta para medida de percepções sobre o uso do checklist do Programa de Cirurgia Segura da Organização Mundial da Saúde.

BACKGROUND: The World Health Organization (WHO) has recommended greater attention to patient safety, particularly regarding preventable adverse events. The Safe Surgery Saves Lives (CSSV) program was released recommending the application of a surgical checklist for items on the safety of procedures. The checklist implementation reduced the hospital mortality rate in the first 30 days. In Brazil, we found no studies of anesthesiologists' adherence to the practice of the checklist. OBJECTIVE: The main objective was to develop a tool to measure the attitude of anesthesiologists and residents regarding the use of checklist in the perioperative period. METHOD: This was a cross-sectional study performed during the 59(th) CBA in BH/MG, whose participants were enrolled physicians who responded to the questionnaire with quantitative epidemiological approach. RESULTS: From the sample of 459 participants who answered the questionnaire, 55% were male, 44.2% under 10 years of practice, and 15.5% with over 30 years of medical school completion. Seven items with 78% reliability coefficient were selected. There was a statistically significant difference between the groups of anesthesiologists who reported using the instrument in less or more than 70% of patients, indicating that the attitude questionnaire discriminates between these two groups of professionals. CONCLUSIONS: The seven items questionnaire showed adequate internal consistency and a well-defined factor structure, and can be used as a tool to measure the anesthesiologists' perceptions about the checklist usefulness and applicability.

There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia.

BACKGROUND AND OBJECTIVES: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. METHODS: Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS: Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257). CONCLUSIONS: High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.

Ocorre alta incidência de células da pele na primeira e terceira gotas do líquido cefalospinal em raquianestesia / There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia / Ocurre una alta incidencia de células de la piel en la primera y tercera gotas del líquido cefaloespinal en la raquianestesia

JUSTIFICATIVA E OBJETIVOS: Fragmentos de pele durante punções subaracnóideas podem desenvolver tumores epidermoides intraespinais. O objetivo deste estudo foi verificar a incidência de células epiteliais que refluem junto com a primeira e terceira gotas de líquor de pacientes submetido a raquianestesia. MÉTODO: Foram obtidas amostras da primeira e terceira gotas de líquor em 39 pacientes adultos submetidos à raquianestesia com agulha 25G Quincke, sendo confeccionadas quatro lâminas: da primeira gota, da terceira gota, da agulha e uma quarta lâmina controle com uma gota de soro fisiológico. As lâminas foram examinadas de forma randomizada pelo patologista. RESULTADOS: Foram identificadas células epiteliais escamosas em 35 (89,7%) das amostras da primeira gota, em 34 (87,2%) da terceira gota e em 24 (61,5%) das agulhas espinais. A terceira gota apresentou em média maior número de células que a primeira gota (p = 0,046). Células epiteliais nucleadas foram encontradas em uma (2,56%) das amostras da primeira gota, em quatro (10,25%) da terceira gota e em uma (2,56%) das agulhas espinais. A terceira gota apresentou em média maior número de células nucleadas que a primeira gota sem diferença estatística (p = 0,257). CONCLUSÕES: Encontramos uma alta porcentagem de células epiteliais que refluem na primeira (89,7%) e na terceira (87,2%) gotas do líquor e nas agulhas utilizadas (61,5%). Mesmo utilizando agulhas de pequeno calibre, descartáveis e com mandril bem adaptado, foram encontradas células da pele.

BACKGROUND AND OBJECTIVES: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. METHODS: Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS: Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p = 0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p = 0.257). CONCLUSIONS: High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel,.

