Identification and economic burden of main adverse events of nerve injuries caused by regional anesthesia: a systematic review

Abstract Background and objectives: Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (‟regional anesthesia" OR ‟nerve block") AND (‟complications" OR ‟nerve lesion" OR ‟nerve damage" OR ‟nerve injury"). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. Results: Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. Conclusion: Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.

Pudendal nerve block for circumcision of pediatric patient with Pierre Robin Sequence: case report

Abstract Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients' anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort

Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

SBA 2020: Regional anesthesia safety recommendations update / SBA 2020: Atualização das recomendações para segurança em anestesia regional

Abstract The purpose of the Brazilian Society of Anesthesiology (SBA)'s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.

Resumo O propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia (SBA) para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré-procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo-efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.

Recommendations for local-regional anesthesia during the COVID-19 pandemic / Recomendações para realização de anestesia loco-regional durante a pandemia de COVID-19

Abstract Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the post-operative period and provides safety to patients and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.

Resumo Desde o início da pandemia de COVID-19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID-19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção dessa técnica anestésica minimiza os efeitos adversos no pós-operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID-19 e oferecer recomendações práticas para sua realização segura e eficiente.

Daño neurológico perioperatorio. Identificación de factores de riesgo, prevención y estudios relacionados / Perioperative nerve injury. Risk factor identification, prevention and work-up

BACKGROUND: Regional anesthesia techniques can have adverse effects, like peripheral nerve injuries. This can affect the practitioner on the choice of techniques when offering multimodal analgesia. CASE REPORT: We present the case of an arthroscopic rotator cuff repair on a patient with no comorbidities who presented peripheral nerve injury during post-op. Initially thought to have occurred as a consequence of the anesthetic technique, further study of the patient revealed the injuries to have been produced by the arthroscopic surgery. CONCLUSION: There are multiple factors that influence the possibility of peripheral nerve injury associated with nerve blocks. They can be grouped as related to the patient, the anesthetic technique or the surgical technique, the latter being the most relevant. If a patient manifests signs of peripheral nerve injury high-resolution magnetic resonance of the neural tissue must be performed immediately. Sensory nerve conduction study and electromyography must be performed 4 weeks after by an expert neurologist.

INTRODUCCIÓN: La anestesia regional puede producir como efecto adverso lesiones de nervios periféricos, lo que puede hacer desistir al anestesiólogo de realizar técnicas que mejoran la analgesia multimodal. CASO CLÍNICO: Se presenta el caso de un paciente sin comorbilidades que se operó de reparación artroscópica del manguito rotador y presentó daño neurológico postoperatorio. Inicialmente se sospechó que el daño había sido producido durante la técnica anestésica, sin embargo, el estudio adecuado demostró que el daño se relacionaba con la técnica quirúrgica. CONCLUSIÓN: Existen factores que influyen en la posibilidad de daño neurológico asociado a bloqueos de nervios periféricos que pueden ser propios del paciente, de la técnica anestésica o quirúrgicos, siendo estos últimos los más relevantes. En un paciente con clínica compatible debe realizarse resonancia magnética del tejido neural de alta resolución de forma inmediata; estudio de conducción neural sensitiva y electromiografía a las 4 semanas de evolución por un neurólogo experto.

The relevance of regional anesthesia in orthopaedic surgery: advantages, disadvantages and challenges

The relevance of regional anaesthesia in orthopaedic surgery cannot be overemphasized because it has aided reduction in intra-operative and post-operative pain which has always been a challenge in surgical practice. It also reduces the risk of haemorrhage and infection. Though there are complications associated with regional anaesthesia, these complications are rare and can be anticipated; thus prompt intervention measures can be instituted. The outcome of every surgical procedure takes into consideration the risks and benefit of the method, and hence, since the benefits of regional anaesthesia in orthopaedic surgery outweighs the risks, it is highly recommended. Regional anaesthesia is of great importance in orthopaedic surgery because it offers continuous but controlled analgesia. It induces hypotension which leads to a reduction in blood loss during operation. It allows early recovery and ambulation of patients, thus reducing the risks associated with prolonged bed stay, which may, in turn, affect the overall outcome of surgery. This review aims to highlight the advantages and challenges of regional anaesthesia in orthopaedic surgery

