Vomiting after intrathecal chemotherapy under anesthesia in pediatric patients with hematologic cancers: A cohort study.

INTRODUCTION: Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. AIM: To assess the incidence and risk factors for vomiting within 24 h and goodness of fit for the Eberhart score in pediatric patients with hematologic cancers after receiving intrathecal chemotherapy under deep sedation. METHODS: This prospective cohort study included patients under 20 years of age with hematologic cancers who were scheduled to undergo intrathecal chemotherapy under anesthesia. The primary outcome was the occurrence of vomiting within 24 h after the end of anesthesia. Sociodemographic and procedure data and underlying diseases were collected. Patients were monitored during the procedure, in the postanesthesia care unit, and the day after (by phone call). RESULTS: A total of 139 patients were included, and the incidence of vomiting was 30.9% within 24 h after intrathecal chemotherapy under anesthesia, with 90.7% of vomiting prior to 6 h. Prophylactic ondansetron was administered prior to the procedure to 45.3% of patients. Risk factors for vomiting were female gender (hazard ratio: 2.47, 95% confidence interval: 1.35-4.53, p: .003), consolidation phase of treatment (hazard ratio: 2.16, 95% confidence interval: 1.10-4.24, p: .025), and history of kinetosis (hazard ratio: 2.49, 95% confidence interval: 1.31-4.70, p: .005). Incidence of vomit was higher than estimated by the Eberhart score distribution (observed incidence in patients with a score of zero: 33.3%; with a score of one: 28.8%; with a score of two: 60%). CONCLUSION: A high incidence of vomiting was observed within 24 h after intrathecal chemotherapy under propofol deep sedation. Risk factors for this outcome were established (being female, consolidation phase of treatment, and previous kinetosis), and evidence suggested that the Eberhart score was not suitable for the studied population.

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care.

Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

[Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte II: etiologia e diagnóstico.

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) - Parte II: etiologia e diagnóstico

Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

Resumo Este segundo documento, escrito por especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória, tem por objetivo revisar os mecanismos fisiopatológicos, agentes desencadeantes (em adultos e crianças), assim como a abordagem diagnóstica durante e após o episódio. Por se tratar de uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados, e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.

[Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte I: tratamento e orientação pós­crise.

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) - Parte I: tratamento e orientação pós-crise

Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.

Anesthesia and perioperative challenges for surgical separation of thoraco-omphalopagus twins: case report / Anestesia e desafios perioperátorios para cirurgia de separação de gêmeos toraco-onfalópagos: relato de caso

Abstract Background and objectives: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 and 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. Case report: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11 h of cesarean surgery, the pediatric surgical team chose to separate the twins. They were monitored with cardioscopy, oximetry, capnography, nasopharyngeal thermometer, urinary output, and non-invasive blood pressure. We chose inhaled induction with oxygen and 4% Sevoflurane. T1 patient was intubated with a 3.5 uncuffed endotracheal tube, and, after three unsuccessful intubation attempts of patient T2, a number 1 laryngeal mask was used. After securing the twins' airway, the induction was supplemented with fentanyl, propofol, and rocuronium. Mechanical ventilation in controlled pressure mode (6 mL.kg−1) and lumbar epidural (L1-L2) with 0.2% ropivacaine (2.5 mg.kg−1) were used. The pediatric surgical team initiated the separation of the twins via sternotomy, ligation of hepatic vessels. After 2 hours of procedure, the separation was completed, continuing the surgical treatment of T1 and the support of T2 until his death. Conclusions: Conjoined twin separation surgery is a challenge, which requires planning and coordination of a multidisciplinary team during all stages.

