Minimal fresh gas flow sevoflurane anesthesia and postoperative acute kidney injury in on-pump cardiac surgery: a randomized comparative trial

Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.

Peritumoral infiltration of local anesthetic before surgery in early breast cancer: a comment

This is a comment on a study recently published about peritumoral infiltration of local anesthetic before surgery in early breast cancer. Previously, animal models and a randomized study for stage IV breast cancer patients inferred that the removal of the primary tumor resulted in increased growth factors and worse distant disease control. Therefore, breast cancer surgery might not be a strictly local intervention. In this new randomized study, the intervention was a peritumoral infiltration of local anesthetic ­ lidocaine 0.5% in the six tumor margins, as an attempt to limit the systemic repercussions of surgery. Although the adjuvant treatment available for the study seems outdated, leading us to question the external validation, limited resources may have increased the power of surgery. Unknown mechanisms during surgery can change the patient's journey, and it is our duty to look at surgical studies with due seriousness

Condición física e inflamatoria antes de una intervención quirúrgica mayor abdominal / Physical and inflammatory condition before major abdominal quirurgical intervention

Introducción: El desacondicionamiento físico se asocia con disminución en la capacidad cardiorrespiratoria, aumento en el contenido de grasa corporal, e imbalances en respuesta inflamatoria, todos ellos factor de riesgo frente a la agresión de una intervención quirúrgica mayor. El valor de consumo de oxígeno (VO2max), el índice de masa corporal (IMC) y los valores plasmáticos de citoquinas de pacientes programados para una intervención quirúrgica mayor abdominal a menudo no se tienen en cuenta en la valoración prequirúrgica. Objetivo: Determinar la condición física e inflamatoria de pacientes que se trataron con una intervención quirúrgica mayor abdominal. Métodos: Investigación cuantitativa, descriptiva. Muestra por conveniencia de pacientes que se trataron con una intervención quirúrgica mayor abdominal en dos hospitales de Manizales (Colombia). Previo a la intervención, se midió VO2max, el IMC y valores de citoquinas. Resultados: Participaron en el estudio 6 hombres y 48 mujeres. Los valores promedio del VO2max se categorizaron como bajos. Se encontraron valores altos de IMC, del receptor antagonista de IL-1 (IL-1 Ra) y del factor neutrotrófico derivado del cerebro (BDNF). No se hallaron diferencias significativas en los valores promedio de VO2max, de IL-1Ra y de BDNF entre los grupos. Los pacientes programados para intervención quirúrgica ginecológica y gastrointestinal tuvieron sobrepeso y los programados para intervención quirúrgica bariátrica fueron obesos mórbidos. Conclusión: Pacientes programados para una intervención quirúrgica mayor abdominal presentan valores bajos de VO2max para la edad y altos de IMC. Se hallaron valores altos de IL-1Ra y de BDNF asociadas a obesidad y a posible antiinflamación(AU)

Introduction: Physical deconditioning is associated with, a decrease in cardiorespiratory capacity, an increase in body fat content and imbalances in the inflammatory response, all of which are risk factors for the aggression of a major surgical intervention. The oxygen consumption value (VO2max), body mass index (BMI), and plasma cytokine values of patients scheduled for major abdominal surgery are often not taken into account in the presurgical evaluation. Objective: To determine the physical and inflammatory condition of patients who were treated with a major abdominal surgery. Methods: Quantitative, descriptive research. Convenience sample of patients who underwent major abdominal surgery in two hospitals in Manizales (Colombia). Prior to the intervention, VO2max, BMI and cytokine values were measured. Results: 6 men and 48 women participated in the study. Average VO2max values were categorized as low. High values of BMI, IL-1 receptor antagonist (IL-1 Ra) and brain derived neutrotrophic factor (BDNF) were found. No significant differences were found in the mean VO2max, IL-1Ra and BDNF values between the groups. Patients scheduled for gynecological and gastrointestinal surgery were overweight and those scheduled for bariatric surgery were morbidly obese. Conclusion: Patients scheduled for major abdominal surgery have low VO2max values for age and high BMI. High IL-1Ra and BDNF values were found associated with obesity and possible anti-inflammation(AU)

Anesthesia strategy for factor X deficiency coagulopathy: case report

Abstract Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8-14s), International Normalized Ratio (INR) 1.99 (VR: 0.8-1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25-37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.

