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1.
Rev Bras Anestesiol ; 69(4): 390-395, 2019.
Artigo em Português | MEDLINE | ID: mdl-31387740

RESUMO

BACKGROUND: Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. METHODS: We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. RESULT: Patients with a left main bronchus length of less than 40mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). CONCLUSIONS: We identified that patients with a left main bronchus length of less than 40mm have a great chance of desaturation, especially if other desaturation risk factors are present.


Assuntos
Brônquios/anatomia & histologia , Hipóxia/epidemiologia , Intubação Intratraqueal/métodos , Ventilação Monopulmonar/métodos , Adulto , Idoso , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
2.
Rev. bras. anestesiol ; 69(4): 390-395, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1042002

RESUMO

Abstract Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. Methods We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. Result Patients with a left main bronchus length of less than 40 mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). Conclusions We identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.


Resumo Justificativa Os tubos endotraqueais de duplo lúmen (Double-lumen tubes - DLTs) para intubação seletiva esquerda têm sido amplamente utilizados em procedimentos torácicos, esofágicos, vasculares e mediastinais para proporcionar a separação dos pulmões. Com a falta de diretrizes claras, os anestesiologistas geralmente selecionam os tubos com base em sua experiência com os tubos endotraqueais de duplo lúmen de 35 e 37 Fr, os mais comumente usados. Nossa hipótese foi que os pacientes com um brônquio principal esquerdo de menor comprimento (< 40 mm) apresentavam uma chance maior de sofrer dessaturação durante a ventilação monopulmonar, devido à obstrução do orifício do lobo superior esquerdo com o tubo brônquico. Métodos No total, 360 pacientes submetidos à intubação seletiva esquerda mediante o uso de tubo de duplo lúmen foram incluídos no estudo entre setembro de 2014 e agosto de 2015. Idade, sexo, altura, peso e doença de base foram registrados, junto do tipo de procedimento cirúrgico e os episódios de dessaturação. Além disso, a largura da traqueia e a largura e comprimento do brônquio esquerdo foram medidos por meio de tomografia computadorizada. Resultados Os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm, submetidos à intubação seletiva esquerda com tubos endotraqueais de duplo lúmen, tiveram incidência significativamente maior de dessaturação (Odds Ratio - OR: 8,087) durante a ventilação monopulmonar. Outros fatores relacionados aos pacientes e identificados como risco de desenvolver hipoxemia foram diabetes mellitus (OR: 5,368), cirurgia de colapso direito (OR: 4,933) e IMC (OR: 1,105). Conclusões Identificamos que os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm apresentam grande chance de dessaturação, principalmente se outros fatores de risco para dessaturação estiverem presentes.

3.
J Anesth ; 33(3): 463-477, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31076946

RESUMO

Over the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. This review aimed to propose an anatomical nomenclature system by classifying ICB approaches into proximal and distal ones to aid future research and provide practice advisories according to recent updates. We also comprehensively discuss various aspects of this nomenclature system. Our review suggests that ultrasound-guided ICB should be categorized as an advanced technique that should be performed under supervision and dual guidance. For one-shot block, the conventional distal approach is still preferred but should be modified to follow ergonomic practice, with the arm in the proper position. For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.

4.
Nutr Res ; 52: 87-97, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29525610

RESUMO

Arctigenin (ATG), a lignin extracted from Arctium lappa (L.), exerts antioxidant and anti-inflammatory effects. We hypothesized that ATG exerts a protective effect on hepatocytes by preventing nonalcoholic fatty liver disease (NAFLD) progression associated with lipid oxidation-associated lipotoxicity and inflammation. We established an in vitro NAFLD cell model by using normal WRL68 hepatocytes to investigate oleic acid (OA) accumulation and the potential bioactive role of ATG. The results revealed that ATG inhibited OA-induced lipid accumulation, lipid peroxidation, and inflammation in WRL68 hepatocytes, as determined using Oil Red O staining, thiobarbituric acid reactive substance assay, and inflammation antibody array assays. Quantitative RT-PCR analysis demonstrated that ATG significantly mitigated the expression of acetylcoenzyme A carboxylase 1 and sterol regulatory element-binding protein-1 and significantly increased the expression of carnitine palmitoyltransferase 1 and peroxisome proliferator-activated receptor alpha. The 40 targets of the Human Inflammation Antibody Array indicated that ATG significantly inhibited the elevation of the U937 lymphocyte chemoattractant, ICAM-1, IL-1ß, IL-6, IL-6sR, IL-7, and IL-8. ATG could activate the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) and AMP-activated protein kinase (AMPK) pathways and could increase the phosphorylation levels of Akt and AMPK to mediate cell survival, lipid metabolism, oxidation stress, and inflammation. Thus, we demonstrated that ATG could inhibit NAFLD progression associated with lipid oxidation-associated lipotoxicity and inflammation, and we provided insights into the underlying mechanisms and revealed potential targets to enable a thorough understanding of NAFLD progression.


Assuntos
Arctium/química , Furanos/farmacologia , Lignanas/farmacologia , Fígado/efeitos dos fármacos , Hepatopatia Gordurosa não Alcoólica/prevenção & controle , Fosfatidilinositol 3-Quinase/metabolismo , Extratos Vegetais/farmacologia , Proteínas Quinases Ativadas por AMP/metabolismo , Acetil-CoA Carboxilase/metabolismo , Carnitina O-Palmitoiltransferase/metabolismo , Fígado Gorduroso/metabolismo , Fígado Gorduroso/prevenção & controle , Furanos/uso terapêutico , Células Hep G2 , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Humanos , Inflamação/metabolismo , Inflamação/prevenção & controle , Molécula 1 de Adesão Intercelular/metabolismo , Interleucinas/metabolismo , Lignanas/uso terapêutico , Fígado/citologia , Fígado/metabolismo , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Ácido Oleico/metabolismo , Estresse Oxidativo/efeitos dos fármacos , PPAR alfa/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Fitoterapia , Extratos Vegetais/uso terapêutico , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Proteína de Ligação a Elemento Regulador de Esterol 1/metabolismo
5.
Biomed Res Int ; 2017: 8284363, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29226150

RESUMO

Purpose of Review: Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings: Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary: Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.


Assuntos
Músculos Abdominais/efeitos dos fármacos , Bloqueio Nervoso/métodos , Parede Abdominal , Analgesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/química , Bupivacaína/administração & dosagem , Bupivacaína/química , Humanos , Lipossomos/administração & dosagem , Lipossomos/química , Manejo da Dor/métodos , Ultrassonografia de Intervenção/métodos
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