Resumo Justificativa e objetivos: Gêmeos conjugados são gêmeos monozigóticos conectados por alguma parte do corpo. Esse é um fenômeno raro, estimado entre 1:50.000 a 1:200.000 nascimentos. O objetivo deste relato é apresentar o manejo anestésico e os desafios perioperatórios para cirurgia de separação. Relato de caso: Gêmeos toraco-onfalópagos foram diagnosticados por ultrassonografia e acompanhados pela equipe de medicina fetal do serviço. Após 11 horas da cesárea, a equipe cirúrgica pediátrica optou pela separação dos gêmeos. Foram monitorados com cardioscopia, oximetria, capnografia, termômetro nasofaríngeo, débito urinário e pressão arterial não invasiva. Optou-se por indução inalatória com oxigênio e sevoflurano a 4%. O G1 foi intubado com tubo orotraqueal 3,5 sem cuff e após três tentativas de intubação do G2 sem sucesso usou-se máscara laríngea número 1. Após obtenção da via aérea nos gêmeos, complementou-se indução com fentanil, propofol e rocurônio. Ventilação mecânica no modo pressão controlada 6 ml.kg-1 e peridural lombar L1-L2 com ropivacaína 0,2% (2,5 mg.kg-1). A equipe cirúrgica pediátrica iniciou a separação dos gêmeos através de esternotomia, ligadura de vasos hepáticos. Após duas horas de procedimento, a separação foi concluída, prosseguiram-se o tratamento cirúrgico de G1 e os cuidados de G2 até o óbito. Conclusões: A cirurgia de separação de gêmeos conjugados é um desafio, requer planejamento e coordenação de uma equipe multidisciplinar durante todos os estágios.

[Anesthesia and perioperative challenges for surgical separation of thoraco-omphalopagus twins: case report]. / Anestesia e desafios perioperátorios para cirurgia de separação de gêmeos toraco­onfalópagos: relato de caso.

BACKGROUND AND OBJECTIVES: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. CASE REPORT: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11hours of cesarean surgery, the pediatric surgical team chose to separate the twins. They were monitored with cardioscopy, oximetry, capnography, nasopharyngeal thermometer, urinary output, and noninvasive blood pressure. We chose inhaled induction with oxygen and 4% Sevoflurane. T1 patient was intubated with a 3.5 uncuffed endotracheal tube, and, after three unsuccessful intubation attempts of patient T2, a number 1 laryngeal mask was used. After securing the twins' airway, the induction was supplemented with fentanyl, propofol, and rocuronium. Mechanical ventilation in controlled pressure mode (6mL.kg-1) and lumbar epidural (L1-L2) with 0.2% ropivacaine (2.5mg.kg-1) were used. The pediatric surgical team initiated the separation of the twins via sternotomy, ligation of hepatic vessels. After 2hours of procedure, the separation was completed, continuing the surgical treatment of T1 and the support of T2 until his death. CONCLUSIONS: Conjoined twin separation surgery is a challenge, which requires planning and coordination of a multidisciplinary team during all stages.

Avaliação geriátrica ampla como preditor de morbimortalidade nos pacientes oncológicos vulneráveis submetidos ao tratamento quimioterápico / Comprehensive geriatric assessment as a morbimortality predictor in patients vulnerable to the chemotherapy treatment

Objetivos: O objetivo desse estudo foi determinar o valor preditivo da Avaliação Geriátrica Ampla (AGA) em relação à toxicidade e mortalidade nos pacientes oncológicos idosos classificados como vulneráveis, submetidos à quimioterapia. Método: Foi realizado um estudo de coorte prospectivo com coleta de informações extraídas de banco de dados já construído do projeto ÂNCORA e disponível online. Foram construídas tabelas de distribuição de frequência das variáveis estudadas e na análise univariada foi usado o chi-quadrado e Teste de Fisher, quando indicado. Por fim, considerou-se o nível de significância de 5% e todos os testes foram aplicados com 95% de confiança. Resultados: Em uma amostra total de 254 pacientes, o percentual de mortalidade foi de 37% e de intercorrências foi de 46,5%, sendo infecção a mais frequente. Houve associação entre o déficit nutricional e o aumento da mortalidade (p=0,003). Conclusão: Observou-se associação estatística entre o aumento da mortalidade em pacientes vulneráveis que realizaram quimioterapia (p=0,046), quando comparados aos pacientes saudáveis. Os resultados deste estudo reforçam constatações da literatura como o uso da AGA pode ajudar oncologistas e geriatras em suas tomadas de decisão.

