Impaired microvascular reactivity in patients with chronic kidney disease submitted to kidney transplantation: a prospective observational study.

INTRODUCTION: The effect of kidney transplantation on endothelial dysfunction and autonomic dysfunction in uremia remains controversial, and few studies have evaluated this question. Endothelial dysfunction and autonomic dysfunction, both, can be assessed non-invasively using laser Doppler flowmetry (LDF). This study evaluated cutaneous microvascular blood flow and reactivity using LDF in patients undergoing kidney transplantation. METHODS: This prospective longitudinal cohort study involved forty patients with chronic kidney disease (CKD) undergoing kidney transplantation, compared with 40 patients without kidney disease. Using a laser Doppler flowmetry, post-occlusive reactive hyperemia (PORH) [resting flow, peak flow, ratio between peak and resting flow, hyperemic area, PORH index] and sympathetic constrictor response to inspiratory breath-hold [mean minimum inspiratory values] were evaluated. RESULTS: Resting flow (RF) and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values), were lower in the CKD group at one week and three months after transplantation (p<0.005). Mean minimum inspiratory values increase in the CDK group, three months after transplantation. CONCLUSION: Compared with controls with no CKD, in CKD patients undergoing kidney transplantation, microcirculation by laser Doppler flowmetry shows improvement after three months.

Predictive performance of thyromental height for difficult laryngoscopies in adults: a systematic review and meta-analysis

Abstract Background Thyromental height (TMH) was first reported as a great single test for prediction of difficult laryngoscopies, although further studies have shown variable estimates of its accuracy. We thus performed this meta-analysis to summarize the predictive values of TMH mainly for prediction of difficult laryngoscopies. Methods A search in PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included prospective cohorts fully reported with patients ≥ 16 years old, providing data on predictive values of TMH for prediction of either difficult laryngoscopies or difficult intubations. Diagnostic properties and association between TMH and Cormack and Lehanes's classification by direct laryngoscopy were evaluated. A random-effects meta-analysis using hierarchical models was performed. Results Eight studies evaluating 2844 patients were included. All included studies had high risk of bias and low concern regarding applicability. There was significant heterogeneity among the studies. The pooled diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios were as follows: DOR, 57.94 (95% CI: 18.19-184.55); LR+, 11.32 (95% CI: 4.28-29.92); and LR-, 0.23 (95% CI: 0.15-0.35). Summary sensitivity and specificity for studies with common threshold were 82.6 (95% CI: 74-88.8%) and 93.5 (95% CI: 79-98.2%), respectively. The estimated AUC was 81.1%. Conclusion TMH arises as a good predictor of difficult laryngoscopies in adult patients from diverse populations presenting better predictive values than most previously reported bedside tests. However, the high risk of bias throughout the studies may have skewed the results of the individual research as well as the summary points of the present meta-analysis.

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

Women with cancer and COVID-19: an analysis of lethality and clinical aspects in Pernambuco / Mulheres com câncer e COVID-19: uma análise da letalidade e aspectos clínicos em Pernambuco

Abstract Objectives: to analyze the lethality and clinical characteristics in Pernambuco women with neoplasia that were infected by SARS-CoV-2. Methods: a cross-sectional, retrospective study with female patients with neoplasm sin the state of Pernambuco registered and made available by the Secretariat of Planning and Management of the State of Pernambuco (SEPLAG PE). Secondary data from public domain notifications and the independent factors associated with death were analyzed through logistic regression. The value ofp<0.25 was considered significant in the bivariate analysis and for a multivariate analysis, the value ofp<0.05 was considered significant. Results: forty-nine women died. The mean age and standard deviation were 58.75 ± 20.93 years. 55.86% of the patients were 60 years old or more. The overall lethality rate was 72.06% (CI95%=59.8 - 82.2). The most prevalent symptoms were fever (70.59%), cough (58.82%), dyspnea (57.35%) and O2 saturation less than 95% (48.53%). Conclusions: female patients, with cancer and infected by SARS-CoV-2 are particularly susceptible to death, regardless of the presence of comorbidities or age, with peripheral O2 saturation <95% being the only independent factor associated with death in this group.

