RESUMO
BACKGROUND: Acute brain lesions constitute an alarming public health concern. Neuroprotective therapies have been implemented to stabilize, prevent, or reduce brain lesions, thus improving neurological outcomes and survival rates. Hypothermia is the most effective approach, mainly attributed to the reduction in cellular metabolic activity. Whole-body cooling is currently implemented by healthcare professionals; however, adverse events are frequent, limiting the potential benefits of therapeutic hypothermia. Therefore, selective methods have been developed to reduce adverse events while delivering neuroprotection. Nasopharyngeal approaches are the safest and most effective methods currently considered. Our primary objective was to determine the effects of a novel nasopharyngeal catheter on the brain temperature of pigs. METHODS: In this prospective, non-randomized, interventional experimental trial, 10 crossbred pigs underwent nasopharyngeal cooling for 60 min followed by 15 min of rewarming. Nasopharyngeal catheters were inserted into the left nostril and properly positioned at the nasopharyngeal cavity. RESULTS: Nasopharyngeal cooling was associated with a decrease in brain temperature, which was more significant in the left cerebral hemisphere (p = 0.01). There was a reduction of 1.47 ± 0.86 °C in the first 5 min (p < 0.001), 2.45 ± 1.03 °C within 10 min (p < 0.001), and 4.45 ± 1.36 °C after 1 h (p < 0.001). The brain-core gradient was 4.57 ± 0.87 °C (p < 0.001). Rectal, esophageal, and pulmonary artery temperatures and brain and systemic hemodynamic parameters, remained stable during the procedure. Following brain cooling, values of oxygen partial pressure in brain tissue significantly decreased. No mucosal lesions were detected during nasal, pharyngeal, or oral inspection after nasopharyngeal catheter removal. CONCLUSIONS: In this study, a novel nasopharyngeal cooling catheter effectively induced and maintained exclusive brain cooling when combined with effective counter-warming methods. Exclusive brain cooling was safe with no device-related local or systemic complications and may be desired in selected patient populations.
Assuntos
Temperatura Corporal , Encéfalo/fisiologia , Hipotermia Induzida/métodos , Nasofaringe , Animais , Velocidade do Fluxo Sanguíneo , Encéfalo/irrigação sanguínea , Circulação Cerebrovascular , Esôfago , Estudos de Viabilidade , Feminino , Hipotermia Induzida/instrumentação , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Neuroproteção , Artéria Pulmonar , Reto , Sus scrofa , Suínos , Ultrassonografia Doppler TranscranianaRESUMO
Contexto: A hanseníase é uma doença endêmica em nosso meio e pode provocar deformidadesfísicas se não tratada adequadamente. A descompressão cirúrgica do nervo periférico acometido porvezes é necessária para prevenção dessas ocorrências. Objetivo: Relatar a técnica de descompressãode nervo ulnar, o mais frequentemente acometido na hanseníase, realizada ambulatorialmente emserviço de referência no estado da Bahia. Material e métodos: Os autores relatam a experiência com84 pacientes submetidos à cirurgia ambulatorial de neuropatia compressiva ulnar, entre fevereiro de 2008 e fevereiro de 2009. O quadro clínico mais encontrado foi dor de difícil manejo terapêutico e asincapacidades físicas. As cirurgias tiveram uma média de duração de 30 minutos. O procedimentoconsistiu em descompressão seguida de neurólise de nervo ulnar sob anestesia local sem utilização degarrote. Resultados: Os pacientes toleraram bem as cirurgias, e a dor, avaliada pela escala analógica,melhorou em praticamente todos os casos. Conclusão: A técnica ambulatorial de descompressãoulnar é um método eficaz, com baixo índice de complicações e adequada para manuseio de doençatão desafiadora como a hanseníase em países em desenvolvimento.
Background: Leprosy is endemic in our country leading often to physical deformities when not adequatelytreated. The surgical decompression of the peripheral nerve involved by the disease sometimes isthe best option in order to avoid these occurrences. Objective: To report the surgical technique ofulnar decompression with local anesthesia as an outpatient procedure at a Leprosy Institution inBahia, Brazil. Material and methods: Eighty-four outpatients were operated between February 2008and February 2009. Pain of difficult management and the physical disabilities were the predominantsymptoms. The procedure consisted of decompression followed by neurolyses under local anesthesiawithout tourniquet. The median surgical time was thirty minutes. Results: The patients tolerated wellthe procedure and significant pain relief was obtained in almost all cases. Conclusion: The outpatientsurgical decompression of ulnar nerve is efficacious and accompanied by minor complications and is adequate to manage ulnar compression by leprosy in developing countries.