Monitorização dos níveis de consciência em anestesiologia / Consciousness level monitorization in anesthesia

A anestesia geral é o conjunto de vários estados fisiológicos, incluindo o estado de inconsciência. O receptor do ácido gama-aminobutírico, subtipo A, tem se revelado importante alvo de drogas anestésicas, na medida em que contribuiu para indução de sedação e inconsciência. O anestesiologista deve ter conhecimento dos mecanismos de ação dos fármacos na transmissão do sistema gabaérgico e saber utilizar os meios disponíveis para monitorizar a consciência do paciente anestesiado. Nesse contexto, os aparelhos que processam os sinais do eletroencefalograma têm se mostrado muito úteis na motorização da inconsciência.

Hemodilution in the surgical treatment of pressure sores / Hemodiluiçäo aplicada ao tratamento cirúrgico das escaras de decubito

The normovolemic hemodilution is one of the various methods available to reduce (or to abolish) the use of homologous blood during elective surgeries. Ten patients with pressure sores had plastic surgery without the need for allogeneic blood transfusion using this autotranfusion modality. After removal of a concentrated blood unit into a common collection bag, a quick infusion of isotonic solution in the proportion 4:1 is carried out up to hematocrit equal to or lower than 30 (per cent) inducing oligohemia. Consequently, blood lost during surgery has lower erythrocyte concentration, reducing spoliation and getting and improved tissue oxygenation. The blood collected is replaced at the end of intervention. The indications are those of an homologous transfusion or, at least, when it would be judicious to make a preoperative storage. The proposed method was considered equivalent to homologous transfusion in the cases operated, with the advantages of easy performance, no need for refrigeration, and no need of laboratorial tests before transfusion. In addition, the risk of immunological reactions and hematogenic transmission of infectious diseases is abolished.