Resumo Objetivos: analisar a letalidade e características clínicas em mulheres pernambucanas portadoras de neoplasia que apresentaram infecção por SARS-CoV-2. Métodos: estudo de corte transversal, retrospectivo com pacientes do sexo feminino, portadoras de neoplasias no estado de Pernambuco com registros disponibilizados pela Secretaria de Planejamento e Gestão do Estado de Pernambuco. Analisou-se dados secundários de notificações de domínio público e os fatores independentes associados ao óbito através de regressão logística. Foi considerado significativo o valor de p<0,25 na análise bivariada e para a análise multivariada foi considerado significativo o valor de p<0,05. Resultados: quarenta e nove mulheres vieram a óbito. A média da idade e desvio padrão foram 58, 75 ± 20,93 anos. 55,86% das pacientes tinham 60 anos ou mais. A taxa de letalidade global foi de 72,06% (IC95%= 59,8 - 82,2). Os sintomas mais prevalentes foram febre (70,59%), tosse (58,82%), dispneia (57,35%) e saturação de O2 <95% (48,53%). Conclusão: pacientes do sexo feminino, com câncer e infectadas pelo SARS-CoV-2 são particularmente suscetíveis a óbito, independentemente da presença de comorbidades ou da idade, sendo a saturação periférica de O2 <95% o único fator independente associado ao óbito nesse grupo.

Subcutaneous Versus Intravenous Rehydration in Hospitalized Older Adults: A Meta-Analysis.

Subcutaneous rehydration is an optional infusion route in hospitalized older adults. This meta-analysis sought to compare the effectiveness of subcutaneous versus intravenous (IV) fluid administration to reverse mild-to-moderate dehydration in hospitalized older adults. A literature search was performed. No restrictions were imposed regarding language. Three randomized clinical trials conducted with patients 60 years of age or older treated with subcutaneous or IV rehydration were included, with a total sample size of 197 patients. Controlled quasi-randomized and crossover trials were excluded. The primary end point was reversal of dehydration. Secondary end points were patient satisfaction and frequency of adverse events (eg, cellulitis, edema, phlebitis, erythema, hyponatremia, and pain). Both treatments were effective in rehydrating the patients within 48 hours, with no statistically significant difference between the groups. Subcutaneous fluid administration effectively reversed dehydration while protecting against phlebitis. Since the quality of evidence was considerably low, further multicenter randomized clinical trials of efficient methodological quality should be conducted to consolidate the body of evidence.

Development, implementation and evaluation of a management specialization course in oncology using blended learning.

BACKGROUND: Identifying effective methods for safeguarding the efficient functioning of the healthcare system contributes significantly towards establishing a successful healthcare organization. Consequently, quality management programs are currently being implemented in healthcare as a vital strategy for patient care. Quality management encompasses protocols and guidelines in decision-making and in the evaluation of processes and treatment flowcharts, data analysis and health indicators, and addresses improvement in the interaction between different health professionals. Qualifying health professionals to perform quality management has represented a barrier to implementing a well-structured management system. Indeed, the pathway to qualifying health managers is often poorly outlined, with clear gaps in the definition of their competencies, training and career plans. Therefore, studies and education-related actions aimed at qualifying health professionals in management are vital if health services of excellence are to be established. The present study aimed to plan, develop, implement and evaluate a management specialization course in oncology using blended learning. METHODS: Following approval by the institution's internal review board, the study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was used to plan, develop, implement and evaluate the course. Data were collected as the course participants who had concluded all the modules evaluated the program. RESULTS: A management course in oncology, consisting of ten sequential modules, was developed and implemented between March 2018 and February 2019. The course consisted of monthly face-to-face encounters, each with 12 h of activities, and distance education using a virtual learning environment. Each module was presented by a specialist on the subject in question. After the end-of-course conclusion work had already been handed in and evaluated by the tutors, the participants completed a form to assess the course using Kirkpatrick's training evaluation model. CONCLUSIONS: A management course in oncology was developed using the ADDIE model. A high degree of satisfaction was found among the participants regarding improvements in their management skills and their professional behavior. The expectation is that this initiative will ultimately improve healthcare and reduce costs, as well as encourage further innovative educational actions for health professionals.

