Dificuldade na visibilidade e palpação da rede venosa periférica em adultos e idosos / Difficulty in visibility and palpation of the peripheral venous network in adults and elderly people / Dificultad de visibilidad y palpación de la red venosa periférica en adultos y ancianos

ResumoObjetivo: Avaliar a dificuldade na visibilidade e palpação da rede venosa periférica em adultos e idosos admitidos em uma unidade de intervenção hemodinâmica. Método:Trata-se de um estudo observacional e prospectivo com abordagem quantitativa. Realizado com 105 participantes, dentre adultos e idosos, admitidos em unidade de intervenção hemodinâmica, em um hospital geral público e de ensino. Os dados foram coletados por meio de instrumento estruturado contendo variáveis demográficas e clínicas, com observação da punção intravenosa periférica. Realizou-se a análise descritiva, calculando as proporções. Resultados: A dificuldade durante a palpação e a visualização da veia foram de 11,4% e 16,2%, respectivamente. Entre os participantes que apresentaram dificuldade para visualização da veia, 60% tiveram insucesso na primeira tentativa de punção. Conclusão: A punção periférica em veias que possuem maior dificuldade para visibilidade e palpação contribuem para o insucesso na primeira tentativa.

AbstractObjective: To evaluate the difficulty in visibility and palpation of the peripheral venous network in adults and older adults admitted to a hemodynamic intervention unit. Method: An observational prospective study was conducted with 105 adults and older adults admitted to a hemodynamic intervention unit, in a public general teaching hospital. Data were collected by means of a structured instrument consisting of demographic and clinical variables, with observation of peripheral intravenous puncture from October to December 2022. Descriptive analysis was performed, calculating proportions. Results: Results show a difficulty during palpation and visualization of the vein of 11.4% and 16.2%, respectively. Among those who had difficulty visualizing the vein, 60% were unsuccessful in the first puncture attempt. Conclusion: Peripheral puncture in veins with greater visibility and palpation difficulty contribute to failure in the first attempt

ResumenObjetivo: Evaluar la dificultad de visibilidad y de palpación de la red venosa periférica en adultos y ancianos ingresados en una unidad de intervención hemodinámica. Método: Se trata de un estudio observacional y prospectivo con enfoque cuantitativo. Participaron 105 adultos y ancianos ingresados en una unidad de intervención hemodinámica, en un hospital general público y universitario. Los datos se recolectaron mediante un instrumento estructurado, que contiene variables demográficas y clínicas, con observación de punción intravenosa periférica, durante los meses de octubre a diciembre de 2022. Se realizó un análisis descriptivo en el cual se calculó las proporciones. Resultados: La dificultad reportada durante la palpación y la visualización de la vena fue del 11,4% y el 16,2%, respectivamente. Entre los participantes que tuvieron dificultades en la visualización de la vena, el 60% falló en el primer intento de punción. Conclusión:La punción de venas periféricas que presentan mayores dificultades en la visibilidad y la palpación tiene tendencia a fallar en el primer intento

Uso de vasopresina en el postoperatorio de cirugía de Fontan: inferencias sobre morbimortalidad / Vasopressin use in postoperative Fontan surgery: implications for morbidity and mortality

Introducción: Se ha postulado que el uso de vasopresina tendría efectos beneficiosos en el postoperatorio de cirugía cardiovascular. Objetivo: Evaluar la respuesta a la vasopresina en el postoperatorio (POP) de cirugía de Fontan de nuestra población. Métodos: Estudio de casos y controles anidados en una cohorte retrospectiva. Se incluyeron pacientes con cirugía de Fontan entre 2014 y 2019. Se registraron variables demográficas, datos del cateterismo pre-Fontan, días de asistencia respiratoria mecánica (ARM), necesidad de inotrópicos, diuréticos, diálisis, dieta hipograsa, octreotide, sildenafil y nutrición parenteral total (NPT); balance de fluidos al primer y segundo día POP, necesidad de cateterismo en el POP, días de permanencia de tubo pleural, días de internación, necesidad de reinternación y mortalidad. Se compararon los grupos con y sin vasopresina utilizando la prueba de Mann- Whitney-Wilcoxon test. Se consideró significativa una p < 0.05. Resultados: Del total analizado, 35 pacientes recibieron vasopresina. En el grupo control fueron 58 pacientes con características similares de gravedad sin vasopresina. No se encontraron diferencias en la evolución postoperatoria entre ambos grupos. El grupo con vasopresina recibió en mayor proporción dieta hipograsa. Conclusiones: En nuestra serie el uso de vasopresina no marcó diferencias significativas en términos de morbimortalidad con relación al grupo control (AU)

Introduction: The use of vasopressin has been suggested to have beneficial effects in the postoperative period after cardiovascular surgery. Objective: To evaluate the response to vasopressin in the postoperative period (POP) of Fontan surgery in our population. Methods: Nested case-control study in a retrospective cohort. Patients who underwent Fontan surgery between 2014 and 2019 were included. Demographic variables, pre-Fontan catheterization data, days of mechanical ventilation (MRA), need for inotropics, diuretics, dialysis, low-fat diet, octreotide, sildenafil and total parenteral nutrition (TPN); fluid balance at first and second day POP, need for catheterization at POP, duration of chest tube drainage, days of hospitalization, need for readmission, and mortality were recorded. Groups with and without vasopressin were compared using the Mann-Whitney- Wilcoxon test. A p < 0.05 was considered significant. Results: Of all patients analyzed, 35 received vasopressin. The control group consisted of 58 patients with similar severity characteristics who did not receive vasopressin. No differences were found in the postoperative outcome between the two groups. The vasopressin group received a higher proportion of low-fat diet. Conclusions: In our series the use of vasopressin did not show significant differences in terms of morbidity and mortality compared to the control group (AU)

