Estimated Seroprevalence of SARS-CoV-2 Antibodies Among Adults in Orange County, California

BackgroundClinic-based estimates of SARS-CoV-2 may considerably underestimate the total number of infections. Access to testing in the US has been heterogeneous and symptoms vary widely in infected persons. Public health surveillance efforts and metrics are therefore hampered by underreporting. We set out to provide a minimally biased estimate of SARS-CoV-2 seroprevalence among adults for a large and diverse county (Orange County, CA, population 3.2 million). MethodsWe implemented a surveillance study that minimizes response bias by recruiting adults to answer a survey without knowledge of later being offered a SARS-CoV-2 test. Several methodologies were used to retrieve a population-representative sample. Participants (n=2,979) visited one of 11 drive-thru test sites from July 10th to August 16th, 2020 (or received an in-home visit) to provide a finger pin-prick sample. We applied a robust SARS-CoV-2 Antigen Microarray technology, which has superior measurement validity relative to FDA-approved tests. FindingsParticipants include a broad age, gender, racial/ethnic, and income representation. Adjusted seroprevalence of SARS-CoV-2 infection was 11.5% (95% CI: 10.5% to 12.4%). Formal bias analyses produced similar results. Prevalence was elevated among Hispanics (vs. other non-Hispanic: prevalence ratio [PR]= 1.47, 95% CI: 1.22 to 1.78) and household income <$50,000 (vs. >$100,000: PR= 1.42, 95% CI: 1.14 to 1.79). InterpretationResults from a diverse population using a highly specific and sensitive microarray indicate a SARS-CoV-2 seroprevalence of [~]12 percent. This population-based seroprevalence is seven-fold greater than that using official County statistics. In this region, SARS-CoV-2 also disproportionately affects Hispanic and low-income adults. FundingOrange County Healthcare Agency

Anesthetic complications in a rehabilitation hospital: is the incidence related to the pre-anesthetic visit? / Complicação anestésica em hospital de reabilitação. A incidência tem relação com a consulta pré-anestésica? / Complicación anestésica en un hospital de rehabilitación. ¿La incidencia tiene relación con la consulta preanestésica?

Introduction: Approximately 234 million surgeries are done annually worldwide. There is a growing concern for the safety of the anesthetic act, and the pre-anesthetic consultation emerges as an important and widely recommended activity, used as a preventive measure for the emergence of a complication. Objectives: To describe the complications related to anesthesia, to identify the factors that contribute to its appearance and to reflect on ways to improve clinical practice. Methods: 700 patients, 175 cases and 525 controls, were evaluated over a period of 21 months. The data obtained through the pre-anesthetic consultation were evaluated descriptively and then tested with conditional univariate and multivariate logistic regression analysis. Results: 175 cases of anesthesia-related complications (2.74%) out of 6365 anesthetic acts were evaluated. Hypotension was the most common complication (40 patients, 22.8%), followed by vomiting (24 patients, 13.7%) and arrhythmia (24 patients, 13.7%). Among the complications, 55% were due to patient conditions, 26% accidental, 10% predictable and 9% iatrogenic. The complications were classified as mild in 106 (61%), moderate in 63 (36%) and severe in six (3%) patients. Conclusion: Patients with more impaired physical status (American Society of Anaesthesiology 3 and 4), with airway disease, tumor or parenchymal disease, diabetes or disorder of lipid metabolism, thyroid disease, former smokers and very prolonged anesthetic acts present a higher risk of anesthesia-related complications. Therefore, they should be actively investigated in the pre-anesthetic evaluation consultation. .

introdução: Cerca de 234 milhões de cirurgias são feitas anualmente no mundo. É cada vez maior o interesse pela segurança do ato anestésico e a consulta pré-anestésica surge como atividade importante e amplamente recomendada, usada como medida preventiva para o surgimento de uma complicação. Objetivos: Descrever as complicações relacionadas à anestesia, identificar os fatores que contribuem para o seu surgimento e refletir sobre formas de melhoria na prática clínica. Métodos: foram avaliados 700 pacientes, 175 casos e 525 controles, em um período de 21 meses. Os dados obtidos por meio da consulta pré-anestésica foram avaliados descritivamente e em seguida testados com regressão logística condicional univariada e multivariada. Resultados: Foram avaliados 175 casos de complicação relacionada à anestesia (2,74%) dentre 6.365 atos anestésicos. A hipotensão foi a complicação mais comum (40 casos, 22,8%), seguida do vômito (24%, 13,7%) e arritmia (24%, 13,7%). Das complicações, 55% foram devidas às condições do paciente, 26% acidentais, 10% previsíveis e 9% iatrogênicas. As complicações foram classificadas como leves em 106 pacientes (61%), moderadas em 63 (36%) e graves em seis (3%). Conclusão: Pacientes com estado físico mais debilitado (ASA 3 e 4), com doença de vias aéreas, tumor ou doença parenquimatosa, com diabetes ou transtorno do metabolismo lipídico, com doença de tireoide, ex-fumantes e as anestesias muito prolongadas apresentam maior risco de complicações relacionadas à anestesia e, por isso, devem ser investigados ativamente na consulta de avaliação pré-anestésica. .

Introducción: Cerca de 234 millones de cirugías se hacen anualmente en todo el mundo. Cada vez crece más el interés por la seguridad de la anestesia, y la consulta preanestésica surge como una actividad importante y ampliamente recomendada, usada como medida preventiva para el surgimiento de una complicación. Objetivos: Describir las complicaciones relacionadas con la anestesia, identificar los factores que contribuyen a su aparición y reflexionar sobre las formas de mejorar la práctica clínica. Métodos: Se evaluaron 700 pacientes, 175 casos y 525 controles, en un período de 21 meses. Los datos que se obtuvieron por medio de la consulta preanestésica se calcularon descriptivamente y enseguida fueron testados con la regresión logística condicional univariada y multivariada. Resultados: Fueron evaluados 175 casos de complicación relacionada con la anestesia (2,74%) entre 6.365 anestesias practicadas. La hipotensión fue la complicación más común (40 casos; 22,8%), seguida del vómito (24%; 13,7%) y de la arritmia (24%; 13,7%). De las complicaciones, un 55% de debieron a las condiciones del paciente, un 26% accidentales, un 10% previsibles y un 9% iatrogénicas. Las complicaciones fueron clasificadas como leves en 106 pacientes (61%), moderadas en 63 (36%) y graves en 6 (3%). Conclusión: Los pacientes con estado físico más debilitado (ASA 3 y 4), con enfermedad de vías aéreas, tumor o enfermedad parenquimatosa, con diabetes o trastorno del metabolismo lipídico, con enfermedad de la tiroides, exfumadores y las anestesias muy prolongadas presentan un mayor riesgo de complicaciones relacionadas con la anestesia y por eso deben ser investigados activamente en la consulta de evaluación preanestésica. .

