Association between burnout syndrome and anxiety in residents and anesthesiologists of the Federal District / Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal

Abstract Background and objective There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District. Method A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%. Results Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables. Conclusions There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.

Resumo Justificativa e objetivo Existe escassez de estudos sobre a associação entre a síndrome de burnout e ansiedade entre anestesiologistas. A identificação da relação entre as duas condições é de fundamental importância para a prevenção, o acompanhamento e tratamento dos profissionais. Assim, foi avaliada a associação entre síndrome de burnout e ansiedade nos anestesiologistas e residentes em anestesiologia do Distrito Federal. Método Estudo de corte transversal que usou amostra por conveniência composta por residentes e anestesiologistas do Distrito Federal. Correlação entre ansiedade (State Trait Anxiety Inventory) e síndrome de burnout (Maslach burnout Inventory) foi testada a partir da análise de regressão linear múltipla, considerou-se nível de significância de 5%. Resultados Dos 78 formulários respondidos, houve predominância de indivíduos do sexo masculino (57,69%), com média de 42 ± 9,7 anos para os anestesiologistas e de 30 ± 2,9 anos para os residentes. A síndrome de burnout apresentou prevalência de 2,43% entre os anestesiologistas e 2,70% entre médicos residentes, enquanto alto risco para sua manifestação nos anestesiologistas foi de 21,95% e para médicos residentes, de 29,72%. Observou-se correlação entre ansiedade-estado e as variáveis exaustão emocional de burnout, despersonalização de burnout e ansiedade-traço. Em relação à ansiedade-traço não houve correlação estatisticamente significante com as demais variáveis. Conclusão Existe associação entre ansiedade-estado e as dimensões exaustão emocional de burnout, despersonalização de burnout e ansiedade-traço. A ocorrência de ansiedade pode influenciar negativamente a maneira como o indivíduo enfrenta os fatores estressores cotidianos, o que pode estar relacionado ao uso de ineficazes estratégias de enfrentamento diante do estresse.

[Association between burnout syndrome and anxiety in residents and anesthesiologists of the Federal District]. / Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal.

BACKGROUND AND OBJECTIVE: There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District. METHOD: A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%. RESULTS: Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables. CONCLUSIONS: There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.

Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis / Efeito da dexmedetomidina em crianças submetidas à anestesia geral com sevoflurano

Abstract Background and objectives: Sevoflurane is often used in pediatric anesthesia and is associated with high incidence of psychomotor agitation. In such cases, dexmedetomidine (DEX) has been used, but its benefit and implications remain uncertain. We assessed the effects of DEX on agitation in children undergoing general anesthesia with sevoflurane. Method: Meta-analysis of randomized clinical and double-blind studies, with children undergoing elective procedures under general anesthesia with sevoflurane, using DEX or placebo. We sought articles in English in PubMed database using the following terms: Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurante), and agitation (Psychomotor Agitation). Duplicate articles with children who received premedication and used active control were excluded. It was adopted random effects model with DerSimonian-Laird testing and odds ratio (OR) calculation for dichotomous variables, and standardized mean difference for continuous variables, with their respective 95% confidence interval (CI). Results: Of 146 studies identified, 10 were selected totaling 558 patients (282 in DEX group and 276 controls). The use of DEX was considered a protective factor for psychomotor agitation (OR = 0.17; 95% CI 0.13-0.23; p < 0.0001) and nausea and vomiting in PACU (OR = 0.49; 95% CI 0.35-0.68; p < 0.0001). Wake-up time and PACU discharge time were higher in the dexmedetomidine group. There was no difference between groups for extubation time and duration of anesthesia. Conclusion: Dexmedetomidine reduces psychomotor agitation during wake-up time of children undergoing general anesthesia with sevoflurane.