Greater muscle strength is associated with better hemodynamic parameters, physical, cognitive and kidney function in older nursing-home residents / Maior força muscular está associada a melhores parâmetros hemodinâmicos, função física, cognitiva e renal em idosos residentes em casas de repouso

Objective: To analyze hemodynamic parameters, kidney and cognitive function, and physical performance of institutionalized older adults with high- and low-strength. Method: Cross-sectional study. Twenty-one older adults (11 women, 10 men) participated in this study. Blood samples were collected for analysis of biochemical parameters. Cognitive function was evaluated using the mini-mental state examination (MMSE), clock drawing test (CDT), and verbal fluency test, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and, blood pressure, heart rate, and Framingham Risk Score were evaluated. Result: Based on the median value, participants were divided into low-strength (81.63 ± 3.03 years) and high-strength (82.10 ± 2.11 years). The high-strength group showed significantly lower systolic (138.8 ± 3.6 vs. 116.5 ± 3.1; p<0.05), diastolic (84.9 ± 2.14 vs. 72.9 ± 2.2; p<0.05), mean blood pressure (102.2 ± 2.4 vs. 87.4 ± 2.4; p<0.05), and cardiovascular risk (39.7 ± 4.6 vs. 26.0 ± 3.5; p<0.05) than the low-strength group. In addition, the high-strength group had better HDL-c levels (27.4 ± 1.7 vs. 35.6 ± 3.4; p<0.05), higher estimated glomerular filtration rate (51.5 ± 4.9 vs. 86.2 ± 5.5; p<0.05), and lower creatinine (0.94 ± 0.1 vs 0.57 ± 0.1; p<0.05) than the low-strength group. For cognitive data (MMSE and CDT p<0.05) and physical performance (semi-tandem, tandem and walking speed p<0.05), the high-strength group had better scores compared to the low-strength group. Conclusion: Institutionalized older adults with high-strength has better hemodynamic parameters, physical performance, kidney and cognitive function than those with low-strength levels

Objetivo: Analisar os parâmetros hemodinâmicos, a função física, cognitiva e renal de idosos institucionalizados com alta e baixa força. Método: Estudo transversal. Vinte e um idosos (11 mulheres, 10 homens) participaram do estudo. Foram coletadas amostras de sangue para análise de parâmetros bioquímicos. A função cognitiva foi avaliada por meio do miniexame do estado mental (MEEM), do teste de desenho do relógio (TDR) e do teste de fluência verbal, enquanto o desempenho físico foi avaliado por meio da Short Physical Performance Battery (SPPB) e foram aferidas a pressão arterial, a frequência cardíaca e o escore de risco de Framingham. Resultado: Com base no valor da mediana, os participantes foram divididos em baixa força (81,63 ± 3,03 anos) e alta força (82,10 ± 2,11 anos). O grupo de alta força apresentou pressão arterial sistólica (138,8 ± 3,6 vs. 116,5 ± 3,1; p<0,05), diastólica (84,9 ± 2,14 vs. 72,9 ± 2,2; p<0,05), média (102,2 ± 2,4 vs. 87,4 ± 2,4; p<0,05) e risco cardiovascular (39,7 ± 4,6 vs. 26,0 ± 3,5; p<0,05) significativamente menores do que o grupo de baixa força. Além disso, o grupo de alta força apresentou melhores níveis de HDL-c (27,4 ± 1,7 vs. 35,6 ± 3,4; p<0,05), maior taxa de filtração glomerular estimada (51,5 ± 4,9 vs. 86,2 ± 5,5; p<0,05) e menor creatinina (0,94 ± 0,1 vs. 0,57 ± 0,1; p<0,05) do que o grupo de baixa força. Em relação aos dados cognitivos (MEEM e TDR, p<0,05) e ao desempenho físico (semi-tandem, tandem e velocidade de caminhada, p<0,05), o grupo de alta força apresentou melhores escores em comparação com o grupo de baixa força. Conclusão: Os idosos institucionalizados com altos níveis de força têm melhores parâmetros hemodinâmicos, desempenho físico, função renal e cognitiva do que aqueles com baixos níveis de força.PALAVRAS-CHAVEAvaliação GeriátricaCardiovascularDesempenho CognitivoFunção RenalForça Muscular

Avaliação do perfil hemodinâmico por fluidodinâmica computacional e o risco de crescimento de aneurisma de aorta ascendente: um estudo longitudinal / Assessment of the hemodynamic profile by computational fluid dynamics and the risk of ascending aortic aneurysm growth: a longitudinal study

Fundamentos: O aneurisma de aorta ascendente é uma doença silenciosa, com alta mortalidade, cujos fatores relacionados ao seu crescimento não são totalmente conhecidos. O padrão hemodinâmico na aorta ascendente aneurismática pode estar associado a um maior risco de complicação. O objetivo deste estudo foi identificar variáveis do escoamento sanguíneo, determinadas numericamente que poderiam estar associadas ao crescimento do aneurisma de aorta ascendente. Método: Estudo observacional, longitudinal, retrospectivo e unicêntrico. Modelos anatomia-específicos foram obtidos através de imagens de duas angiotomografias de aorta realizadas com intervalo de um a três anos. A partir de estudo numérico por fluidodinâmica computacional, buscou-se padrões de escoamento presentes na primeira angiotomografia associados ao crescimento do aneurisma (definido pelo aumento do volume da aorta ascendente em 5% ou mais), através dos testes qui-quadrado e Exato de Fisher. Admitiu-se erro alfa de 5% e consideraram-se significantes valores de p ≤ 0,05. Resultados: Trinta pacientes foram incluídos no estudo, dos quais 16 (53,3%) apresentaram crescimento do aneurisma. O crescimento do aneurisma foi associado às seguintes variáveis: alta pressão relativa na parede (≥ 100 Pa); alta tensão cisalhante na parede (≥ 7 Pa) combinada com alta pressão relativa; e carga de tensão cisalhante. Conclusão: Este estudo demonstrou associação entre as variáveis de alta pressão relativa e alta tensão cisalhante, obtidas através da fluidodinâmica computacional, e o crescimento do aneurisma de aorta ascendente(AU)

