28 de fevereiro de 2013

Artigo recomendado: Case Scenario: Pain-associated Respiratory Failure in Chest Trauma


Young Ahn, Klaus Görlinger, Hasan B. Alam, Matthias Eikermann

Anesthesiology 2013; 118:701-8, Ahn et al.

The leading cause of death in young people is trauma. Chest trauma has high associated mortality, thus diagnosis and treatment need to be addressed early on presentation. The incidence of rib fractures range from 10% to 26% in traumatic thoracic injury and the number of rib fractures independently predict patients’ pulmonary morbidity and mortality. Numerous cardiopulmonary to neurologic causes such as tamponade, hemo- pneumothorax, and cervical spine injury can be implicated. Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure. Epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas.

Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.

We describe a patient under clopidogrel therapy presenting to the intensive care unit (ICU) with severe respiratory distress that improved with epidural analgesia. We provide a discussion of the risks and benefits of neuraxial analgesia in patients presenting with rib-fracture pain-related respiratory failure.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.


25 de fevereiro de 2013

Artigo recomendado: Inspiratory Stridor after Tracheal Intubation with a MicroCuff® Tracheal Tube in Three Young Infants

MadhanKumar Sathyamoorthy, Jerrold Lerman, Satyan Lakshminrusimha, Doron Feldman

Anesthesiology 2013; 118:748-50, Sathyamoorthy et al.


Uncuffed tracheal tubes (TTs) have been the standard for tracheal intubation in infants and children for decades until the recent introduction of the MicroCuff (Kimberley-Clark, Roswell, GA) cuffed TT. Evidence suggests that the incidence of perioperative airway events after use of these new TTs is small, although the evidence for their safe use in neonates and young infants is scant. We identified three infants, two of whom were born premature and one who was syndromic, who developed postextubation stridor after the use of Microcuff® TTs. Because postextubation stridor after surgery has been infrequent in infants in our neonatal intensive care unit (NICU), we believe that this cluster of three infants with postextubation stridor may signify an underrecognized risk when these TTs are used in young infants.

Accordingly, we prepared this communication, summarizingthe perioperative course of the three affected infants.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.

19 de fevereiro de 2013

Inscrições até domingo! Pós-graduação em Anestesia Regional - Hospital Sírio-Libanês



O curso de Aperfeiçoamento em Anestesia Regional é o único curso de Pós-Graduação Lato Sensu que oferece teoria e prática em anestesia com discussões de casos clínicos reais.

A pertinência deste curso deve-se às intervenções em determinadas situações de cuidado clínico-cirúrgico e ao desenvolvimento de tecnologias inovadoras para esse cuidado.

Tudo isso demonstrado por especialistas renomados e membros do corpo docente do Hospital-Sírio Libanês, o primeiro hospital privado do Brasil a ter rotineiramente a utilização da ultrassonografia como recurso principal para guiar os bloqueios regionais.

Diferenciais
- Duração de nove meses com aulas mensais realizadas aos finais de semana;
- Pioneirismo do Hospital Sírio-Libanês na utilização rotineira da ultrassonografia como recurso para guiar os bloqueios regionais;
- Compreensão teórico-prática da Anestesia Regional;
- Ênfase na utilização de novas tecnologias como ferramenta para agregar qualidade em anestesia.

Objetivos
Aperfeiçoar profissionais médicos especialistas em Anestesiologia na área de Anestesia Regional aproximando-os à prática, suas potencialidades e limites, envolvendo as bases moleculares, morfológicas, farmacológicas e patológicas; aplicações clínicas, técnicas e a tecnologia frequentemente utilizada

Critérios de avaliação
Percentual de frequência igual ou superior a 75% nas atividades educacionais e 
Entrega do Trabalho de Conclusão de Curso

Metodologia
Ações integradas de ENSINO e PRÁTICA
A metodologia de aprendizagem utilizada pelo Instituto visa incentivar a interação nas relações éticas e sociais, a discussão construtiva e a disseminação do conhecimento.
Por meio dos grupos de discussão é possível a aproximação dos conteúdos teóricos da realidade, além de estimular a troca de informações entre alunos e professores.
Além disso, o Instituto Sírio-Libanês de Ensino e Pesquisa está sempre atento às descobertas de pesquisa e às inovações tecnológicas, oferecendo aos profissionais da saúde a possibilidade de aperfeiçoamento constante.

18 de fevereiro de 2013

Artigo recomendado: Practice Advisory for the Prevention and Management of Operating Room Fires


An Updated Report by the American Society of Anesthesiologists Task Force on Operating Room Fires

Anesthesiology 2013; 118:271-90 - Practice Advisory

Practice Advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis and analysis of expert opinion, clinical feasibility data, openforum commentary, and consensus surveys. Practice Advisories developed by the American Society of Anesthesiologists (ASA) are not intended as standards, guidelines, or absolute requirements, and their use cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies.

