Avaliação da indução, recuperação, agitação ao despertar e consumo com uso de duas marcas de sevoflurano para anestesia ambulatorial / Assessment of induction, recovery, agitation upon awakening, and consumption with the use of two brands of sevoflurane for ambulatory anesthesia / Evaluación de la inducción, recuperación, agitación al despertar y consumo con el uso de dos marcas de sevoflurano para la anestesia ambulatorial

JUSTIFICATIVA E OBJETIVOS: O sevoflurano por suas características farmacológicas é o anestésico ideal para procedimentos de curta duração. Existem duas marcas de sevoflurano no mercado brasileiro, o Sevocris® e Sevorane®, com diferentes formulações e envasamento. O objetivo deste estudo foi analisar se existem diferenças entre os dois anestésicos na indução, manutenção, recuperação e consumo. MÉTODO: Foram incluídas 130 crianças dividas em dois grupos segundo a marca do agente utilizado: Grupo 1 sevoflurano da Cristália® e Grupo 2 da Abbott®. Foram analisados os seguintes parâmetros: frequência cardíaca, pressão arterial sistólica e diastólica, fração inspirada e expirada de sevoflurano, valores de BIS, temperatura timpânica, tempos de indução e recuperação, agitação ao despertar pela escala PAED e consumo do anestésico por pesagem dos vaporizadores. A indução foi realizada com 1 CAM e incrementadas a cada três movimentos respiratórios em 0,5 CAM, até no máximo 3 CAM. RESULTADO: Não houve diferença entre os grupos quanto ao tempo de procedimento e de anestesia e nos parâmetros avaliados na indução. No Grupo 1, o número de crianças que necessitaram bolus adicionais de sevoflurano na manutenção da anestesia foi maior que no 2 (p < 0,05). A fração inspirada e expirada de sevoflurano no final do procedimento foi menor no Grupo 1 (p < 0,001). No momento do despertar o valor do BIS foi menor no Grupo 1 (p = 0,045). Outros parâmetros avaliados na recuperação não mostraram diferença entre os grupos. O consumo de anestésico foi semelhante entre os grupos.

BACKGROUND AND OBJECTIVES: Due to its pharmacological characteristics, sevoflurane is the ideal anesthetic for short-duration procedures. There are two brands of sevoflurane in the Brazilian market, Sevocris® and Sevorane®, with different formulations and packaging. The objective of this study was to assess whether there are differences between the two anesthetics regarding induction, maintenance, recovery, and consumption. METHODS: One hundred and thirty children were included, divided into two groups according to the brand used: Group 1 was assigned to sevoflurane Cristália® and Group 2 to sevoflurane Abbott®. The following parameters were assessed: heart rate, systolic and diastolic blood pressure, fraction of inspired and expired sevoflurane, BIS values, tympanic temperature, induction and recovery time, agitation upon awakening measured by the PAED scale, and anesthetic consumption by weighing the vaporizers. Anesthesia was induced with 1 MAC and increased every three breaths at 0.5 MAC, up to 3 MAC. RESULTS: There was no difference between groups regarding the duration of the procedure, the anesthesia, and the parameters evaluated at induction. In Group 1, the number of children who required additional bolus of sevoflurane for anesthesia maintenance was higher than in Group 2 (p < 0.05). The fraction of inspired and expired sevoflurane at the end of the procedure was lower in Group 1 (p < 0.001). Upon awakening, BIS value was lower in Group 1 (p = 0.045). Other parameters evaluated in recovery showed no difference between groups. The use of anesthesia was similar between groups.