Background: Ascending aortic aneurysm is a silent disease, with high mortality, whose factors related to its growth are not fully known. The hemodynamic pattern in the ascending aorta may be associated with a higher risk of complications. The aim of this study was to identify blood flow variables, numerically obtained that could be related to ascending aortic aneurysm growth. Methods: Observational, longitudinal, single-center study. Specific anatomy models were obtained through images of two angiotomographies of the aorta performed one to three years apart. Based on a numerical study by computational fluid dynamics, flow patterns present in the first angiotomography associated with aneurysm growth (defined as an increase in the volume of the ascending aorta ≥ 5%) were sought, using the chi-square test and Fisher's exact test. An alpha error of 5% was admitted and p values ≤ 0.05 were considered significant. Results: 30 patients were included in the study, of which 16 (53.3%) had aneurysm growth. Aneurysm growth was related to: high relative pressure (≥ 100 Pa); high shear stress (≥ 7 Pa) in the intersection region with the high relative pressure region; and stress load over time. Conclusion: This study demonstrated an association between the variables of high relative pressure and high shear stress, obtained through computational fluid dynamics, and ascending aortic aneurysm growth(AU)

Anticoagulación precoz con warfarina en pacientes sometidos a sustitución valvular aórtica por bioprótesis: ensayo prospectivo randomizado: análisis interino / Early anticoagulation with warfarin in patients undergoing bioprosthetic aortic valve replacement: randomized prospective trial: interim analysis / Anticoagulação precoce com varfarina em pacientes submetidos à troca valvar aórtica por bioprótese: ensaio prospectivo randomizado: análise provisória

Introducción: aunque las bioprótesis son menos trombogénicas que las válvulas mecánicas; la trombosis de estas es una entidad cada vez más reconocida como causa de disfunción protésica potencialmente reversible. No está definido el beneficio de la anticoagulación rutinaria versus antiagregación plaquetaria luego de la sustitución valvular aórtica (SVA) por bioprótesis. La anticoagulación precoz podría asociarse a menores gradientes transprotésicos con similar riesgo de complicaciones. Objetivos: el objetivo primario es determinar si existe una diferencia significativa en la variación del gradiente transprotésico medio al año de la SVA entre las dos estrategias de tratamiento antitrombótico. Los objetivos secundarios son la comparación de la variación del gradiente máximo y del área valvular aórtica, y parámetros clínicos que incluyen la Clase Funcional de la New York Heart Association, las tasas de sangrado mayor y menor y la incidencia de eventos embólicos. Este trabajo representa el análisis interino a 3 meses de un proyecto a más largo plazo, y se propone mostrar los resultados preliminares de los puntos finales previamente definidos. Métodos: se presenta el análisis interino de un ensayo randomizado multicéntrico. Todos los pacientes sometidos a SVA por bioprótesis porcinas fueron sucesivamente reclutados en dos centros de cirugía cardíaca desde el 01/01/2019 hasta el 01/09/2019. El grupo anticoagulación recibió warfarina durante los primeros 3 meses y ambos recibieron aspirina a largo plazo. Se realizaron instancias de seguimiento clínicas y ecocardiográficas antes del alta, a los 3 meses y al año. Resultados: se reclutaron 107 pacientes; 46% de ellos fueron randomizados al grupo anticoagulación y 54% al grupo control. No existieron diferencias en las características basales. Tampoco existieron diferencias significativas entre ambos grupos en la variación entre el alta y los 3 meses del área valvular protésica, coeficiente de obstrucción, gradiente máximo ni gradiente medio ni en la clase funcional. En cuanto a las complicaciones, no existieron eventos embólicos y los sangrados no difirieron significativamente entre ambos grupos. Conclusiones: la anticoagulación no modificó la variación de los gradientes transprotésicos a los 3 meses. Asimismo, no produjo mayor incidencia de efectos adversos. Todavía no está dilucidado si la anticoagulación precoz con warfarina luego de la SVA tiene impacto en los resultados a largo plazo.

Introduction: although bioprostheses are less thrombogenic than mechanical valves, bioprosthesis valve thrombosis is an increasingly recognized entity that can cause potentially reversible prosthetic valve dysfunction. There is a lack of consensus whether to use anticoagulation after aortic valve replacement (AVR) or antiplatelet therapy. Our hypothesis is that early anticoagulation is associated with lower transprosthetic gradients with similar risk of complications. Objective: primary objective is to determine if there is a significant difference in the variation of the mean transprosthetic gradient (ΔGm) one year after SVA between the two antithrombotic treatment strategies. Secondary objectives are the comparison of the variation of maximum gradient and aortic valve area, and clinical parameters including NYHA functional class, major and minor bleeding rates, and the incidence of embolic events. This work represents the 3-month interim analysis of a longer-term project, and is intended to show the preliminary results of the previously defined end points. Methods: this is an interim analysis of a multicenter randomized trial. All patients who underwent AVR by porcine bioprostheses were successively recruited in two cardiac surgery centers in Montevideo between 01/01/2019 and 01/09/2019. The anticoagulation group received warfarin for 3 months. Both groups received aspirin. Clinical and echocardiographic follow-up consultations were performed before discharge, at 3 months, and at 1 year. Results: 107 patients were recruited, 46% were randomized to the anticoagulation group and 54% to the control group. There were no differences in baseline characteristics. There were no significant differences between the two groups in the variation between discharge and 3 months of effective orifice area, doppler velocity index, peak gradient and mean gradient. There were also no differences between both groups in functional class. Regarding complications, there were no embolic events and bleeding did not differ significantly. Conclusions: in this study, anticoagulation did not modify the variation of transprosthetic gradients at 3 months. Likewise, it did not produce a higher incidence of adverse effects. It remains unclear whether early anticoagulation with warfarin after AVR has an impact on long-term outcomes.