Practice Advisories are not supported by scientific literature to the same degree as standards or guidelines because of the lack of sufficient numbers of adequately controlled studies. Practice Advisories are subject to periodic update or revision as warranted by the evolution of medical knowledge, technology, and practice.

This document updates the “Practice Advisory for Prevention and Management of Operating Room Fires: A Report by the American Society of Anesthesiologists Task Force on Operating Room Fires,” adopted by the ASA in 2007 and published in 2008.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.

14 de fevereiro de 2013

Artigo recomendado: Adductor Canal Block versus Femoral Nerve Block and Quadriceps Strength

A Randomized, Double-blind, Placebo-controlled, Crossover Study in Healthy Volunteers

Pia Jaeger, Zbigniew J.K. Nielsen, Maria H. Henningsen, Karen Lisa Hilsted, Ole Mathiesen, Jørgen B. Dahl

Anesthesiology, V 118 • No 2, February 2013

ABSTRACT
Background: The authors hypothesized that the adductor canal block (ACB), a predominant sensory blockade, reduces quadriceps strength compared with placebo (primary endpoint, area under the curve, 0.5–6 h), but less than the femoral nerve block (FNB; secondary endpoint). Other secondary endpoints were adductor strength and ability to ambulate.

Methods: The authors enrolled healthy young men into this double blind, placebo-controlled, randomized, crossover study. On two separate study days, subjects received either ACB or FNB with ropivacaine, and placebo in the opposite limb. Strength was assessed as maximum voluntary isometric contraction for quadriceps and adductor muscles. In addition, subjects performed three standardized ambulation tests. Clinicaltrials.gov Identifier: NCT01449097.

Results: Twelve subjects were randomized, 11 analyzed. Quadriceps strength (area under the curve, 0.5–6 h) was significantly reduced when comparing ACB with placebo (5.0 ± 1.0 vs. 5.9 ± 0.6, P = 0.02, CI: −1.5 to −0.2), FNB with placebo (P = 0.0004), and when comparing FNB with ACB (P = 0.002). The mean reduction from baseline was 8% with ACB and 49% with FNB. The only statistically significant difference in adductor strength was between placebo and FNB (P = 0.007). Performance in all mobilization tests was reduced after an FNB compared with an ACB (P < 0.05).

Conclusions: As compared with placebo ACB statistically significantly reduced quadriceps strength, but the reduction was only 8% from baseline. ACB preserved quadriceps strength and ability to ambulate better than FNB did. Future studies are needed to compare the analgesic effect of the ACB with the FNB in a clinical setting.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.

8 de fevereiro de 2013

Artigo recomendado: A Double-blind Randomized Trial of Wound and Intercostal Space Infiltration with Ropivacaine during Breast Cancer Surgery

Effects on Chronic Postoperative Pain

Aline Albi-Feldzer, Emmanuelle Mouret-Fourme E, Smail Hamouda, Cyrus Motamed, Pierre-Yves Dubois, Ludivine Jouanneau, Christian Jayr

Anesthesiology 2013; 118:318-26, Albi-Feldzer et al.

ABSTRACT

Background: The efficacy of local anesthetic wound infiltration for the treatment of acute and chronic postoperative pain is controversial and there are no detailed studies. The primary objective of this study was to evaluate the influence of ropivacaine wound infiltration on chronic pain after breast surgery.

Methods: In this prospective, randomized, double-blind, parallel-group, placebo-controlled study, 236 patients scheduled for breast cancer surgery were randomized (1:1) to receive ropivacaine or placebo infiltration of the wound, the second and third intercostal spaces and the humeral insertion of major pectoralis. Acute pain, analgesic consumption, nausea and vomiting were assessed every 30 min for 2 h in the postanesthesia care unit and every 6 h for 48 h. Chronic pain was evaluated 3 months, 6 months, and 1 yr after surgery by the brief pain inventory, hospital anxiety and depression, and neuropathic pain questionnaires.

Results: Ropivacaine wound infiltration significantly decreased immediate postoperative pain for the first 90 min, but did not decrease chronic pain at 3 months (primary endpoint), or at 6 and 12 months postoperatively. At 3 months, the incidence of chronic pain was 33% and 27% (P = 0.37) in the ropivacaine and placebo groups, respectively. During follow-up, brief pain inventory, neuropathic pain, and anxiety increased over time in both groups (P < 0.001) while depression remained stable. No complications occurred.

Conclusion: This multicenter, prospective study shows that ropivacaine wound infiltration after breast cancer surgery decreased immediate postoperative pain but did not decrease
chronic pain at 3, 6, and 12 months postoperatively.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.




6 de fevereiro de 2013

Artigo recomendado: Practice Guidelines for Postanesthetic Care


An Updated Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care

Anesthesiology 2013; 118:291-307 - Practice Guidelines

PRACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.

This document updates the “Practice Guidelines for Postanesthetic Care: A Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care,” adopted by the ASA in 2001 and published in 2002.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.


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