Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade: A retrospective study.

This research aimed to assess the use of neuromuscular blockers (NMB) and its reversal, associated or not with neuraxial blockade, after general anesthesia.This retrospective study analyzed 1295 patients that underwent surgery with general anesthesia at Prof. Dr. José Aristodemo Pinotti Hospital in 2013. The study included patients aged >1 year, with complete, readable medical charts and anesthetic records.Rocuronium (ROC) was the most used NMB (96.7%), with an initial dose of 0.60 (0.52-0.74) mg/kg and total dose of 0.38 (0.27-0.53) mg/kg/h. In 24.3% of the cases, neuraxial blockade was associated with a significantly longer anesthesia (P < .001) than in cases without neuraxial block, regardless of technique (total intravenous (TIV) vs intravenous and inhalational (IV+IN)). In 71.9% of the cases, a single dose of NMB was used. Patients under TIV general anesthesia associated with neuraxial blockade had a lower total dose of ROC (mg/kg/h) in comparison with TIV GA alone (0.30 (0.23-0.39) and 0.42 (0.30-0.56) mg/kg/h, respectively, P < .001). The same was observed for patients under IV+IN GA (0.32 (0.23-0.41) and 0.43 (0.31-0.56) mg/kg/h, respectively, P < .001). The duration of anesthesia was longer according to increasing number of additional NMB doses (P < .001). Dose of neostigmine was 2.00 (2.00-2.00) mg or 29.41 (25.31-33.89) µg/kg. The interval between neostigmine and extubation was >30 minutes in 10.9% of cases.The most widely used NMB was ROC. Neuroaxial blockade (spinal or epidural) was significantly associated with reduced total dose of ROC (mg/kg/h) during general anesthesia, even in the absence of neuromuscular monitoring and regardless of general anesthetic technique chosen. In most cases, neostigmine was used to reverse neuromuscular block. The prolonged interval between neostigmine and extubation (>30 minutes) was neither associated with total doses of ROC or neostigmine, nor with the time of NMB administration. This study corroborates the important role of quantitative neuromuscular monitors and demonstrates that neuraxial blockade is associated with reduced total ROC dose. Further studies are needed to evaluate the possible role of neuraxial blockade in reducing the incidence of postoperative residual curarization.

Terapia expressiva: veículo de cuidado integral num hospital universitário / Expressive therapy: instrument to integral care in an universitary hospital

Caracterizamos a Terapia Expressiva como um veículo para o Cuidado Integral, e relatamos a experiência do Programa de Terapia Expressiva no Hospital Universitário Antonio Preto (HUAP), da Universidade Federal Fluminense (UFF). Contribuir para a humanização e integralidade do cuidado; desenvolver o Cuidado de Si entre profissionais de saúde; aprimorar a qualidade do cuidado aos usuários, remodelando o conceito de doença; contribuir para a formação em saúde e cultura do UFF; produzir evidências sobre a eficácia da Terapia Expressiva. O Programa inclui diversas ações: Curso de Extensão "Cuidar de si com Arte" para profissionais de saúde; "Infusão de Vida" - sessões coletivas da Terapia Expressiva durante a quimioterapia, no Núcleo de Atenção Oncológica (NAO); "Tempo de Espera" - intervenções na sala de espera do mesmo serviço, para pacientes, familiares e cuidadores; "O HUAP vai dançar" - rodas semanais abertas de Danças Circulares no saguão do hospital; "Pra todo mundo se ver" - produção de vídeos e documentários para divulgação do programa; encontros anuais para troca de experiências. Conta com uma equipe interdisciplinar: docentes, alunos de diversos cursos e terapeutas voluntários, sob a liderança da idealizadora - médica, artista plástica e professora de Terapia Expressiva. Integra ensino, pesquisa e assistência, sob uma ética da compaixão e emancipatória. Com um ano e meio de duração, o programa atingiu resultados acima das expectativas: grande aceitação por parte de pacientes e staff, que referem mudança na qualidade do cuidado. Resultados das pesquisas serão brevemente publicados. Há perspectivas de ampliação para outros serviços.(AU)

We characterize Expressive Therapy as an instrument to Integral Care, and we relate the experience of the Program of Expressive Therapy in the University Hospital Antonio Pedro (HUAP), at the Fluminense Federal University (UFF). To contribute to humanization and integrality of care, remodeling concepts of disease; to contribute to health and culture education in UFF; to join evidences about the efficacy of Expressive Therapy. The program includes diverse actions: the Course "Self-caring with Art", for health professionals; "Infusion of Life" - collective sections of Expressive Therapy during chemotherapy in the Oncologic Service and Caregivers; "HUAP dances" - open circles of Sacred Circle Dance at the entrance hall of the hospital; ging experience. The interdisciplinary team includes teachers, students from different areas and voluntary therapists, under the leadership of the supervisor - a medical doctor, artist and a master in Expressive Therapy. The program integrates education, research and assistance, under a compassionate and emancipatory ethics. After one year and a half the program has achieved results above all expectations: a broad acceptance by patients and staff, who relate an improvement in the quality of care. The results of the researches will be soon published. There are prospects of extension of the program to other services.(AU)