Introdução: embora as biopróteses sejam menos trombogênicas que as mecânicas, a trombose de biopróteses é uma entidade cada vez mais reconhecida como causa de disfunção protética potencialmente reversível. A anticoagulação de rotina após a substituição da valva aórtica por bioprótese (SVA) não está definida. Nossa hipótese é que a anticoagulação precoce está associada a menores gradientes transprotéticos com risco semelhante de complicações. Objetivo: o objetivo principal é determinar se há uma diferença significativa na variação do gradiente transprotético médio (ΔGm) um ano após SVA entre as duas estratégias de tratamento antitrombótico. Os objetivos secundários são a comparação da variação do gradiente máximo e da área valvar aórtica e parâmetros clínicos, incluindo NYHA CF, taxas de sangramento maior e menor e incidência de eventos embólicos. Este trabalho representa a análise intercalar de 3 meses de um projeto de longo prazo, e pretende mostrar os resultados preliminares dos pontos finais previamente definidos. Métodos: apresenta-se a análise interina de um estudo multicêntrico randomizado. Todos os pacientes submetidos a SVA por biopróteses suínas foram sucessivamente recrutados em dois centros de cirurgia cardíaca em Montevidéu, durante um período de recrutamento de 1/1/2019 a 1/9/2019. O grupo de anticoagulação recebeu warfarina por 3 meses. Ambos os grupos receberam aspirina. Foram realizadas consultas médicas clínicas e ecocardiográficas antes da alta, aos 3 meses e ao 1 ano. Resultados: foram recrutados 107 pacientes, 46% foram randomizados para o grupo anticoagulação e 54% para o grupo controle. Não houve diferenças nas características basais. Não houve diferenças significativas entre os dois grupos da variação entre alta e 3 meses na área valvar, coeficiente de obstrução, gradiente máximo ou gradiente médio. Também não houve diferenças entre os dois grupos na classe funcional. Em relação às complicações, não houve eventos embólicos e sangramentos não diferiram significativamente. Conclusões: neste estudo, a anticoagulação não modificou a variação dos gradientes transprotéticos aos 3 meses. Da mesma forma, não produziu maior incidência de efeitos adversos. Ainda não está claro se a anticoagulação precoce com varfarina após SVA tem impacto nos resultados a longo prazo.

Application Value of Sevoflurane Combined with Brachial Plexus Block in Children with Humeral Fracture Surgery and its Effect on Hemodynamics: A Clinical and Anatomical Study

SUMMARY: To observe the effect of sevoflurane combined with brachial plexus block (BPB) in children with humeral fracture surgery and its effect on hemodynamics. 84 children who received surgical treatment of humeral fracture in our hospital from September 2019 to September 2022 were selected. According to different anesthesia methods, the children were divided into control group and study group. The control group only received laryngeal mask sevoflurane; the study group received laryngeal mask sevoflurane combined with BPB. The operation situation, hemodynamic indexes, stress level, pain and adverse reactions of children was observed. The postoperative awakening time in the study group was lower than control group, the postoperative pain onset time in the study group was higher than control group (P0.05). Postoperative 2h, the levels of serum cortisol, b-endorpin, norepinephrine and epinephrine in the study group were lower than control group (P0.05). Sevoflurane combined with BPB is helpful to shorten the postoperative awakening time of children with humeral fracture, reduce the degree of postoperative pain, improve hemodynamics, and reduce stress response, and has good safety.

El objetivo fue observar el efecto del sevoflurano combinado con bloqueo del plexo braquial (BPB) en niños con cirugía de fractura de húmero y su efecto sobre la hemodinámica. Se seleccionaron 84 niños que recibieron tratamiento quirúrgico de fractura de húmero en nuestro hospital desde septiembre de 2019 hasta septiembre de 2022. Según diferentes métodos de anestesia, los niños se dividieron en grupo control y grupo de estudio. El grupo control solo recibió sevoflurano en mascarilla laríngea; el grupo de estudio recibió sevoflurano con mascarilla laríngea combinado con BPB. Se observó la situación operatoria, índices hemodinámicos, nivel de estrés, dolor y reacciones adversas de los niños. El tiempo hasta el despertar postoperatorio en el grupo de estudio fue menor que el del grupo control, el tiempo de aparición del dolor postoperatorio en el grupo de estudio fue mayor que el del grupo control (P0,05). A las 2 horas postoperatorias, los niveles séricos de cortisol, β-endorfina, norepinefrina y epinefrina en el grupo de estudio fueron más bajos que los del grupo control (P 0,05). El sevoflurano combinado con BPB es útil para acortar el tiempo de despertar del posoperatorio de los niños con fractura de húmero, reduce el grado de dolor postoperatorio, mejora la hemodinámica y reduce la respuesta al estrés, además de tener buena seguridad.

First immediate transfusion at a prehospital environment in Latin America: A case report

According to the World Health Organization, trauma from external causes remains the major cause of death and disability among people aged from 5 to 29 years old.1 In order to reestablish hemodynamic stability and adequate hemostasis of these patients, without the dilutional effects of infusing large volumes of crystalloids, the concept of hemostatic resuscitation was developed.2 The purpose of this report is to discuss a case in which hemostatic resuscitation was performed quickly, resulting in a good macro-hemodynamic response of the patient at the first prehospital transfusion service in Latin America.