[Anesthetic complications in a rehabilitation hospital: is the incidence related to the pre-anesthetic visit?]. / Complicação anestésica em hospital de reabilitação. A incidência tem relação com a consulta pré-anestésica?

INTRODUCTION: Approximately 234 million surgeries are done annually worldwide. There is a growing concern for the safety of the anesthetic act, and the pre-anesthetic consultation emerges as an important and widely recommended activity, used as a preventive measure for the emergence of a complication. OBJECTIVES: To describe the complications related to anesthesia, to identify the factors that contribute to its appearance and to reflect on ways to improve clinical practice. METHODS: 700 patients, 175 cases and 525 controls, were evaluated over a period of 21 months. The data obtained through the pre-anesthetic consultation were evaluated descriptively and then tested with conditional univariate and multivariate logistic regression analysis. RESULTS: 175 cases of anesthesia-related complications (2.74%) out of 6365 anesthetic acts were evaluated. Hypotension was the most common complication (40 patients, 22.8%), followed by vomiting (24 patients, 13.7%) and arrhythmia (24 patients, 13.7%). Among the complications, 55% were due to patient conditions, 26% accidental, 10% predictable and 9% iatrogenic. The complications were classified as mild in 106 (61%), moderate in 63 (36%) and severe in six (3%) patients. CONCLUSION: Patients with more impaired physical status (American Society of Anaesthesiology 3 and 4), with airway disease, tumor or parenchymal disease, diabetes or disorder of lipid metabolism, thyroid disease, former smokers and very prolonged anesthetic acts present a higher risk of anesthesia-related complications. Therefore, they should be actively investigated in the pre-anesthetic evaluation consultation.

Parasite load and risk factors for poor outcome among children with visceral leishmaniasis. A cohort study in Belo Horizonte, Brazil, 2010-2011

Clinical and laboratory risk factors for death from visceral leishmaniasis (VL) are relatively known, but quantitative real-time polymerase chain reaction (qPCR) might assess the role of parasite load in determining clinical outcome. The aim of this study was to identify risk factors, including parasite load in peripheral blood, for VL poor outcome among children. This prospective cohort study evaluated children aged ≤ 12 years old with VL diagnosis at three times: pre-treatment (T0), during treatment (T1) and post-treatment (T2). Forty-eight patients were included and 16 (33.3%) met the criteria for poor outcome. Age ≤ 12 months [relative risk (RR) 3.51; 95% confidence interval (CI) 1.89-6.52], tachydyspnoea (RR 3.46; 95% CI 2.19-5.47), bacterial infection (RR 3.08; 95% CI 1.27-7.48), liver enlargement (RR 3.00; 95% CI 1.44-6.23) and low serum albumin (RR 7.00; 95% CI 1.80-27.24) were identified as risk factors. qPCR was positive in all patients at T0 and the parasite DNA was undetectable in 76.1% of them at T1 and in 90.7% at T2. There was no statistical association between parasite load at T0 and poor outcome.

Parasite load and risk factors for poor outcome among children with visceral leishmaniasis. A cohort study in Belo Horizonte, Brazil, 2010-2011.

Clinical and laboratory risk factors for death from visceral leishmaniasis (VL) are relatively known, but quantitative real-time polymerase chain reaction (qPCR) might assess the role of parasite load in determining clinical outcome. The aim of this study was to identify risk factors, including parasite load in peripheral blood, for VL poor outcome among children. This prospective cohort study evaluated children aged ≤ 12 years old with VL diagnosis at three times: pre-treatment (T0), during treatment (T1) and post-treatment (T2). Forty-eight patients were included and 16 (33.3%) met the criteria for poor outcome. Age ≤ 12 months [relative risk (RR) 3.51; 95% confidence interval (CI) 1.89-6.52], tachydyspnoea (RR 3.46; 95% CI 2.19-5.47), bacterial infection (RR 3.08; 95% CI 1.27-7.48), liver enlargement (RR 3.00; 95% CI 1.44-6.23) and low serum albumin (RR 7.00; 95% CI 1.80-27.24) were identified as risk factors. qPCR was positive in all patients at T0 and the parasite DNA was undetectable in 76.1% of them at T1 and in 90.7% at T2. There was no statistical association between parasite load at T0 and poor outcome.

Assessing the Spatial Distribution of Perfluorooctanoic Acid Exposure via Public Drinking Water Pipes Using Geographic Information Systems

OBJECTIVES: Geographic Information Systems (GIS) is a powerful tool for assessing exposure in epidemiologic studies. We used GIS to determine the geographic extent of contamination by perfluorooctanoic acid, C8 (PFOA) that was released into the environment from the DuPont Washington Works Facility located in Parkersburg, West Virginia. METHODS: Paper maps of pipe distribution networks were provided by six local public water districts participating in the community cross-sectional survey, the C8 Health Project. Residential histories were also collected in the survey and geocoded. We integrated the pipe networks and geocoded addresses to determine which addresses were serviced by one of the participating water districts. The GIS-based water district assignment was then compared to the participants' self-reported source of public drinking water. RESULTS: There were a total of 151,871 addresses provided by the 48,800 participants of the C8 Health Project that consented to geocoding. We were able to successfully geocode 139,067 (91.6%) addresses, and of these, 118,209 (85.0%) self-reported water sources were confirmed using the GIS-based method of water district assignment. Furthermore, the GIS-based method corrected 20,858 (15.0%) self-reported public drinking water sources. Over half (54%) the participants in the lowest GIS-based exposure group self-reported being in a higher exposed water district. CONCLUSIONS: Not only were we able to correct erroneous self-reported water sources, we were also able to assign water districts to participants with unknown sources. Without the GIS-based method, the reliance on only self-reported data would have resulted in exposure misclassification.

