Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.

Post-vaccination incidence and side effects of COVID-19 in a cohort of Brazilian healthcare professionals: an internet-based survey

Abstract Objective So far, at least 18 different severe acute respiratory syndrome coronavirus-2 vaccines have been approved. Until October 2022, 12.8 billion doses had been administered all over the world. Vaccination of high-risk groups and healthcare professionals was initially prioritized. This cross-sectional survey aimed to investigate the occurrence of vaccine side effects, as well as the incidence of COVID-19 among vaccinated healthcare professionals. Methods A survey was structured and shared with healthcare professionals using a digital platform to collect data between May and June 2021. Results This study included 6,115 participants. The most prevalent age group was 30-39 years (31.3%), 67.3% were female and 73.2% accounted for physicians, and nearly half worked in frontline care for COVID-19. Approximately, two-thirds of them were vaccinated with CoronaVac, and about 60% reported at least one side effect following the vaccination. Nevertheless, minor reactions were more frequent, such as pain at site of injection, fatigue, and headache. Our data could be used to inform people on the likelihood of side effects of COVID-19 vaccines, particularly CoronaVac, since this is the largest study about vaccine reactions using this vaccine, to our best knowledge. Conclusion The incidence of side effects in Brazilian healthcare professionals was 60%, and the most common side effects included local swelling/pain, fatigue/tiredness, fever, headache, and limb pain.

Simpatectomia torácica por videotoracoscopia para tratamento da hiperidrose primária: estudo retrospectivo de 521 casos comparando diferentes níveis de ablação / Video-assisted thoracic sympathectomy in the treatment of primary hyperhidrosis: a retrospective study of 521 cases comparing different levels of ablation

OBJETIVO: Comparar grau de satisfação dos pacientes simpatectomizados e presença de sudorese reflexa, de acordo com diferentes níveis de ablação. MÉTODOS: Estudo retrospectivo de 521 pacientes com hiperidrose primária, submetidos à simpatectomia torácica no Hospital Monte Sinai e Hospital Universitário da Universidade Federal de Juiz de Fora - UFJF, de janeiro de 2001 a dezembro de 2005. Grupo I (n = 162): termoablação do tronco simpático, tendo T2 como nível mais cranial da ressecção, independentemente de outros níveis seccionados caudalmente. Grupo II (n = 65): termoablação do tronco simpático, tendo T3 como nível mais alto. Grupo III (n = 294): termoablação do tronco simpático, tendo T4 como nível mais alto. RESULTADOS: Pós-operatório ótimo no controle da hiperidrose palmar/axilar em, respectivamente, 94/82 por cento dos pacientes do grupo I, 89/89 por cento do grupo II e 80/80 por cento do grupo III. Sudorese reflexa em 67 por cento dos pacientes dos grupos I e II, caindo para 61,29 por cento no grupo III devido à maior termoablação a partir de T4. Ocorreu sudorese reflexa severa em 32 por cento dos pacientes do grupo I, 9 por cento do grupo II e 4 por cento do grupo III. CONCLUSÃO: A simpatectomia propiciou excelente grau de satisfação e baixo índice de complicações. Não houve diferença na incidência de sudorese reflexa com diferentes níveis seccionados; porém, a intensidade desta complicação se mostrou menor quando optamos por níveis de bloqueio mais baixos, principalmente T4.

OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82 percent of the patients of group I, 89/89 percent of those in group II and 80/80 percent of those in group III. Postoperative reflex sweating was observed in 67 percent of the patients in groups I and II, compared with 61.29 percent of those in group III. Severe reflex sweating occurred in 32 percent of the group I patients, 9 percent of the group II patients and 4 percent of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Investigação de efeitos lesivos de doses antiinflamatórias e imunossupressoras de dexametasona sobre a mucosa gástrica em camundongos / Investigation of damage effects by antiinflammatory and immunosuppressive doses of dexamethasone on mice´s gastric mucosal

A dexametasona, potente glicocorticóide, pode causar inúmeras complicações, porém com incerto papel ulcerogênico no trato gastrintestinal. O objetivo do presente estudo foi investigar o papel da dexametasona nas doses antiinflamatórias e imunossupressoras na geração de lesão gástrica em camundongos Swiss Webster. Quarenta camundongos fêmeas foram divididos em três grupos. No Grupo I (n=16), os animais receberam 5 mg/kg/dia via intraperitoneal (IP) de dexametasona (dose imunossupressora); no Grupo II (n=16), 1,25 mg/kg/dia IP (dose antiinflamatória); e no Grupo III (n=8), solução fisiológica estéril IP (grupo controle). Os animais foram sacrificados em câmara de CO2 a cada três dias a partir do 3° ao 12° dia. Foram realizadas gastrectomia total, adrenectomia bilateral e esternectomia. A leucometria global e específica foi feita em cinco animais de cada grupo a cada três dias. Não foram encontradas alterações macroscópicas e histológicas no trato gastrintestinal nos diferentes grupos. Em dois camundongos do grupo I e em dois do grupo II, observamos degeneração balonizante das células da supra-renal. Esteatose hepática foi observada apenas em um animal do grupo I. Os animais imunossuprimidos apresentaram leucopenia com linfopenia, neutrofilia e monocitopenia e naqueles submetidos a doses antiinflamatórias notaram-se apenas leucopenia com linfopenia. O grupo controle manteve a contagem dentro da normalidade. Não foi observado dano à mucosa gástrica com o uso de doses antiinflamatórias e imunossupressoras, utilizando-se a via intraperitoneal. Estudos complementares comparando diferentes vias de administração, doses, animais de experimentação e preparações de glicocorticóides deverão ser conduzidos antes de afastar um papel ulcerogênico deste grupo de medicamentos.

Dexamethasone is a powerful glucocorticoid and it may result in some adverse effects, but it is uncertain whether it is ulcerogenic to the gastrointestinal tract. The aim of the present study was to investigate the antiinflammatory and immunosuppressive dose's effect of dexamethasone on the production of gastric mucosal damage in Swiss Webster mice. Forty female mice were separated in 3 groups. In Group I (n=16), the animals received 5 mg/kg/day (intraperitoneal route (IP) of dexamethasone (immunosuppressive dose); Group II (n=16): 1.25 mg/kg/day IP (antiinflammatory dose); and in Group III (n=8), saline solution IP (control group). The animals were sacrificed and necropsied at 3, 6, 9 and 12 days postinnoculation. Stomach, adrenal and sternal samples were collected and processed for microscopy studies. Global and specific counts of white blood cell were made in five animals in each group, each three days. Macroscopic and histological alterations on the gastrointestinal tract were not found in the different groups. In two mice of group I and in two of group II, balloon degeneration in adrenal cells was observed. In one animal of group I hepatic steatosis was found. The immunosuppressed animals presented leukopenia with lymphopenia, neutrofilia and monocytopenia and in those submitted to antiinflammatory doses it was noticed only leukopenia with lymphopenia. The control group kept the count within normality. Gastric mucosal damage with the use of antiinflammatory and immunosuppressive doses was not observed by using the intraperitoneal route. Complementary studies comparing different administration routes, doses, experimental animals and preparations of glucocorticoid must be undertaken before discarding a ulcerogenic role of this medicine group.