Cambios Hemodinámicos Asociados a Exodoncias de Terceros Molares Inferiores con el Uso de Articaína 4 % y/o Lidocaína 2 %: Una revisión sistemática / Hemodynamic Changes Associated with Lower Third Molar Extractions with the Use of Articaine 4 % and/or Lidocaine 2 %: A systematic Review

La exodoncia de los terceros molares inferiores es uno de los procedimientos clínicos más comunes en el cual el control del dolor mediante el bloqueo anestésico del nervio alveolar inferior, bucal y lingual resulta ser fundament al y la manera más común de hacerlo es mediante la infiltración de soluciones de anestesia local. Entre ellos la lidocaína y articaína son algunos de los más comunes y pueden estar asociado a vasoconstrictores como la epinefrina que puede provocar aumento de la presión arterial y frecuencia cardíaca razón por la cual se hace necesario la monitorización de cambios hemodinámicos durante la cirugía. Describir los cambios hemodinámicos asociados al uso de lidocaína al 2 % y/ o articaína al 4 % en la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en relación a distintos tiempos operatorios. Se realizó una revisión sistemática en las bases de datos de PubMed, SCOPUS, Web of Science y Sciencedirect. Se analizaron 7 ensayos clínicos controlados en los que utilizaron articaína al 4 % y/o lidocaína al 2 % con epinefrina al 1:100,000 y/o 1:200,000 en volúmenes de 1,8 a 5,4 mL, en los cuales evaluaron la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en distintos tiempos de la cirugía. Si bien hubo cambios en PAS, PAD, FC y SPO2, todas se mantuvieron dentro de rangos normales bajo el uso de articaína al 4 % y lidocaína al 2 % con epinefrina 1:100,000 y/o 1:200,000 a volúmenes de 1,8 a 5,4mL medidas a distintos tiempos operatorios.

The extraction of lower third molars is one of the most common clinical procedures in which pain control through anesthetic blockade of the lower alveolar, buccal and lingual nerves turns out to be essential and the most common way to do it is through the infiltration of solutions of local anesthesia. Among them, lidocaine and articaine are some of the most common and may be associated with vasoconstrictors such as epinephrine, which can cause an increase in blood pressure and heart rate, which is why it is necessary to monitor hemodynamic changes during surgery. To describe the hemodynamic changes associated with the use of 2 % lidocaine and/or 4 % articaine in systolic and diastolic pressure, heart rate and partial oxygen saturation in relation to different operative times. A systematic review was carried out in the PubMed, SCOPUS, Web of Science and Sciencedirect databases. Seven controlled clinical trials were analyzed in which 4 % articaine and/or 2 % lidocaine were used with epinephrine at 1:100,000 and/or 1:200,000 in volumes of 1,8 to 5,4 mL, in which systolic pressure was evaluated. and diastolic, heart rate and partial oxygen saturation at different times of surgery. Although there were changes in SBP, DBP, HR and SPO2, all remained within normal ranges under the use of 4 % articaine and 2 % lidocaine with epinephrine 1:100,000 and/or 1:200,000 at volumes of 1,8 to 5 .4mL measured at different operative times.

Local Anaesthetics Combined with Vasoconstrictors in Controlled Hypertensive Patients Undergoing Dental Procedures: Systematic Review and Meta-Analysis / Uso de Anestésicos Locales con Vasoconstrictor en Pacientes con Hipertensión Controlada Durante la Atención Odontológica: Una Revisión Sistemática y Metaanálisis

The aim of this systematic review is to assess the safety of local anaesthetics (LA) combined with vasoconstrictors (VC) for patients with controlled hypertension undergoing dental procedures. A comprehensive search strategy were used to identify all relevant randomized controlled trials (RCTs) that evaluated the effect of LA combined with VC. All searches covered the period from 1990 to February 2021. We performed a meta-analysis using random-effect models and assessed overall certainty in evidence using GRADE approach. Our search strategy yielded 1262 references. Finally, seven randomised trials were included, but only three were included in the meta-analysis. The use of LA with VC may result in little to no difference in the heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), but the certainty of the evidence was assessed as low. Death, stroke, acute myocardial infarction, need for hospitalization, pain and bleeding were not reported by the included studies. The hemodynamic changes using VC do not imply an increased risk of occurrence of adverse cardiovascular events. The use of VC could even be recommendable considering their multiple advantages.

El objetivo de esta revisión sistemática es evaluar la seguridad del uso de anestésicos locales (AL) combinados con vasoconstrictor (VC) en pacientes con hipertensión controlada durante procedimientos dentales. Se realizó una estrategia de búsqueda para identificar todos los estudios clínicos aleatorizados (ECA) relevantes que evaluaban el efecto del AL combinado con VC. Todos los estudios fueron del periodo entre 1990 a febrero del 2021. Se realizó un meta-análisis usando modelos de efecto aleatorizado y una revisión de la certeza de la evidencia usando el método GRADE. Nuestra estrategia de búsqueda arrojó 1262 referencias. Finalmente, siete estudios clínicos aleatorizados fueron incluidos, de los cuales tres fueron incluidos en el meta-análisis. El uso de AL con VC produce una pequeña a ninguna diferencia en el pulso cardiaco, presión sistólica y diastólica, pero la certeza de la evidencia fue baja. Muerte, infarto agudo al miocardio, accidente cerebrovascular, necesidad de hospitalización, dolor y hemorragia no fueron reportados en los estudios incluidos. Los cambios hemodinámicos en el uso de VC no implican un aumento de riesgo de ocurrencia de efectos adversos cardiovasculares. El uso de VC puede ser recomendable considerando sus múltiples ventajas.