Eficácia e efeitos hemodinâmicos da anestesia raquidiana com ropivacaína isobárica, hipobárica ou hiperbárica em cães anestesiados com isofluorano / Efficacy and hemodynamic effects of spinal anesthesia with isobaric, hypobaric or hyperbaric ropivacaine in dogs anesthetized with isoflurane

O presente estudo objetivou avaliar a anestesia raquidiana com ropivacaína em cães alterando a baricidade do anestésico local, investigando as alterações hemodinâmicas e complicações. Foram utilizados seis cães, Beagle, 4 anos, submetidos a anestesia inalatória com isofluorano e aos tratamentos: Ghipo = anestesia raquidiana hipobárica (0,5 mL NaCl 0,9% + 0,5 mL ropivacaína 0,75%); Giso = anestesia raquidiana isobárica (0,5 mL NaCl 1,53% + 0,5 mL ropivacaína 0,75%); Ghiper = anestesia raquidiana hiperbárica (0,5 mL glicose 10% + 0,5 mL ropivacaína 0,75%). Após indução anestésica e manutenção com isofluorano, os animais foram posicionados em decúbito lateral direito para a passagem de um cateter de artéria pulmonar pela veia jugular esquerda. Após esse procedimento, a punção subaracnóide foi realizada entre L5-L6 com uma agulha espinhal 22G, seguida da administração de 1 mL de anestésico local em 1 min. Os animais foram mantidos por 60 minutos anestesiados em decúbito ventral. A FC, f, PAM, DC, PAPm e TºC apresentaram aumento progressivo em todos os grupos enquanto que a PCPm, apenas no GHIPO, aumentou ao longo de todos os momentos. O IRPT no GISO apresentou valores significativamente superiores no M1, M5 e M10 comparado aos demais grupos, exceto no M5, em que o GISO diferiu somente do GHIPER. O IRVP no GISO aumentou no M5 em comparação ao MB. Foram observados efeitos adversos como déficit motor unilateral, atonia vesical, excitação, dor aguda e quemose. De acordo com os dados obtidos no presente estudo pode-se concluir que os animais que receberam anestesia raquidiana com as soluções hiperbárica e isobárica apresentaram maior bloqueio motor comprovando que a baricidade influencia diretamente o tipo de fibra a ser bloqueada. A utilização de solução isobárica resulta em um bloqueio misto (motor e sensitivo). As alterações hemodinâmicas descritas na literatura como, bradicardia e hipotensão, não puderam ser evidenciadas neste estudo embora o volume de anestésico tenha sido baixo associado a influência dos efeitos do isofluorano. Em relação às complicações evidenciadas, sugere-se acompanhamento pós-anestésico dos animais submetidos à anestesia raquidiana a fim de que quaisquer alterações possam ser identificadas precocemente e tratadas.(AU)

The aim of the study was to assess hemodynamic changes and complications of spinal anesthesia with ropivacaine at different baricities. Six beagle dogs aged four years. The dogs were anesthetized with isoflurane and subjected to the following treatments: Ghypo = spinal anesthesia with hypobaric ropivacaine (0.5mL of 0.9% NaCl+0.5mL ropivacaine at 0.75%); Giso = isobaric spinal anesthesia (0.5mL of 0,906% NaCl+0.5mL ropivacaine at 0.75%); Ghyper = hyperbaric spinal anesthesia (0.5mL of 10% glucose+0.5mL ropivacaine at 0.75%). After induction to anesthesia and maintenance with isoflurane, animals were positioned in right lateral recumbency for pulmonary artery catheterization through the left jugular vein. Spinal anesthesia was carried out with injection of 1mL of local anesthetic using a 22G Quincke tip needle in the L5-L6 space along 1 minute. Dogs were maintained under inhalation anesthesia for 60 minutes in ventral recumbency. HR, FR, MAP, CO, mPAP and body temperature progressively increased in all groups, whereas PCWP increased only in GHYPO at all time points. The TPRI showed significantly higher values in GISO at M1, M5 and M10 compared to the other groups, except for M5, during which GISO differed only from GHYPER. The PVRI increased at M5 compared to MB in GISO. Side effects such as unilateral motor deficit, bladder atony, excitation, acute pain and chemosis were observed. The hemodynamic changes were not relevant, although inhalation anesthesia with isoflurane might have influenced the results. The changes observed in the study demonstrate that motor blockade is likely to be obtained with isobaric and hyperbaric ropivacaine, thereby confirming the influence of baricity on the type of nerve fibers on the spinal cord. The isobaric solution results in a mixed blockade (motor and sensory blockade). Hemodynamic changes such as hypotension and bradycardia were not evidenced in this study, although local anesthetics were administered in low volumes and together with isoflurane anesthesia. Regarding complications, post-anesthetic observation is warranted in order to identify and treat possible changes. Spinal anesthesia in the conditions studied did not cause hemodynamic changes in isoflurane-anesthetized dogs and is thus considered safe for routine practice, although a few complications are prone to occur.(AU)

Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis / Efetividade da associação da anestesia regional à anestesia geral na redução da mortalidade em revascularização miocárdica: metanálise

ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01), CVA (RR = 0.79, 95% CI = 0.32-1.95), MI (RR = 0.96, 95% CI = 0.52-1.79) and LHS (MD = -1.94, 95% CI = -3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93). ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26). CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

RESUMO INTRODUÇÃO E OBJETIVOS: A anestesia neuroaxial (AN) vem sendo utilizada em associação com a anestesia geral (AG) para revascularização miocárdica, entretanto a anticoagulação durante a cirurgia torna questionável a viabilidade dos benefícios mediante o risco de hematoma de espaço peridural. O objetivo deste estudo foi executar metanálises analisando a efetividade da AN associada à AG comparada à AG isolada para a cirurgia de revascularização miocárdica relativa à redução da mortalidade. MÉTODOS: Foram analisados mortalidade, arritmias, acidente vascular cerebral (AVC), infarto miocárdico (IM), tempo de internação hospitalar (TIH), tempo de internação em unidade de terapia intensiva (TUTI), reoperações, transfusão sanguínea (TS), qualidade de vida, grau de satisfação e disfunção cognitiva pós-opertória. A diferença média (DM) ponderada foi estimada para as variáveis contínuas e risco relativo (RR) e a diferença de risco (DR) para variáveis categóricas. RESULTADOS: Analisados 17 artigos originais. Metanálise da mortalidade (DR = -0,01; IC 95% = -0,03 a 0,01), AVC (RR = 0,79; IC 95% = 0,32 a 1,95), IM (RR = 0,96; IC 95% = 0,52 a 1,79) e TIH (DM = -1,94; IC 95% = -3,99 a 0,12) não demonstraram significância estatística. Arritmia foi menos frequente com AN (RR = 0,68; IC 95% = 0,50 a 0,93). O TUTI foi menor no com AN (DM = -2,09; IC 95% = -2,92 a -1,26). CONCLUSÃO: Não se observaram diferenças estatisticamente significantes quanto a mortalidade. A combinação de AN e AG mostrou menor incidência de arritmias e menor TUTI.

Anestesia regional: casos complicados y factores asociados, Hospital Escuela Universitario, Tegucigalpa, Honduras, 2012-2013 / Regional anesthesia: complicated cases and associated factors, Hospital Escuela Universitario, Tegucigalpa, Honduras, 2012-2013