A clinical risk analysis of postoperative nausea and vomiting after colorectal cancer surgery

Objective: Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery. Methods: A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV. Results: The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p < 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170-8.226; p < 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018-1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287-8.652; p = 0.013) were independent risk factors for POV. Conclusion: Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV. (AU)

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022 / 中国医学科学杂志(英文版)

Objective Airway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists. Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis. Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1%) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P= 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 d vs. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27,P = 0.024). Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.

Roles of c-Fos, EGR-1, PKA, and PKC in cognitive dysfunction in rats after propofol anesthesia

Abstract This study aimed to investigate possible changes in the spatial memory of rats and the expression or activity of EGR-1, c-Fos, PKA, and PKC after propofol anesthesia. Thirty-six Sprague-Dawley rats aged 20 months and 36 Sprague-Dawley rats aged three months were each randomly divided into three groups: the control group, the Morris Water Maze (MWM) group, and the propofol group. In the propofol groups of both young and aged rats, the rats were anesthetized by propofol for two or four hours and then performed the MWM test two days or two weeks after anesthesia to assess cognitive function. EGR-1, c-Fos, PKA, and PKC expressions in the rat hippocampus were determined via immunohistochemistry. For the older rats, the escape latency in the P4h/2d group was significantly prolonged (P < 0.05), and the learning curve was right-shifted in the P4h/2w group (P < 0.05). The expression levels of EGR-1, c-Fos, PKA, and PKC in the MWM groups were significantly higher than those in the control groups (P < 0.05). In the P4h/2d group of aged rats, the expression levels of both PKA and PKC were decreased compared with those of the MWM groups. The decreased expression of both protein kinases may be responsible for the observed impairment after propofol anesthesia

Hipotermia perioperatoria / Perioperative hypothermia

Perioperative hypothermia is a common complication of general anesthesia, but it can also occur in patients undergoing regional anesthesia. It signifiicantly increases perioperative morbidity and mortality. Complications such as increased incidence of surgical site infection, delayed healing, coagulation abnormalities, increased surgical bleeding, perioperative cardiac events, decreased metabolism of drugs involved in anesthesia and a great discomfort in the immediate postoperative period (due to shivering), have been identified. The decrease in the patient's core temperature is due to a combination of physiological events related to the surgical anesthetic act. These include deterioration of the effector responses of the hypothalamus (tending to conserve heat), heat distribution between the central compartment and the periphery, and net heat loss to a generally colder environment, such as the surgical ward. Hypothermia is often an undetected complication of the anesthetic act due to the lack of regular temperature monitoring. It is not considered a basic standard of care, despite the fact that in recent years new guidelines and recommendations have emerged, which suggest its implementation in all patients in whom the duration of their surgery is expected to last longer than 1 hour. The measures aimed at keeping the patient normothermic can be classified as passive, within which the simplest is to cover the patient for as long as possible during their presence in the ward, and active, which are those that transfer heat to the body, within the which the most effective is the use of convective heat blankets. It has recently been suggested that prewarming the patient before inducing anesthesia is an efficient strategy to avoid hypothermia, decreasing temperature differences between core and peripheral tissues. However, the effectiveness of this measure remain to be evaluated with prospective, randomized trials. In the context of the emergency patient, although hypothermia shows the same characteristics as in the elective patient, it becomes more relevant in three clinical settings: patient with major burns, patient in hemorrhagic shock and the polytraumatized patient. In these scenarios, keeping the patient normothermic will prevent a series of serious complications, which can strongly affect mortality.