Marcadores inflamatorios y de disfunción endotelial en pacientes hipertensos y con diabetes Mellitus tipo 2 / Inflammatory and endothelial dysfunction markers in hypertensive patients with type 2 diabetes mellitus

La hipertensión y la diabetes son dos de los principales factores de riesgo para el desarrollo de enfermedades cardiovasculares, y ambas patologías se superponen de manera significativa en sus mecanismos fisiopatológicos. El objetivo de este estudio fue determinar la concentración de marcadores inflamatorios y de disfunción endotelial en pacientes con hipertensión y diabetes mellitus tipo 2, comparar con individuos sanos y determinar si la coexistencia de ambas patologías tiene un efecto diferente en el comportamiento de estos marcadores. Se realizó una investigación de tipo descriptiva, correlacional, de corte transversal, en el periodo comprendido desde el mes de julio del año 2022 a febrero del año 2023. Se seleccionaron 120 individuos para este estudio: (30 sujetos controles, 30 con diabetes mellitus tipo 2, 30 hipertensos y 30 con diabetes más hipertensión). A cada sujeto se le extrajo una muestra de sangre en ayunas para la determinación de colesterol total, triglicéridos, HDL colesterol, LDL colesterol, proteína C reactiva ultrasensible (PCR-us), hemoglobina glicosilada, sICAM-1, sE-selectina, IL-6 y TNF-α. Se encontró un incremento significativo en la concentración de sICAM-1, sE-selectina, IL-6 y TNF-α en los pacientes diabéticos, hipertensos y en los diabéticos con hipertensión al compararlos con los controles (p<0.0001). La coexistencia de diabetes e hipertensión no representó una elevación significativa en la concentración de los marcadores de disfunción endotelial e inflamación. En conclusión, nuestros resultados sugieren la activación endotelial, así como un estado inflamatorio en pacientes con diabetes e hipertensión, indicada por niveles elevados de moléculas de adhesión circulantes y citocinas proinflamatorias. La presencia simultánea de diabetes e hipertensión no tuvo un efecto aditivo en los niveles de éstas moléculas.

Hypertension and diabetes are two of the main risk factors for the development of cardiovascular disease, and both pathologies overlap significantly in their pathophysiological mechanisms. The aim of this study was to determine the concentration of inflammatory markers and endothelial dysfunction in patients with hypertension and type 2 diabetes mellitus, to compare with healthy individuals, and to determine whether the coexistence of both pathologies has a different effect on the behavior of these markers. A descriptive, correlational, cross-sectional research was carried out from July 2022 to February 2023. A total of 120 individuals were selected for this study (30 controls, 30 with type 2 diabetes mellitus, 30 with hypertension and 30 with diabetes plus hypertension). Each subject had a fasting blood sample drawn for determination of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, ultrasensitive C-reactive protein (hs-CRP), glycosylated hemoglobin, sICAM-1, sE-selectin, IL-6 and TNF-α. A significant increase in the concentration of sICAM-1, sE-selectin, IL-6 and TNF-α was found in diabetic, hypertensive and diabetic patients with hypertension when compared to controls (p<0.0001). The coexistence of diabetes and hypertension did not represent a significant elevation in the concentration of markers of endothelial dysfunction and inflammation. In conclusion, our results suggest endothelial activation as well as an inflammatory state in patients with diabetes and hypertension, indicated by elevated levels of circulating adhesion molecules and proinflammatory cytokines. The simultaneous presence of diabetes and hypertension did not have an additive effect on the levels of these molecules.

Ensayo clínico aleatorizado. Efecto de dos tipos de ayuno en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local en un servicio de hemodinámica en Medellín, 2019 / Randomized clinical trial. Effect of two types of fasting in patients undergoing percutaneous intervention procedures under local anesthesia in a hemodynamic service in Medellín, 2019 / Ensaio clínico randomizado. Efeito de dois tipos de jejum em pacientes submetidos a procedimentos de intervenção percutânea sob anestesia local em um serviço de hemodinâmica em Medellín, 2019

Objetivo: determinar el efecto de dos tipos de ayuno sobre parámetros de satisfacción, náuseas, vómito, presión arterial y glucometría en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local en un servicio de hemodinámica en Medellín, 2019. Metodología: ensayo clínico aleatorizado abierto de dos brazos en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local durante tres meses. Cada brazo con 153 participantes; se asignó un ayuno de seis horas y al grupo de exposición un ayuno de dos horas para alimentos de fácil digestión; no hubo cega­miento, se realizó cálculo de muestra, y se hizo análisis univariado, bivariado y modelo de regresión logística con la variable satisfacción. Resultados: en el grupo de ayuno de seis horas el 2.6% presentó náuseas y en el grupo de exposición el 1.3%; se observó un caso de vómito. La presión arterial y glucometría mostraron diferencias estadísticas sin relevancia clínica. Se encontró significancia esta­dística para mareo, cefalea, hambre, sed y tipo de ayuno respecto con la satisfacción del paciente. Los pacientes con ayuno tuvieron un puntaje de satisfacción entre 60 y 100 y los de dieta ligera entre 82.5 y 100 puntos. Conclusiones: El ayuno de dos horas en dieta ligera mejora la satisfacción de los pa­cientes, disminuye la sensación de hambre, sed, presencia de cefalea y mareo, compa­rado con un ayuno de seis horas. Este estudio no encontró diferencias en las variables hemodinámicas ni en la frecuencia de náuseas y vómito.

Objective: to determine the effect of two types of fasting on parameters of satisfaction, nausea, vomiting, blood pressure and glucose measurement in patients undergoing percutaneous intervention procedures under local anesthesia in a hemodynamic service in Medellín, 2019. Methodology: Two-arm open-label randomized clinical trial in patients undergoing percutaneous interventional procedures under local anesthesia for three months, each arm with 153 participants, who were assigned a six-hour fast and the exposure group a two-hour fast for easily digestible foods. There was no blinding, sample calculation was performed, and univariate and bivariate analysis and logistic regression model were performed with the satisfaction variable. Results: in the six-hour fasting group, 2.6% presented nausea and in the exposure group, 1.3%; one case of vomiting was observed. Blood pressure and blood glucose showed statistical differences without clinical relevance. Statistical significance was found for dizziness, headache, hunger, thirst, and type of fasting with respect to patient satisfaction. Fasting patients had a satisfaction score between 60 and 100 and those on a light diet between 82.5 and 100 points. Conclusions: Fasting for two hours on a light diet improves patient satisfaction, decreases the sensation of hunger, thirst, headache and dizziness, compared to a six-hour fast. This study found no differences in the hemodynamic variables, nor in the frequency of nausea and vomiting.