JUSTIFICATIVA E OBJETIVOS: Algunos fragmentos de piel durante las punciones subaracnoideas pueden desarrollar tumores epidermoides intraespinales. El objetivo de este estudio fue verificar la incidencia de células epiteliales que refluyen junto con la primera y tercera gotas de líquido cefalorraquídeo de los pacientes sometidos a la raquianestesia. MÉTODO: Se obtuvieron muestras de la primera y tercera gotas de líquido cefalorraquídeo en 39 pacientes adultos sometidos a la raquianestesia con una aguja 25G Quincke, siendo confeccionadas cuatro láminas: de la primera gota, de la tercera gota, de la aguja y una cuarta lámina control con una gota de suero fisiológico. Las láminas fueron examinadas de forma aleatoria por el patólogo. RESULTADOS: Se identificaron células epiteliales escamosas en 35 (89,7%) de las muestras de la primera gota, en 34 (87,2%) de la tercera gota y en 24 (61,5%) de las agujas espinales. La tercera gota tuvo como promedio un mayor número de células que la primera gota (p = 0,046). Las células epiteliales nucleadas fueron encontradas en una (2,56%) de las muestras de la primera gota, en cuatro (10,25%) de la tercera gota y en una (2,56%) de las agujas espinales. La tercera gota presentó como promedio, un mayor número de células nucleadas que la primera gota sin diferencias estadísticas (p = 0,257). CONCLUSIONES: Encontramos un alto porcentaje de células epiteliales que refluyen en la primera (89,7%) y en la tercera (87,2%) gotas del líquido cefalorraquídeo y en las agujas utilizadas (61,5%). Y aunque hayamos usado agujas de pequeño calibre, desechables y con un mandril bien adaptado, se encontraron células de la piel.

There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia.

BACKGROUND AND OBJECTIVES: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the fi rst and third drops of CSF of patients undergoing spinal anesthesia. METHODS: Samples of the fi rst and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the fi rst drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS: Squamous epithelial cells were identified in 35 (89.7%) samples from the fi rst drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the fi rst drop (p = 0.046). Nucleated epithelial cells were found in a sample of the fi rst drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than fi rst drop with no statistical difference (p = 0.257). CONCLUSIONS: High percentage of epithelial cells was found in the fi rst (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.

Diminuição da concentração da levobupivacaína em excesso enantiomérico (S75: R25) para 0, 4% hiperbárica proporciona raquianestesia unilateral: estudo com diferentes volumes / Reducing the concentration to 0. 4% enantiomeric excess hyperbaric levobupivacaine (S75: R25) provides unilateral spinal anesthesia: study with different volumes / Disminución de la concentración de la levobupivacaína en exceso enantiomérico (S75: R25) para 0, 4% hiperbárica que proporciona raquianestesia unilateral: estudio con diferentes volúmenes

JUSTIFICATIVA E OBJETIVOS: Raquianestesia unilateral pode-se obter com solução hipobárica ou hiperbárica. O objetivo deste estudo foi comparar diferentes doses de levobupivacaína em excesso enantiomérico hiperbárico para se obter raquianestesia unilateral. PACIENTES E MÉTODO: Cento e vinte pacientes foram aleatoriamente separados para receber 4 mg, 6 mg ou 8 mg de levobupivacaína em excesso enantiomérico a 0,4%. As soluções foram administradas entre L3-L4, em posição lateral e permanecendo nessa posição em 5, 10 ou 15 minutos de acordo com a dose empregada. Bloqueios sensitivo (picada de agulha) e motor (escala de 0 a 3) foram comparados entre o lado a ser operado e contralateral. RESULTADOS: O início da analgesia foi rápido e comparável entre os grupos. Em todos os momentos das avaliações o bloqueio sensitivo no membro operado foi significativamente mais alto do que no membro não operado. O aumento de 1 mL (2 mg) na dose correspondeu a um aumento de dois segmentos (moda) no lado operado. No lado operado, o bloqueio motor completo (BM = 3) ocorreu em 31 (77,5%) dos pacientes com 4 mg, 38 (95%) com 6 mg e 40 (100%) com 8 mg. Houve uma correlação positiva entre o aumento da dose, a duração do bloqueio e a hipotensão. Todos os pacientes tiveram uma satisfação ótima com a técnica usada. CONCLUSÕES: A raquianestesia com diferentes volumes da solução de levobupivacaína em excesso enantiomérico (S75:R25) hiperbárica proporcionou uma incidência de 78% de unilateralidade do bloqueio espinal, sendo a menor dose empregada (4 mg) a mais eficiente.