Ethanol Lock Therapy for the Prevention of Nontunneled Catheter-Related Bloodstream Infection in Pediatric Patients.

BACKGROUND: Ethanol lock therapy (ELT) has been reported as being effective in preventing central line-associated bloodstream infection (CLABSI) in tunneled (or long-term) central venous catheters (CVCs). To the best of our knowledge, no studies have evaluated this therapy in relation to nontunneled (or short-term) CVCs. OBJECTIVE: To evaluate the effectiveness of ELT in preventing CLABSI in nontunneled CVC in pediatric patients. METHODS: This randomized clinical trial was conducted with children aged 0-5 years and >2 kg in weight, in whom a double-lumen polyurethane nontunneled CVC had been inserted. Patients with catheters inserted in an emergency situation, critically ill patients, and/or those with a history of hypersensitivity or allergic reactions to ethanol were excluded from the study. The variables evaluated were CLABSI, etiological agents, adverse events, and the mechanical effects of ethanol on the catheter (breakage and obstruction). RESULTS: The CLABSI rate was lower in the ELT group compared with the control group (P = 0.0177). However, when the occurrence of CLABSI was evaluated per 1000 catheter-days, no significant difference was found between the groups (P = 0.077). The frequency of side effects and catheter breakage was greater in the ELT group (P = 0.0001 and P = 0.0005, respectively). CONCLUSIONS: The CLABSI rate was statistically significantly reduced in the ELT group compared with the controls, but the analysis of frequency per catheter-day showed no significant difference between the groups. Thus, we should not recommend ELT for CLABSI prophylaxis in nontunneled polyurethane CVC, which requires further clinical trials.

Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial

Abstract Introduction: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. Objective: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. Methods: A prospective observational study was carried out with 100 children aged 2-10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. Results: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p < 0.000). Conclusion: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Resumo Introdução Delírio ao despertar anestésico é um fenômeno clínico autolimitado muito comum em crianças. Apesar de fisiopatologia ainda incerta, alguns fatores parecem estar envolvidos, como despertar rápido em um ambiente desconhecido, agitação durante a indução anestésica, ansiedade pré-operatória, perturbações ambientais, uso de medicação pré-anestésica, uso de anestésicos inalatórios e dor pós-operatória. Objetivo Determinar a prevalência e os fatores de risco associados ao delírio ao despertar anestésico em crianças submetidas à cirurgia ambulatorial. Métodos Estudo observacional prospectivo, envolveu 100 crianças entre dois e 10 anos, submetidos à cirurgia em caráter ambulatorial. As variáveis de estudo foram: delírio ao despertar anestésico e os fatores de risco associados (ansiedade pré-operatória, comportamento impulsivo da criança, uso de medicação pré-anestésica, indução traumática, tipo de anestesia e dor pós-operatória). Foi feita a regressão multivariada de Poisson para análise das possíveis variáveis explanatórias, na qual foram estimadas as razões de prevalência com os respectivos intervalos de confiança de 95%, considerou-se o nível de significância de 5%. Resultados Delírio e dor foram observados em 27% e 20% das crianças respectivamente. Apenas a dor no pós-operatório, após a regressão de Poisson, mostrou ter uma associação com o delírio ao despertar anestésico, cuja razão de prevalência foi 3,91 (p < 0,000). Conclusão O presente estudo evidenciou uma prevalência de delírio ao despertar anestésico de 27% na população estudada. A incidência de delírio ao despertar anestésico foi maior em crianças que apresentaram dor no pós-operatório.

[Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery]. / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial.

INTRODUCTION: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. OBJECTIVE: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. METHODS: A prospective observational study was carried out with 100 children aged 2 to 10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. RESULTS: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p<0.000). CONCLUSION: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial.