Objetivo: determinaro efeito de dois tipos de jejum nos parâmetros de satisfação, náuseas, vômitos, pressão arterial e glicemia em pacientes submetidos a procedimentos de intervenção percutânea sob anestesia local em um serviço de hemodinâmica em Medellín, 2019. Metodologia: Ensaio clínico randomizado aberto de dois braços em pacientes submetidos a procedimentos intervencionistas percutâneos sob anestesia local por três meses. Cada braço com 153 participantes; um jejum de seis horas foi designado e o grupo de desafio um jejum de duas horas para alimentos facilmente digeríveis; não houve cegamento, foi realizado cálculo amostral, análise univariada, bivariada e modelo de regressão logística com a variável satisfação. Resultados: no grupo de jejum de seis horas, 2,6% apresentaram náuseas e no grupo de exposição, 1,3%; foi observado um caso de vômito. A pressão arterial e a glicemia apresentaram diferenças estatísticas sem relevância clínica. Foi encontrada significância estatística para tontura, dor de cabeça, fome, sede e tipo de jejum em relação à satisfação do paciente. Os pacientes em jejum tiveram um escore de satisfação entre 60 e 100 e os em dieta light entre 82,5 e 100 pontos. Conclusões: O jejum de duas horas com dieta leve melhora a satisfação do paciente, diminui a sensação de fome, sede, dor de cabeça e tontura, em comparação com o jejum de seis horas. Este estudo não encontrou diferenças nas variáveis hemodinâmicas ou na frequência de náuseas e vômitos.

Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery / 中国医学科学杂志(英文版)

Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.

In Vitro Experimental Study on Hemodynamics of Transcatheter Aortic Valve Replacement / 中国医疗器械杂志

The patient-specific aortic silicone model was established based on CTA data. The digital particle image velocimetry (DPIV) test method in the modified ViVitro pulsatile flow system was used to investigate the aortic hemodynamic performance and flow field characteristics before and after transcatheter aortic valve replacement (TAVR). The results showed that the hemodynamic parameters were consistent with the clinical data, which verified the accuracy of the model. From the comparative study of preoperative and postoperative effective orifice area (0.33 cm2 and 1.78 cm2), mean pressure difference (58 mmHg and 9 mmHg), percentage of regurgitation (52% and 8%), peak flow velocity (4.60 m/s and 1.81 m/s) and flow field distribution (eccentric jet and uniform jet), the immediate efficacy after TAVR is good. From the perspective of viscous shear stress and Reynolds shear stress, the risk of hemolysis and thrombotic problems was low in preoperative and postoperative patient-specific models. This study provides a set of reliable DPIV testing methods for aortic flow field, and provides biomechanical basis for the immediate and long-term effectiveness of TAVR from the perspective of hemodynamics and flow field characteristics. It has important application value in clinical diagnosis, surgical treatment and long-term evaluation.

Effectiveness of lung recruitment maneuver in the oxygenation, hemodynamics and post-operative pain of patients undergoing laparoscopic cholecystectomy

Introduction@#Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures.@*Methods@#Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively.@*Results@#The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01].@*Conclusion@#Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.

Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis / 中国医学科学杂志(英文版)

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

The relationship between the characteristics of tears and the progression of Stanford type B aortic dissection after endovascular treatment / 中华外科杂志

Endovascular treatment of Stanford type B aortic dissection (type B dissection) has been widely used. There will be complications such as aortic dilatation, which will lead to poor prognosis of some patients. With more in-depth researches, it was found that there was a possible correlation between the prognosis of type B dissection and tears, such as the increasing of aortic diameter would be faster with longer tears, and the location of the tear will affect the thrombosis of the false lumen. Studies on hemodynamics have also found that different characteristics of tears of aortic dissection can cause changes in the pressure, blood flow rate and blood capacity in the true and false lumens recently. The hemodynamic changes can be used to predict the prognosis of type B dissection. The main characteristics of tears included the size, position, number of tears, residual tears and stent graft induced new entry. Describing the effect of tear characteristics on the development of type B dissection, can provide the basis for the clinical treatment and further research of type B dissection.

Building of a Clinical Prediction Model for Hemodynamic Depression after Carotid Artery Stenting / 中国医学科学院学报

Objective To analyze the risk factors and build a clinical prediction model for hemodynamic depression (HD) after carotid artery stenting (CAS). Methods A total of 116 patients who received CAS in the Department of Vascular Surgery,Drum Tower Clinical College of Nanjing Medical University and the Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University from January 1,2016 to January 1,2022 were included in this study.The patients were assigned into a HD group and a non-HD group.The clinical baseline data and vascular disease characteristics of each group were collected,and multivariate Logistic regression was employed to identify the independent predictors of HD after CAS and build a clinical prediction model.The receiver operating characteristic (ROC) curve was drawn,and the area under the ROC curve (AUC) was calculated to evaluate the predictive performance of the model. Results The HD group had lower proportions of diabetes (P=0.014) and smoking (P=0.037) and higher proportions of hypertension (P=0.031),bilateral CAS (P=0.018),calcified plaque (P=0.001),eccentric plaque (P=0.003),and the distance<1 cm from the minimum lumen level to the carotid bifurcation (P=0.009) than the non-HD group.The age,sex,coronary heart disease,symptomatic carotid artery stenosis,degree of stenosis,and length of lesions had no statistically significant differences between the HD group and the non-HD group (all P>0.05).Based on the above predictive factors,a clinical prediction model was established,which showed the AUC of 0.807 and the 95% CI of 0.730-0.885 (P<0.001).The model demonstrated the sensitivity of 62.7% and the specificity of 87.7% when the best cut-off value of the model score reached 12.5 points. Conclusions Diabetes,smoking,calcified plaque,eccentric plaque,and the distance<1 cm from the minimum lumen level to the carotid bifurcation are independent predictors of HD after CAS.The clinical prediction model built based on the above factors has good performance in predicting the occurrence of HD after CAS.