Antecedentes: El uso de técnicas de anestesia regional se ha incrementado en los últimos años, por lo que es necesario conocer sus complicaciones. Objetivo: Describir las características de pacientes sometidos a anestesia regional y factores asociados a complicaciones, Hospital Escuela Universitario, Tegucigalpa, Enero 2012-Enero 2013. Métodos: Estudio analítico tipo caso/control. Caso: paciente sometido a procedimiento quirúrgico electivo o emergencia bajo anestesia regional que presentó alguna complicación anestésica; Control: igual que caso y que no presentó complicaciones, pareado por edad +1 año. Muestra 150 casos y 150 controles. Se registró información clínica-epidemiológica de expedientes seleccionados aleatoriamente. Se estimó OR, IC 95%; se consideró significancia estadística cuando p<0.05. Resultados: Ambos grupos presentaron distribución similar por sexo y peso. Categoría ASA I y procedimiento electivo se presentó en 50.6% (76) y 46.0% (69) de los casos, y en 58.6% (88) y 54.6% (82) de los controles, respectivamente. El bloqueo raquídeo fue el más utilizado, 76 (50.6%) y 106 (70.6%) casos y controles, respectivamente. Las complicaciones incluyeron bloqueo fallido (75.0%), hipotensión (24.6%) y bradicardia (10.0%). Bloqueo raquídeo y ausencia de co-morbilidad fueron protectores; categorías ASA III-IV y presencia de co-morbilidad fueron factores de riesgo; hipertensión arterial y diabetes mellitus se asociaron 4 y 7 veces más, respectivamente, a casos complicados; p<0.05. Discusión: El tipo de procedimiento electivo o emergen- cia no se asoció a complicaciones. Se recomienda estabilizar los pacientes que serán sometidos a bloqueoregional, especialmente aquellos con factores de riesgo. Es necesario identificar los factores relacionados a bloqueo fallido e implementar correctivos...(AU)

A randomized, double blind comparison of pethidine and ketoprofen as adjuvants for lignocaine in intravenous regional anaesthesia / Estudo comparativo, randômico e duplo-cego de petidina e cetoprofeno como adjuvantes de lidocaína em anestesia regional intravenosa / Estudio comparativo, aleatorizado y doble ciego, de la petidina y del ketoprofeno como adyuvantes de la lidocaína en la anestesia regional intravenosa

BACKGROUND AND OBJECTIVES: A review of all the adjuncts for intravenous regional anaesthesia concluded that there is good evidence to recommend NonSteroidal Anti-Inflammatory agents and pethidine in the dose of 30 mg dose as adjuncts to intravenous regional anaesthesia. But there are no studies to compare pethidine of 30 mg dose to any of the NonSteroidal Anti-Inflammatory agents. METHODS: In a prospective, randomized, double blind study, 45 patients were given intravenous regional anaesthesia with either lignocaine alone or lignocaine with pethidine 30 mg or lignocaine with ketprofen 100 mg. Fentanyl was used as rescue analgesic during surgery. For the first 6 h of postoperative period analgesia was provided by fentanyl injection and between 6 and 24 h analgesia was provided by diclofenac tablets. Visual analogue scores for pain and consumption of fentanyl and diclofenac were compared. RESULTS: The block was inadequate for one case each in lignocaine group and pethidine group, so general anaesthesia was provided. Time for the first dose of fentanyl required for postoperative analgesia was significantly more in pethidine and ketoprofen groups compared to lignocaine group (156.7 ± 148.8 and 153.0 ± 106.0 vs. 52.1 ± 52.4 min respectively). Total fentanyl consumption in first 6 h of postoperative period was less in pethidine and ketoprofen groups compared to lignocaine group (37.5 ± 29.0 mcg, 38.3 ± 20.8 mcg vs. 64.2 ± 27.2 mcg respectively). Consumption of diclofenac tablets was 2.4 ± 0.7, 2.5 ± 0.5 and 2.0 ± 0.7 in the control, pethidine and ketoprofen group respectively, which was statistically not significant. Side effects were not significantly different between the groups. CONCLUSION: Both pethidine and ketoprofen are equally effective in providing postoperative analgesia up to 6 h, without significant difference in the side effects and none of the adjuncts provide significant ...