PURPOSE: The purpose of this study is to evaluate the effectiveness of low-level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic stem cell transplantation. METHODS: This is a randomized, parallel, superiority trial including 35 patients divided into the following: laser (n = 17) and sham (n = 18). The variables assessed were oral mucositis (grade 2 of the World Health Organization oral toxicity scale), severe oral mucositis (grade 3 or 4), and pain (according to a visual analogue scale). In the laser group, a InGaAlP laser, wavelength of 650 nm, power 100 mW, energy per point of 2 J, time 20 s by point, extremity fiber optic 0.028 cm(2), and energy density 70 J/cm(2), was used, applied the first day of conditioning until D + 5, while the sham group received simulated laser over the same period. RESULTS: No statistically significant difference was found in the incidence of oral mucositis (p = 0.146). Severe mucositis was found in 40% of the patients (14/35), 3 in the intervention group (17.65%) and 11 in the sham group (61.11%) (p = 0.015). The cumulative probability of survival with respect to the development of severe oral mucositis was >0.6 for the intervention group and 0 for the control group (p = 0.0397). On the day on which pain was considered the worst, patients in the sham group were more likely to classify their pain as severe compared to those in the laser group (p = 0.041). CONCLUSION: Low-level laser therapy proved effective for the prevention of severe oral mucositis and intense oral pain in patients submitted to hematopoietic stem cell transplantation.

Is the anesthesiologist actually prepared for loss of airway or respiratory function? A cross-sectional study conducted in a tertiary hospital.

OBJECTIVE: To identify compliance with the procedures for securing the airway of patients submitted to anesthesia, defined as highly recommended in the World Health Organization Surgical Safety Checklist. METHODS: A prospective, cross-sectional, observational study was conducted with 87 patients aged 18 to 60 years, classified as ASA grade 1 or 2 according to the American Society of Anesthesiologists' Physical Status Classification. The study variables consisted of: whether the Mallampati test had been performed, whether equipment was readily available for orotracheal intubation, whether the correct placement of the endotracheal tube was verified, whether patient ventilation was monitored and whether fasting was confirmed. Prevalence ratios and their respective 95% confidence intervals were calculated as measures of relative risk. Statistical significance was defined at 5%. RESULTS: It was found that in 87.4% of patients, the airway was not evaluated using the Mallampati classification and in 51.7% of cases, preoperative fasting was not confirmed. In 29.9% of cases, the ready availability of equipment for orotracheal intubation was not verified. In all of the cases in which the availability of this equipment was not checked, the patient was submitted to regional anesthesia, with a statistically significant difference compared to the cases in which the patient was submitted to general anesthesia. CONCLUSION: Measures considered essential for the safety of the patient during surgery are still being ignored.

Is the anesthesiologist actually prepared for loss of airway or respiratory function? A cross-sectional study conducted in a tertiary hospital / O anestesiologista está efetivamente preparado para perda da via aérea ou da função respiratória? Um estudo de corte transversal em hospital terciário

Objective To identify compliance with the procedures for securing the airway of patients submitted to anesthesia, defined as highly recommended in the World Health Organization Surgical Safety Checklist. Methods A prospective, cross-sectional, observational study was conducted with 87 patients aged 18 to 60 years, classified as ASA grade 1 or 2 according to the American Society of Anesthesiologists’ Physical Status Classification. The study variables consisted of: whether the Mallampati test had been performed, whether equipment was readily available for orotracheal intubation, whether the correct placement of the endotracheal tube was verified, whether patient ventilation was monitored and whether fasting was confirmed. Prevalence ratios and their respective 95% confidence intervals were calculated as measures of relative risk. Statistical significance was defined at 5%. Results It was found that in 87.4% of patients, the airway was not evaluated using the Mallampati classification and in 51.7% of cases, preoperative fasting was not confirmed. In 29.9% of cases, the ready availability of equipment for orotracheal intubation was not verified. In all of the cases in which the availability of this equipment was not checked, the patient was submitted to regional anesthesia, with a statistically significant difference compared to the cases in which the patient was submitted to general anesthesia. Conclusion Measures considered essential for the safety of the patient during surgery are still being ignored. .