Resumo Justificativa e objetivos: Sevoflurano é frequentemente usado em anestesia pediátrica e está associado à alta incidência de agitação psicomotora ao despertar. Nesses casos a dexmedetomidina (dex) tem sido usada, porém permanecem incertos seus benefícios e suas implicações. Foram avaliados os efeitos da dex sobre a agitação no despertar de crianças submetidas à anestesia geral com sevoflurano. Método: Metanálise de ensaios clínicos randomizados e duplamente encobertos, com crianças submetidas a procedimentos eletivos sob anestesia geral com sevoflurano, que usaram dex ou placebo. Buscaram-se artigos em língua inglesa na base de dados Pubmed com termos como Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurane) e agitation (Psychomotor Agitation). Artigos duplicados, com crianças que receberam medicação pré-anestésica e que usaram controle ativo foram excluídos. Adotou-se modelo de efeitos aleatórios com testes de DerSimonian-Laird e cálculo de odds ratio (OR) para variáveis dicotômicas e diferença de média padronizada para variáveis contínuas, com seus respectivos intervalos de confiança de 95% (IC). Resultados: Dos 146 estudos identificados, 10 foram selecionados, com 558 pacientes (282 no grupo dex e 276 controles). O uso da dex foi considerado fator de proteção para agitação psicomotora (OR = 0,17; 95% IC 0,13-0,23; p < 0,0001) e para náuseas e vômitos na SRPA (OR = 0,49; 95% IC 0,35-0,68; p < 0,0001). Tempo para despertar e para alta da SRPA foram maiores no grupo dexmedetomidina. Não houve diferença entre os grupos para tempo de extubação e duração da anestesia. Conclusão: A dexmedetomidina reduz a agitação psicomotora no despertar de crianças submetidas à anestesia geral com sevoflurano.

Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis.

BACKGROUND AND OBJECTIVES: Sevoflurane is often used in pediatric anesthesia and is associated with high incidence of psychomotor agitation. In such cases, dexmedetomidine (DEX) has been used, but its benefit and implications remain uncertain. We assessed the effects of DEX on agitation in children undergoing general anesthesia with sevoflurane. METHOD: Meta-analysis of randomized clinical and double-blind studies, with children undergoing elective procedures under general anesthesia with sevoflurane, using DEX or placebo. We sought articles in English in PubMed database using the following terms: Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurante), and agitation (Psychomotor Agitation). Duplicate articles with children who received premedication and used active control were excluded. It was adopted random effects model with DerSimonian-Laird testing and odds ratio (OR) calculation for dichotomous variables, and standardized mean difference for continuous variables, with their respective 95% confidence interval (CI). RESULTS: Of 146 studies identified, 10 were selected totaling 558 patients (282 in DEX group and 276 controls). The use of DEX was considered a protective factor for psychomotor agitation (OR=0.17; 95% CI 0.13-0.23; p<0.0001) and nausea and vomiting in PACU (OR=0.49; 95% CI 0.35-0.68; p<0.0001). Wake-up time and PACU discharge time were higher in the dexmedetomidine group. There was no difference between groups for extubation time and duration of anesthesia. CONCLUSION: Dexmedetomidine reduces psychomotor agitation during wake-up time of children undergoing general anesthesia with sevoflurane.

[Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis]. / Efeito da dexmedetomidina em crianças submetidas à anestesia geral com sevoflurano.

BACKGROUND AND OBJECTIVES: Sevoflurane is often used in pediatric anesthesia and is associated with high incidence of psychomotor agitation. In such cases, dexmedetomidine (DEX) has been used, but its benefit and implications remain uncertain. We assessed the effects of DEX on agitation in children undergoing general anesthesia with sevoflurane. METHOD: Meta-analysis of randomized clinical and double-blind studies, with children undergoing elective procedures under general anesthesia with sevoflurane, using DEX or placebo. We sought articles in English in PubMed database using the following terms: Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurante), and agitation (Psychomotor Agitation). Duplicate articles with children who received premedication and used active control were excluded. It was adopted random effects model with DerSimonian-Laird testing and odds ratio (OR) calculation for dichotomous variables, and standardized mean difference for continuous variables, with their respective 95% confidence interval (CI). RESULTS: Of 146 studies identified, 10 were selected totaling 558 patients (282 in DEX group and 276 controls). The use of DEX was considered a protective factor for psychomotor agitation (OR=0.17; 95% CI 0.13 to 0.23; p<0.0001) and nausea and vomiting in PACU (OR=0.49; 95% CI 0.35 to 0.68; p<0.0001). Wake-up time and PACU discharge time were higher in the dexmedetomidine group. There was no difference between groups for extubation time and duration of anesthesia. CONCLUSION: Dexmedetomidine reduces psychomotor agitation during wake-up time of children undergoing general anesthesia with sevoflurane.

Prevalence of burnout syndrome among anesthesiologists in the Federal District / Prevalência de síndrome de burnout entre os anestesiologistas do Distrito Federal / Prevalencia del síndrome de burnout entre los anestesistas del Distrito Federal

BACKGROUND: Burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and a sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference. OBJECTIVE: To evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District. METHOD: A cross-sectional study was carried out with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data. RESULTS: Of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over 10 years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of the three criteria to develop the syndrome and only 8.2% have a low risk to manifest it. CONCLUSION: The prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction. .