Development and validation of a microbial counting method for mebendazole oral suspension / Desenvolvimento e validação de um método de contagem microbiana para o mebendazol suspensão oral

Mebendazole is an important medicine used to treat helminth infections. These infections affect more than two billion people worldwide. The LAFEPE® (Recife-PE, Brazil) produces the drug mebendazole oral suspension that contains the preservatives methylparaben and propylparaben in its formulation. Drugs that have antimicrobial properties due to preservatives must undergo neutralization of these compounds to allow microbial count testing according to recommendations by the official compendia. In order to obtain a validated method for microbial counting and to ensure its safety and reliability within the pharmaceutical industry, validation of preservative neutralization and of the method for microbial counting was performed according to the USP 30 and PDA Technical Report No. 33. The method used ATCC Gram positive and Gram negative microorganisms, yeasts, most and culture media Tryptic Soy Agar and Sabouraud dextrose agar. The neutralizers were polysorbate 80 and lecithin. Recovery levels of over 70 percent of the microorganisms used in the test indicated the neutralization of antimicrobial activity and proved the absence of toxicity of neutralizers. The microbial counting method validated proved accurate, precise, robust and linear and can be safely used in routine operations.

O mebendazol é um importante medicamento utilizado no tratamento de infecções por helmintos. Essas infecções afetam mais de dois bilhões de pessoas em todo o mundo. O LAFEPE (Recife-PE, Brasil) produz o medicamento mebendazol suspensão oral, que possui em sua formulação os conservantes metilparabeno e propilparabeno. Em medicamentos que possuem propriedades antimicrobianas em decorrência dos conservantes faz-se necessária a neutralização da ação desses compostos para a realização do teste de contagem microbiana segundo preconizado pelos compêndios oficiais. A fim de obter um método de contagem microbiana validado e que garanta sua segurança e reprodutibilidade dentro da indústria farmacêutica foi realizada a validação da neutralização dos antimicrobianos e validação do método de contagem microbiana de acordo com a USP 30 e PDA-Technical Report N° 33. O método desenvolvido utilizou microrganismos ATCC Gram positivos, Gram negativos, leveduras e fungos e meios de cultura Tryptic Soy Agar e Sabouraud-dextrose Agar. Os neutralizantes foram polissorbato 80 e lecitina de soja . Níveis de recuperação superiores a 70 por cento dos microrganismos utilizados no ensaio indicaram neutralização da atividade antimicrobiana e comprovou a ausência de toxicidade dos neutralizantes. O método de contagem microbiana validado revelou-se exato, preciso, robusto e linear podendo ser utilizado com segurança na rotina operacional.

Incidência de síndrome dolorosa regional após cirurgia para descompressão do túnel do carpo: existe correlação com a técnica anestésica realizada? / Incidence of regional pain syndrome after carpal tunnel release: is there a correlation with the anesthetic technique? / Incidencia del síndrome doloroso regional posterior a la cirugía para la descompresión del túnel del carpo: ¿ existe una correlación con la técnica anestésica realizada?

JUSTIFICATIVA E OBJETIVOS: A síndrome dolorosa complexa regional (SDCR), anteriormente conhecida como distrofia simpático-reflexa, descreve um conjunto de sinais e sintomas que incluem dor, sudorese e instabilidade vasomotora. A dor geralmente é desencadeada por estímulo nocivo em um nervo periférico e se mostra desproporcional ao estímulo desencadeante. Seu aparecimento após cirurgia não é incomum, variando com a intervenção. Após descompressão do túnel do carpo (DTC), descreve-se incidência de 2,1 por cento a 5 por cento. O bloqueio simpático pode prevenir o aparecimento de SDCR, mas nenhum estudo validou essa técnica como prevenção da SCR após cirurgia para DTC. O objetivo do estudo foi definir a incidência de SDCR após cirurgia de DTC e sua relação com quatro técnicas de anestesia. MÉTODO: Os pacientes foram distribuídos aleatoriamente e receberam uma das técnicas: anestesia geral, anestesia venosa regional com lidocaína, anestesia venosa regional com lidocaína e clonidina ou bloqueio de plexo axilar. No pós-operatório, foram acompanhados por uma enfermeira que desconhecia a técnica utilizada, fazendo-se o seguimento pelo prontuário eletrônico até 6 meses depois da anestesia. Nesse período, foram pesquisados sinais e sintomas típicos de SDCR e, em caso positivo, instituiu-se o tratamento. Foi realizada avaliação descritiva, empregando-se o Qui-quadrado. RESULTADOS: Foram estudados 301 pacientes. Destes, 25 desenvolveram SDCR configurando uma incidência de 8,3 por cento. Não houve predominância entre as técnicas de anestesia. Foram pesquisados outros fatores como: tabagismo, profissão e outras doenças concomitantes e nenhum mostrou relação com o desenvolvimento de SDCR após DTC. CONCLUSÕES: A incidência de SDCR após cirurgia para DTC é de 8,3 por cento sem relação com as técnicas anestésicas estudadas.

BACKGROUND AND OBJECTIVE: Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain, increased sweating, and vasomotor instability. Pain is usually triggered by a noxious stimulus in a peripheral nerve, which is disproportionate to the triggering stimulus. Its development after surgery is not uncommon varying with the type of intervention. An incidence of 2.1 to 5 percent has been reported after carpal tunnel release (CTR). Sympathetic blockade may prevent the onset of CRPS. However, there is no study validating this technique to prevent CRPS after CTR. The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques. METHODS: Patients were randomly distributed to undergo one of the following techniques: general anesthesia, regional intravenous anesthesia with lidocaine, regional intravenous anesthesia with lidocaine and clonidine, or axillary plexus block. Postoperatively, they were followed-up by a nurse who was unaware of the anesthetic technique used, and follow-up was done through electronic patient records for up to 6 months after the anesthesia. During this period signs and symptoms typical of CRPS were investigated and, if positive, treatment was instituted. A descriptive evaluation using the chi-square test was performed. RESULTS: Three-hundred and one patients were investigated. Twenty-five of them developed CRPS, an incidence of 8.3 percent. Predominance was not observed among the anesthetic techniques used. Other factors such as smoking, profession, and other concomitant diseases were also investigated, and none showed a relationship with the development of post-CTR CRPS. CONCLUSIONS: Complex regional pain syndrome has an incidence of 8.3 percent after CTR surgery without association with the anesthetic techniques investigated.