The haemodynamic effects of umbilical cord milking in term infants: a randomised controlled trial

INTRODUCTION@#Umbilical cord milking (UCM) is a method that allows for postnatal placental transfusion. The benefits of UCM have been demonstrated in some studies, but knowledge about its haemodynamic effects in term infants is limited. The aim of this study was to evaluate the haemodynamic effects of UCM in term infants.@*METHODS@#In this prospective, randomised controlled study, 149 healthy term infants with a birth week of ≥37 weeks were randomly assigned to either the UCM or immediate cord clamping (ICC) group. Blinded echocardiographic evaluations were performed in all the neonates in the first 2-6 h.@*RESULTS@#Superior vena cava (SVC) flow measurements were higher in the UCM group compared to the ICC group (132.47 ± 37.0 vs. 126.62 ± 34.3 mL/kg/min), but this difference was not statistically significant. Left atrial diameter (12.23 ± 1.99 vs. 11.43 ± 1.78 mm) and left atrium-to-aorta diastolic diameter ratio (1.62 ± 0.24 vs. 1.51 ± 0.22) were significantly higher in the UCM group. There were no significant differences in other echocardiographic parameters between the two groups.@*CONCLUSION@#We found no significant difference in the SVC flow measurements in term infants who underwent UCM versus those who underwent ICC. This lack of significant difference in SVC flow may be explained by the mature cerebral autoregulation mechanism in term neonates.

Efeitos do tratamento manipulativo osteopático na hemodinâmica e na qualidade de vida de gestantes no terceiro trimestre: coorte prospectiva / Effects of osteopathic manipulative treatment on the hemodynamics and quality of life of pregnant women in the third trimester: prospective cohort

Na gestação várias mudanças pelas quais as mulheres passam são capazes de intervir no seu estado de saúde. Estudos relatam que a incapacidade do corpo de algumas gestantes de acomodarem o crescimento uterino estaria na raiz de problemas na hemodinâmica materno-fetal. A busca por terapêuticas não medicamentosas vem crescendo dentro da área da saúde nos últimos anos. O tratamento manipulativo osteopático é uma terapêutica integrativa complementar de saúde reconhecida pela organização mundial de saúde e aceita pelo sistema único de saúde brasileiro. Método: Trata-se de uma coorte prospectiva realizada com 80 pacientes do ambulatório de pré-natal e da enfermaria de gestantes do Instituto Fernandes Figueira/Fiocruz entre julho de 2021 e setembro de 2022. Foram realizados dois estudos, um estudo transversal com 51 grávidas para avaliar os efeitos hemodinâmicos materno-fetais após o tratamento manipulativo osteopático através da dopplervelocimetria nas gestantes e um estudo prospectivo com 64 gestantes para avaliar a influência do tratamento manipulativo osteopático sobre a intensidade das dores lombar e pélvica, assim como mudanças na sua qualidade de vida. População: foram investigadas gestantes no terceiro trimestre de gestação, acima de 18 anos, e excluídas as gestantes com ruptura prematura de membrana, com malformações fetais, com fetos múltiplos e trabalho de parto ativo. Resultados: Os resultados do estudo transversal após o tratamento manipulativo não foram significantes estatisticamente. No estudo prospectivo, as gestantes foram divididas em dois grupos ≤ 3 e ≥ 4. Observou-se uma melhora significante estatisticamente na intensidade das dores lombar e pélvica em ambos os grupos. Houve melhora nos dois grupos nos índices de qualidade de vida, sendo que no grupo≥ 4 atendimentos todos os resultados foram estatisticamente significativos. Conclusão: a análise dos dados do estudo considerou que o tratamento manipulativo osteopático é seguro para o feto e para gestantes portadoras de comorbidades, não afetando os sinais vitais maternos e nem a circulação uteroplacentária e feto-placentária. Os dados também apontaram que o tratamento osteopático foi eficaz na redução da intensidade da dor lombar e pélvica e efetivo na melhora da qualidade de vida das gestantes.

During pregnancy, several changes women undergo can affect their health status. Studies related to the inability of the body of some pregnant women to accommodate uterine growth would be at the root of problems in maternal-fetal hemodynamics. The search for non-drug treatments has grown in the health area recently. Manipulative osteopathic treatment is a complementary, integrative health therapy recognized by the world health organization and accepted by the Brazilian single health system. Method: This prospective cohort study was carried out with 80 patients from the prenatal clinic and the pregnant women's ward of Instituto Fernandes Figueira/Fiocruz between July 2021 and September 2022. Two studies were carried out, a cross-sectional study with 51 pregnant women to evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment through Doppler velocimetry in pregnant women and a prospective study with 64 pregnant women to evaluate the influence of osteopathic manipulative treatment on the intensity of lumbar and pelvic pain, as well as changes in their quality of life. Population: pregnant women in the third trimester of pregnancy, over 18 years old, were investigated, and pregnant women with premature membrane rupture, fetal malformations, multiple fetuses, and active labor were excluded. Results: The results of the cross-sectional study after manipulative treatment were not statistically significant. Pregnant women were divided into two groups ≤ 3 and ≥ 4 in the prospective study. There was a statistically significant improvement in lumbar and pelvic pain intensity in both groups. There was an improvement in both groups in the quality-of-life indices, and in the group≥ four consultations, all results were statistically achieved. Conclusion: an analysis of the study data found that osteopathic manipulative treatment is safe for the fetus and pregnant women with comorbidities, not affecting maternal signs or uteroplacental and fetal-placental circulation. The data also showed that osteopathic treatment effectively reduced the intensity of lumbar and pelvic pain and improved the quality of life of pregnant women.

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Abstract Background Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Methods Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. Results Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p< 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p< 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. Conclusion Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.