JUSTIFICATIVA: a síndrome de burnout (queimar até a exaustão), consequência do estresse crônico, caracteriza-se por exaustão emocional, despersonalização e sentimento de baixa realização profissional. Acomete trabalhadores sob extrema responsabilidade ou que assistem indivíduos sob risco, incluindo anestesiologistas. Podem apresentar distanciamento em relação ao trabalho, pacientes e colegas, por sentirem-se mais seguros ao manter a indiferença. OBJETIVO: avaliar a prevalência da síndrome do esgotamento profissional, a intensidade de seus componentes e identificar características dos seus portadores entre anestesiologistas do Distrito Federal. MÉTODO: estudo transversal, com 241 anestesiologistas inscritos na Sociedade de Anestesiologia do Distrito Federal. Usou-se questionário autoaplicável que incluiu o Inventário de Burnout de Maslach, dados sociodemográficos, profissionais e de lazer. RESULTADOS: dos 134 questionários respondidos (55,8%), foram predominantes os preenchidos por homens (65,6%), com faixa de 30 a 50 anos (67,9%). Foram encontrados níveis significativos de baixa realização profissional (47,7%), despersonalização (28,3%) e exaustão emocional (23,1%). A síndrome de burnout apresentou prevalência de 10,4%, ocorreu principalmente em homens (64,2%), na faixa de 30 a 50 anos (64,2%), com mais de dez anos de profissão (64,2%), com atuação em plantões noturnos (71,4%), sedentários (57,1%) e que não fazem cursos não relacionados à medicina (78,5%). Dos participantes, 50,7% apresentaram pelo menos um de três critérios para desenvolver a síndrome e apenas 8,2% têm baixo risco para sua manifestação. CONCLUSÃO: a prevalência da síndrome de burnout é relevante entre os anestesiologistas do Distrito Federal. É aconselhável buscar estratégias de reorganização laboral para diminuir fatores de estresse e perda da motivação e aumentar a satisfação no emprego. .

JUSTIFICACIÓN: El síndrome de burnout (quemarse hasta la saciedad), consecuencia del estrés crónico, se caracteriza por agotamiento emocional, despersonalización y sentimiento de baja satisfacción profesional. Afecta a trabajadores bajo extrema responsabilidad o que ayudan a individuos que están en situación de riesgo, incluyendo a los anestesistas. Pueden presentar un distanciamiento con relación al trabajo, pacientes y colegas, al sentirse más seguros con el mantenimiento de la indiferencia. OBJETIVO: Evaluar la prevalencia del síndrome del burnout, la intensidad de sus componentes e identificar las características de sus portadores entre los anestesistas del Distrito Federal. MÉTODO: Estudio transversal, con 241 anestesistas registrados en la Sociedad de Anestesiología del Distrito Federal. Usamos un cuestionario autoadministrado que incluyó el Inventario de Burnout de Maslach, datos sociodemográficos, profesionales y de ocio. RESULTADOS D: e los 134 cuestionarios respondidos (55,8%) predominaron los que fueron rellenados por hombres (65,6%), con una franja etaria de 30-50 años (67,9%). Fueron encontrados niveles significativos de baja satisfacción profesional (47,7%), despersonalización (28,3%) y agotamiento emocional (23,1%). El síndrome de burnout presentó una prevalencia de un 10,4%, ocurrió principalmente en los hombres (64,2%), en la franja etaria de 30-50 años (64,2%), con más de 10 años de profesión (64,2%), que trabajaban haciendo guardias nocturnas (71,4%), sedentarios (57,1%) y que no hacen cursos no relacionados con la medicina (78,5%). De los participantes, un 50,7% tuvieron por lo menos uno de los 3 criterios existentes para desarrollar el síndrome y solamente un 8,2% presentó un bajo riesgo para su manifestación. CONCLUSIÓN: La prevalencia del síndrome de burnout es relevante entre los anestesistas del Distrito Federal. Se aconseja buscar estrategias de reorganización laboral para disminuir los factores de estrés y ...

[Prevalence of burnout syndrome among anesthesiologists in the Federal District]. / Prevalência de síndrome de burnout entre os anestesiologistas do Distrito Federal.