La hipotermia perioperatoria es una complicación frecuente de la anestesia general, pero que también se puede presentar en pacientes sometidos a anestesia regional. Se relaciona con un aumento significativo de la morbilidad y mortalidad perioperatorias, donde se han identificado complicaciones como aumento de la incidencia de infección del sitio quirúrgico, retardo de la cicatrización, alteraciones de la coagulación, aumento del sangrado quirúrgico, de los eventos cardiacos perioperatorios, disminución del metabolismo de drogas implicadas en la anestesia y sensación de gran incomodidad del paciente en el posoperatorio inmediato, por la presencia de calosfríos. La disminución de la temperatura central del paciente se debe a un combinación de eventos fisiológicos relacionados con el acto anestésico quirúrgico, con deterioro de las respuestas efectoras del hipotálamo tendientes a conservar calor, fenómenos distributivos de calor entre el compartimiento central y la periferia del propio paciente y pérdida de calor neta hacia un medio ambiente en general más frío, como lo es el pabellón quirúrgico. El hecho de que la hipotermia sea muchas veces considerada una complicación no detectada del acto anestésico, se debe a que aún la monitorización regular de la temperatura no se considera un estándar básico de cuidado, pese a que en los últimos años han surgido nuevas guías y recomendaciones, que sugieren que ésta sea implementada en todo paciente en que se proyecte una duración de la cirugía mayor a 1 hora. Las medidas tendientes a mantener al paciente normotérmico, pueden ser clasificadas en pasivas, dentro de las cuales la más simple es cubrir al paciente el mayor tiempo posible durante su presencia en pabellón y activas, que son aquellas que transfieren calor al cuerpo, dentro de las cuales la más efectiva es el uso de mantas de calor convectivo. Recientemente, se ha sugerido que una de las estrategias eficientes para evitar la HPO es el precalentamiento del paciente, que permite que sus tejidos periféricos estén a mayor temperatura al momento de inducir la anestesia, sin embargo, la efectividad de esta medida debe ser evaluada con estudios prospectivos y aleatorizados más concluyentes. La hipotermia en el contexto del paciente de urgencia, si bien presenta las mismas características que en el paciente electivo, cobra mayor relevancia en tres escenarios clínicos: el gran quemado, el paciente en hemorrágico y el paciente politraumatizado, escenarios en que mantener al paciente normotérmico, implicará evitar una serie de complicaciones graves, que pueden incidir fuertemente en la mortalidad.

Efectividad de la ketamina y el sulfato de magnesio en pacientes con temblor posanestesia subaracnoidea / Effectiveness of ketamine and magnesium sulfate in patients with shaking after subarachnoid anesthesia

Introducción: El temblor es frecuente. Además de agravar el dolor, aumenta la demanda metabólica y el consumo de oxígeno; varios fármacos son utilizados para eliminarlo. Objetivo: Determinar la efectividad de la ketamina y el sulfato de magnesio en pacientes con temblor posanestesia subaracnoidea. Métodos: Se realizó una investigación cuasi-experimental de 394 pacientes, quienes se encontraban bajo anestesia espinal de forma electiva, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde septiembre de 2016 hasta igual periodo de 2018. Se dividieron en 2 grupos aleatorios con 197 integrantes cada uno: A (ketamina 0,4 mg/kg) y B (sulfato de magnesio 50 mg/kg), a los cuales se le suministraron los medicamentos una vez iniciado el temblor. Resultados: En ambos grupos predominaron los pacientes de 45-64 años de edad. Hubo homogeneidad entre hombres y mujeres, sin significación estadística (p= 0,5378). La mayoría de los afectados se encontraban en el grupo de riesgo anestésico II (88,1 %). En los 2 grupos primó del grado III del temblor antes de la terapia, solo 3,5 % del grupo B a los 30 minutos mantuvo igual condición. En los primeros 10 minutos de suministrar el sulfato de magnesio despareció el temblor en la mayoría de los pacientes (74,5 %). Dicho fármaco resultó efectivo en 83,8 % de los afectados y en aquellos que recibieron ketamina fue de 42,1 %, ambos sin efectos secundarios. Conclusiones: La incidencia del temblor fue alta. La ketamina y el sulfato de magnesio fueron efectivos al permitir la desaparición del temblor en un corto periodo de tiempo, pero el segundo fármaco superó al primero en magnitud considerable.