JUSTIFICATIVA Y OBJETIVOS: El sevoflurano, por sus características farmacológicas, es el anestésico ideal para procedimientos de corta duración. Existen dos marcas de sevoflurano en el mercado brasileño, el Sevocris® y el Sevorane®, con diferentes formulaciones y envases. El objetivo de este estudio, fue analizar si existen diferencias entre los dos anestésicos en la inducción, mantenimiento, recuperación y consumo. MÉTODO: Se incluyeron 130 niños divididos en dos grupos según la marca del agente utilizado: Grupo 1 sevoflurano de Cristália® y Grupo 2 de Abbott®. Se analizaron los siguientes parámetros: frecuencia cardíaca, presión arterial sistólica y diastólica, fracción inspirada y espirada de sevoflurano, valores de BIS, temperatura timpánica, tiempos de inducción y recuperación, agitación al despertar por la escala PAED, y consumo del anestésico por pesaje de los vaporizadores. La inducción fue realizada con 1 CAM e incrementada a cada tres movimientos respiratorios en 0,5 CAM, hasta el máximo de 3 CAM. RESULTADO: No hubo diferencia entre los grupos en cuanto al tiempo de procedimiento y de anestesia y en los parámetros evaluados en la inducción. En el Grupo 1, el número de niños que necesitaron bolos adicionales de sevoflurano en el mantenimiento de la anestesia, fue mayor que en el 2 (p < 0,05). La fracción inspirada y espirada de sevoflurano al final del procedimiento fue menor en el Grupo 1 (p < 0,001). Al momento del despertar, el valor del BIS fue menor en el Grupo 1 (p = 0,045). Otros parámetros evaluados en la recuperación no arrojaron diferencia entre los grupos. El consumo de anestésico fue similar entre los grupos.

[ survey on frequency of drug-induced akathisia in psychiatric wards using two methods: clinical diagnosis and Barnes rating scale]

Akathisia syndrome is one of the medication induced movement disorders that is found is patients who take neuroleptic drug. In this disorder the patients has an inner sense of restlessness and there are some restless movement in patients' limbs. Akathisia can cause drug noncompliance. To make a proper decision for treating the patients and using the best kinds of drugs, a proper rating scale for diagnosing akathisia should be determined. This cross sectional study was performed in descriptive - analytic style. Samples were 156 hospitalized patients who were on psychiatric drugs. For each patient two data collection forms were prepared. The first form involved questions about diagnosis and akathisia management by physicians. The second form involved Barnes rating scale for Akathisia [BARS]. The data analysis was performed using SPSS, tests were t-student and statistical significance was assessed at the 5% alpha level. This study was performed in Noor, Farabi and Modares hospitals in the spring and summer of 1383 [2004] in Isfahan [Iran]. Among 156 patients, akathisia was diagnosed in 15.4% by BARS scale and in 9.6% by physicians. There was significant difference between the diagnosis of Akathisia by BARS and the diagnosis by physicians. Among patients who had akathisia [in BARS], 29.2% had mild akathisia, 50% had moderate akathisia, 20.8% had marked akathisia Pseudoakathisia was diagnosed in 2.6% of 156 samples. All of the patients, who had akathisia, were taking Antipsychotic drug [83.3% Typical and 16.7% atypical antipsychotic]. For treatment, the physicians reduced the dosage of antipsychotic drugs in 80% of the akathisia patients, and added a new drug for 60% of the patients and changed the antipsychotic drug for 20% of them. In our study, akathisia was diagnosed for 24 patients by BARS. But the physicians did not diagnose akathisia in some of these patients. This might have negative effects on treatment of the patients. Therefore, it's necessary to introduce the Barns akathisia rating scale [BARS] to all physicians and encourage them to apply in all wards to suspicious cases

Acatisia: enfoque clínico-descritivo e aprofundamento diagnóstico / Akathisia a clinical-descriptive approach a contribution to a diagnosis

A acatisia se caracteriza por um sentimento subjetivo de intranquilidade de uma inquietaçäo motora. A interaçäo entre psiquismo e motricidade é enfocada: a acatisia é considerada um fenômeno neuropsiquiátrico com componenentes motores, afetivos e cognitivos. Após apresentaçäo de aspectos clínicos e descritivos é abordado o diagnóstico diferencial. Escalas neuropsiquiátricas para o acesso da acatisia säo comentadas