JUSTIFICATIVA E OBJETIVOS: uma revisão de todos os adjuvantes para anestesia regional intravenosa concluiu que há boas evidências para recomendar os agentes anti-inflamatórios não esteroides e petidina em dose de 30 mg como adjuvantes para anestesia regional intravenosa. Porém, não há estudos que comparem petidina (30 mg) com quaisquer dos agentes anti-inflamatórios não esteroides. MÉTODOS: em um estudo prospectivo, randômico e duplo-cego, 45 pacientes receberam anestesia regional intravenosa com apenas lidocaína ou lidocaína com petidina (30 mg) ou lidocaína com cetoprofeno (100 mg). Fentanil foi usado como analgésico de resgate durante a cirurgia. Durante as seis primeiras horas de pós-operatório, analgesia foi fornecida via injeção de fentanil e, entre seis e 24 horas, analgesia foi fornecida via comprimidos de diclofenaco. Os escores visuais analógicos para dor e do consumo de fentanil e diclofenaco foram comparados. RESULTADOS: o bloqueio foi inadequado para um caso tanto do grupo lidocaína quanto do grupo petidina; portanto, anestesia geral foi administrada. O tempo para a primeira dose necessária de fentanil para analgesia pós-operatória foi significativamente maior nos grupos petidina e cetoprofeno em comparação com o grupo lidocaína (156,7 ± 148,8 e 153,0 ± 106,0 vs. 52,1 ± 52,4 minutos, respectivamente). O consumo total de fentanil nas primeiras seis horas de pós-operatório foi menor nos grupos petidina e cetoprofeno em comparação com o grupo lidocaína (37,5 ± 29,0 mcg, 38,3 ± 20,8 mcg vs. 64,2 ± 27,2 mcg, respectivamente). O consumo de comprimidos de diclofenaco foi de 2,4 ± 0,7, 2,5 ± 0,5 e 2,0 ± 0,7 no grupo controle, petidina e cetoprofeno, respectivamente, o que não foi estatisticamente significante. ...

JUSTIFICACIÓN Y OBJETIVOS: una revisión sobre todos los adyuvantes para la anestesia regional intravenosa concluyó que hay buenas evidencias para recomendar los agentes antiinflamatorios no esteroideos y la petidina en dosis de 30 mg como adyuvantes para la anestesia regional intravenosa. Sin embargo, no hay estudios comparando la petidina (30 mg) con cualesquiera de los agentes antiinflamatorios no-esteroideos. MÉTODOS: en un estudio prospectivo, aleatorizado y doble ciego, 45 pacientes recibieron anestesia regional intravenosa con solamente lidocaína o lidocaína con petidina (30 mg) o lidocaína con ketoprofeno (100 mg). El fentanilo fue usado como analgésico de rescate durante la cirugía. Durante las 6 primeras horas del postoperatorio, la analgesia fue suministrada vía inyección de fentanilo y entre 6 y 24 h, la analgesia fue suministrada vía comprimidos de diclofenaco. Se compararon las puntuaciones visuales analógicas para el dolor y el consumo de fentanilo y diclofenaco. RESULTADOS: el bloqueo fue inadecuado para un caso tanto del grupo lidocaína como del grupo petidina; por tanto, se administró anestesia general. El tiempo para la primera dosis necesaria de fentanilo para analgesia postoperatoria fue significativamente mayor en los grupos petidina y ketoprofeno en comparación con el grupo lidocaína (156,7 ± 148,8 y 153,0 ± 106,0 vs. 52,1 ± 52,4 min, respectivamente). El consumo total de fentanilo en las primeras 6 h del postoperatorio fue menor en los grupos petidina y ketoprofeno en comparación con el grupo lidocaína (37,5 ± 29,0 mcg; 38,3 ± 20,8 mcg vs. 64,2 ± 27,2 mcg, respectivamente). El consumo de comprimidos de diclofenaco fue de 2,4 ± 0,7; 2,5 ± 0,5; y 2 ± 0,7 en el grupo control, petidina y ketoprofeno, respectivamente, lo que no fue estadísticamente significativo. Los ...