BACKGROUND: burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference. OBJECTIVE: evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District. METHOD: cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data. RESULTS: of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of three criteria to develop the syndrome and only 8.2% have a low risk to manifest it. CONCLUSION: the prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.

Uso de preditores clínicos simples no diagnóstico pré-operatório de dificuldade de intubação endotraqueal em pacientes portadores de obesidade / Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients / Uso de predictores clínicos sencillos en el diagnóstico preoperatorio de dificultad de intubación endotraqueal en pacientes obesos

JUSTIFICATIVA E OBJETIVOS: Apesar da semelhante incidência de dificuldade à laringoscopia em obesos e não obesos há mais relatos de dificuldade de intubação endotraqueal em portadores de obesidade. Alternativas de diagnóstico e previsão de dificuldade de intubação no pré-operatório podem ajudar diminuir complicações anestésicas em indivíduos obesos. O objetivo do estudo foi identificar preditores para diagnóstico de via aérea difícil em pacientes obesos, pela correlação com métodos clínicos de avaliação pré-anestésica e polissonografia. Comparou-se também a incidência de dificuldade à ventilação sob máscara facial e à laringoscopia entre obesos e não obesos, verificando os preditores mais prevalentes. MÉTODOS: Estudo observacional, prospectivo, comparativo, com 88 pacientes adultos, submetidos à anestesia geral. No período pré-operatório, avaliou-se questionário sobre preditores clínicos de síndrome da apneia obstrutiva do sono (SAOS) e parâmetros anatômicos. Durante a anestesia, pesquisou-se dificuldade à ventilação sob máscara facial e laringoscopia. Para análise, estatística descritiva e teste de correlação. RESULTADOS: Os pacientes foram alocados em dois grupos, 43 obesos e 45 não obesos. Estado físico, prevalência de roncos, hipertensão e diabetes mellitus, circunferência cervical e índice de Mallampati foram maiores nos obesos. Pacientes obesos apresentaram maior incidência de dificuldade de ventilação sob máscara e laringoscopia. Nenhuma variável clínica ou anatômica apresentou correlação com dificuldade de ventilação sob máscara nos grupos. Nos obesos, o diagnóstico de SAOS mostrou forte correlação com dificuldade à laringoscopia. CONCLUSÕES: Os diagnósticos clínico e polissonográfico de SAOS se mostraram úteis no diagnóstico pré-operatório de dificuldade à laringoscopia. Pacientes obesos estão mais propensos à dificuldade de ventilação sob máscara e laringoscopia.

BACKGROUND AND OBJECTIVES: Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. METHODS: Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. RESULTS: Patients were allocated into two groups: obese group (n = 43) and non-obese group (n = 45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. CONCLUSIONS: The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy.

JUSTIFICATIVA Y OBJETIVOS: A pesar de la incidencia similar de dificultad a la laringoscopia en obesos y no obesos, existen relatos de dificultad de intubación endotraqueal en obesos. Alternativas de diagnóstico y previsión de dificultad de intubación en el preoperatorio pueden ayudar a disminuir las complicaciones anestésicas en los individuos obesos. El objetivo del estudio fue identificar los predictores para el diagnóstico de la vía aérea difícil en pacientes obesos, por medio de la correlación con los métodos clínicos de evaluación preanestésica y la polisomnografía. También comparamos la incidencia de dificultad a la ventilación bajo mascarilla facial y a la laringoscopia entre obesos y no obesos, verificando los predictores más prevalentes. MÉTODOS: Estudio observacional, prospectivo y comparativo con 88 pacientes adultos, sometidos a la anestesia general. En el período preoperatorio, se evaluó el cuestionario sobre predictores clínicos del síndrome de la apnea obstructiva del sueño (SAOS) y los parámetros anatómicos. Durante la anestesia, investigamos una dificultad para la ventilación bajo mascarilla facial y laringoscopia. Para el análisis, la estadística descriptiva y el test de correlación. RESULTADOS: Los pacientes fueron ubicados en dos grupos, 43 obesos y 45 no obesos. El estado físico, la prevalencia de ronquidos, la hipertensión, la diabetes mellitus, la circunferencia cervical y le índice de Mallampati fueron más elevados en los obesos. Los pacientes obesos tenían una mayor incidencia de dificultad de ventilación bajo mascarilla y laringoscopia. Ninguna variable clínica o anatómica tuvo correlación con la dificultad de ventilación bajo mascarilla en los grupos. En los obesos, el diagnóstico de SAOS arrojó una fuerte correlación con la dificultad a la laringoscopia. CONCLUSIONES: Los diagnósticos clínico y polisomnográfico de SAOS fueron útiles para el diagnóstico preoperatorio de dificultad a la laringoscopia. Los pacientes obesos son más propensos a la dificultad de ventilación bajo mascarilla y laringoscopia.