Objectives: to determine the predictive value of the Comprehensive geriatric assessment (CGA) regarding toxicity and mortality in elderly cancer patients classified as vulnerable who were submitted to chemotherapy. Method: A prospective cohort study was performed with data gathered from the database already built by the anchor project and available online. Tables of the frequency of distribution of the studied variables were created. The chi-square test was used in the univariate analysis, and the Fisher test when indicated. The level of significance of 5% were considered and all the tests were applied with a confidence of 95%. Results: The frequency of patients classified as vulnerable by CGA was 40.2%, and the mortality rate in the total number of patients was 37%. The association between nutritional status and mortality (p=0.003) was observed, where most of the denuded patients (51.4%) died during follow-up, and most patients (46.5%) had some type of complication. Conclusion: There was an association between the increase in mortality in patients vulnerable to chemotherapy (p=0,046), when compared to healthy patients. The results of this study follow the literature on the use of CGA can help oncologists and geriatricians in their decision making.

Perioperative factors associated with delayed graft function in renal transplant patients / Fatores perioperatórios associados à função retardada do enxerto em pacientes transplantados renais

ABSTRACT Introduction: Successful renal transplant and consequent good graft function depend on a good surgical technique, an anesthetic that ensures the hemodynamic stability of the receiver, and appropriate conditions of graft and recipient. Several factors can interfere with the perfusion of the graft and compromise its viability. The objective of this study was to evaluate perioperative factors associated with delayed graft function (DGF) in renal transplantation patients. Methods: This is a historical cohort study of patients who underwent renal transplantation between 2011 and 2013. Three hundred and ten transplants were analyzed. DGF was defined as the need for dialysis during the first week post-transplant. Logistic regression with a stepwise technique was used to build statistical models. Results: Multivariate analysis revealed the following risk factor for DGF: combined anesthesia technique (OR = 3.81, 95%CI, 1.71 to 9.19), a fluid regimen < 50 mL·kg-1 (OR = 3.71, 95%CI, 1.68 to 8.61), dialysis for more than 60 months (OR = 4.77, 95%CI, 1.93 to 12.80), basiliximab (OR = 3.34, 95%CI, 1.14 to 10.48), cold ischemia time > 12 hour (OR = 5.26, 95%CI, 2.62 to 11.31), living donor (OR = 0.19, 95%CI, 0.02 to 0.65), and early diuresis (OR = 0.02, 95%CI, 0.008 to 0.059). The accuracy of this model was 92.6%, calculated using the area under the ROC curve. The incidence of DGF in the study population was 76.1%. Conclusions: Combined anesthesia technique, dialysis for more than 60 months, basiliximab, and cold ischemia time > 12 hours are risk factor for DGF, while liberal fluid regimens and kidneys from living donors are protective factors.

RESUMO Introdução: O sucesso do transplante renal e a boa função do enxerto dependem de uma boa técnica cirúrgica, anestesia que assegure a estabilidade hemodinâmica do receptor e condições adequadas de enxerto e receptor. Diversos fatores podem interferir na perfusão do enxerto e comprometer sua viabilidade. O objetivo deste estudo foi avaliar os fatores perioperatórios associados à função retardada do enxerto (FRE) em pacientes transplantados renais. Métodos: Estudo de coorte histórica em 310 pacientes submetidos a transplante entre 2011 e 2013. A FRE foi definida como a necessidade de diálise durante a primeira semana pós-transplante. Utilizou-se regressão logística e técnica Stepwise para construir modelos estatísticos. Resultados: A análise multivariada revelou fatores associados à FRE: técnica de anestesia combinada (OR = 3,81,95% CI, 1,71 a 9,19), regime de fluidos < 50 mL.kg-1 (OR = 3,71,95% CI, 1,68 a 8,61), diálise por mais de 60 meses (OR = 4,77,95% IC, 1,93 a 12,80), basiliximab (OR = 3,34,95% IC, 1,14 a 10,48), tempo de isquemia fria > 12 horas (OR = 5,26,95 % IC, 2,62 a 11,31), doador vivo (OR = 0,19,95% CI, 0,02 a 0,65) e diurese precoce (OR = 0,02,95% IC, 0,008 a 0,059). A precisão desse modelo é de 92,6%, calculada usando a área sob a curva ROC. A incidência de FRE na população estudada foi de 76,1%. Conclusões: Técnica combinada de anestesia, diálise por mais de 60 meses, basiliximab e tempo de isquemia fria> 12 horas são fatores de risco para FRE; regimes de fluidos liberais e rins de doadores vivos são protetores.

