29 de maio de 2012

4 de junho de 2012: I Simpósio Brasileiro de Monitorização Neurofisiológica Intra-Operatória

Artigo recomendado: Mortality in Anesthesia: A Systemic Review

Braz LG, Braz DG, Cruz DS, Fernandes LA, Módolo NSP, Braz JRC

CLINICS 2009;64(10):999-1006

This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed.

Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries.

The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesiarelated mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

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22 de maio de 2012

Artigo recomendado: Acute Respiratory Failure during Pediatric Anesthesia: Atelectasis and Hypertensive Pneumothorax: Case Report

Joel Massari Rezende, Bruno Ricciardi Silveira

Rev Bras Anestesiol 2012; 62: 1: 80-87

Background and objectives: The main anesthesiologist’s task is to ensure appropriate oxygenation of patient. The objective of this report is to describe both diagnosis and behavior in case of acute respiratory failure during anesthesia, with educational purposes.

Case report: Three-year-old child underwent anesthesia for urologic surgery presented respiratory failure by bronchial obstruction by secretion, evolving to atelectasis and hypertensive pneumothorax. We present the evolution of the case and applied treatment means, emphasizing the urgency and drainage technique in hypertensive pneumothorax.

Conclusions: The anesthesiologist’s attention to early diagnosis of respiratory complications and knowledge of priority measures in each moment may prevent serious adverse effects.

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15 de maio de 2012

Artigo recomendado: DCS-1, DCS-2, and DFV share amino acid substitutions at the extracellular RhD protein vestibule

Willy A. Flegel, Inge von Zabern, Andrea Doescher, Franz F. Wagner, Jindra Vytisková, and Martin Písacka

TRANSFUSION 2008;48:25-33

Background: RhD and RhCE are structurally related to ammonium transporter proteins, yet their physiologic function remains unclear. Recent threedimensional homology modeling with Escherichia coli AmtB as a template defined a putative transmembraneous channel. Three RhD variants with amino acid substitutions located at the extracellular channel aperture are described.

Study Design and Methods: Blood samples were selected because of serologic abnormalities. RHD, RHCE, and LW nucleotide sequences were determined from genomic DNA. D epitope patterns were established with monoclonal anti-D panels. Threedimensional Rh structures were calculated by alignment to AmtB.

Results: The RHD allele DCS-1 was found to carry the two amino acid substitutions F223V (667T > G) and A226P (676G > C) caused by missense mutations in RHD exon 5. This study compared DCS-1 with the D variants DFV (F223V) and DCS-2 (A226P), harboring solely one or the other of the two substitutions. All three D variants were associated with a cDE haplotype. The antigen densities were approximately 3000 D antigens per red blood cell for DCS-1, 800 for DCS-2, and 9300 for DFV. DCS-1 and DCS-2 were partial D, because they lacked distinct epitopes. DFV presented as an almost normal D phenotype; the sample contained allo-anti-LWa. The Dw antigen was absent from DCS-1, DFV, and DAU-4, but expressed by DAU-5.

Conclusion: DCS-1, DCS-2, and DFV carry amino acid substitutions at the extracellular vestibule, visualized by 3-dimensional modeling. Proline at position 226 greatly influenced the D antigen density and may reduce the RhD membrane integration. Although the F223V substitution is regarded as the initial event in the evolution of the weak D Type 4 cluster, the current DFV allele probably evolved independently, as evident from different RHCE haplotypes.

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11 de maio de 2012

Artigo recomendado: Communication between anaesthesiologists and patients: how are we doing it now and how can we improve?

Alison Hool and Andrew F. Smith

Curr Opin Anaesthesiol 22:431–435

Purpose of review
The purpose of this review is to present and bring together the relatively small body of recent work on anaesthesiologist–patient communication.

Recent findings
Anaesthesiologists and patients may have different ‘agendas’ during their consultations, with anaesthesiologists focusing more on information and patients more on the emotional aspects of care. As effective communication implies a two-way process, anaesthesiologists should be aware of this. Communication can make good use of written media, video, E-mail and telephone as well as face-to-face interaction. The content of communication, both verbal and nonverbal, is critical but much of this is learned informally despite the recent interest in teaching communication skills. Some recent studies have observed and described how communication is actually performed in practice and these are a useful starting point for reflection and experiment. The few studies to examine whether communication can improve outcomes for patients have all produced broadly positive findings. Communication with children, communicating about risk and dealing with the aftermath of anaesthetic disasters are also reviewed specifically.

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7 de maio de 2012

24 e 25 de maio de 2012: VIII Congresso Brasileiro de Gerenciamento de Riscos e Segurança do Paciente.

Artigo recomendado: Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

Maarouf A Hoteit, Amaar H Ghazale, Andrew J Bain, Eli S Rosenberg, Kirk A Easley, Frank A Anania, Robin E Rutherford

World J Gastroenterol 2008 March 21; 14(11): 1774-1780

AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.

METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.

RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 ± 3.9 vs 12.6 ± 4.7, P = 0.9) or in the mean CTP (7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP: 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3).

CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with

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2 de maio de 2012

Lançamento SAESP: Aplicativo Android e iPhone para o 9º COPA!

Confira! Acesse já o Google play ou a Apple Store!

Programação Científica do 9º  COPA, Palestrantes, Área de Exposição, Informações Úteis e Notícias! Já instalou?

Artigo recomendado: Goal-directed Colloid Administration Improves the Microcirculation of Healthy and Perianastomotic Colon

Oliver Kimberger, M.D., Michael Arnberger, M.D., Sebastian Brandt, M.D., Jan Plock, M.D., Gisli H. Sigurdsson, M.D., Ph.D., Andrea Kurz, M.D., Luzius Hiltebrand, M.D.

Anesthesiology 2009; 110:496–504

Background: The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.

Methods: Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml · kg-1 · h-1 Ringer lactate (RL); GD-RL group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of RL; GD-C group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.

Results: After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 ± 31% in group GD-C versus 123 ± 40% in group GD-RL versus 94 ± 23% in group R-RL (percent of postoperative baseline values, mean ± SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 ± 93% in the GD-C group versus 147 ± 58% in the GD-RL group and 116 ± 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.

Conclusions: Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.

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