Introduction: The shaking is frequent. Besides increasing the pain, it increases the metabolic demand and the oxygen consumption; several drugs are used to eliminate it. Objective: To determine the effectiveness of ketamine and magnesium sulfate in patients with shaking after subarachnoid anesthesia. Methods: A quasi-experimental investigation of 394 patients who received spinal anesthesia in an elective way, assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from September, 2016 to the same period in 2018. They were divided in 2 random groups with 197 members each one: A (ketamine 0.4 mg/kg) and B (magnesium sulfate 50 mg/kg), to whom the medications were given once shaking began. Results: In both groups the 45-64 years patients prevailed. There was homogeneity between men and women, without statistical significance (p = 0.5378). Most of those affected were in the group of anesthetic risk II (88.1 %). In the 2 groups the degree III of shaking before therapy prevailed, just 3.5 % in group B maintained the same condition at 30 minutes. In the first 10 minutes of giving the magnesium sulfate shaking disappeared in most of the patients (74.5 %). This drug was effective in 83.8 % of those affected and in those that received ketamine it was of 42.1 %, both without side effects. Conclusions: The incidence of shaking was high. The ketamine and magnesium sulfate were effective when allowing the disappearance of shaking in a short period of time, but the second drug overcame the first one in a considerable magnitude.

Effect of competence health cultivation on the prevention and control of inadvertent perioperative hypothermia

SUMMARY OBJECTIVE To explore the feasibility of health competence cultivation on the prevention and control of Inadvertent Perioperative Hypothermia (IPH). METHODS Patients with expected spinal surgery were divided into group A and group B by the random number method. Group B followed routine IPH management, and health training measures for performance and ability were implemented in Group A. The scores of the health competence questionnaire, the temperature at different times, IPH complications, and hospitalization for the two groups were observed and compared. RESULTS The main evaluation indexes, such as the health competence questionnaire score, temperature fluctuations, and IPH complications, during the perioperative period in group A were significantly better than those in group B (p < 0.05). The indexes of anesthesia, total hospital expenses, and health service satisfaction in group A were also significantly better than those in group B, which shows the advantages of cultivating health capabilities in both doctors and patients. CONCLUSION Through health competence cultivation and feasible health management measures, the medical staff can improve the quality of IPH prevention and management.

RESUMO OBJETIVO Explorar a viabilidade do cultivo da competência em saúde na prevenção e controle da hipotermia perioperativa inadvertida (IPH). MÉTODOS Pacientes com cirurgia espinhal marcada foram divididos em dois grupos, A e B, pelo método de números aleatórios. O grupo B foi conduzido com base na gestão rotineira para prevenção de IPH; já no grupo A, foram implementadas medidas de treinamento em competência de saúde. As pontuações do questionário sobre competência em saúde, a temperatura aferida em diferentes momentos, complicações relacionadas à IPH e hospitalização dos dois grupos foram observadas e comparadas. RESULTADOS Os principais índices de avaliação, como a pontuação do questionário sobre competência em saúde, a variação de temperatura e as complicações relacionadas à IPH durante o período perioperatório foram significativamente melhores no grupo A do que no grupo B (p<0,05). Os índices de anestesia, despesas hospitalares totais e satisfação com o serviço de saúde também foram significativamente melhores no grupo A do que no B, o que demonstra as vantagens do cultivo da competência de saúde tanto em médicos como em pacientes. CONCLUSÃO Por meio do cultivo de competências de saúde e de medidas viáveis de gestão da saúde, a equipe médica pode melhorar a qualidade da prevenção e gestão da IPH.

