RESUMO
The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.
Assuntos
Analgésicos Opioides/uso terapêutico , Gastroplastia/métodos , Laparoscopia/métodos , Metadona/uso terapêutico , Morfina/uso terapêutico , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/efeitos adversos , Período de Recuperação da Anestesia , Método Duplo-Cego , Feminino , Humanos , Período Intraoperatório , Masculino , Metadona/efeitos adversos , Pessoa de Meia-Idade , Morfina/efeitos adversos , Manejo da Dor , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: Ischemia-reperfusion injury is an unavoidable aspect of transplantation, as well as an important cause of acute kidney injury in clinical practice. Pre- and post-ischemic conditioning are strategies that may provide organs with resistance to major ischemic events. This study evaluates the effects of ischemic preconditioning and ischemic postconditioning, either separately or in combination, after an acute ischemia-reperfusion kidney injury. METHODS: Forty Wistar rats received isoflurane anesthesia and were randomized into 5 groups: 1. the sham group underwent laparotomy; 2. the control group underwent laparotomy and 30 minutes of renal ischemia followed by reperfusion; 3. the preconditioning group underwent laparotomy, ischemic preconditioning, and 30 minutes of renal ischemia followed by reperfusion; 4. the preconditioning and postconditioning group underwent laparotomy, ischemic preconditioning, 30 minutes of renal ischemia, and ischemic postconditioning followed by reperfusion; and 5. the postconditioning group underwent laparotomy, 30 minutes of renal ischemia, and ischemic postconditioning followed by reperfusion. Serum analyses of creatinine and neutrophil gelatinase-associated lipocalin (NGAL) were performed, and renal histology was examined 24 hours later. RESULTS: Severe tubular injury and increases in creatinine were observed in all groups except the sham group. The control group and all ischemic conditioning groups were no different in the degree of renal injury and values of NGAL and creatinine after the injury. CONCLUSIONS: Ischemic preconditioning and ischemic postconditioning, together or separately, are unable to preserve kidney function or exert a protective effect against tubular cell injury after an acute ischemia-reperfusion kidney injury.
Assuntos
Injúria Renal Aguda/prevenção & controle , Pós-Condicionamento Isquêmico/métodos , Precondicionamento Isquêmico/métodos , Traumatismo por Reperfusão/prevenção & controle , Injúria Renal Aguda/patologia , Animais , Masculino , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologiaRESUMO
We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3-13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Intracuff pressure was monitored and maintained below 20 cmH2 O. The mean (SD) increases in systolic blood pressure after tracheal extubation compared with before extubation were 10.9 (10.8) mmHg, 7.3 (17.7) mmHg, 4.1 (10.5) mmHg and 1.9 (9.5) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.021). The mean (SD) increases in diastolic blood pressure after tracheal extubation compared with before extubation were 3.9 (9.7) mmHg, 7.9 (14.6) mmHg, 0.7 (10.4) mmHg and 3.6 (6.9) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.019). The mean (SD) increases in heart rate after tracheal extubation compared with before extubation were 14.2 (7.6) beats.min-1 , 15.5 (13.1) beats.min-1 , 5.2 (9.6) beats.min-1 and 4.1 (6.6) beats.min-1 in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p < 0.001). The incidence of sore throat 8 h after tracheal extubation was 22.0% in the air-filled group, 9.8% in the saline group, 4.9% in the 0.5% alkalinised lidocaine group and 2.4% in the 1% alkalinised lidocaine group, p = 0.015. We conclude that filling the tracheal tube cuff with alkalinised lidocaine-filled reduces the haemodynamic response to tracheal extubation and postoperative laryngotracheal morbidity in children.
Assuntos
Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringe/lesões , Traqueia/lesões , Adolescente , Ar , Extubação , Álcalis , Pressão Sanguínea , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lidocaína , Masculino , Faringite/epidemiologia , Faringite/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pressão , Estudos Prospectivos , Solução SalinaRESUMO
Our aim was to compare peri-operative core temperatures and the incidence of hypothermia in obese and non-obese women with active forced-air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0-34.9 kg.m(-2) ) and 10 non-obese (18.5-24.9 kg.m(-2) ) women received forced-air warming on their lower limbs. At the end of surgery, the mean (SD) core temperatures were 36.7 (0.5) °C in the obese group and 36.0 (0.6) °C in the non-obese group (p < 0.001). Only in the non-obese group was there a significant decrease in the intra-operative core temperature values (p < 0.001). The incidences of intra-operative hypothermia were lower in the obese group (10%) compared with non-obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the non-obese group (36.2 (0.4) vs 35.6 (0.5) °C, respectively (p < 0.001)). In conclusion, obese female patients have higher peri-operative core temperature and a lower incidence of hypothermia compared with non-obese female patients during abdominal surgery with active forced-air warming.
Assuntos
Temperatura Corporal , Hipotermia/complicações , Obesidade/complicações , Período Perioperatório , Abdome/cirurgia , Adulto , Análise de Variância , Regulação da Temperatura Corporal , Feminino , Calefação , Humanos , Hipotermia/diagnóstico , Complicações Intraoperatórias , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Obesidade/cirurgia , Período Pós-OperatórioRESUMO
BACKGROUND: Little information exists regarding factors influencing perioperative cardiac arrests and their outcome. This survey evaluated the incidence, causes and outcome of perioperative cardiac arrests in a Brazilian tertiary general teaching hospital between April 1996 and March 2005. METHODS: The incidence of cardiac arrest during anaesthesia was prospectively identified from an anaesthesia database. There were 53,718 anaesthetics during the study period. Data collected included patient characteristics, surgical procedures (elective, urgent or emergency), ASA physical status classification, anaesthesia provider information, type of surgery, surgical areas and outcome. All cardiac arrests were retrospectively reviewed and grouped by cause of arrest and death into one of four groups: totally anaesthesia related, partially anaesthesia related, totally surgery related or totally patient disease or condition related. RESULTS: One hundred and eighty-six cardiac arrests (34.6:10,000) and 118 deaths (21.97:10,000) were found. Major risk factors for cardiac arrest were neonates, children under 1 yr and the elderly (P<0.05), male patients with ASA III or poorer physical status (P<0.05), in emergency surgery (P<0.05) and under general anaesthesia (P<0.05). Patient disease/condition was the major cause of cardiac arrest or death (P<0.05). There were 18 anaesthesia-related cardiac arrests (3.35:10,000) -- 10 totally attributed (1.86:10,000) and 8 partially related to anaesthesia (1.49:10,000). There were 6 anaesthesia-related deaths (1.12:10,000) -- 3 totally attributable and 3 partially related to anaesthesia (0.56:10,000 in both cases). The main causes of anaesthesia-related cardiac arrest were respiratory events (55.5%) and medication-related events (44.5%). CONCLUSIONS: Perioperative cardiac arrests were relatively higher in neonates, infants, the elderly and in males with severe underlying disease and under emergency surgery. All anaesthesia-related cardiac arrests were related to airway management and medication administration which is important for prevention strategies.
Assuntos
Anestesia/efeitos adversos , Parada Cardíaca/etiologia , Complicações Intraoperatórias , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Emergências , Métodos Epidemiológicos , Feminino , Indicadores Básicos de Saúde , Parada Cardíaca/epidemiologia , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por SexoRESUMO
Trinta e quatro pacientes adultos, estado físico I e II ASA, submetidos à operaçäo eletiva abdominal, foram divididos aleatoriamente em dois grupos de 17 pacientes, quanto a idade, peso e altura. A medicaçäo pré-anestésica de todos os pacientes constou de diazepam (10mg) via oral e meperidina (100mg) por via muscular. A induçäo anestésica foi realizada em ambos os grupos com: diazepam (0,2 mg.Kg-1 e fentanil (10microng.Kg.-1). Um grupo recebeu como agente bloqueador neuromuscular o atracúrio (0,5 mg.Kg -1 venosa, in bolus e 0,02 mg.Kg-1 em doses de manutençäo) e o outro, pancurônio (0,1 mg.Kg-1, venosa in bolus e 0,03 mg.Kg-1 em doses de manutençäo). A anestesia foi mantida com ventilaçäo controlada, N2O (60%) e O2 (40%), halotano (0,5 a 1%) e doses fracionadas foram: pressäo arterial, freqüência cardíaca, condiçöes da intubaçäo traqueal e do relaxamento muscular abdominal, duraçäo do bloqueio neuromuscular e necessidade de antagonizaçäo farmacológica do bloqueio neuromuscular no final da anestesia. As variáveis circulatórias permaneceram estáveis nos dois grupos, observando-se apenas aumento da freqüência cardíaca no grupo pancurônio. As condiçöes para a intubaçäo traqueal e o relaxamento muscular abdominal foram boas nos dois grupos. A duraçäo do bloqueio neuromuscular foi, no grupo atracúrio, de 30 min em média e no grupo pancurpnio, de 50 min. Ao contrário do grupo pancurônio, na maioria dos pacientes do grupo atracúrio houve completa reversäo do bloqueio neuromusuclar, sem necessidade de antagonismo pela neostigmine. Os autores concluem que o atracúrio e o pancurônio säo bons agentes bloqueadores neuromusculares, apresentando o atracúrio, em comparaçäo com o pancurônio, a vantagem de näo alterar significantemente a freqüência cardíaca, duraçäo de açäo mais curta e reversäo espontânea do bloqueio neuromuscular, na maioria dos pacientes