Perioperative factors associated with delayed graft function in renal transplant patients.

INTRODUCTION: Successful renal transplant and consequent good graft function depend on a good surgical technique, an anesthetic that ensures the hemodynamic stability of the receiver, and appropriate conditions of graft and recipient. Several factors can interfere with the perfusion of the graft and compromise its viability. The objective of this study was to evaluate perioperative factors associated with delayed graft function (DGF) in renal transplantation patients. METHODS: This is a historical cohort study of patients who underwent renal transplantation between 2011 and 2013. Three hundred and ten transplants were analyzed. DGF was defined as the need for dialysis during the first week post-transplant. Logistic regression with a stepwise technique was used to build statistical models. RESULTS: Multivariate analysis revealed the following risk factor for DGF: combined anesthesia technique (OR = 3.81, 95%CI, 1.71 to 9.19), a fluid regimen < 50 mL·kg-1 (OR = 3.71, 95%CI, 1.68 to 8.61), dialysis for more than 60 months (OR = 4.77, 95%CI, 1.93 to 12.80), basiliximab (OR = 3.34, 95%CI, 1.14 to 10.48), cold ischemia time > 12 hour (OR = 5.26, 95%CI, 2.62 to 11.31), living donor (OR = 0.19, 95%CI, 0.02 to 0.65), and early diuresis (OR = 0.02, 95%CI, 0.008 to 0.059). The accuracy of this model was 92.6%, calculated using the area under the ROC curve. The incidence of DGF in the study population was 76.1%. CONCLUSIONS: Combined anesthesia technique, dialysis for more than 60 months, basiliximab, and cold ischemia time > 12 hours are risk factor for DGF, while liberal fluid regimens and kidneys from living donors are protective factors.

Prevalence of neuropathic pain in patients with cancer / Prevalência da dor neuropática em pacientes com câncer