Perfil clínico-epidemiológico de pacientes cirúrgicos com ressecamento ocular e risco de ressecamento ocular / Clinical-epidemiological profile of surgical patients with ocular dryness and risk of dry eye

Objetivo: determinar o perfil clínico-epidemiológico de pacientes cirúrgicos com ressecamento ocular e com o diagnóstico de enfermagem Risco de ressecamento ocular, no período pós-operatório. Métodos: estudo transversal, com 82 pacientes em pós-operatório. Para análise, utilizaram-se as frequências, medidas do centro de distribuição e respectivas variabilidades. Resultados: prevalência equivalente entre o ressecamento ocular e o diagnóstico de enfermagem. A média de idade foi 57,7 anos para pacientes com ressecamento ocular e 59,6 anos para aqueles com o diagnóstico de risco. Em ambos os grupos, existiu predominância do sexo feminino, cirurgias cardiovasculares e uso de anestésico geral. O tempo de procedimento cirúrgico obteve mediana de 105 minutos para pacientes com ressecamento ocular e 67,5 minutos para aqueles com o diagnóstico de risco. Conclusão: predominância de mulheres em meia idade submetidas a cirurgias eletivas de motivos cardiovasculares para ambos os grupos, entretanto, com tempo de procedimento cirúrgico distinto.(AU)

Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Adverse events in anesthesiology: analysis based on the Logbook tool used by specializing physicians in Brazil / Eventos adversos em anestesiologia: análise por meio da ferramenta Logbook usada por médicos em especialização no Brasil

Abstract Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014-2015).

Resumo O Logbook é uma ferramenta digital, lançada pela Sociedade Brasileira de Anestesiologia em 2014 e empregada desde então. Essa ferramenta permite, aos médicos em especialização em anestesiologia, o registro e o armazenamento das atividades executadas durante o período de treinamento. Isto possibilitou a análise descritiva de um extenso banco de dados dos procedimentos anestésicos, bem como das complicações ocorridas, relatadas por esses médicos. O presente estudo compreende a revisão desses dados num período de dois anos (2014-2015).

Risk factors for postoperative hypothermia in the post-anesthetic care unit: a prospective prognostic pilot study / Fatores de risco para hipotermia pós-operatória em sala de recuperação pós-anestésica: estudo piloto prospectivo de prognóstico

Abstract Background: Hypothermia occurs in up to 20% of perioperative patients. Systematic postoperative temperature monitoring is not a standard of care in Brazil and there are few publications about temperature recovery in the postoperative care unit. Design and setting: Multicenter, observational, cross-sectional study, at Hospital de Base do Distrito Federal and Hospital Materno Infantil de Brasília. Methods: At admission and discharge from postoperative care unit, patients undergoing elective or urgent surgical procedures were evaluated according to tympanic temperature, vital signs, perioperative adverse events, and length of stay in postoperative care unit and length of hospital stay. Results: 78 patients, from 18 to 85 years old, were assessed. The incidence of temperatures <36 ºC at postoperative care unit admission was 69.2%. Spinal anesthesia (p < 0.0001), cesarean section (p = 0.03), and patients who received morphine (p = 0.005) and sufentanil (p = 0.003) had significantly lower temperatures through time. During postoperative care unit stay, the elderly presented a greater tendency to hypothermia and lower recovery ability from this condition when compared to young patients (p < 0.001). Combined anesthesia was also associated to higher rates of hypothermia, followed by regional and general anesthesia alone (p < 0.001). Conclusion: In conclusion, this pilot study showed that perioperative hypothermia is still a prevalent problem in our anesthetic practice. More than half of the analyzed patients presented hypothermia through postoperative care unit admission. We have demonstrated the feasibility of a large, multicenter, cross-sectional study of postoperative hypothermia in the post-anesthetic care unit.

