Postoperative continuous plexular analgesia. A study on the side effects and risk factors of catheter infection.

BACKGROUND AND OBJECTIVES: The importance of postoperative analgesia has increased over the years. Plexular catheters represent a good option for high quality analgesia with reduced systemic repercussions. The objective of the present study was to evaluate the incidence of side effects and complications in postoperative analgesia with plexular catheters and identify risk factors for bacterial colonization of the catheters. METHODS: Patients undergoing orthopedic surgeries between March of 2005 and January of 2007 received analgesia via plexular catheters. The incidence of side effects and complications of this technique were evaluated. In some of the cases, the catheter tip was cultured. RESULTS: Four hundred and thirty-three patients were evaluated. Urinary retention and nausea/vomiting had an incidence of 1.3 and 16.6%, respectively. Of 280 catheters examined, 8.6% were colonized. Infections, nerve lesions, or systemic repercussion were not observed. CONCLUSIONS: The use of antibiotics preoperatively and the type of needle were the risk factors of infection identified.

Analgesia pós-operatória plexular contínua: estudo dos efeitos colaterais e do risco de infecção dos cateteres / Analgesia postoperatoria plexular continua: estudio de los efectos colaterales y de riesgo de infección de los catéteres / Postoperative continuous plexular analgesia: a study on the side effects and risk factors of catheter infection

JUSTIFICATIVA E OBJETIVOS: A analgesia pós-operatória foi muito valorizada nos últimos anos. Os cateteres plexulares são boa opção para analgesia de qualidade com a mínima repercussão sistêmica. O presente estudo visou a avaliar a ocorrência de efeitos colaterais e complicações em analgesia pós-operatória com cateteres plexulares e identificar fatores de risco para colonização bacteriana nos cateteres. MÉTODO: Pacientes submetidos a operações ortopédicas entre março de 2005 e janeiro de 2007 receberam analgesia por cateteres de plexo. Foi avaliada a ocorrência de efeitos colaterais e de complicações com o uso da técnica. Em parte dos casos foi feita cultura da ponta do cateter. RESULTADOS: Foram estudados 433 pacientes. As incidências de retenção urinária e náuseas/vômitos foram de 1,3 por cento e 16,6 por cento, respectivamente. Houve colonização em 8,6 por cento dos 280 cateteres examinados. Não houve infecções, lesões nervosas nem repercussões sistêmicas. CONCLUSÕES: O uso pré-operatório de antibióticos e o tipo de agulha utilizado foram fatores de risco para colonização dos cateteres.

BACKGROUND AND OBJECTIVES: The importance of postoperative analgesia has increased over the years. Plexular catheters represent a good option for high quality analgesia with reduced systemic repercussions. The objective of the present study was to evaluate the incidence of side effects and complications in postoperative analgesia with plexular catheters and identify risk factors for bacterial colonization of the catheters. METHODS: Patients undergoing orthopedic surgeries between March of 2005 and January of 2007 received analgesia via plexular catheters. The incidence of side effects and complications of this technique were evaluated. In some of the cases, the catheter tip was cultured. RESULTS: Four hundred and thirty-three patients were evaluated. Urinary retention and nausea/vomiting had an incidence of 1.3 and 16.6 percent, respectively. Of 280 catheters examined, 8.6 percent were colonized. Infections, nerve lesions, or systemic repercussion were not observed. CONCLUSIONS: The use of antibiotics preoperatively and the type of needle were the risk factors of infection identified.

JUSTIFICATIVA Y OBJETIVOS: La analgesia postoperatoria fue muy estimada en los últimos años. Los catéteres plexulares son una buena opción para la analgesia de calidad con una mínima repercusión sistémica. El presente estudio quiso evaluar la incidencia de efectos colaterales y complicaciones en analgesia postoperatoria con catéteres plexulares, e identificar factores de riesgo para la colonización bacteriana en los catéteres. MÉTODO: Pacientes sometidos a operaciones ortopédicas entre marzo de 2005 y enero del 2007 que recibieron analgesia a través de catéteres de plexo. Se evaluaron la incidencia de los efectos colaterales y las complicaciones con el uso de la técnica. En una parte de los casos, se efectuó el cultivo de la punta del catéter. RESULTADOS: Fueron estudiados 433 pacientes. La incidencia de retención urinaria y náuseas/vómitos fue de 1,3 y de un 16,6 por ciento, respectivamente. Hubo colonización en un 8,6 por ciento de los 280 catéteres examinados. No hubo infecciones, lesiones nerviosas, ni tampoco repercusiones sistémicas. CONCLUSIONES: El uso preoperatorio de antibióticos y el tipo de aguja utilizado fueron factores de riesgo para la colonización de los catéteres.

Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral / Respiratory complications in patients with cerebral palsy undergoing general anesthesia

JUSTIFICATIVA E OBJETIVOS: Anestesia em pacientes com paralisia cerebral (PC) pode representar um desafio para o anestesiologista. Este estudo prospectivo teve como objetivo determinar a prevalência e o risco de complicações respiratórias em crianças com PC submetidas à anestesia geral inalatória (AGI) para tomografia computadorizada (TC). MÉTODO: Participaram do estudo pacientes com idades entre 1 e 17 anos, estado físico ASA I a III, submetidos a AGI com sevoflurano e máscara laríngea para TC no período de junho/2002 a junho/2003, divididos em três grupos: PC tetraplégicos (PCT), outros tipos de PC (PCO) e paciente sem PC (NPC). Os pais ou responsáveis responderam a um questionário com perguntas sobre o histórico médico dos pacientes, infecção de vias aéreas superiores (IVAS), asma, convulsão, incoordenação orofaríngea, refluxo gastroesofágico, etc. Dados sobre incidência e gravidade das complicações respiratórias foram coletados prospectivamente (tosse, broncoespasmo, laringoespasmo, hipoxemia, aspiração). A amostra foi calculada para uma incidência esperada de 5 por cento no grupo NPC, com uma diferença de 15 por cento entre os grupos (alfa = 0,05 e beta = 0,1), utilizando-se os testes do Qui-quadrado, exato de Fisher e t de Student. RESULTADOS: Compuseram a amostra 290 pacientes divididos nos grupos da seguinte forma: PCT - 100, PCO - 79 e NPC - 111. Não houve diferença na prevalência de complicações respiratórias entre os grupos PCT (4 por cento), PCO (8,9 por cento) e NPC (7,3 por cento). Houve associação entre a presença de IVAS e a ocorrência de complicações (risco relativo, 10,71). CONCLUSÕES: Crianças com paralisia cerebral tipo tetraplegia espástica não parecem ter um risco aumentado de complicações respiratórias durante anestesia geral inalatória com sevoflurano e máscara laríngea. O estudo confirma IVAS como fator de risco para a ocorrência dessas complicações.

BACKGROUND AND OBJETIVES: Anesthesia in patients with cerebral palsy (CP) poses a challenge for the anesthesiologist. The objective of this prospective study was to determine the prevalence and risk of respiratory complications in children with CP undergoing general inhalational anesthesia for computed tomography. METHODS: Patients with ages ranging from 1 to 17 years, physical status ASA I to III, undergoing general inhalational anesthesia with sevoflurane and laryngeal mask for a CT scan from June 2002 to June 2003, participated in this study. Patients were divided in 3 groups: quadriplegic CP (CPQ), other types of CP (CPO), and patients without CP (NCP). Parents or guardians answered a questionnaire that assessed the past medical history of the patient, upper respiratory infections (URI), asthma, seizures, oropharyngeal dysfunction, gastroesophageal reflux, etc. Data on the incidence and severity of respiratory complications were gathered prospectively (cough, bronchospasm, laryngeal spasm, hypoxemia, aspiration, etc). The size of the study group was calculated for an expected 5 percent incidence in the NCP group, with a 15 percent difference among groups (alpha = 0.05 and beta = 0.1), using the Chi-square test, Fisher exact test, and test t Student. RESULTS: Two hundred and ninety patients, divided in three groups, participated in this study. Groups were composed of: CPQ = 100 patients, CPO = 79 patients, and NCP = 111 patients. There were no differences on the prevalence of respiratory infections among the CPQ (4 percent), CPO (8.9 percent), and NCP (7.3 percent) groups. There was a correlation between the presence of URI and the development of complications (relative risk of 10.71). CONCLUSIONS: Children with cerebral palsy with spastic quadriplegia do not seem to have an increased risk of respiratory complications during general inhalational anesthesia with sevoflurane and laryngeal mask. This study confirms URI as a risk factor...