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate the prevalence and factors associated with neuropathic pain in cancer patients METHODS: A prospective cross-sectional study conducted from August 2016 to July 2017, with 267 cancer patients above 18 years of age, with pain. Diabetic patients and patients with previous chronic pain unrelated to the current neoplasia were excluded. The demographic and disease information was obtained from the medical records and directly with the patient. The Douleur Neuropathique en 4 questions questionnaire and the numeric pain scale were later applied. RESULTS: The prevalence of neuropathic pain in the study population was 53%. The average age of patients was 55.3 years. Of the 267 patients, 76% were female. There was no significant difference in the occurrence of neuropathic pain among gender, age, histological type of cancer and type of treatment. Of the patients, 35.5% who underwent chemotherapy had neuropathic pain, and there was no statistical difference between the types of chemotherapy performed. Twenty-four patients who reported pain at the radiotherapy site were diagnosed with neuropathic pain. Of the total, 63 patients who reported pain at the surgical site, 36 were classified with neuropathic pain. An increasing trend of neuropathic pain was observed when treatments were associated. The intensity of this pain was reported as moderate to severe by the majority of patients in the various types of treatment: chemotherapy, radiotherapy, and surgery. CONCLUSION: When compared to other studies, a high prevalence of neuropathic pain was observed in more than half of the patients evaluated.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar a prevalência e os fatores associados à dor neuropática em pacientes oncológicos. MÉTODOS: Estudo transversal prospectivo realizado no período de agosto de 2016 a julho de 2017. Participaram 267 pacientes oncológicos maiores de 18 anos que apresentavam dor, e excluídos os pacientes diabéticos e portadores de dor crônica pregressa sem relação com a neoplasia atual. Foram obtidas informações demográficas e sobre a doença no prontuário e diretamente com o paciente. Posteriormente foi aplicado o questionário Douleur Neuropathique en 4 questions e a escala numérica da dor. RESULTADOS: A prevalência da dor neuropática na população de estudo foi de 53%. A idade média dos pacientes foi 55,3 anos. Dos 267 pacientes, 76% eram do sexo feminino. Não houve diferença significativa de ocorrência de dor neuropática entre os sexos, idade, tipo histológico do câncer e o tipo de tratamento. Dos pacientes, 35,5% que realizaram quimioterapia tinham dor neuropática, não havendo diferença estatística entre os tipos de quimioterapia realizada. Vinte e quatro pacientes que referiam dor no local do tratamento radioterápico apresentaram o diagnóstico de dor neuropática. Do total, 63 pacientes que referiam dor na área cirúrgica, 36 foram classificados com dor neuropática. Observou-se tendência crescente de dor neuropática quando os tratamentos foram associados. A intensidade dessa dor foi referida como moderada a intensa pela maioria dos pacientes nos diversos tipos de tratamento: quimioterapia, radioterapia e cirurgia. CONCLUSÃO: Quando comparada a outros estudos, foi observada alta prevalência de dor neuropática, em mais da metade dos pacientes avaliados

Difficult laryngoscopy and tracheal intubation: observational study / Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional

Abstract Introduction: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. Method: A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack-Lehane Degrees 3 and 4). Results: In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p = 0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormack-Lehane, which was considered reasonable. On the other hand, a poor agreement (κ = 0.06) was seen between modified Mallampati test and Cormack-Lehane test. Conclusion: The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies.

Resumo Introdução: As complicações anestésicas associadas às vias aéreas difíceis inesperadas por serem potencialmente catastróficas devem ser evitadas. O teste de Mallampati modificado e a manobra de protrusão mandibular possibilitam a identificação da via aérea difícil. O objetivo deste estudo foi associar o teste de Mallampati modificado e a manobra de protrusão mandibular com a laringoscopia (Cormack-Lehane) e tentar identificar um melhor preditor de via aérea difícil na população adulta submetida à cirurgia eletiva. Método: Estudo corte transversal, foram analisados 133 pacientes adultos submetidos a cirurgias eletivas que necessitavam de intubação orotraqueal. Avaliaram-se a acurácia e especificidade do teste de Mallampati modificado e da manobra de protrusão mandibular, correlacionados com laringoscopia difícil (Cormack-Lehane Graus 3 e 4). Resultados: Entre os 133 pacientes avaliados, a taxa de intubação difícil encontrada foi 0,8%, houve associação entre os dois testes preditores propostos (p = 0,012). Foram encontrados os seguintes valores para a especificidade 94,5% e a acurácia 95,4% na manobra de protrusão mandibular. Já para o teste de Mallampati modificado valores de 81,1% e de 81,2% respectivamente. A análise de concordância Kappa identificou entre manobra de protrusão mandibular e Cormarck-Lehane um resultado de 0,240; considerado razoável. Por outro lado, observou-se uma fraca (κ = 0,06) concordância entre o teste de Mallampati modificado e o Cormarck-Lehane. Conclusão: A manobra de protrusão mandibular apresentou acurácia e concordância superiores ao teste de Mallampati modificado, mostrou a capacidade de identificar uma via aérea difícil. Faz-se necessário enfatizar a associação dos testes na avaliação do paciente, destacar a complementariedade deles, minimizar as consequências negativas de laringoscopias repetidas.