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia may be obtained with hypobaric or hyperbaric solution. The objective of this study was to compare different doses of enantiomeric excess hyperbaric levobupivacaine to achieve unilateral spinal anesthesia. METHOD: One hundred and twenty patients were randomized to receive 4 mg, 6 mg or 8 mg of 0.4% enantiomeric excess levobupivacaine. The solutions were administered at the L3-L4, with the patient in a lateral position and kept at this position according to dose administration for 5, 10 or 15 minutes. Sensory block (pinprick) and motor block (scale 0-3) were compared between the operated and contralateral sides. RESULTS: The onset of analgesia was rapid and comparable between groups. Sensory block was significantly higher in the operated than in nonoperated limb at all times of evaluation. Increasing the dose by 1 mL (2 mg) corresponded to an increase of two segments in the mode for the operated side. In the operated side, motor block (MB = 3) of patients occurred in 31 (77.5%) with 4mg, 38 (95%) with 6 mg, and 40 (100%) with 8 mg. There was a positive correlation between increased dose, blockade duration, and hypotension. All patients were satisfied with the technique used. CONCLUSIONS: Spinal anesthesia with different volumes of enantiomeric excess hyperbaric bupivacaine (S75: R25) provided a 78% incidence of unilateral spinal block, with the smallest dose used (4 mg) the most efficient.

JUSTIFICATIVA Y OBJETIVOS: La Raquianestesia unilateral se puede obtener con una solución hipobárica o hiperbárica. El objetivo de este estudio, fue comparar las diferentes dosis de levobupivacaína en exceso enantiomérico hiperbárico para poder obtener la raquianestesia unilateral. PACIENTES Y MÉTODO: Ciento veinte pacientes fueron aleatoriamente separados para recibir 4 mg, 6 mg u 8 mg de levobupivacaína en exceso enantiomérico al 0,4%. Las soluciones fueron administradas entre L3-L4, en posición lateral permaneciendo en esa posición en 5, 10 ó 15 minutos de acuerdo con la dosis usada. Los bloqueos sensitivo (picada de aguja) y motor (escala de 0 a 3) se compararon entre el lado que sería operado y el lado contralateral. RESULTADOS: El inicio de la analgesia fue rápido y se comparó entre los grupos. En todos los momentos de las evaluaciones, el bloqueo sensitivo en el miembro operado fue significativamente más alto que en el miembro no operado. El aumento de 1 mL (2 mg) en la dosis correspondió a un aumento de los segmentos en la moda en el lado operado. En el lado operado, el bloqueo motor completo (BM = 3) se dio en 31 (77,5%) de los pacientes con 4 mg, 38 (95%) con 6 mg y 40 (100%) con 8 mg. Hubo una correlación positiva entre el aumento de la dosis, la duración del bloqueo y la hipotensión. Todos los pacientes alcanzaron una excelente satisfacción con la técnica usada. CONCLUSIONES: La raquianestesia con diferentes volúmenes de la solución de levobupivacaína en exceso enantiomérico (S75:R25) hiperbárica, proporcionó una incidencia de un 78% de unilateralidad del bloqueo espinal, siendo la menor dosis usada (4 mg) la más eficiente.

Reducing the concentration to 0.4% enantiomeric excess hyperbaric levobupivacaine (s75: r25) provides unilateral spinal anesthesia. Study with different volumes.

BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia may be obtained with hypobaric or hyperbaric solution. The objective of this study was to compare different doses of enantiomeric excess hyperbaric levobupivacaine to achieve unilateral spinal anesthesia. METHOD: One hundred and twenty patients were randomized to receive 4 mg, 6 mg or 8 mg of 0.4% enantiomeric excess levobupivacaine. The solutions were administered at the L3-L4, with the patient in a lateral position and kept at this position according to dose administration for 5, 10 or 15 minutes. Sensory block (pinprick) and motor block (scale 0-3) were compared between the operated and contralateral sides. RESULTS: The onset of analgesia was rapid and comparable between groups. Sensory block was significantly higher in the operated than in nonoperated limb at all times of evaluation. Increasing the dose by 1 mL (2mg) corresponded to an increase of two segments in the mode for the operated side. In the operated side, motor block (MB = 3) of patients occurred in 31 (77.5%) with 4 mg, 38 (95%) with 6 mg, and 40 (100%) with 8 mg. There was a positive correlation between increased dose, blockade duration, and hypotension. All patients were satisfied with the technique used. CONCLUSIONS: Spinal anesthesia with different volumes of enantiomeric excess hyperbaric bupivacaine (S75: R25) provided a 78% incidence of unilateral spinal block, with the smallest dose used (4 mg) the most efficient.

