Estudo comparativo entre doses de morfina intratecal para analgesia após cesariana / Comparative study between doses of intrathecal morphine for analgesia after caesarean / Estudio comparativo entre dosis de morfina intratecal para analgesia después de la cesárea

JUSTIFICATIVA E OBJETIVOS: Analgesia após cesarianas é importante, pois puérperas com dor têm dificuldade na movimentação, o que prejudica o aleitamento. Morfina intratecal proporciona analgesia adequada e duradoura após cesarianas. O objetivo deste estudo foi comparar a qualidade da analgesia proporcionada por duas doses de morfina intratecal e seus efeitos colaterais em pacientes submetidas à cesariana. MÉTODO: Participaram do estudo 123 gestantes, com idade gestacional superior a 38 semanas e plano de cesariana eletiva. As gestantes foram alocadas de maneira aleatória em dois grupos que receberam 50 ou 100 µg de morfina intratecal (Grupo 50/Grupo 100). Todas as pacientes foram anestesiadas com 12 mg de bupivacaína 0,5% hiperbárica via intratecal. As pacientes foram avaliadas entre a 9ª e a 11ª horas e entre a 22ª e a 24ª horas após o bloqueio, em relação à qualidade da analgesia, ao consumo de analgésico, aos efeitos colaterais e à principal causa de desconforto nas primeiras 24 horas após a cirurgia. RESULTADOS: Os grupos foram semelhantes em relação aos dados antropométricos e antecedente obstétrico. Não houve diferença estatística na intensidade dolorosa entre os grupos. Nos dois grupos a dor foi maior nas primeiras 12 horas após a anestesia (p < 0,001). O consumo de cloridrato de tramadol e o intervalo até a primeira dose foram semelhantes nos dois grupos. Prurido foi o efeito colateral mais frequente, com incidência estatisticamente maior no Grupo 100 (p = 0,026). CONCLUSÕES: Morfina intratecal em 50 µg tem a mesma qualidade de analgesia que 100 µg, com menor incidência de efeitos colaterais.

BACKGROUND AND OBJECTIVES:Analgesia after caesarean section is important because postpartum women with pain have difficulty in mobility, which undermines breastfeeding. Intrathecal morphine provides adequate and prolonged analgesia after cesarean. The aim of this study was to compare the quality of analgesia provided by two doses of intrathecal morphine and its side effects in patients undergoing cesarean section. METHOD: The study included 123 pregnant women with gestational age over 38 weeks and scheduled for cesarean section. The women were randomly allocated into two groups to receive either 50 or 100 µg of intrathecal morphine (Group 50/Group 100). All patients were intrathecally anesthetized with 12 mg of 0.5% hyperbaric bupivacaine. Patients were assessed between the 9th and 11th hour and the 22nd and 24th hour after blockade for quality of analgesia, analgesic consumption, side effects, and main cause of discomfort in the first 24 hours after surgery. RESULTS: There was similarity between groups regarding anthropometric data and obstetric history. There was no statistical difference in pain intensity between groups. In both groups, pain was more intense in the first 12 hours after anesthesia (p < 0.001). Tramadol hydrochloride consumption and time to first dose were similar in both groups. Pruritus was the most common side effect, with statistically higher incidence in Group 100 (p = 0.026). CONCLUSIONS: Intrathecal morphine 50 µg provides the same quality of analgesia as 100 µg, with a lower incidence of side effects.

JUSTIFICATIVA Y OBJETIVOS: La analgesia posterior a las cesáreas es importante porque puérperas con dolor tienen dificultad para moverse, lo que perjudica el amamantamiento. La morfina intratecal proporciona una analgesia adecuada y duradera después de las cesáreas. El objetivo de este estudio fue comparar la calidad de la analgesia proporcionada por dos dosis de morfina intratecal y sus efectos colaterales en las pacientes sometidas a la cesárea. MÉTODO: Participaron en el estudio 123 gestantes, con una edad gestacional superior a las 38 semanas y un plan para la cesárea electiva. Las gestantes se ubicaron aleatoriamente en dos grupos que recibieron 50 ó 100 µg de morfina intratecal (Grupo 50/Grupo 100). Todas las pacientes fueron anestesiadas con 12 mg de bupivacaína al 0,5% hiperbárica vía intratecal. Las pacientes se evaluaron entre la 9ª y la 11ª horas y entre la 22ª y la 24ª horas después del bloqueo, con relación a la calidad de la analgesia, al consumo de analgésico, a los efectos colaterales y a la principal causa de incomodidad en las primeras 24 horas después de la cirugía. RESULTADOS: Los grupos fueron parecidos con relación a los datos antropométricos y al antecedente obstétrico. No hubo diferencia estadística en cuanto a la intensidad dolorosa entre los grupos. En los dos grupos el dolor fue más elevado en las primeras 12 horas posteriores a la anestesia (p < 0,001). El consumo de clorhidrato de tramadol y el intervalo hasta la primera dosis, fueron parecidos en los dos grupos. El prurito fue el efecto colateral más frecuente, con una incidencia estadísticamente mayor en el Grupo 100 (p = 0,026). CONCLUSIONES: 50 mg de morfina intratecal proporcionan la misma calidad de analgesia que 100 µg, con una menor incidencia de efectos secundarios.

Laringoespasmo e extubaçåo traqueal em plano anestésico: estudo comparativo em crianças / Extubation in deep level of anesthesia does not prevent laryngospasm in children

To investigate the role of the timing of extubation on the incidence of laryngospasm in children we studied 299 patients randomly extubated either in deep level of anesthesia (group p, n=150) or fully awake (group A, n=149)). Intubations were done without muscle relaxants in the majority of cases. All patients received halothane and nitrous oxide as anesthetics and were maintained in spontaneous ventilation. Patients who underwent throat operation, those under 6 months old as well as those with full stomach were excluded. Patients in group P and A aged respectively 62 more or less 40 months and 59 more or less44 months (NS). There was no difference between the two groups with regard to the incidence of laryngospasm (group P:4.66 percents; group A: 2.68 percents), butgroup P presented a higher incidence of airway obstruction due to dislodgment of the tongue against the posterior wall of pharynx. Based on these data the authors recommend that children shold be extubated while fully awake

Ativaçåo do sistema complemento causada pela circulaçåo extracorpórea em crianças submetidas à cirurgia cardíaca / Complement cascade activation due to cardiopulmonary bypass in children undergoing heart surgery

Complement activation was studied in 10 children undergoing heart surgery with (group 1) and in 9 children undergoing heart without cardiopulmonary bypass (group 2). Children with infectious disease and under corticotherapy as well as those with immunological disease were excluded. Cardiopulmonary bypass was performed with bubble oxygenators, primed with blood and crystalloid. Blood samples were drawn at hte beginning oh the operation and approximately 15 minutes before skin closure. Plasma concentrations of the third component factor (C3) and of its split product C3d were measured in all patients. C3 levels were expressed in mg/dl and C3d levels were expressed as a percentage of a normal control value. Plasma concentrations of C3 decreased significantly in group 1 (84.8 more or less 14.7 mg/dl and 34.2 more or less 8.2 mg/dl; p=0.007) and remained unchanged in group 2 (91 more or less 11.9 mg/dl and 85.9 more or less 13.4 mg/dl; p=0.13-NS). Plasma concentrations of C3d rose significantly in group 1 (12928.5 and 33867.5; p=0,005) but remained unchanged in group 2(86 more or less 15.1 and 93 more or less 21.3; p=0.10-NS). We concluded that the third componenet of the complement system C3 was consumed during the cardiopulmonary bypass and this consumption was due to activation