Objetivo Identificar a realização de procedimentos altamente recomendados para assegurar a via aérea de pacientes submetidos a anestesia, previstos no manual de segurança anestésica da Organização Mundial da Saúde. Métodos Realizou-se um estudo prospectivo do tipo transversal observacional, envolvendo 87 pacientes com idade entre 18 e 60 anos, ASA 1 e 2 de acordo com a classificação do Estado Físico pela Sociedade Americana de Anestesiologia. Variáveis estudadas: realização do teste de Mallampati, disponibilidade de material para intubação orotraqueal, confirmação do posicionamento do tubo endotraqueal, monitoração da ventilação do paciente e confirmação do jejum. Calculou-se a Razão de Prevalência (RP) e o seu Intervalo de Confiança a 95% (IC 95%) como medida do risco relativo. Adotou-se o nível de significância de 5%. Resultados Em 87,4% dos pacientes a via aérea não foi avaliada pelo teste de Mallampati e 51,7% não tiveram seus jejuns pré-operatórios confirmados, e em 29,1% das anestesias não se verificou a disponibilidade de material para intubação orotraqueal. Todos os casos em que não ocorreu esta verificação o paciente foi submetido à anestesia regional, com diferença significativa entre os grupos (p = 0.00). 95,8% dos pacientes tiveram a intubação orotraqueal confirmada pela capnografia e 68% tiveram esta confirmação realizada pela ausculta. Conclusão Medidas consideradas essenciais para a segurança do paciente durante a cirurgia ainda são negligenciadas. .

Prevalence of post-mastectomy pain syndrome and associated risk factors: a cross-sectional cohort study.

This study was designed to determine the prevalence of post-mastectomy pain and its associated risk factors in women submitted to surgical treatment for breast cancer. A cross-sectional cohort study was conducted involving 250 women treated surgically for breast cancer. The variables evaluated were (a) post-mastectomy pain syndrome (PMPS) (as a dependent variable or outcome) and (b) the patients' social characteristics (schooling, marital status), biological characteristics (body mass index, skin color, age), prior history of headache and dysmenorrhea, occurrence of acute postoperative pain, and type of surgery (mastectomy or quadrantectomy) (as independent or predictive variables). The prevalence ratios (PR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of the risk of PMPS. Multivariate analysis was performed using a hierarchical model of stepwise logistic regression that included possible explanatory variables, calculating the adjusted risk of PMPS from the odds ratio (OR) and the 95% CI at a significance level of 5%. PMPS was found in 44.4% of patients. The variables that remained strongly associated with PMPS following multiple logistic regression analysis were quadrantectomy with axillary lymphadenectomy (OR = 2.83; 95% CI: 1.60-5.02), prior history of headache (OR = 1.92; 95% CI: 1.10-3.34), and age <50 years (OR = 4.37; 95% CI: 2.43-7.86). PMPS is a common condition, particularly in women submitted to quadrantectomy with axillary lymphadenectomy, those under 50 years of age, and those with a prior history of headache. Attention should be paid to these factors at preoperative evaluation and counseling, and they should be taken into consideration in postoperative management.

Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial.

OBJECTIVE: The objective of this study was to compare maternal satisfaction with childbirth according to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. METHODS: A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE anesthesia while 35 received only non-pharmacological forms of pain relief during labor. The variables evaluated were visual analogue scale (VAS) pain score, maternal satisfaction with the technique of pain relief used during childbirth and with delivery, the patient's intention to request the same technique in a subsequent delivery, and loss of control during delivery. RESULTS: VAS pain score decreased significantly in patients receiving CSE during vaginal delivery. Furthermore, maternal satisfaction with the technique of pain relief and with delivery was higher in the CSE group, and around 97% of the patients would repeat the same technique at future deliveries compared to 82.4% of the women in the group using only non-pharmacological methods. With respect to the women's impressions of their control during delivery, approximately half the women in both groups felt that they had lost control at some point during the process. CONCLUSION: The use of CSE was associated with a significant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.

Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial / Anestesia combinada e métodos não farmacológicos para alívio da dor durante o trabalho de parto e satisfação materna: ensaio clínico randomizado

OBJECTIVE: The objective of this study was to compare maternal satisfaction with childbirth according to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. METHODS: A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE anesthesia while 35 received only non-pharmacological forms of pain relief during labor. The variables evaluated were visual analogue scale (VAS) pain score, maternal satisfaction with the technique of pain relief used during childbirth and with delivery, the patient's intention to request the same technique in a subsequent delivery, and loss of control during delivery. RESULTS: VAS pain score decreased significantly in patients receiving CSE during vaginal delivery. Furthermore, maternal satisfaction with the technique of pain relief and with delivery was higher in the CSE group, and around 97 percent of the patients would repeat the same technique at future deliveries compared to 82.4 percent of the women in the group using only non-pharmacological methods. With respect to the women's impressions of their control during delivery, approximately half the women in both groups felt that they had lost control at some point during the process. CONCLUSION: The use of CSE was associated with a significant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.