JUSTIFICATIVA Y OBJETIVOS: El síndrome doloroso complejo regional (SDCR), anteriormente conocido como distrofia simpático refleja, es un conjunto de señales y de síntomas que incluyen dolor, sudoresis e inestabilidad vasomotora. El dolor generalmente se desencadena por un estímulo nocivo en un nervio periférico, y no es proporcional al estímulo que lo desencadena. Su aparición después de la cirugía no es algo poco frecuente, variando con la intervención. Posteriormente a la descompresión del túnel del carpo (DTC), vemos una incidencia de 2,1-5 por ciento. El bloqueo simpático puede prevenir la aparición de SDCR. Pero ningún estudio ha refrendado esa técnica como prevención de la SCR después de una cirugía para DTC. El objetivo del estudio fue definir la incidencia de SDCR después de una cirugía de DTC y su relación con cuatro técnicas de anestesia. MÉTODO: Los pacientes se distribuyeron aleatoriamente y recibieron una de las siguientes técnicas: anestesia general, anestesia venosa regional con lidocaína, anestesia venosa regional con lidocaína y clonidina o bloqueo del plexo axilar. En el postoperatorio, estuvieron acompañados por una enfermera que no conocía la técnica utilizada, y se hizo el seguimiento por medio de los datos de la historia clínica electrónica hasta 6 meses después de la anestesia. En ese período, se investigaron las señales y los síntomas típicos de SDCR y en caso positivo, se inició el tratamiento. Fue realizada una evaluación descriptiva, usando el Xi-Cuadrado (Xi²). RESULTADOS: Se estudiaron 301 pacientes. De ellos, 25 desarrollaron SDCR, configurando una incidencia de un 8,3 por ciento. No hubo una predominancia entre las técnicas de anestesia. Se investigaron otros factores, como el tabaquismo, la profesión y otras enfermedades concomitantes, y ningún caso se registró con relación al desarrollo de SDCR posterior a la DTC. CONCLUSIONES: La incidencia de SDCR después de la cirugía para DTC está en el umbral del 8,3 por ciento sin que exista una relación con las técnicas anestésicas estudiadas.

Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique?

BACKGROUND AND OBJECTIVES: Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain, increased sweating, and vasomotor instability. Pain is usually triggered by a noxious stimulus in a peripheral nerve, which is disproportionate to the triggering stimulus. Its development after surgery is not uncommon varying with the type of intervention. An incidence of 2.1 to 5% has been reported after carpal tunnel release (CTR). Sympathetic blockade may prevent the onset of CRPS. However, there is no study validating this technique to prevent CRPS after CTR. The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques. METHODS: Patients were randomly distributed to undergo one of the following techniques: general anesthesia, regional intravenous anesthesia with lidocaine, regional intravenous anesthesia with lidocaine and clonidine, or axillary plexus block. Postoperatively, they were followed-up by a nurse who was unaware of the anesthetic technique used, and follow-up was done through electronic patient records for up to 6 months after the anesthesia. During this period signs and symptoms typical of CRPS were investigated and, if positive, treatment was instituted. A descriptive evaluation using the chi-square test was performed. RESULTS: Three-hundred and one patients were investigated. Twenty-five of them developed CRPS, an incidence of 8.3%. Predominance was not observed among the anesthetic techniques used. Other factors such as smoking, profession, and other concomitant diseases were also investigated, and none showed a relationship with the development of post-CTR CRPS. CONCLUSIONS: Complex regional pain syndrome has an incidence of 8.3% after CTR surgery without association with the anesthetic techniques investigated.

Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the Bispectral Index (BIS) in patients with cerebral palsy.

BACKGROUND AND OBJECTIVES: Patients with cerebral palsy (CP) frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre-anesthetic drug on the BIS of patients with CP undergoing chronic treatment with anticonvulsant agents. METHOD: Three groups of patients were assessed: CP without anticonvulsant treatment, CP undergoing treatment with anticonvulsant and a group with no disease and no medication use (control group). On the day before the surgery, with the patients conscious and in dorsal decubitus, the BIS monitor was placed and the basal BIS values were recorded. On the following day, 40 minutes before the surgery, the patients received 0.6 mg*kg(-1) of midazolam orally. Before the start of the anesthetic procedure, the same procedure for BIS recording was carried out after midazolam administration. RESULTS: A total of 107 patients were studied - 39 patients from the Control Group (CG) and 68 with a diagnosis of CP. Among these, 17 used anticonvulsant drugs. Regarding the mean BIS value after the midazolam administration, there was no difference between patients from the CG and those in the CP group that did not take anticonvulsant drugs, whereas the ones who took anticonvulsants exhibited a difference (p = 0.003). The possibility of decrease in the BIS after midazolam use increases according to the number of anticonvulsant drugs used by the patient. CONCLUSIONS: The chronic use of anticonvulsants associated to oral midazolam as pre-anesthetic medication can lead to the decrease in the BIS values, which configures deep level of hypnosis.

Ação do anticonvulsivante isolado e associado ao midazolam como medicação pré-anestésica sobre o índice bispectral (BIS) em pacientes com paralisa cerebral / Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the bispectral index (BIS) in patients with cerebral palsy

JUSTIFICATIVA E OBJETIVOS: Os pacientes com paralisia cerebral (PC) frequentemente usam fármacos para tratamento de doenças concomitantes, como convulsões. O midazolam é o hipnótico mais utilizado como medicação pré-anestésica e suas interações medicamentosas nos pacientes com PC são desconhecidas. O objetivo deste estudo foi avaliar o midazolam como medicação pré-anestésica no BIS dos pacientes com PC em uso crônico de anticonvulsivantes. MÉTODO: Foram avaliados três grupos de pacientes: PC sem uso de anticonvulsivantes, PC em uso de anticonvulsivante e outro grupo sem doença e sem uso de medicações (Grupo Controle). Na véspera da cirurgia, com os pacientes despertos e em decúbito dorsal, foi colocado o monitor do BIS e foram registrados os valores basais do BIS. No dia seguinte, 40 minutos antes da cirurgia, os pacientes receberam 0,6 mg.kg-1 de midazolam por via oral. Antes do início da anestesia, foi realizado o mesmo procedimento para registro do BIS, após o uso do midazolam. RESULTADOS: Foram estudados 107 pacientes - 39 pacientes do Grupo Controle e 68 com diagnóstico de PC. Desses, 17 faziam uso de anticonvulsivante. Com relação ao valor médio de BIS após o uso do midazolam, não houve diferença entres os pacientes do Grupo Controle e do Grupo PC que não tomavam anticonvulsivante, enquanto entre os pacientes que faziam uso de anticonvulsivantes houve diferença (p = 0,003). A possibilidade de diminuição do BIS após o uso do midazolam aumenta de acordo com o número de anticonvulsivantes usados pelo paciente. CONCLUSÕES: O uso crônico de anticonvulsivante associado ao midazolam via oral como medicação pré-anestésica pode levar à diminuição dos valores de BIS, configurando níveis profundos de hipnose.