Resumo Justificativa: A hipotermia ocorre em até 20% dos pacientes no perioperatório. A monitoração sistemática pós-operatória da temperatura não é um padrão de atendimento no Brasil e há poucas publicações sobre recuperação da temperatura na sala de recuperação pós-anestésica. Desenho e cenário: Estudo multicêntrico, observacional, transversal, conduzido no Hospital de Base do Distrito Federal e no Hospital Materno Infantil de Brasília. Métodos: Na admissão e alta da sala de recuperação pós-anestesia, os pacientes submetidos a procedimentos cirúrgicos eletivos ou de urgência foram avaliados de acordo com a temperatura timpânica, sinais vitais, eventos adversos perioperatórios, tempo de permanência na sala de recuperação pós-anestesia e tempo de internação hospitalar. Resultados: Setenta e oito pacientes com idades entre 18 e 85 anos foram avaliados. A incidência de temperatura <36 ºC na admissão à sala de recuperação pós-anestesia foi de 69,2%. Raquianestesia (p < 0,0001), cesariana (p = 0,03) e os pacientes que receberam morfina (p = 0,005) e sufentanil (p = 0,003) apresentaram temperaturas significativamente menores ao longo do tempo. Durante a permanência na sala de recuperação pós-anestesia, os pacientes idosos apresentaram uma tendência maior a apresentarem hipotermia e menor capacidade de recuperação dessa condição, em comparação com os pacientes jovens (p < 0,001). Anestesia combinada também foi associada a taxas mais altas de hipotermia, seguida pelas anestesias regional e geral isoladas (p < 0,001). Conclusão: Em conclusão, este estudo piloto mostrou que a hipotermia perioperatória ainda é um problema prevalente em nossa prática anestésica. Mais de metade dos pacientes analisados apresentaram hipotermia durante a admissão à sala de recuperação pós-anestésica. Demonstramos a viabilidade de um grande estudo multicêntrico, transversal, de hipotermia pós-operatória em sala de recuperação pós-anestésica.

Should maternal anesthesia delay breastfeeding? A systematic review of the literature / Anestesia materna deve atrasar a amamentação? Revisão sistemática da literatura

Abstract Introduction: The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anesthesia and, due to the lack of information, many of them interrupt breastfeeding after anesthesia. There are limited data available regarding anesthetics transfer to breast milk. This review aims to develop some considerations and recommendations based on available literature. Methods: A systematic search of the literature was conducted by using the following health science databases: Embase, Lilacs, Pubmed, Scopus, and Web of Science. The latest literature search was performed on April 6th, 2018. Additional literature search was made via the World Health Organization's website. We used the following terms for the search strategy: "Anesthesia" and "Breastfeeding", and their derivatives. Results: In this research, 599 registers were found, and 549 had been excluded by different reasons. Fifty manuscripts have been included, with different designs of studies: prospective trials, retrospective observational studies, reviews, case reports, randomized clinical trials, case-control, and website access. Small concentrations of the most anesthetic agents, are transferred to the breast milk; however, their administration seem to be safe for lactating mothers when administered as a single dose during anesthesia and this should not contraindicate the breastfeeding. On the other hand, high-doses, continuous or repeated administration of drugs increase the risk of adverse effects on neonates, and should be avoided. Few drugs, such as diazepam and meperidine, produce adverse effects on breastfed babies even in single doses. Dexmedetomidine seems to be safe if breastfeeding starts 24 h after discontinuation of the drug. Conclusions: Most of the anesthetic drugs are safe for nursing mothers and offer low risk to the breastfed neonates when administered in single-dose. However, high-dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. Moreover, diazepam and meperidine should be avoided in nursing women. Finally, anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects.