[Difficult laryngoscopy and tracheal intubation: observational study]. / Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional.

INTRODUCTION: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. METHOD: A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack-Lehane Degrees 3 and 4). RESULTS: In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p=0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormarck-Lehane, which was considered reasonable. On the other hand, a poor agreement (κ=0.06) was seen between modified Mallampati test and Cormarck-Lehane test. CONCLUSION: The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies.

Anesthesiologists' knowledge about packed red blood cells transfusion in surgical patients / Conhecimento dos anestesiologistas sobre transfusão de concentrado de hemácias em pacientes cirúrgicos

Abstract Introduction Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively. Method Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis. Results 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR = 4.46) followed by heart disease (MR = 4.26); hematocrit (MR = 4.34); age (RM = 4.1) and microcirculation evaluation (MR = 4.22). Respondents (82.3%) identified levels of Hb = 6 g.dL-1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR = 2.81) and decided by drugs (MR = 2.95) were the least reported. Conclusion We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject.

Resumo Introdução O sangue é importante recurso em diversas intervenções mantenedoras da vida, como corrigir a anemia e melhorar a capacidade de transporte de oxigênio. Apesar dos avanços, a transfusão de concentrado de hemácias (TCH) ainda envolve riscos. O objetivo deste estudo foi descrever o conhecimento dos anestesiologistas sobre as indicações, os efeitos adversos e as opções ao procedimento de transfusão de concentrado de hemácias no intraoperatório. Método Estudo transversal que usou questionário com perguntas de múltipla escolha e casos clínicos, referentes a fatores relevantes na decisão de transfundir concentrado de hemácias, seus efeitos adversos, gatilhos de hemoglobina, suas medidas preventivas e estratégias de conservação de sangue. Respondido sem a presença do pesquisador. Usada a escala de Likert e feito cálculo do ranking médio das respostas. Análise dos dados feita com programa Epi Info 7. Resultados Dos anestesiologistas da instituição, 79% responderam ao questionário e 100% identificaram os principais efeitos adversos relacionados à hemotransfusão. Questionados sobre os fatores que influenciariam na decisão de transfundir, o nível de hemoglobina obteve a maior concordância (RM = 4,46), seguido de cardiopatia (RM = 4,26), níveis de hematócrito (RM = 4,34), idade (RM = 4,1) e avaliação da microcirculação (RM = 4,22). Dos entrevistados, 82,3% identificaram níveis de Hb = 6 g.dL-1 como gatilho para transfundir paciente sadio. Quanto às estratégias de conservação de sangue, a hemodiluição hipervolêmica (RM = 2,81) e a deliberada por medicamentos (RM = 2,95) foram as menos citadas. Conclusão Identificou-se uma boa compreensão dos anestesiologistas a respeito da TCH. No entanto, há necessidade de cursos de atualização sobre o tema.

Low back pain during pregnancy / Lombalgia na gestação

Abstract Objective: Low back pain is a common complaint among pregnant women. It is estimated that about 50% of pregnant women complain of some form of back pain at some point in pregnancy or during the postpartum period. The aim of this study was to evaluate the frequency of low back pain during pregnancy and its characteristics. Methods: Cross-sectional study with low-risk pregnant women. After approval by the Human Research Ethics Committee and receiving written informed consent, we included pregnant women over 18 years of age and excluded those with psychiatric disorders, previous lumbar pathologies, and receiving treatment for low back pain. Results: We interviewed 97 pregnant women. The frequency of low back pain was 68%. The mean age was 26.2 years and the median gestational age was 30 weeks. Fifty-eight pregnant women declared themselves as brown (58%). Most (88.6%) were married or living in common-law marriage, 56 (57.7%) worked outside the home, and 71 (73.2%) had completed high school. Low back pain was more frequent during the second trimester of pregnancy (43.9%), referred to as a "burning" sensation in 37.8% of patients, with intermittent frequency in 96.9% of the women. The symptoms got worse at night (71.2%). Resting reduced low back pain in 43.9% of pregnant women, while the standing position for a long time worsened it in 27.2% of patients. Conclusion: Low back pain is common in pregnant women, has specific characteristics, and is more frequent in the second trimester of pregnancy. This indicates the need for prevention strategies that enable better quality of life for pregnant women.