BACKGROUND AND OBJECTIVES: Patients with cerebral palsy (CP) frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre-anesthetic drug on the BIS of patients with CP undergoing chronic treatment with anticonvulsant agents. METHOD: Three groups of patients were assessed: CP without anticonvulsant treatment, CP undergoing treatment with anticonvulsant and a group with no disease and no medication use (control group). On the day before the surgery, with the patients conscious and in dorsal decubitus, the BIS monitor was placed and the basal BIS values were recorded. On the following day, 40 minutes before the surgery, the patients received 0.6 mg.kg-1 of midazolam orally. Before the start of the anesthetic procedure, the same procedure for BIS recording was carried out after midazolam administration. RESULTS: A total of 107 patients were studied - 39 patients from the Control Group (CG) and 68 with a diagnosis of CP. Among these, 17 used anticonvulsant drugs. Regarding the mean BIS value after the midazolam administration, there was no difference between patients from the CG and those in the CP group that did not take anticonvulsant drugs, whereas the ones who took anticonvulsants exhibited a difference (p = 0.003). The possibility of decrease in the BIS after midazolam use increases according to the number of anticonvulsant drugs used by the patient. CONCLUSIONS: The chronic use of anticonvulsants associated to oral midazolam as pre-anesthetic medication can lead to the decrease in the BIS values, which configures deep level of hypnosis.

JUSTIFICATIVA Y OBJETIVOS: Los pacientes con parálisis cerebral (PC), a menudo usan fármacos para el tratamiento de enfermedades concomitantes, como las convulsiones. El midazolam es el hipnótico más utilizado como medicación preanestésica y no se conocen sus interacciones medicamentosas en los pacientes con PC. El objetivo de este estudio fue evaluar el midazolam como medicación preanestésica en el BIS de los pacientes con PC en uso crónico de antiepilépticos. MÉTODO: Se evaluaron tres grupos de pacientes: PC sin uso de antiepilépticos, PC en uso de antiepiléptico y otro grupo sin enfermedad y sin uso de medicaciones (grupo control). En la víspera de la cirugía, con los pacientes despiertos y en decúbito dorsal, fue colocado el monitor del BIS y se registraron los valores basales del BIS. Al día siguiente, 40 minutos antes de la cirugía, los pacientes recibieron 0,6 mg.kg-1 de midazolam por vía oral. Antes del inicio de la anestesia fue realizado el mismo procedimiento para registro del BIS, después del uso del midazolam. RESULTADOS: Fueron estudiados 107 pacientes, 39 pacientes del grupo control y 68 con diagnóstico de PC. De ellos, 17 usaban antiepilépticos. Con relación al valor promedio de BIS después del uso del midazolam, no hubo diferencia entres los pacientes del grupo control y del grupo PC que no tomaban antiepiléptico, mientras que los pacientes que usaban antiepilépticos fueron diferentes (p = 0,003). La posibilidad de disminución del BIS después del uso del midazolam, aumenta de acuerdo con el número de antiepiléptico usado por el paciente. CONCLUSIONES: El uso crónico de antiepiléptico asociado al midazolam vía oral como medicación preanestésica, puede conllevar a la disminución de los valores de BIS configurando niveles profundos de hipnosis.

Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block.

BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children. METHODS: This is a randomized, double-blind study with children undergoing surgeries for posteromedial release of CCF, who were divided in four groups according to the anesthetic technique: caudal (ACa), sciatic and femoral block (IF), sciatic and saphenous block (IS), and sciatic block and local anesthesia (IL), associated with general anesthesia. In the first 24 hours, patients received oral dypirone and acetaminophen, and they were evaluated by anesthesiologists who were unaware of the technique used. Oral morphine (0.19 mg x kg(1) per day) was administered according to the scores of the CHIPPS (Children's and infants' postoperative pain scale) scale. RESULTS: One hundred and eighteen children separated into four groups: ACa (30), IF (32), IS (28), and IL (28) participated in this study. The mean time between the blockade and the first dose of morphine was 6.16 hours in group ACa, 7.05 hours in group IF, 7.58 in IS, and 8.18 hours in IL. Morphine consumption was 0.3 mg.kg-1 per day in all four groups. Significant differences were not observed among the groups. CONCLUSIONS: peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.

Influence of angiotensin-converting enzyme inhibitors on hypotension after anesthetic induction: is the preoperative discontinuation of this drug necessary?

BACKGROUND AND OBJECTIVES: The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective of the present study was to evaluate the influence of the preoperative use of ACE inhibitors on the development of hypotension during anesthesia. METHODS: This is a case-controlled study of patients who developed hypotension after anesthetic induction. The control group was composed of patients of the same age and gender who underwent surgeries during the same period and who did not develop hypotension. Parameters of interest included: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA), intraoperative bleeding, anesthetic technique, and duration of the surgery. RESULTS: In 2,179 surgeries, 40 patients developed hypotension. Twenty of those patients used ACEIs on the day of the surgery. The control group was composed by 171 patients, 11 of which used ACE inhibitors. Univariate analysis showed an association between hypertension and advanced age (p < 0.001), prior diagnosis of hypertension (p < 0.001), use of ACEIs (p = 0.006), physical status (ASA) (p = 0.006), and size of the surgery (p = 0.028). Stratified analysis did not show an association between hypotension and use of ACE inhibitors. On logistic regression, the association between the size of the surgery and the age of the patient and the development of hypotension remained. CONCLUSIONS: We did not observe an association between the use of ACE inhibitors and hypotension during anesthesia. The authors considered that the recommendation to discontinue ACE inhibitors on the day before the surgery should be reviewed. Other studies are necessary to confirm those results.

Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal / Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal / Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

Justificativa e objetivos: O procedimento de correção de pé torto congênito (PTC) cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças...

Background and objetives: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children...

Justificativa y objetivos: El procedimiento de corrección depie jorobado congénito (PJC), debuta con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección...

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório? / Influencia del uso crónico de los inhibidores de la enzima conversora de la angiotensina en la hipotensión arterial después de la inducción anestésica: ¿es necesario suspender ese fármaco en el preoperatorio? / Influence of angiotensin-converting enzyme inhibitors on hypotension after anesthetic induction: is the preoperative discontinuation of this drug necessary?

Justificativa e objetivos: Tem sido sugerida a suspensão de medicamentos como os inibidores da enzima conversora de angiotensina (IECA) com base em relatos de hipotensão arterial durante a anestesia. Isso pode implicar em maior risco de picos hipertensivos no intraoperatório, com efeitos deletérios para o paciente. O objetivo deste estudo foi avaliar a influência dos IECA utilizados no pré-operatório na ocorrência de hipotensão arterial...

