ABSTRACT
ABSTRACT Background: Models for endoscopic retrograde cholangiopancreatography training allow practice with an expert feedback and without risks. A method to rapidly exchange the papilla can be time saving and accelerate the learning curve. Aim: To demonstrate a newly method of rapid exchange papilla in ex-vivo models to teach retrograde cholangiopancreatography advanced procedures. Methods: A new model of ex-vivo papilla was developed in order to resemble live conditions of procedures as cannulation, papilotomy or fistula-papilotomy, papiloplasty, biliary dilatation, plastic and metallic stentings. Results: The ex-vivo model of papilla rapid exchange is feasible and imitates with realism conditions of retrograde cholangiopancreatography procedures. Conclusion: This model allows an innovative method of advanced endoscopic training.
RESUMO Racional: Nas últimas décadas os simuladores de colangiopancreatografia retrógrada tiveram grande evolução. Atualmente dispõem-se de vários métodos para realizar o treinamento minimizando os riscos de complicações e tornando a curva de aprendizagem muito rápida. Objetivo: Demonstrar uma variação dos modelos ex-vivos desenvolvidos para o treinamento avançado em colangiopancreatografia retrograda. Método: Foi criado um modelo ex-vivo simulando fatores e condições reais para o treinamento avançado de colangiopancreatografia retrograda como canulação, papilotomia, fistulotomia, papiloplastia e uso de próteses plásticas e metálicas. Resultados: Esse modelo ex-vivo, com a possibilidade de troca rápida da papila, mostrou-se viável e no treinamento simula condições muito próximas às reais. Conclusão: Neste modelo há grande inovação para o treinamento de novos endoscopistas em procedimento avançados na colangiopancreatografia retrógrada.
Subject(s)
Animals , Radiology/education , Ampulla of Vater , Cholangiopancreatography, Endoscopic Retrograde/methods , Swine , Time Factors , Models, AnimalABSTRACT
Para evaluar los efectos cardiorespiratorios y los requerimientos de isofluorano en conejos sometidos a cirugía oftálmica tratados en diferentes momentos con tramadol, fue realizado un estudio prospectivo experimental de tipo ciego en 24 conejos distribuidos aleatoriamente en tres grupos de ocho individuos cada uno: grupo tramadol preoperatorio (Tpre), grupo tramadol transoperatorio (Ttrans) y grupo tramadol postoperatorio (Tpos). Cada animal recibió tres inyecciones intramusculares de igual volumen en los periodos pre, intra y postoperatorio, conteniendo tramadol (4mg/kg) o NaCl 0,9%, de acuerdo al momento indicado para cada grupo. La inducción y mantenimiento anestésico fueron realizados con isofluorano en FiO2 1,0. Una vez estabilizado el plano anestésico, fue iniciado el procedimiento quirúrgico. Se evaluaron: frecuencia cardíaca (FC), presión arterial media (PAM), frecuencia respiratoria (f), presión de CO2 al final de la expiración (EtCO2), saturación parcial de oxihemoglobina (SpO2) y concentración de isofluorano al final de la expiración (EtISO). Las variables fueron medidas después de la estabilización anestésica (m1) y cada 10 min desde el inicio de la cirugía, hasta el final del experimento (m10 a m40). La FC, SpO2, f , EtCO2 y EtISO fueron similares entre grupos durante todo el tiempo. La PAM fue significativamente mayor (p<0,01) durante m1 comparada con el resto del tiempo y el grupo Tpre mostró valores inferiores (p=0,04) de este parámetro durante m1 con relación a los demás grupos. El clorhidrato de tramadol promueve la reducción transitoria de la presión arterial en conejos anestesiados con isofluorano y sometidos a cirugía oftálmica. La administración preoperatoria del fármaco no disminuye el requerimiento anestésico y resulta en hipotensión más pronunciada. Adicionalmente, la anestesia con isofluorano, asociada al reflejo óculo-cardiaco, generan hipotensión arterial, fenómeno que debe tenerse en cuenta durante cirugías oftalmológicas.
To evaluate the cardiorespiratory effects and isoflurane requirements of tramadol applied at different times during ophthalmic surgery, a blind prospective study was made in 24 rabbits, randomly divided into three groups of eight subjects each: pre-operatory tramadol group (Tpre), trans-operatory tramadol group (Ttrans) and post-operatory tramadol group (Tpos), which received three intramuscular injections of equal volume, in the pre, intra and post-operative period, containing tramadol hydrochloride (4 mg/kg) or NaCl 0,9%, according to each group. Anesthetic induction and maintenance was made with isoflurane diluted FiO2 1.0. Once the anesthetic plane was stabilized, surgical procedure was started. Were evaluated heart rate (HR), medium arterial presseure (MAP), respiratory rate (f), end tidal CO2 (EtCO2), Oxihemoglobin saturation (SpO2) and end tidal isoflurane (EtISO). Variables were measured after anesthesia stabilization (m1) and every 10 min after onset of surgery, until the end of experimental protocol (m10 to m40). HR, SpO2, f, EtCO2 and EtISO were similar among groups at all times. MAP were significantly higher (p<0.01) in m1 than in other moments and Tpre group showed lower (p=0.04) values than the other groups at this moment. Tramadol hydrochloride promotes transient reduction of blood pressure in isoflurane anesthetized rabbits subjected to ophthalmic surgery. The preoperative administration of the drug does not reduce the anesthetic requirement and results in a more pronounced hypotension. Additionally, isoflurane anesthesia, associated to oculocardiac reflex generates a hypotension phenomenon that must be taken in to considertation during ophthalmologic surgeries.