Resumo Objetivo: A lombalgia é uma queixa comum entre grávidas. Estima-se que cerca de 50% das gestantes queixam-se de algum tipo de dor lombar em algum momento da gravidez ou durante o puerpério. O objetivo deste estudo foi avaliar a frequência da lombalgia na gestação e suas características. Método: Estudo de corte transversal com gestantes de baixo risco. Após a aprovação pelo Comitê de Ética em Pesquisa em Seres Humanos e a assinatura do termo de consentimento livre e esclarecido, foram incluídas maiores de 18 anos e alfabetizadas e excluídas gestantes com distúrbios psiquiátricos, com patologias lombares prévias e em tratamento para dor lombar. Resultados: Foram entrevistadas 97 gestantes. A frequência de dor lombar foi 68%. A média de idade foi 26,2 anos e a mediana da idade gestacional de 30 semanas; 58 consideraram-se pardas (58%). A maioria (88,6%) era casada ou vivia em união estável, 56 (57,7%) trabalhavam fora e 71 (73,2%) tinham o ensino médio completo. A lombalgia foi mais frequente durante o segundo trimestre gestacional (43,9%), referida como "em queimação" por 37,8% das pacientes e com frequência intermitente em 96,9%. Os sintomas pioravam no período noturno (71,2%). O repouso reduzia a dor lombar em 43,9%, enquanto a posição ortostática por longo tempo agravava em 27,2%. Conclusão: A lombalgia é comum em gestantes, apresenta características específicas e é mais frequente no segundo trimestre. Isso alerta para a necessidade de serem instituídas estratégias de prevenção que possibilitem melhor qualidade de vida para a gestante.

[Low back pain during pregnancy]. / Lombalgia na gestação.

OBJECTIVE: Low back pain is a common complaint among pregnant women. It is estimated that about 50% of pregnant women complain of some form of back pain at some point in pregnancy or during the postpartum period. The aim of this study was to evaluate the frequency of low back pain during pregnancy and its characteristics. METHODS: Cross-sectional study with low-risk pregnant women. After approval by the Human Research Ethics Committee and receiving written informed consent, we included pregnant women over 18 years of age and excluded those with psychiatric disorders, previous lumbar pathologies, and receiving treatment for low back pain. RESULTS: We interviewed 97 pregnant women. The frequency of low back pain was 68%. The mean age was 26.2 years and the median gestational age was 30 weeks. Fifty-eight pregnant women declared themselves as brown (58%). Most (88.6%) were married or living in common-law marriage, fifty-six (57.7%) worked outside the home, and 71 (73.2%) had completed high school. Low back pain was more frequent during the second trimester of pregnancy (43.9%), referred to as a "burning" sensation in 37.8% of patients, with intermittent frequency in 96.9% of the women. The symptoms got worse at night (71.2%). Resting reduced low back pain in 43.9% of pregnant women, while the standing position for a long time worsened it in 27.2% of patients. CONCLUSION: Low back pain is common in pregnant women, has specific characteristics, and is more frequent in the second trimester of pregnancy. This indicates the need for prevention strategies that enable better quality of life for pregnant women.

[Anesthesiologists' knowledge about packed red blood cells transfusion in surgical patients]. / Conhecimento dos anestesiologistas sobre transfusão de concentrado de hemácias em pacientes cirúrgicos.

INTRODUCTION: Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively. METHOD: Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis. RESULTS: 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR=4.46) followed by heart disease (MR=4.26); hematocrit (MR=4.34); age (RM=4.1) and microcirculation evaluation (MR=4.22). Respondents (82.3%) identified levels of Hb=6g.dL-1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR=2.81) and decided by drugs (MR=2.95) were the least reported. CONCLUSION: We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject.