25 de junho de 2012

Artigo recomendado: Principals of Hemodynamic Monitoring

Patricio M. Polanco, Michael R. Pinsky

Ronco C, Bellomo R, Kellum JA (eds): Acute Kidney Injury.
Contrib Nephrol. Basel, Karger, 2007, vol 156, pp 133–157

Background/Aims: Hemodynamic monitoring is the cornerstone of patient management in the intensive care unit. However, to be used effectively its applications and limitations need to be defined and its values applied within the context of proven therapeutic approaches.

Methods: Review of the physiological basis for monitoring and a review of the literature on its utility in altering patient outcomes.

Results: Most forms of monitoring are used to prevent cardiovascular deterioration or restore cardiovascular wellness. However, little data support the generalized use of aggressive resuscitation protocols in all but the most acutely ill prior to the onset of organ injury. Outcomes improve with aggressive resuscitation in some patients presenting with early severe sepsis and in postoperative high-risk surgical patients.

Conclusions: Monitoring should be targeted to meet the specific needs of the patient and should not be applied in a broad fashion and whenever possible it should be used as part of a treatment protocol of proven efficacy.

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19 de junho de 2012

Artigo recomendado: Current Concepts In the Management Of the Difficult Airway

Carin A. Hagberg
Anesthesiology News - May 2012

Management of the difficult airway remains one of the most relevant and challenging tasks for anesthesia care providers. This review focuses on several of the alternative airway management devices/techniques and their clinical applications, with particular emphasis on the difficult or failed airway. It includes descriptions of many new airway devices, several of which have been included in the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm.

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15 de junho de 2012

Ultrasound-Guided Central Venous Cannulation: Current Recommendations and Guidelines

Julie A. Gayle and Alan David Kaye

Anesthesiology News - June 2012

Ultrasound technology has become an essential tool for the everyday practice of anesthesiology. Some of the many uses include the placement of central, arterial, and peripheral lines, as well as peripheral nerve blocks. Until recently, neither a national standard for ultrasound use nor a well-accepted standard in training for ultrasound-guided central venous cannulation (CVC) existed. In the past few years, several specialty societies and national organizations - including the American Society of Anesthesiologists, the Anmerican Society of Echocardiography, the Society of Cardiovascular Anesthesiologists, and the Centers for Disease Control and Prevention (CDC) - have published guidelines and recommendations regarding ultrasound-guided vascular cannulation.

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11 de junho de 2012

Artigo recomendado: Anesthesia-related mortality in pediatric patients: a systematic review

Leopoldo Palheta Gonzalez, Wangles Pignaton, Priscila Sayuri Kusano, Norma Sueli Pinheiro Módolo, José Reinaldo Cerqueira Braz, Leandro Gobbo Braz

CLINICS 2012;67(4):381-387

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period.

Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

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6 de junho de 2012

Artigo recomendado: Dexmedetomidine for the prevention of shivering during spinal anesthesia

Burhanettin Usta, Muhammet Gozdemir, Ruveyda Irem Demircioglu, Bunyamin Muslu, Huseyin Sert, Adnan Yaldız

CLINICS 2011;66(7):1187-1191

PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia.

METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection.

RESULTS: Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207).

CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

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1 de junho de 2012

Artigo recomendado: Regional intravenous anesthesia in knee arthroscopy

Mahmut Arslan, Mehmet Cantürk, Dilsen Örnek, Mehmet Gamli, Yasar Pala, Bayazit Dikmen, Meleksah Basaran

CLINICS 2010;65(9):831-835

OBJECTIVE: The goal of the study was to investigate the regional intravenous anesthesia procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain.

MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted. The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters.

RESULTS: The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer.

CONCLUSION: Regional intravenous anesthesia using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.

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