Comparison of intravenous butorphanol, ondansetron and tramadol for control of shivering during regional anesthesia: a prospective, randomized double-blind study

We conducted this study to compare the efficacy and safety of butorphanol, ondansetron and tramadol for control of shivering in patients undergoing surgical procedures under spinal anesthesia. In this prospective double-blind, randomized, controlled study, 150 patients of both genders, 18-60 years old, ASA I or II, booked for elective surgery under spinal anesthesia were randomly distributed into three groups of 50 each. Each patient, who developed shivering, was given either 0.03 mg/kg of inj. butorphanol 1% [Group-B], 0.06 mg/kg of inj. ondansetron [Group-O] or 1.0 mg/kg of inj. tramadol 1% [Group-T] IV. Demographic characteristics, incidence of shivering, response rate after 1, 3, 5, 10 and 20 min, recurrence rate, hemodynamic parameters and complications were observed. All patients were relieved of shivering after butorphanol; 66.6% of them were relieved within 1 min, 93.33% within 3 min and 100% within 5 min. Ondansetron could relieve shivering in only 29.4% of the patients; 5.88% within 1, 11.76% within 3, 23.52% within 10 and 29.4% within 20 min. Tramadol relieved shivering in 92.30%; 46.15% within 1, 84.61% within 3 and 92.30% within 5 min respectively [p < 0.05]. Recurrence of shivering was observed in 26.67% of butorphanol group and 15.38% of tramadol group [p> 0.05]. Ondansetron was not found to be much effective for the control of shivering during regional anesthesia. Butorphanol and tramadol were equally effective in controlling shivering under regional anesthesia, the only difference being in their onset of action. Butorphanol was quicker in onset which is essential for control of shivering and should be preferred

Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration

PURPOSE: To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA). MATERIALS AND METHODS: In 2011 radical cystectomy with extended pelvic and iliac lymphadenectomy was performed on 14 patients using urinary diversion without applying general anesthesia. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Postoperatively, pain management took three days with the remaining epidural catheter before oral analgesics were administered. Mobilization and diet restoration were carried out according to the fast-track concept. Outcome measurements included operative time, blood loss, beginning of oral nutrition, beginning of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), length of hospital stay. RESULTS: All surgical procedures were performed without any complications. The absence of general anesthesia did not result in any relevant disadvantages. The postoperative progress was normal in all patients. Particularly, cardiopulmonary complications and enteroparesis did not occur. The provided palliative care proved sufficient (NAS max. 3-4). Discharge followed 10 to 22 days after surgery. At the time of discharge, the patients described the procedure to be relatively positive. CONCLUSIONS: Our data show that CSTEA is an effective technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes, and complications of CSTEA.

Normotermia perioperatoria / Peri-operative normothermia

Introducción: La hipotermia perioperatoria inadvertida es un desafío para la seguridad del paciente quirúrgico y puede tener un impacto negativo en su recuperación. Materiales y métodos: Se realizó aleatoriamente una encuesta personalizada a anestesiólogos federados que asistieron al Congreso Argentino de Anestesiología realizado en Salta, Argentina, en septiembre de 2007, a fin de obtener un panorama sobre las estrategias de manejo de la temperatura en pacientes bajo anestesia en su medio de trabajo (monitorización, calentamiento activo, métodos de soporte). Resultados: Sobre 92 encuestas realizadas, 85 correspondieron a anestesiólogos argentinos, de los cuales 20 eran jefes de servicio de anestesiología, 59 médicos de planta y 6 residentes de anestesiología. Del total de los profesionales en estudio, 37,6 por ciento trabaja en la Ciudad Autónoma de Buenos Aires, 25,9 por ciento en la provincia de Buenos Aires, 5,9 por ciento en la provincia de Córdoba, 5,9 por ciento en la provincia de Salta, 4,7 por ciento en la provincia de Jujuy, 3,5 por ciento en la provincia de Chaco, 3,5 por ciento en la provincia de Santa Fe, 2,4 por ciento en la provincia de Corrientes, 2,4 por ciento en la provincia de Neuquén, 2,4 por ciento en la provincia de Tucumán, 1,2 por ciento en la provincia de Chubut, 1,2 por ciento en la provincia de Mendoza, 1,2 por ciento en la provincia de Santa Cruz, 1,2 por ciento en la provincia de Santiago del Estero y 1,2 por ciento en la provincia de Tierra del Fuego. La media de camas hospitalarias fue de 384,5 para el grupo Ciudad Autónoma de Buenos Aires (CABA), 111,7 para el grupo Gran Buenos Aires (GBA) y 159,2 para el grupo Interior. La media de quirófanos fue de 10,6 para el grupo CABA, 4,9 para el grupo GBA y 5,1 para el grupo Interior... (TRUNCADO)