Resumo Introdução: A importância e os benefícios do aleitamento materno para os bebês e para as mães estão bem estabelecidos e documentados na literatura. No entanto, é frequente que mães lactantes precisem se submeter à anestesia geral ou raquianestesia e, devido à falta de informações, muitas delas interrompem a amamentação após a anestesia. Existem poucos dados disponíveis sobre a transferência de anestésicos para o leite materno. O objetivo desta revisão foi desenvolver algumas considerações e recomendações com base na literatura disponível. Métodos: Uma busca sistemática da literatura realizada usando com os seguintes bancos de dados em ciências da saúde: Embase, Lilacs, Pubmed, Scopus e Web of Science. A pesquisa bibliográfica mais recente foi realizada em 6 de abril de 2018. Uma pesquisa bibliográfica adicional foi realizada através do site da Organização Mundial da Saúde. Usamos os seguintes termos para a estratégia de busca: "Anestesia" e "Aleitamento materno" e seus derivados. Resultados: Nesta pesquisa, 599 registros foram encontrados e 549 foram excluídos por diferentes razões. Foram incluídos 50 manuscritos, com diferentes modelos de estudo: estudos prospectivos, estudos observacionais retrospectivos, revisões, relatos de casos, ensaios clínicos randômicos, caso-controle e acesso a sites. Pequenas concentrações da maioria dos agentes anestésicos são transferidas para o leite materno; entretanto, sua administração parece ser segura para mães lactantes quando administrados em dose única durante a anestesia e isso não deve contraindicar o aleitamento materno. Por outro lado, altas doses, administração contínua ou repetida dos fármacos aumentam o risco de efeitos adversos em neonatos e devem ser evitados. Poucas drogas, como diazepam e meperidina, produzem efeitos adversos em bebês amamentados, mesmo quando administradas em doses únicas. Dexmedetomidina parece ser segura se a amamentação começar 24 horas após a interrupção do medicamento. Conclusões: A maioria dos anestésicos é segura para mães que amamentam e oferecem baixo risco para os recém-nascidos amamentados quando a administração é em dose única. No entanto, altas doses e repetidas administrações de drogas aumentam significativamente o risco de efeitos adversos em recém-nascidos. Além disso, diazepam e meperidina devem ser evitados em mulheres que amamentam. Finalmente, anestesiologistas e pediatras devem considerar o risco-benefício individual, com atenção especial para os recém-nascidos prematuros ou bebês com doenças concomitantes, pois são mais suscetíveis a efeitos adversos.

Effects of huperzine A on hippocampal inflammatory response and neurotrophic factors in aged rats after anesthesia

Abstract Purpose To investigate the effects of huperzine A (HupA) on hippocampal inflammatory response and neurotrophic factors in aged rats after anesthesia. Methods Thirty-six Sprague Dawley rats (20-22 months old) were randomly divided into control, isofluran, and isoflurane+HupA groups; 12 rats in each group. The isoflurane+HupA group was intraperitoneally injected with 0.2 mg/kg of HupA. After 30 min, isoflurane inhalation anesthesia was performed in the isoflurane and isoflurane+HupA groups. After 24 h from anesthesia, Morris water maze experiment and open-field test were performed. Hippocampal inflammatory and neurotrophic factors were determined. Results Compared with isoflurane group, in isofluran+HupA group the escape latency of rats was significantly decreased (P < 0.05), the original platform quadrant residence time and traversing times were significantly increased (P < 0.05), the central area residence time was significantly increased (P < 0.05), the hippocampal tumor necrosis factor α, interleukin 6 and interleukin 1β levels were significantly decreased (P < 0.05), and the hippocampal nerve growth factor, brain derived neurotrophic factor and neurotrophin-3 levels were significantly increased (P < 0.05). Conclusion HupA may alleviate the cognitive impairment in rats after isoflurane anesthesia by decreasing inflammatory factors and increasing hippocampal neurotrophic factors in hippocampus tissue.