Evaluation of the influence of the codon 16 polymorphism of the Beta-2 adrenergic receptor gene on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid anesthesia.

BACKGROUND AND OBJECTIVES: The beta-2 adrenergic receptor gene has several polymorphisms. Recent studies have demonstrated the clinical importance of the latter. The objective of the present study was to evaluate the influence of the Arg16Gli polymorphism on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid block for Cesarean section. METHOD: Healthy parturients (ASA I and II) were submitted to subarachnoid anesthesia for elective Cesarean section (n = 50). Ephedrine was administered in cases of arterial hypotension. The incidence of arterial hypotension and the required dose of ephedrine to correct the arterial pressure were compared between the different genotypes identified. RESULTS: The most prevalent genotype was Arg16Gli (60%, n = 30) followed by Gli16Gli (26%, n = 13) and Arg16Arg (14%, n = 7). No differences were observed regarding the basic characteristics of the genotypes. In comparison to the Arg16Arg genotype, the Gli16Gli presented a 3.95-fold increase in the hazard ratio of arterial hypotension (95%CI 0.86-18.11; p = 0.076), whereas the Arg16Gli presented a 4.83-fold increase (95%CI 1.13-20.50; p = 0.033). The parturients with the Arg16Arg needed, on average, 6.4 +/- 8.5 mg of ephedrine to correct the arterial hypotension, whereas those with the Arg16Gli needed 19.5 +/- 15.9 mg (p = 0.0445; 95%CI 0.3325-25.78) and the ones with the Gli16Gli genotype, 19.2 +/- 14.3 (p = 0.0445, 95%CI 0.3476-25.26). CONCLUSIONS: The results show that the genetic variant Arg16Arg presents a lower incidence of arterial hypertension and that lower doses of ephedrine were necessary to reestablish normal arterial pressure in the patients with this genetic profile. We conclude that the Arg16Arg genotype confers better pressure stability to the parturients submitted to subarachnoid anesthesia for Cesarean section.

Avaliação da influência do polimorfismo do códon 16 do receptor beta-2 adrenérgico na incidência de hipotensão arterial e uso de efedrina em grávidas submetidas à anestesia subaracnoidea / Evaluation of the influence of the codon 16 polymorphism of the beta-2 adrenergic receptor gene on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid anesthesia

JUSTIFICATIVA E OBJETIVOS: O gene do receptor beta-2 adrenérgico possui diversos polimorfismos. Estudos recentes vêm demonstrando sua importância clínica. O objetivo deste trabalho foi avaliar a influência do polimorfismo Arg16Gli na incidência de hipotensão arterial e uso de efedrina em parturientes submetidas ao bloqueio subaracnoideo para cesariana. MÉTODO: Parturientes hígidas (ASA I e II) foram submetidas à anestesia raquidiana para realização de cesariana eletiva (n = 50). Efedrina foi administrada nos casos de hipotensão arterial. A incidência de hipotensão arterial e a dose requerida de efedrina para correção da pressão arterial foram comparadas entre os diferentes genótipos encontrados. RESULTADOS: O genótipo mais prevalente foi o Arg16Gli (60 por cento, n = 30) seguido pelo Gli16Gli (26 por cento, n = 13) e Arg16Arg (14 por cento, n = 7). Não foram observadas diferenças entre as características básicas dos genótipos. Com relação ao genótipo Arg16Arg, o Gli16Gli apresentou aumento da razão de risco de hipotensão arterial (hazard ratio) de 3,95 vezes (IC 95 por cento 0,86-18,11; p = 0,076), enquanto o Arg16Gli apresentou aumento de 4,83 vezes (IC 95 por cento 1,13-20,50; p = 0,033). As parturientes com Arg16Arg precisaram, em média, de 6,4 ± 8,5 mg de efedrina para correção de hipotensão arterial, enquanto as do Arg16Gli precisaram de 19,5 ± 15,9 mg (p = 0,0445; IC 95 por cento 0,3325-25,78) e as do tipo Gli16Gli, 19,2 ± 14,3 (p = 0,0445, IC 95 por cento 0,3476-25,26). CONCLUSÕES: Os resultados mostraram que a variante genética Arg16Arg apresenta menor incidência de hipotensão arterial e que menores doses de efedrina foram necessárias para restabelecimento de normotensão arterial nas pacientes com esse perfil genético. Concluímos que o genótipo Arg16Arg confere maior estabilidade pressórica às parturientes submetidas à anestesia raquidiana para cesariana.