Introduction: inadvertent peri-operative hypothermia represents a challenge to the safety of the surgical patient, and can produce a negative impact on recovery. Materials & methods: A randomized personalized survey was made of federated anesthesiologists who attended the Argentine Convention in Salta, Argentina, in September 2007, so as to have an overview of strategies of temperature management in anesthetized patients in the anesthesiologist’s area (monitoring, active heat, supportive methods). Results: Of the 92 professionals surveyed, 85 were Argentine anesthesiologists, 20 were Heads of Service, 59 staff members, and 6 residents in Anesthesiology. From this total, 37,6 percent work in the Autonomous City of Buenos Aires, 25,9 percent in the Province of Buenos Aires, 5,9 percent in Cordoba, 5,9 percent in Salta, 4,7 percent in Jujuy, 3,5 percent in Chaco, 3,5 percent in Santa Fe, 2,4 percent in Neuquén, 2,4 percent in Tucumán, 1,2 percent in Chubut, 1,2 percent in Mendoza, 1,2 percent in Santa Cruz, 1,2 percent in Santiago del Estero, and 1,2 percent in Tierra del Fuego. The average of hospital beds was 384,5 for Buenos Aires City, 111,7 for Greater Buenos Aires and 159,2 for the group of provinces. The average of operating rooms was 10,6 for Buenos Aires City, 4,9 for Greater Buenos Aires, and 5,1 for the group of provinces. Temperature monitoring was used by 63,5 percent of the professionals in pediatric patients, 40 percent in geriatric patients, 14,1 percent in pregnant patients, 50,6 percent in traumatized patients, 51,8 percent in critical patients, and 14,1 percent in all patients. Nasopharyngeal was the preferred location for the sensor (74,1 percent), followed by axillary and tympanic (17,6 percent), skin (14,1 percent), and rectal (12,9 percent) areas... (TRUNCADO)

Introdução: A hipotermia perioperatória inadvertida é um desafio para a segurança do paciente cirúrgico, e pode ter um impacto negativo na recuperação hospitalar. Materiais e métodos: Foi feita aleatoriamente uma pesquisa personalizada a anestesiologistas que participaram do Congresso Argentino de Anestesiologia realizado em Salta, Argentina, em setembro de 2007, a fim de ter um panorama das estratégias de controle da temperatura nos pacientes sob anestesia (monitoração, aquecimento ativo, métodos de suporte). Resultados: Em 92 pesquisas realizadas, 85 corresponderam a anestesiologistas argentinos, dos quais 20 eram chefes de serviço de anestesiologia, 59 médicos de planta e 6 residentes de anestesiologia. Do total dos profissionais do estudo, 37,6 por cento trabalhavam na Ciudad Autónoma de Buenos Aires, 25,9 por cento na província de Buenos Aires, 5,9 por cento na província de Córdoba, 5,9 por cento na província de Salta, 4,7 por cento na província de Jujuy, 3,5 por cento na província de Chaco, 3,5 por cento na província de Santa Fe, 2,4 por cento na província de Corrientes, 2,4 por cento na província de Neuquén, 2,4 por cento na província de Tucumán, 1,2 por cento na província de Chubut, 1,2 por cento na província de Mendoza, 1,2 por cento na província de Santa Cruz, 1,2 por cento na província de Santiago del Estero e 1,2 por cento na província de Tierra del Fuego. A média de leitos hospitalares foi de 384,5 no grupo Ciudad Autónoma de Buenos Aires (CABA), 111,7 no grupo Gran Buenos Aires (GBA) e 159,2 no grupo Interior. A média de salas de operações foi de 10,6 no grupo CABA, 4,9 no grupo GBA e 5,1 no grupo Interior. Em relação à monitoração, 63,5 por cento disseram realizá-la em pacientes pediátricos, 40 por cento em pacientes idosos, 14,1 por cento em grávidas, 50,6 por cento em traumatizados, 51,8 por cento em pacientes críticos e 14,1 por cento em todos os pacientes... (TRUNCADO)