Background and objetives: The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective of the present study was to evaluate the influence of the preoperative use of ACE inhibitors on the development of hypotension...

Justificativa y objetivos: En base a relatos de hipotensión arterial durante la anestesia, se ha sugerido la suspensión de medicamentos como los inhibidores de la enzima conversora de angiotensina (IECA). Eso puede redundar en un riesgo más elevado de picos hipertensivos en el intraoperatorio y con efectos perjudiciales para el paciente. El objetivo de este estudio, fue evaluar la influencia de los IECA utilizados en el preoperatorio si surge la hipotensión arterial...

[The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids]. / Incidência de depressão respiratória no pós-operatório em pacientes submetidos à analgesia venosa ou peridural com opioides.

BACKGROUND AND OBJECTIVES: Intravenous or epidural patient-controlled analgesia (PCA) is a safe and effective technique in the treatment of postoperative pain. However, the use of opioids is not devoid of risks,and respiratory depression represents the most feared complication. The objective of the present study was to describe the incidence of respiratory depression associated with postoperative analgesia with the intravenous or epidural administration of opioids and the characteristics of the patients who developed this complication. METHODS: This is a retrospective, incidence study in patients who underwent surgeries at the Hospital SARAH Brasília from December 1999 to December 2007 and treated with intravenous or epidural PCA with opioids. Respiratory depression was defined as: respiratory rate < 8 bpm, need to use naloxone, or peripheral oxygen saturation below 90%. RESULTS: Two thousand seven hundred and ninety patients were evaluated; 635 of those patients received intravenous PCA and 2155 epidural analgesia. Seven patients developed postoperative respiratory depression (0.25%). Six of those patients were treated with intravenous PCA with morphine, while the last one received epidural analgesia with fentanyl. Patients had a mean age of 30.5 +/- 24.7 years; the mean time between the end of anesthesia and the development of respiratory depression was 18.1 +/- 26.3 hours. The incidence of respiratory depression was significantly higher in PCA with intravenous morphine (p = 0.001) and age below 16 years (p < 0.05). CONCLUSIONS: The incidence of respiratory depression was similar to that described in the literature; it is more frequent in children and adolescents, and with intravenous PCA.

Incidência de depressão respiratória no pós-operatório em pacientes submetidos à analgesia venosa ou peridural com opioides / Incidencia de depresión respiratoria en el postoperatorio en pacientes sometidos a la analgesia venosa o epidural con opioides / The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids

JUSTIFICATIVA E OBJETIVOS: A analgesia controlada pelo paciente (PCA), por via venosa ou peridural, é técnica segura e eficaz no tratamento da dor pós-operatória. Todavia, o uso de opioides não é isento de risco, e a depressão respiratória é a complicação mais temida. Os objetivos deste estudo foram descrever a incidência de depressão respiratória associada à analgesia pós-operatória com opioides administrados por via peridural ou venosa e as características dos pacientes que apresentaram a complicação. MÉTODO: Estudo de incidência, retrospectivo, em pacientes operados no Hospital SARAH Brasília entre dezembro de 1999 e dezembro de 2007 e tratados com PCA com opioides por via venosa ou peridural. Foram definidos como casos de depressão respiratória: frequência respiratória < 8 irpm, necessidade do uso de naloxona ou saturação periférica de oxigênio abaixo de 90 por cento. RESULTADOS: Foram avaliados 2790 pacientes, dos quais 635 pacientes receberam PCA venosa e 2155, analgesia peridural. Ocorreram sete casos de depressão respiratória pós-operatória (incidência de 0,25 por cento). Destes, seis pacientes foram tratados com PCA venosa com morfina, enquanto o último recebeu analgesia peridural com fentanil. A média de idade foi de 30,5 ± 24,7 anos; o tempo médio entre o término da anestesia até a ocorrência da depressão respiratória foi de 18,1 ± 26,3 horas. A ocorrência de depressão respiratória foi significativamente mais frequente na PCA venosa com morfina (p = 0,001) e idade menor que 16 anos (p < 0,05). CONCLUSÕES: A incidência de depressão respiratória encontrada foi semelhante à descrita na literatura, sendo mais frequente em crianças e adolescentes, e com PCA venosa.

BACKGROUND AND OBJECTIVES: Intravenous or epidural patient-controlled analgesia (PCA) is a safe and effective technique in the treatment of postoperative pain. However, the use of opioids is not devoid of risks,and respiratory depression represents the most feared complication. The objective of the present study was to describe the incidence of respiratory depression associated with postoperative analgesia with the intravenous or epidural administration of opioids and the characteristics of the patients who developed this complication. METHODS: This is a retrospective, incidence study in patients who underwent surgeries at the Hospital SARAH Brasília from December 1999 to December 2007 and treated with intravenous or epidural PCA with opioids. Respiratory depression was defined as: respiratory rate < 8 bpm, need to use naloxone, or peripheral oxygen saturation below 90 percent. RESULTS: Two thousand seven hundred and ninety patients were evaluated; 635 of those patients received intravenous PCA and 2155 epidural analgesia. Seven patients developed postoperative respiratory depression (0.25 percent). Six of those patients were treated with intravenous PCA with morphine, while the last one received epidural analgesia with fentanyl. Patients had a mean age of 30.5 ± 24.7 years; the mean time between the end of anesthesia and the development of respiratory depression was 18.1 ± 26.3 hours. The incidence of respiratory depression was significantly higher in PCA with intravenous morphine (p = 0.001) and age below 16 years (p < 0.05). CONCLUSIONS: The incidence of respiratory depression was similar to that described in the literature; it is more frequent in children and adolescents, and with intravenous PCA.

JUSTIFICATIVA Y OBJETIVOS: La analgesia controlada por el paciente (PCA), por vía venosa o epidural, es una técnica segura y eficaz en el tratamiento del dolor postoperatorio. Sin embargo, el uso de opioides no está exento de riesgos y la depresión respiratoria es la complicación más temida. Los objetivos de este estudio fueron describir la incidencia de depresión respiratoria asociada a la analgesia postoperatoria con opioides administrados por vía epidural o venosa, y las características de los pacientes que presentaron la complicación. MÉTODO: Estudio de incidencia retrospectiva en pacientes operados en el Hospital SARAH Brasília entre diciembre de 1999 y diciembre de 2007 y tratados con PCA con opioides por vía venosa o epidural. Se definieron como casos de depresión respiratoria, frecuencia respiratoria d" 8 irpm, necesidad del uso de naloxona, o saturación periférica de oxígeno por debajo de un 90 por ciento. RESULTADOS: Fueron evaluados 2790 pacientes, de los cuales 635 pacientes recibieron PCA venosa y 2155, analgesia epidural. Se dieron siete casos de depresión respiratoria postoperatoria (incidencia de 0,25 por ciento). De ellos, seis pacientes fueron tratados con PCA venosa con morfina, mientras que el último recibió analgesia epidural con fentanil. El promedio de edad fue de 30,5 ± 24,7 años; el tiempo medio entre el término de la anestesia hasta el aparecimiento de la depresión respiratoria fue de 18,1 ± 26,3 horas. El aparecimiento de depresión respiratoria fue significativamente más frecuente en la PCA venosa con morfina (p = 0,001) y en una edad menor que 16 años (p < 0,05). CONCLUSIONES: La incidencia de depresión respiratoria encontrada fue similar a la descrita en la literatura, siendo más frecuente en niños y adolescentes con PCA venosa.

Oral midazolam as pre-anesthetic medication in children and teenagers with cerebral palsy. A comparative study on the variations of the bispectral index.

BACKGROUND AND OBJECTIVES: Midazolam is a benzodiazepine with hypnotic action widely used as pre-anesthetic medication in pediatric anesthesia. Children with cerebral palsy (CP) also benefit from the use of midazolam, but its effects on this group of patients, who present several particularities, including changes at the site of action of midazolam, are still unknown. The objective of this study was to evaluate the effects of midazolam, when used as pre-anesthetic medication, on the bispectral index (EEG-BIS) of patients with cerebral palsy. METHODS: Two groups of patients were evaluated: one group with the diagnosis of CP and the other without central and peripheral nervous system disorders. The EEG-BIS was recorded in the room, the day before the surgery and at the day of the surgery, 40 minutes after the administration of 0.6 mg.kg(-1) of oral midazolam. Patients with a history of paradoxal reaction to midazolam as well as patients in the control group who were using other medications were excluded. RESULTS: Seventy-seven patients of both genders, 4 to 18 years old, participated in this study. Differences in EEG-BIS between both groups were not detected. After the use of midazolam EEG-BIS decreased in both groups with a statistically significant difference in each group. Statistically significant intergroup differences were not observed. CONCLUSIONS: Midazolam, used as pre-anesthetic medication, at a dose of 0.6 mg.kg(-1), reduced basal EEG-BIS without characterizing hypnosis and without statistically significant differences between the study groups.

Midazolam por via oral como medicação pré-anestésica em crianças e adolescentes com paralisia cerebral: estudo comparativo das variações do índice bispectral / Midazolam por vía oral como medicación preanestésica en niños y adolescentes con parálisis cerebral: estudio comparativo de las variaciones del índice bispectral / Oral midazolam as pre-anesthetic medication in children and teenagers with cerebral palsy: a comparative study on the variations of the bispectral index

JUSTIFICATIVA E OBJETIVOS: O midazolam é um derivado benzodiazepínico com ação hipnótica e muito utilizado como medicação pré-anestésica em anestesia pediátrica. As crianças com paralisia cerebral (PC) também se beneficiam do uso do midazolam, mas seus efeitos são ainda desconhecidos sobre esse grupo de pacientes que apresentam uma série de particularidades, com alterações inclusive no local de ação do midazolam. O objetivo do estudo foi avaliar a ação do midazolam utilizado como medicação pré-anestésica sobre o índice bispectral (EEG-BIS) dos pacientes com paralisia cerebral. MÉTODO: Foram avaliados dois grupos de pacientes: um com diagnóstico de PC e outro sem doença do sistema nervoso central (SNC) e periférico. Foram registrados valores de EEG-BIS na enfermaria na véspera da operação e no dia da operação, 40 minutos depois da administração de 0,6 mg.kg-1 de midazolam via oral. Foram excluídos pacientes com história de reação paradoxal ao midazolam e pacientes do grupo-controle que estivessem em uso de outra medicação. RESULTADOS: Foram estudados 77 pacientes de ambos os sexos, entre 4 e 18 anos de idade. Não houve diferença entre os valores de EEG-BIS basal entre os grupos estudados. Após o uso do midazolam houve diminuição dos valores do EEG-BIS nos dois grupos estudados, com diferença estatística significativa em cada grupo. Na comparação entre grupos não houve diferença estatística. CONCLUSÕES: O midazolam administrado como medicação pré-anestésica na dose de 0,6 mg.kg-1 diminui os valores basais do EEG-BIS sem caracterizar hipnose e sem diferença estatística nos grupos estudados.

JUSTIFICATIVA Y OBJETIVOS: El midazolam es un derivado benzodiazepínico con acción hipnótica y muy utilizado como medicación preanestésica en anestesia pediátrica. Los niños con parálisis cerebral (PC) también se benefician del uso del midazolam, pero sus efectos todavía se desconocen sobre ese grupo de pacientes que presentan una serie de particularidades, con alteraciones inclusive en la región de la acción del midazolam. El objetivo del estudio fue evaluar la acción del midazolam utilizado como medicación preanestésica sobre el índice bispectral (EEG-BIS) de los pacientes con parálisis cerebral. MÉTODO: Se evaluaron dos grupos de pacientes: uno con diagnóstico de PC y el otro sin enfermedad del sistema nervioso central (SNC) y periférico. Se registraron valores de EEG-BIS en la enfermería en la víspera de la operación y el día de la operación, 40 minutos después de la administración de 0,6 mg.kg-1 de midazolam por vía oral. Quedaron excluidos pacientes con historial de reacción paradoxal al midazolam y pacientes del grupo control que estuviesen usando otra medicación. RESULTADOS: Se estudiaron 77 pacientes de ambos sexos, entre 4 y 18 años de edad. No hubo diferencia entre los valores de EEG-BIS basal entre los grupos estudiados. Después del uso del midazolam hubo una reducción de los valores del EEG-BIS en los dos grupos estudiados, con diferencia estadística significativa en cada grupo. En la comparación entre los grupos no hubo diferencia estadística. CONCLUSIONES: El midazolam administrado como medicación preanestésica en la dosis de 0,6 mg.kg-1 redujo los valores basales del EEG-BIS sin caracterizar la hipnosis y sin diferencia estadística en los grupos estudiados.

