Sevoflurane anesthesia deteriorates pulmonary surfactant promoting alveolar collapse in male Sprague-Dawley rats.

General anesthesia is frequently associated to transient hypoxemia and lung atelectasis. Although volatile anesthetics are safe and widely used, their potential role on anesthesia-induced pulmonary impairment has not been fully explored. In this study, we investigated the effect of volatile anesthetic sevoflurane on pulmonary surfactant composition and structure that could contribute to atelectasis. After 30 min of sevoflurane anesthesia, Sprague-Dawley rats showed increased levels of lyso-phosphatidylcholine and decreased levels of phosphatidylcholine associated with significant impairment in lung mechanics and alveolar collapse, but showed no deterioration of alveolar fluid reabsorption when compared to control group of rats anesthetized with pentobarbital. Exposure to sevoflurane altered the thermotropic profile of surfactant model membranes, as detected by fluorescence anisotropy. In this sense, sevoflurane-promoted fluidification of condensed phases could potentially impair the ability of surfactant films to sustain the lowest surface tensions. In conclusion, the observed changes in surfactant composition and viscosity properties suggest a direct effect of sevoflurane on surfactant function, a factor potentially involved in anesthetic-induced alterations in lung mechanics.

La presencia de los padres en los procedimientos médicos realizados a niños: ¿qué opinan los padres y niños uruguayos? / Parental presence in the context of medical procedures in children: what do Uruguayan parents and children think?

Introducción: en Uruguay la presencia de padres junto a sus hijos durante la realización de procedimientos médicos es una práctica controvertida. No existen investigaciones nacionalesal respecto. Tampoco publicaciones que pregunten a los protagonistas: los niños.Objetivo: conocer la opinión de:- los padres respecto a si desean estar presentes durante la realización de procedimientos médicos a sus hijos;- los niños respecto al deseo de ser acompañados por sus padres.Material y método: estudio descriptivo, observacional, transversal.Encuesta anónima semiestructurada a padres y niños en un hospital pediátrico y en centros de atención primaria.Resultados: se incluyeron 126 padres. Desearían estar presentes durante la realización de los siguientes procedimientos: 91% extracción de sangre, 89% colocación de circuito venoso, 81% cateterismo vesical, 77% raquicentesis y 70% intubaciónorotraqueal. El 58%de los padres cree que la decisión la debe tomar la familia o el niño, o ambos. Se incluyeron 130niños. Desean que sus padres estén con ellos en los siguientes procedimientos: 93% raquicentesis, 92% extracción desangre y 87% cateterismo vesical.Conclusiones: la mayoría de los niños quieren ser acompañados por sus padres en caso de procedimientos médicos. La mayoría de los padres desean estar junto a sus hijos y quierenser los responsables de la decisión acerca de estar o no presentes. Es necesario que los profesionales y las instituciones respeten los derechos de los niños y que adecuen sus conductas, políticas y normativas a las preferencias y valores culturales de cada niño y familia.

Introduction: in Uruguay, parental presence during medical procedures in their children is a controversial practice.There is no national research in the field. Neither are there publications asking children, the protagonists.Objective: to learn about the opinion of:- parents about their wish to be present during medical procedures in their children, - Children about their wish to be accompanied by their parents.Method: descriptive, observational and transversal study. Anonymous, semi-structured survey to parents and children in a pediatrics hospital and primary health care centers.Results: 126 parents were included in the study. They would like to be present during the following procedures: 91% blood sampling; 89% placement of a venous circuit, 81% vesical catheterism, 77% rachicentesis and 70% endotraqueal intubation. 58 % of parentsbelieve the decision is to be made by de family, the child, or both. 130 were included in the study. . They would liketheir parents to be present during the following procedures: 93% rachicentesis, 92% blood sampling and 87% vesical catheterism.Conclusions: most children want tobe accompanied by their parents during medical procedures. Most parentswant to be with their children and want to be the ones to decide whether to be present or not. Health professionalsand institutions need to respect childrenÆs rights and adapt their protocols, policies and regulations to every child and familyÆs preference and cultural values.

Introdução: no Uruguai a presença dos pais juntamente com seus filhos durante a realização de procedimento é uma prática controvertida. Não existem pesquisas nacionais sobre esse tema, ou publicações que perguntem aos protagonistas: as crianças.Objetivo: conhecer a opinião de: - Pais sobre seu desejo de estar presente durante a realização de procedimentos médicos a seus filhos, - Crianças sobre seu desejo de estar acompanhadas porseus pais nesses momentos.Material e método: estudo descritivo, observacional, transversal. Inquérito anônimo semi-estruturado a pais efilhos emumhospital pediátrico e emcentros de atenção primaria.Resultados: Foram incluídos 126 pais. Desejariam estar presente durante a realização dos seguintes procedimentos:91% extração de sangue, 89% colocação de circuito venoso, 81% cateterismo vesical, 77% punçãolombar e 70% intubação orotraqueal. 58 % dos pais acreditam que a decisão deve ser tomada pela família ou pela criança ou por ambas partes. Foram incluídas 130 crianças. Desejam que seus pais estejam com elas nosseguintes procedimentos: 93% punção lombar, 92% extração de sangue e 87% cateterismo vesical.Conclusões: a maioria das crianças quer estar acompanhada por seus pais quando se realizem procedimentosmédicos. A maioria dos pais deseja estar presente e quer ser responsável pela decisão de estar ou não junto a seus filhos nesses momentos. É necessário que os profissionais e as instituições respeitem os direitos das crianças e adaptem suas condutas, políticas e normas às preferências e valores culturais de cada criança e família.

Adenosine triphosphate-dependent calcium signaling during ventilator-induced lung injury is amplified by hypercapnia.

Adenosine triphosphate (ATP) is released by alveolar epithelial cells during ventilator-induced lung injury (VILI) and regulates fluid transport across epithelia. High CO(2) levels are observed in patients with "permissive hypercapnia," which inhibits alveolar fluid reabsorption (AFR) in alveolar epithelial cells. The authors set out to determine whether VILI affects AFR and whether the purinergic pathway is modulated in cells exposed to hypercapnia. Control group was compared against VILI (tidal volume [Vt] = 35 mL/kg, zero positive end-expiratory pressure [PEEP]) and protective ventilation (Vt = 6 mL/kg, PEEP = 10 cm H(2)O) groups. Lung mechanics, histology, and AFR were evaluated. Alveolar epithelial cells (AECs) were loaded with Fura 2-AM to measure intracellular calcium in the presence ATP (10 µM) at 5% or 10% CO(2) as compared with baseline. High tidal volume ventilation impairs lung mechanics and AFR. Hypercapnia (HC) increases intracellular calcium levels in response to ATP stimulation. HC + ATP is the most detrimental combination decreasing AFR. Purinergic signaling in AECs is modulated by high CO(2) levels via increased cytosolic calcium. The authors reason that this modulation may play a role in the impairment of alveolar epithelial functions induced by hypercapnia.