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

BACKGROUND AND OBJECTIVES: Reducing postoperative pain in hemorrhoidectomy is still a challenge. This prospective, randomized, double-blind study was conducted to compare bilateral pudendal blockade with peripheral nerve stimulator to relieve postoperative pain with the method commonly used. METHOD: 200 patients scheduled for hemorrhoidectomy were randomly divided into Control Group and Pudendal Group. Bilateral pudendal block was performed with levobupivacaine enantiomeric excess (S75:R25) after location with a peripheral nerve stimulator. The parameters evaluated were pain intensity, duration of analgesia, rescue analgesia, complications, patient satisfaction and pain at first defecation. Data were recorded at 6, 12, 18 and 24 hours after the surgery. RESULTS: Bilateral pudendal nerves with mean 23.4±4.4 hours provided better relief of postoperative pain (p<0.001), reducing the need for analgesics and residual analgesia for more than 24 hours in 41% of patients. All patients in Pudental Group had spontaneous micturition versus 96 in the control group. There was no local or systemic complications. CONCLUSIONS: Bilateral blockade of the pudendal nerve using a neurostimulator provided better pain relief with less need for rescue dose and no local or systemic complications. (AU)

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória em hemorroidectomia ainda é um problema desafiador. Este estudo prospectivo, aleatório, duplamente encoberto, foi realizado para comparar o bloqueio bilateral do pudendo com estimulador de nervos periféricos para alívio da dor pós-operatória ao método habitualmente utilizado. MÉTODO: 200 pacientes escalados para hemorroidectomia foram aleatoriamente separados em Grupo Controle e Grupo Pudendo. O bloqueio bilateral do Grupo Pudendo foi realizado com levobupivacaína em excesso enantiomérico (S75:R25) após localização com estimulador de nervo periférico. Os parâmetros avaliados foram: intensidade da dor, duração da analgesia, resgate de analgésico, complicações, satisfação dos pacientes e dor à primeira defecação. Os dados foram anotados as 6, 12, 18 e 24 horas após a cirurgia. RESULTADO: O bloqueio bilateral dos pudendos, com média de 23,4±4,4 horas proporcionou um melhor alívio da dor pós-operatória (p<0,001), reduzindo a necessidade de analgésicos e com analgesia residual maior de 24 horas em 41% dos pacientes. Todos do Grupo Pudendo tiveram micção espontânea contra 96 do Grupo Controle. Não se observaram complicações locais ou sistêmicas. CONCLUSÕES: O bloqueio bilateral dos nervos pudendos com neuroestimulador proporcionou melhor alívio da dor, com menor necessidade de dose de resgate e sem complicações locais ou sistêmicas. (AU)

[Evaluation of preoperative anxiety and depression in patients undergoing invasive cardiac procedures]. / Avaliação da ansiedade e depressão no período pré-operatório em pacientes submetidos a procedimentos cardíacos invasivos.

BACKGROUND AND OBJECTIVES: Specific assessment of anxiety and depression is not included in routine preoperative evaluation; therefore, in cases of cardiac diseases in which the emotional status of the patient may be modified by the disease those disorders may not be diagnosed. The objective of the present study was to compare the level and prevalence of anxiety and depression in patients with cardiac disease undergoing invasive and/or surgical procedures using the Hospital Anxiety and Depression Scale - HAD. METHODS: After approval by the Ethics Committee, 96 patients, physical status ASA II and III, were divided in three groups: electrophysiological study (EPS), pacemaker (PM) placement, and myocardial revascularization (MR). 'Cutting points' were as follows: HAD-anxiety scale (HAD-A) with anxiety > 9; HAD-depression scale (HAD-D) with depression > 9. RESULTS: All three groups were homogenous regarding sociodemographic parameters. Statistically significant differences were observed among the three groups (p = 0.006; p = 0.034) in the level and prevalence of anxiety (HAD-A); and in the intergroup comparison of the anxiety level significant differences were observed between the EPS x MR and EPS x PM groups (p < 0.05). Significant differences in the level and prevalence of depression (HAD-D) among the study groups were not observed. CONCLUSIONS: Patients with cardiac diseases undergoing electrophysiological studies, pacemaker implantation, and myocardial revascularization have different levels and prevalence of anxiety, but they do not show differences in the level and prevalence of depression.