BACKGROUND AND OBJECTIVES: The beta-2 adrenergic receptor gene has several polymorphisms. Recent studies have demonstrated the clinical importance of the latter. The objective of the present study was to evaluate the influence of the Arg16Gli polymorphism on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid block for Cesarean section. METHOD: Healthy parturients (ASA I and II) were submitted to subarachnoid anesthesia for elective Cesarean section (n = 50). Ephedrine was administered in cases of arterial hypotension. The incidence of arterial hypotension and the required dose of ephedrine to correct the arterial pressure were compared between the different genotypes identified. RESULTS: The most prevalent genotype was Arg16Gli (60 percent, n = 30) followed by Gli16Gli (26 percent, n = 13) and Arg16Arg (14 percent, n = 7). No differences were observed regarding the basic characteristics of the genotypes. In comparison to the Arg16Arg genotype, the Gli16Gli presented a 3.95-fold increase in the hazard ratio of arterial hypotension (95 percentCI 0.86-18.11; p = 0.076), whereas the Arg16Gli presented a 4.83-fold increase (95 percentCI 1.13-20.50; p = 0.033). The parturients with the Arg16Arg needed, on average, 6.4 ± 8.5 mg of ephedrine to correct the arterial hypotension, whereas those with the Arg16Gli needed 19.5 ± 15.9 mg (p = 0.0445; 95 percentCI 0.3325-25.78) and the ones with the Gli16Gli genotype, 19.2 ± 14.3 (p = 0.0445, 95 percentCI 0.3476-25.26). CONCLUSIONS: The results show that the genetic variant Arg16Arg presents a lower incidence of arterial hypertension and that lower doses of ephedrine were necessary to reestablish normal arterial pressure in the patients with this genetic profile. We conclude that the Arg16Arg genotype confers better pressure stability to the parturients submitted to subarachnoid anesthesia for Cesarean section.

JUSTIFICATIVA Y OBJETIVOS: El gen del receptor beta-2 adrenérgico posee diversos polimorfismos. Estudios recientes han venido demostrando su importancia clínica. El objetivo de este trabajo, fue evaluar la influencia del polimorfismo Arg16Gli en la incidencia de hipotensión arterial y el uso de efedrina en parturientas sometidas al bloqueo subaracnoideo para cesárea. MÉTODO: Parturientas sanas (ASA I y II) fueron sometidas a la anestesia raquídea para la realización de cesárea electiva (n = 50). Efedrina fue administrada en los casos de hipotensión arterial. La incidencia de hipotensión arterial y la dosis requerida de efedrina para la corrección de la presión arterial fueron comparadas entre los diferentes genotipos encontrados. RESULTADOS: El genotipo que más prevaleció fue el Arg16Gli (60 por ciento, n = 30) seguido por el Gli16Gli (26 por ciento, n = 13) y Arg16Arg (14 por ciento, n = 7). No se observaron diferencias entre las características básicas de los genotipos. Con relación al genotipo Arg16Arg, el genotipo Gli16Gli presentó un aumento de la razón de riesgo de hipotensión arterial (hazard ratio) de 3,95 veces (IC 95 por ciento 0,86-18,11; p = 0,076), mientras que el genotipo Arg16Gli presentó un aumento de 4,83 veces (IC 95 por ciento 1,13-20,50; p = 0,033). Las parturientas con genotipo Arg16Arg, necesitaron como promedio 6,4 ± 8,5 mg de efedrina para la corrección de la hipotensión arterial, mientras que las del genotipo Arg16Gli necesitaron 19,5 ± 15,9 mg (p = 0,0445; IC 95 por ciento 0.3325-25.78) y las del tipo Gli16Gli 19,2 ± 14,3 (p = 0,0445, IC 95 por ciento 0.3476-25.26). CONCLUSIONES: Los resultados mostraron que la variante genética Arg16Arg presenta una menor incidencia de hipotensión arterial y que menores dosis de efedrina fueron necesarias para el reestablecimiento de la normotensión arterial en las pacientes con ese perfil genético. Concluimos que el genotipo Arg16Arg le da una mayor estabilidad de presión a...