Factores de riesgo asociados a complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia / Risk factors associated with anesthetic complications in chronic renal patients undergoing emergency surgery

INTRODUCTION: Chronic kidney disease is a clinical entity secondary to the common final pathway of multiple etiologies with risk factors common to other chronic diseases. OBJECTIVE: To identify the risk factors related to the appearance of anesthetic complications in chronic renal patients undergoing emergency surgery. METHOD: A prospective cohort study was performed in patients with chronic kidney disease undergoing emergency surgery. The exposed cohort consisted of 15 patients with chronic kidney disease who developed complications during the study period. RESULTS: Age over 40 years, patients with ischemic heart disease and hypertensive patients presented a higher risk of anesthetic complications. Obesity and bronchial asthma were no risk factors. It was demonstrated that when the time elapsed between hemodialysis and the operation was less than 2 hours, the risk of anesthetic complications increased, the stage of the disease and the associated drugs were not related to the appearance of complications. Patients who received general anesthesia had three times more risk of complications than those under regional anesthesia. CONCLUSIONS: Age, arterial hypertension, ischemic heart disease, heart failure and the use of general anesthesia are risk factors associated with complications.

INTRODUCCIÓN: La enfermedad renal crónica es una entidad clínica secundaria a la vía final común de múltiples etiologías con factores de riesgo comunes a otras enfermedades crónicas. OBJETIVO: Identificar los factores de riesgo relacionados con la aparición de complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia. MÉTODO: Se realizó un estudio de cohorte prospectivo en pacientes con enfermedad renal crónica intervenidos por cirugía general de urgencia. La cohorte expuesta estuvo constituida por 15 pacientes con enfermedad renal crónica que desarrollaron complicaciones en el período en estudio. RESULTADOS: La edad mayor o igual a 40 años, los pacientes con cardiopatía isquémica y los hipertensos presentaron mayor riesgo de complicaciones anestésicas, no así la obesidad al igual que el asma bronquial. Se demostró que cuando el tiempo transcurrido entre la hemodiálisis y la operación fue inferior a 2 horas se incrementó el riesgo de complicaciones anestésicas, el estadio de la enfermedad y los medicamentos asociados no estuvieron relacionados con la aparición de complicaciones. Los pacientes a los que se administró anestesia general tuvieron tres veces más riesgo de complicaciones que aquellos que fueron intervenidos con anestesia regional. CONCLUSIONES: La edad, la hipertensión arterial, la cardiopatía isquémica, la insuficiencia cardiaca y el empleo de anestesia general son factores de riesgo asociados a complicaciones, en los pacientes portadores de IRC, sometidos a cirugía de urgencia.

Riesgos anestésicos en los pacientes con apnea obstructiva del sueño / Obstructive sleep apnea anesthesic risk factors

Anesthesia and airway management in patients with obstructive sleep apnea (OSA) presents difficulties regarding the ventilation mask, intubation and ventilation after extubation. Approximately 10% to 20% of surgical patients have high probability of OSA and 81% of them have not been previously diagnosed. Early identification of these patients and the implementation of strategies to reduce perioperative respiratory depression, improves the perioperative care and reduces the risk of adverse outcomes in patients with confirmed or suspected OSA who receive sedation or anesthesia for diagnostic or therapeutic procedures under the care of an anesthesiologist. The available literature is reviewed in terms of complications and recommendations for the perioperative management of patients at risk of OSA with or without previous diagnosis.

La anestesia y manipulación de vía aérea en pacientes con síndrome de apnea obstructiva del sueño (SAHOS) presenta dificultades con respecto a la máscara de ventilación, intubación y ventilación posterior a extubación. Aproximadamente 10% a 20% de los pacientes quirúrgicos presentan alta probabilidad para SAHOS y 81% de ellos no han sido previamente diagnosticados. La identificación temprana de estos pacientes y la implementación de estrategias para disminuir la depresión respiratoria perioperatoria, mejora el cuidado perioperatorio y reduce el riesgo de complicaciones en pacientes con sospecha de SAHOS o SAHOS definido, quienes se someterán a sedación o anestesia para procedimientos diagnósticos o terapéuticos. Se revisa la literatura disponible en cuanto a complicaciones y recomendaciones para el manejo perioperatorio del paciente en riesgo de SAHOS con o sin diagnóstico previo.