Avaliação da ansiedade e depressão no período pré-operatório em pacientes submetidos a procedimentos cardíacos invasivos / Evaluación de la ansiedad y depresión en el período preoperatorio en pacientes sometidos a procedimientos cardíacos / Evaluation of preoperative anxiety and depression in patients undergoing invasive cardiac procedures

JUSTIFICATIVA E OBJETIVOS: A avaliação específica da ansiedade e da depressão não está incluída na rotina de avaliação pré-operatória, o que faz com que em situações como as doenças cardíacas, em que o estado emocional dos pacientes pode estar modificado pela própria doença, possam não ser diagnosticadas. O objetivo do estudo foi comparar o nível e a prevalência de ansiedade e depressão em pacientes com doença cardíaca a serem submetidos a procedimentos invasivos e/ou cirúrgicos, utilizando a Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HAD). MÉTODO: Após a aprovação pelos Comitês de Ética, foram incluídos 96 pacientes, estado físico ASA II e III, que constituíram três grupos: estudo eletrofisiológico (EEF), implante de marcapasso (MP) e revascularização do miocárdio (RM). Os escores considerados "ponto de corte" foram: escala HAD-ansiedade (HAD-A) com ansiedade > 9; escala HAD-depressão (HAD-D) com depressão > 9. RESULTADOS: Os grupos foram homogêneos quanto às variáveis sociodemográficas. Observou-se diferença estatística significativa entre os três grupos (p = 0,006; p = 0,034) quanto ao nível e prevalência de ansiedade (HAD-A) e na comparação do nível de ansiedade grupo a grupo verificou-se diferença significativa entre os grupos EEF × RM e EEF × MP (p < 0,05). A comparação dos três grupos quanto ao nível e prevalência de depressão (HAD-D) não mostrou diferença estatística significativa. CONCLUSÕES: Os pacientes com doença cardíaca a serem submetidos a estudo eletrofisiológico, implante de marcapasso e revascularização do miocárdio têm diferença dos níveis e prevalência de ansiedade, mas não apresentam diferença em relação aos níveis e prevalência de depressão.

BACKGROUND AND OBJECTIVES: Specific assessment of anxiety and depression is not included in routine preoperative evaluation; therefore, in cases of cardiac diseases in which the emotional status of the patient may be modified by the disease those disorders may not be diagnosed. The objective of the present study was to compare the level and prevalence of anxiety and depression in patients with cardiac disease undergoing invasive and/or surgical procedures using the Hospital Anxiety and Depression Scale - HAD. METHODS: After approval by the Ethics Committee, 96 patients, physical status ASA II and III, were divided in three groups: electrophysiological study (EPS), pacemaker (PM) placement, and myocardial revascularization (MR). "Cutting points" were as follows: HAD-anxiety scale (HAD-A) with anxiety > 9; HAD-depression scale (HAD-D) with depression > 9. RESULTS: All three groups were homogenous regarding sociodemographic parameters. Statistically significant differences were observed among the three groups (p = 0.006; p = 0.034) in the level and prevalence of anxiety (HAD-A); and in the intergroup comparison of the anxiety level significant differences were observed between the EPS x MR and EPS x PM groups (p < 0.05). Significant differences in the level and prevalence of depression (HAD-D) among the study groups were not observed. CONCLUSIONS: Patients with cardiac diseases undergoing electrophysiological studies, pacemaker implantation, and myocardial revascularization have different levels and prevalence of anxiety, but they do not show differences in the level and prevalence of depression.

JUSTIFICATIVA Y OBJETIVOS: La evaluación específica de la ansiedad y de la depresión no está incluida en la rutina de evaluación preoperatoria, lo que hace con que en algunas situaciones como las enfermedades cardiacas, en que el estado emocional de los pacientes puede estar modificado por la propia enfermedad, puedan no quedar diagnosticadas. El objetivo del estudio fue comparar el nivel y la prevalencia de ansiedad y depresión en pacientes con enfermedad cardiaca a ser sometidos a procedimientos invasivos y/o quirúrgicos, utilizando la Escala Hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale - HAD). MÉTODO: Después de la aprobación por parte de los Comités de Ética, se incluyeron 96 pacientes, estado físico ASA II y III, que constituyeron tres grupos: estudio electrofisiológico (EEF), implante de marcapaso (MP) y revascularización del miocardio (RM). Las puntuaciones consideradas "punto de corte" fueron las siguientes: escala HAD-ansiedad (HAD-A): con ansiedad > 9; escala HAD-depresión (HAD-D): con depresión > 9. RESULTADOS: Los grupos fueron homogéneos en cuanto a las variables sociodemográficas. Se observó una diferencia estadística significativa entre los tres grupos (p = 0,006; p = 0,034) en lo concerniente al nivel y a la prevalencia de ansiedad (HAD-A) y en la comparación del nivel de ansiedad grupo a grupo, se verificó la diferencia significativa entre los grupos EEF x RM y EEF x MP (p < 0,05). La comparación de los tres grupos en cuanto al nivel y a la prevalencia de Depresión (HAD-D) no arrojó diferencia estadística significativa. CONCLUSIONES: Los pacientes con enfermedad cardiaca a ser sometidos a estudio electrofisiológico, implante de marcapaso y revascularización del miocardio, tienen diferencia de los niveles y prevalencia de ansiedad, pero no presentan diferencia con relación a los niveles y a la prevalencia de depresión.