BACKGROUND AND OBJECTIVES: Midazolam is a benzodiazepine with hypnotic action widely used as pre-anesthetic medication in pediatric anesthesia. Children with cerebral palsy (CP) also benefit from the use of midazolam, but its effects on this group of patients, who present several particularities, including changes at the site of action of midazolam, are still unknown. The objective of this study was to evaluate the effects of midazolam, when used as pre-anesthetic medication, on the bispectral index (EEG-BIS) of patients with cerebral palsy. METHODS: Two groups of patients were evaluated: one group with the diagnosis of CP and the other without central and peripheral nervous system disorders. The EEG-BIS was recorded in the room, the day before the surgery, and at the day of the surgery, 40 minutes after the administration of 0.6 mg.kg-1 of oral midazolam. Patients with a history of paradoxal reaction to midazolam as well as patients in the control group who were using other medications were excluded. RESULTS: Seventy-seven patients of both genders, 4 to 18 years old, participated in this study. Differences in EEG-BIS between both groups were not detected. After the use of midazolam EEG-BIS decreased in both groups with a statistically significant difference in each group. Statistically significant intergroup differences were not observed. CONCLUSIONS: Midazolam, used as pre-anesthetic medication, at a dose of 0.6 mg.kg-1, reduced basal EEG-BIS without characterizing hypnosis and without statistically significant differences between the study groups.

A anestesia peridural torácica realizada com segurança no paciente anestesiado: estudo de uma série de casos / Thoracic epidural block performed safely in anesthetized patients: a study of a series of cases / Anestesia peridural torácica realizada con seguridad en el paciente anestesiado: estudio de una serie de casos

JUSTIFICATIVA E OBJETIVOS: O surgimento de casos de paraplegia seguindo a inserção de cateter peridural em pacientes anestesiados levou a questionamento por parte de alguns autores, mesmo que não se confirme que a lesão tenha ocorrido porque o paciente estava anestesiado. Por esse motivo, idealizamos este estudo, que teve como objetivo avaliar a freqüência de complicações neurológicas e de surgimento de seqüelas após anestesia peridural torácica realizada com os pacientes sob anestesia geral. MÉTODO: Participaram do estudo pacientes submetidos à intervenção cirúrgica torácica no período de 16/02/2004 a 30/05/2006. Após monitoração dos sinais vitais e realização da anestesia geral, os pacientes foram colocados em decúbito lateral e realizada anestesia peridural torácica simples ou contínua. Numa ficha especial foram registradas as intercorrências, complicações e dificuldades na realização da técnica. No pós-operatório os pacientes foram acompanhados em busca de sinais e sintomas de disfunção neurológica. RESULTADOS: Foram avaliados 113 pacientes e em 108 foi inserido cateter peridural torácico. Em 45 pacientes a punção foi considerada traumática, ou seja, sangramento no local da punção e punções múltiplas. Em dois pacientes houve perfuração acidental de dura-máter. No pós-operatório imediato um paciente relatou sensação de formigamento em membros inferiores, outro paciente apresentou dormência em membro superior, desaparecendo com a retirada e tração do cateter. A punção foi única nos dois casos. Nenhum outro paciente apresentou sinais ou sintomas de alterações neurológicas. CONCLUSÕES: Nos casos estudados não houve complicação neurológica. Quando executado com bom senso e cuidados específicos o bloqueio peridural torácico pode ser realizado com segurança no paciente anestesiado.

BACKGROUND AND OBJECTIVES: The development of paraplegia following the insertion of epidural catheter in anesthetized patients raised questions by some authors about the procedure, even without the confirmation that the lesion occurred because the patient was anesthetized. For this reason, we designed this study, with the objective to evaluate the frequency of neurological complications and development of sequelae after thoracic epidural block in patients under general anesthesia. METHODS: Patients undergoing thoracic surgeries from 02/16/2004 to 05/30/2006 participated in the study. After monitoring vital signs and the installation of general anesthesia, patients were placed in lateral decubitus for simple or continuous thoracic epidural block. Intercurrences, complications, and technical difficulties were recorded on a special form. Patients were followed postoperatively to detect the development of any signs and symptoms of neurological dysfunction. RESULTS: One hundred and thirteen patients were evaluated and the thoracic epidural catheter was placed in 108 patients. The puncture was considered traumatic, i.e., bleeding at the puncture site and multiple punctures, in 45 patients. Accidental perforation of the dura-mater occurred in two patients. In the immediate postoperative period, a patient complained of tingling in the lower limbs, another patient developed numbness in an upper limb, which resolved after the catheter was removed. Both patients had a single puncture. The other patients did not develop any signs or symptoms of neurologic changes. CONCLUSIONS: The cases studied here did not develop any neurologic complications. When performed judiciously and with specific care, thoracic epidural block can be safely done in the anesthetized patient.

JUSTIFICATIVA Y OBJETIVOS: El surgimiento de casos de paraplejia continuando la inserción de catéter peridural en pacientes anestesiados, hizo con que algunos autores se cuestionasen el hecho incluso cuando no se confirmase que la lesión haya ocurrido porque el paciente estaba anestesiado. Por ese motivo, idealizamos este estudio, que tuvo como objetivo evaluar la frecuencia de complicaciones neurológicas y el aparecimiento de secuelas después de la anestesia peridural torácica realizada con los pacientes bajo anestesia general. MÉTODO: Participaron en el estudio pacientes sometidos a la intervención quirúrgica torácica en el período de 16/02/2004 a 30/05/2006. Después de la monitorización de las señales vitales y de la anestesia general, los pacientes fueron puestos en decúbito lateral y fue realizada la anestesia peridural torácica simple o continua. En una ficha especial se registraron las intercurrencias, complicaciones y dificultades en la realización de la técnica. En el postoperatorio los pacientes tuvieron acompañamiento en busca de señales y de síntomas de disfunción neurológica. RESULTADOS: Se evaluaron 113 pacientes y a 108 de ellos se les insertó catéter peridural torácico. En 45 pacientes la punción fue considerada traumática, o sea, hubo sangramiento en el local de la punción y punciones múltiples. En dos pacientes hubo perforación accidental de duramadre. En el postoperatorio inmediato, un paciente relató una sensación de hormigueo en los miembros inferiores, otro paciente presentó adormecimiento en miembro superior, desapareciendo con la retirada y la tracción del catéter. La punción fue única en los dos casos. En ningún otro paciente hubo señales o síntomas de alteraciones neurológicas. CONCLUSIONES: En los casos estudiados no hubo complicación neurológica. Cuando se efectúa con sentido común y con los cuidados específicos, el bloqueo peridural torácico puede ser realizado con seguridad en el paciente anestesiado.