Anestesia regional para cesariana em gestantes obesas: estudo retrospectivo / Regional anesthesia for cesarean section in obese pregnant women: a retrospective study / Anestesia regional para cesárea en embarazadas obesas: estudio retrospectivo

JUSTIFICATIVA E OBJETIVOS: O levantamento dos dados teve por objetivo identificar as técnicas anestésicas, suas dificuldades e complicações em pacientes com IMC > 30 kg.m-2 submetidas à cesariana. Este levantamento de dados justifica-se por embasar o desenvolvimento de novos protocolos e condutas mais adequadas a essa população de gestantes. MÉTODO: Estudo retrospectivo de levantamento de dados e complicações anestésicas em pacientes obesas, maiores de 18 anos, submetidas à cesariana no período de janeiro de 2004 a dezembro de 2006. As variáreis avaliadas foram: idade, peso, altura, IMC, estado físico (ASA), técnicas anestésicas, dificuldades na palpação e punção, complicações hemodinâmicas (sangramento e hipotensão) e complicações anestésicas. RESULTADOS: Foram avaliadas 315 fichas anestésicas. A média de idade foi de 29,1 anos, o IMC médio foi de 39,25 e a maioria das pacientes foi classificada como ASA II (63,2 por cento). A técnica anestésica mais utilizada foi raquianestesia. Em 47 procedimentos, havia descrição de dificuldade de punção e, em 31 casos, dificuldade de palpação. CONCLUSÕES: As dificuldades técnicas encontradas foram mais acentuadas em pacientes de classes mais elevadas de obesidade, assim como hipotensão, sangramento e tempo cirúrgico.

BACKGROUND AND OBJECTIVES: The objective of the data gathering was to indentify anesthetic techniques, and their difficulties and complications in patients with BMI > 30 kg.m-2 undergoing cesarean sections. The study intends to support the development of new protocols and more adequate conducts for this population of pregnant women. METHODS: This is a retrospective study of data and anesthetic complications in obese patients older than 18 years of age who underwent cesarean sections from January 2004 to December 2006; variables investigated included: age, weight, height, BMI, physical status (ASA), anesthetic techniques, difficulties in palpation and puncturing, hemodynamic complications (bleeding and hypotension), and anesthetic complications. RESULTS: Three hundred and fifteen anesthetic forms were evaluated. Mean age was 29.1 years, mean BMI 39.25, and the majority of patients was classified as ASA II (63.2 percent). Spinal anesthesia charts used more often, difficulty to puncture was reported in 47 procedures, and difficulty to palpate was reported in 31 procedures. CONCLUSIONS: Technical difficulties as well as hypotension, bleeding, and surgical time were more frequent in patients with higher degrees of obesity.

JUSTIFICATIVA Y OBJETIVOS: La investigación de los datos tuvo el objetivo de identificar las técnicas anestésicas, sus dificultades y complicaciones en pacientes con IMC > = 30 kg.m-2, sometidas a la cesárea. Esa investigación se justifica porque tiene como base el desarrollo de nuevos protocolos y de conductas más adecuadas para esa población de embarazadas. MÉTODO: Estudio retrospectivo de investigación de datos y complicaciones anestésicas en pacientes obesas, mayores de 18 años y sometidas a la cesárea durante el período de enero de 2004 a diciembre de 2006. Las variables evaluadas fueron: edad, peso, altura, IMC, estado físico (ASA), técnicas anestésicas, dificultades en la palpación y punción, complicaciones hemodinámicas (sangramiento e hipotensión) y complicaciones anestésicas. RESULTADOS: Se evaluaron 315 fichas anestésicas. El promedio de edad fue de 29,1 años, el IMC promedio fue de 39,25 y la mayoría de las pacientes se clasificaron como ASA II (63,2 por ciento). La técnica anestésica más utilizada fue la raquianestesia. En 47 procedimientos se registró la dificultad de punción y en 31 casos dificultad de palpación. CONCLUSIONES: Las dificultades técnicas encontradas fueron más profundas en pacientes con clase más alta de obesidad, como también hipotensión, sangramiento y tiempo de quirófano.