OBJETIVOS: Comparar a satisfação materna com o processo do nascimento de acordo com a realização ou não de métodos farmacológicos para alívio da dor do trabalho de parto. MÉTODOS: Realizou-se um ensaio clínico randomizado com 70 parturientes, 35 das quais receberam anestesia combinada (raquidiana e peridural associadas) e 35 receberam métodos não farmacológicos para alívio da dor durante o parto vaginal. As variáveis estudadas foram: escores de dor pela Escala Visual Analógica (EVA), satisfação materna com a técnica analgésica e com o parto, desejo de repetir a técnica analgésica em parto posterior e perda do controle sobre o parto. A análise estatística foi realizada no programa Epi-Info 3.5.3, com base na intenção de tratar. RESULTADOS: Pacientes recebendo anestesia combinada (AC) durante o parto vaginal experimentaram uma diminuição significativa dos escores da EVA e maior satisfação materna com a técnica analgésica e com o parto. A maioria das parturientes, cerca de 97 por cento do grupo da anestesia combinada, repetiu a técnica em partos futuros, contra 82,4 por cento do grupo dos métodos não farmacológicos. No que diz respeito ao sentimento de controle do parto, aproximadamente metade das parturientes dos dois grupos sentiu que em algum momento do parto perdeu o controle deste, não havendo diferença significativa entre os grupos. CONCLUSÃO: O uso da AC está associado a uma significante diminuição dos escores da dor durante o parto, e maior satisfação materna com a técnica analgésica e com o parto.

Uso da eletroestimulaçäo transcutânea para alívio da dor durante o trabalho de parto em uma maternidade-escola: ensaio clínico controlado / The use of transcutaneous nerve stimulation for pain relief during labor in a teaching hospital: a randomized controlled trial

Objetivos: determinar os desfechos maternos e neonatais de acordo com a aplicaçäo ou näo de estimulaçäo elétrica transcutânea (EET) para alívio da dor do trabalho de parto antes da instalaçäo da técnica combinada (raquianestesia + peridural). Métodos: realizou-se ensaio clínico, randomizado, aberto, envolvendo 22 parturientes, com gestaçäo a termo e feto único em apresentaçäo cefálica, atendidas em hospital-escola de nível terciário em Recife, Brasil. Estas pacientes foram randomizadas para receber ou näo EET antes da instalaçäo da anestesia combinada (raquianestesia + anestesia peridural) para analgesia de parto. Avaliaram-se a intensidade da dor pela escala analógica visual (EAV), o tempo transcorrido entre a avaliaçäo inicial e a necessidade de instalaçäo da anestesia combinada, a duraçäo do trabalho de parto, a freqüência de cesariana e parto instrumental, os escores de Apgar e a freqüência de hipóxia neonatal. Para análise estatística, foram utilizados os testes de Mann-Whitney e exato de Fisher, considerando-se o nível de significância de 5 por cento. Resultados: o tempo decorrido entre a avaliaçäo da dor da parturiente e a necessidade de instalaçäo da técnica combinada foi significativamente maior no grupo da EET (mediana de 90 minutos) quando comparado ao grupo controle (mediana de 30 minutos). A duraçäo do trabalho de parto foi similar nos dois grupos (em torno de seis horas). Näo houve diferença na evoluçäo dos escores de EAV durante o trabalho de parto. A freqüência de cesariana foi de 18,2 por cento nos dois grupos. Apenas um parto foi ultimado a fórcipe, no grupo controle. A mediana do escore de Apgar no quinto minuto foi 10, näo se encontrando nenhum caso de hipóxia neonatal. Conclusões: a aplicaçäo de EET foi efetiva em retardar a instalaçäo da anestesia combinada para manter analgesia satisfatória durante o trabalho de parto, porém näo apresentou efeito significativo sobre a intensidade da dor e a duraçäo do trabalho de parto. Näo houve efeitos deletérios maternos e neonatais