Soroprevalência do vírus de hepatite B em anestesiologistas / Serum prevalence of hepatitis B virus in anesthesiologists

JUSTIFICATIVA E OBJETIVOS: Os anestesiologistas estão particularmente expostos ao contato com sangue e secreções. A infecção pelo vírus da hepatite B constitui o maior risco ocupacional para os profissionais da área da saúde. O objetivo deste estudo foi avaliar a soroprevalência do Ag-HBs, anti-HBs e anti-HBc, assim como a situação vacinal dos anestesiologistas da cidade de Goiânia. MÉTODO: Participaram da pesquisa 90 dos 200 anestesiologistas da cidade de Goiânia. As amostras foram colhidas pelo autor. Foram retirados 10 ml de sangue de uma veia periférica, identificadas no momento da coleta. O material foi analisado nas primeiras 24 horas, sob condições ideais de conservação. Realizou-se, através do ensaio imunoenzimático, a detecção dos seguintes marcadores: anti-HBc, anti-HBs e Ag-HBs. Os participantes da pesquisa foram pessoalmente contatados pelo autor, e consentiram por escrito com a realização do estudo. Assegurado sigilo absoluto, tanto dos resultados, como das informações contidas em questionário aplicado. RESULTADOS: Os dados analisados mostraram que 65/90 (72,2 por cento) foram reagentes para o anti-HBs e 25/90 (27,8 por cento) não reagentes. Quanto ao anti-HBc, 76/10 (90,5 por cento) foram não reagentes e 09/90 (10 por cento) mostraram-se reagentes. Nenhum dos participantes mostrou positividade para Ag-HBs. CONCLUSÕES: Este estudo mostrou uma soroprevalência para o anti-HBs de 72,2 por cento (65/90). A prevalência da infecção pelo vírus B entre os anestesiologistas foi de 8,9 por cento representados pelo 8 anti-HBc + / anti-HBs +. Com base nos resultados, campanhas de vacinação e implantação de medidas profiláticas devem ser intensificadas.

BACKGROUND AND OBJECTIVES: Anesthesiologists are especially exposed to blood and secretions. Hepatitis B virus infection is the major occupational risk for health care professionals. This study aimed at evaluating the prevalence of Ag-HBs, anti-HBs and anti-HBc among anesthesiologists of the city of Goiânia, as well as their vaccination status. METHODS: Participated in this study 90 out of 200 anesthesiologists of the city of Goiânia. Samples were collected by the author and consisted of 10 ml blood of a peripheral vein identified at collection. Blood was analyzed in the first 24 hours, under optimal conservation conditions. The following markers were detected by immunoenzymatic essay: anti-HBc, anti-HBs and Ag-HBs. Participants were personally contacted by the author and gave their written consent to participate in the study. Absolute secrecy of results and questionnaire information was assured. RESULTS: Analyzed material showed that 65 out of 90 (72.2%) were anti-HBs positive, as compared to 25 out of 90 (27.8%) who were negative. As to anti-HBc, 76 out of 10 (90.5%) were negative and 9 out of 90 (10%) were positive. No participant was Ag-HBs-positive. CONCLUSIONS: This study has shown 72.2% serum prevalence for anti-HBs. The prevalence of Hepatitis-B infection among anesthesiologists was 8.9%, represented by 8 anti-HBc + / anti-HBs +. Based on these results, vaccination campaigns and successful prevention should be intensified.