JUSTIFICATIVA Y OBJETIVOS: La anestesia en pacientes con parálisis cerebral (PC) puede representar un desafío para el anestesiólogo. Este estudio prospectivo tuvo como objetivo determinar la prevalencia y el riesgo de complicaciones respiratorias en niños con PC sometidos a anestesia general inhalatoria para tomografía computadorizada. MÉTODO: Participaron del estudio pacientes con edades entre 1 y 17 años, estado físico ASA I a III, sometidos a AGI con sevoflurano y máscara laríngea para TC en el período de junio/2002 a junio/ 2003, divididos en 3 grupos: PC tetraplégicos (PCT), Otros tipos de PC (PCO), y paciente sin PC (NPC). Los padres o responsables respondieron a un cuestionario con preguntas sobre el historial médico de los pacientes, infección de vías aéreas superiores (IVAS), asma, convulsión, no coordinación oro faríngea, reflujo gastroesofágico, etc. Datos sobre la incidencia y la gravedad de las complicaciones respiratorias fueron recolectados proscpectivamente (tos, bronco espasmo, laringo espasmo, hipoxemia, aspiración). La muestra fue calculada para una incidencia esperada de 5 por ciento en el grupo NPC, con una diferencia de 15 por ciento entre los grupos (alfa = 0,05 y beta = 0,1), utilizando los tests del Chi-cuadrado, exacto de Fisher y t de Student. RESULTADOS: Conformaron la muestra 290 pacientes divididos en los grupos de la siguiente forma: PCT - 100, PCO - 79 y NPC- 111. No hubo diferencia en la prevalencia de complicaciones respiratorias entre los grupos PCT (4 por ciento), PCO (8,9 por ciento) y NPC (7,3 por ciento). Hubo una asociación entre la presencia de IVAS y la incidencia de complicaciones (riesgo relativo 10,71). CONCLUSIONES: Niños con parálisis cerebral tipo tetraplegia espástica no parecen correr riesgo aumentado de complicaciones respiratorias durante la anestesia general inhalatoria con sevoflurano y máscara laríngea. El estudio confirma IVAS como factor de riesgo para la incidencia de esas complicaciones.

[Respiratory complications in patients with cerebral palsy undergoing general anesthesia.]. / Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral.

BACKGROUND AND OBJECTIVES: Anesthesia in patients with cerebral palsy (CP) poses a challenge for the anesthesiologist. The objective of this prospective study was to determine the prevalence and risk of respiratory complications in children with CP undergoing general inhalational anesthesia for computed tomography. METHODS: Patients with ages ranging from 1 to 17 years, physical status ASA I to III, undergoing general inhalational anesthesia with sevoflurane and laryngeal mask for a CT scan from June 2002 to June 2003, participated in this study. Patients were divided in 3 groups: quadriplegic CP (CPQ), other types of CP (CPO), and patients without CP (NCP). Parents or guardians answered a questionnaire that assessed the past medical history of the patient, upper respiratory infections (URI), asthma, seizures, oropharyngeal dysfunction, gastroesophageal reflux, etc. Data on the incidence and severity of respiratory complications were gathered prospectively (cough, bronchospasm, laryngeal spasm, hypoxemia, aspiration, etc). The size of the study group was calculated for an expected 5% incidence in the NCP group, with a 15% difference among groups (alpha = 0.05 and beta = 0.1), using the Chi-square test, Fisher exact test, and test t Student. RESULTS: Two hundred and ninety patients, divided in three groups, participated in this study. Groups were composed of: CPQ = 100 patients, CPO = 79 patients, and NCP = 111 patients. There were no differences on the prevalence of respiratory infections among the CPQ (4%), CPO (8.9%), and NCP (7.3%) groups. There was a correlation between the presence of URI and the development of complications (relative risk of 10.71). CONCLUSIONS: Children with cerebral palsy with spastic quadriplegia do not seem to have an increased risk of respiratory complications during general inhalational anesthesia with sevoflurane and laryngeal mask. This study confirms URI as a risk factor for the development of those complications.