JUSTIFICATIVA Y OBJETIVOS: Los anestesiologistas están particularmente expuestos al contacto con sangre y secreciones. La infección por el virus de la hepatitis B constituye el mayor riesgo ocupacional para los profesionales de la área de la salud. El objetivo de este estudio fue evaluar el soroprevalecimiento del Ag-HBs, anti-HBs y anti-HBc, así como a situación de vacunas de los anestesiologistas de la ciudad de Goiania. MÉTODO: Participaron de la pesquisa 90 de los 200 anestesiologistas de la ciudad de Goiania. Las muestras fueron cogidas por el autor. Fueron retirados 10 ml de sangre de una vena periférica, identificadas en el momento de la colecta. El material fue analizado en las primeras 24 horas, bajo condiciones ideales de conservación. Se realizó, a través del ensayo inmunoenzimático, la detección de los siguientes marcadores: anti-HBc, anti-HBs y Ag-HBs. Los participantes de la pesquisa fueron personalmente contactados por el autor, y por escrito consintieron con la realización del estudio. Garantizado el sigilo absoluto, tanto de los resultados, como las informaciones contenidas en el cuestionario aplicado. RESULTADOS: Los datos analizados mostraron que 65/90 (72,2%) fueron reagentes para el anti-HBs y 25/90 (27,8%) no reagentes. Cuanto al anti-HBc, 76/10 (90,5%) fueron no reagentes y 09/90 (10%) se mostraron reagentes. Ninguno de los participantes mostró positividad para Ag-HBs. CONCLUSIONES: Este estudio mostró una soroprevalencia para el anti-HBs de 72,2% (65/90). La prevalencia de la infección por el virus B entre los anestesiologistas fue de 8,9% representados por el 8 anti-HBc + / anti-HBs +. Con base en los resultados, campañas de vacunación y planteamiento de medidas profilácticas deben ser intensificadas.

Serum prevalence of hepatitis B virus in anesthesiologists.

BACKGROUND AND OBJECTIVES: Anesthesiologists are especially exposed to blood and secretions. Hepatitis B virus infection is the major occupational risk for health care professionals. This study aimed at evaluating the prevalence of Ag-HBs, anti-HBs and anti-HBc among anesthesiologists of the city of Goiânia, as well as their vaccination status. METHODS: Participated in this study 90 out of 200 anesthesiologists of the city of Goiânia. Samples were collected by the author and consisted of 10 ml blood of a peripheral vein identified at collection. Blood was analyzed in the first 24 hours, under optimal conservation conditions. The following markers were detected by immunoenzymatic essay: anti-HBc, anti-HBs and Ag-HBs. Participants were personally contacted by the author and gave their written consent to participate in the study. Absolute secrecy of results and questionnaire information was assured. RESULTS: Analyzed material showed that 65 out of 90 (72.2%) were anti-HBs positive, as compared to 25 out of 90 (27.8%) who were negative. As to anti-HBc, 76 out of 10 (90.5%) were negative and 9 out of 90 (10%) were positive. No participant was Ag-HBs-positive. CONCLUSIONS: This study has shown 72.2% serum prevalence for anti-HBs. The prevalence of Hepatitis-B infection among anesthesiologists was 8.9%, represented by 8 anti-HBc +/anti-HBs +. Based on these results, vaccination campaigns and successful prevention should be intensified.

Evoluçäo imediata de pacientes submetidos a aneurismectomia de ventrículo esquerdo / Short-term follow-up of patients after aneurysmectomy of the left ventricle

OBJECTIVE: Left ventricular aneurysm is a complication of myocardial infarction that can best be treated by reconstructive surgeries that can restore ventricular geometry. We analyzed immediate results in a group of consecutive patients who underwent surgical correction of left ventricular aneurysms. METHODS: From January '90 to August '99, 94 patients - mean age 58.4 (ranging from 36 to 73 years), 65 (69.1 percent) males and 9 ( 30.8 percent) females - were operated upon. Pre-operative ejection fraction ranged from 0.22 to 0.58 (mean = 0.52), and the aneurysm was located in the antero-lateral area in 90.4 percent of the cases. Functional class III and IV (NYHA) was present in 82 (87.2 percent) patients, and 12 (12.7 percent) were in functional class I and II. Congestive heart failure was the most frequent cause (77.6 percent), occurring in isolation in 24.4 percent or associated with coronary artery diseases in 53.2 percent. RESULTS: Short-term follow-up showed a 7.4 percent mortality, and low cardiac output was the main cause of death. Coming off pump was uneventful in 73 patients (77.6 percent), with a 3.2 percent mortality and with the use of inotropics in 20 (21.3 percent). One patient (1 percent) did not come off the pump. CONCLUSION: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class