Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series.

INTRODUCTION: Anesthesia induction through volatile agents is a well-established technique in several fields but not in adult patients undergoing cardiac surgery. Successful inhalation induction requires a poorly soluble, reasonably potent and minimally irritant agent, and the benefits associated to this technique include reduced incidence of hypothermia and hypotension and lower costs when compared to some intravenous anesthetics agents. METHODS: Fifty-six patients undergoing coronary artery bypass grafting were observed at the induction of general anesthesia with sevoflurane in oxygen by facial mask. All patients received 2% sevoflurane in 100% oxygen initially for 30 seconds. The inspired concentration of sevoflurane was increased to 7% until loss of consciousness and then reduced back to 2%. Next, intravenous 0.5 µg/kg sufentanil and 0.1 mg/kg pancuronium were administered. Volume-controlled ventilation was started before tracheal intubation. RESULTS: All 56 patients tolerated the inhalational induction. No patient presented signs of airway irritation. Hypotension occurred in 30 patients and was managed with low dose phenylephrine. CONCLUSIONS: This case series showed that inhalation induction is feasible and safe even in adult patients undergoing cardiac surgery.

Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series

Introduction: Anesthesia induction through volatile agents is a well-established technique in several fields butnot in adult patients undergoing cardiac surgery. Successful inhalation induction requires a poorly soluble, reasonablypotent and minimally irritant agent, and the benefits associated to this technique include reduced incidenceof hypothermia and hypotension and lower costs when compared to some intravenous anesthetics agents.Methods: Fifty-six patients undergoing coronary artery bypass grafting were observed at the induction ofgeneral anesthesia with sevoflurane in oxygen by facial mask. All patients received 2% sevoflurane in 100%oxygen initially for 30 seconds. The inspired concentration of sevoflurane was increased to 7% until loss ofconsciousness and then reduced back to 2%. Next, intravenous 0.5 ìg/kg sufentanil and 0.1 mg/kg pancuroniumwere administered. Volume-controlled ventilation was started before tracheal intubation.Results: All 56 patients tolerated the inhalational induction. No patient presented signs of airway irritation.Hypotension occurred in 30 patients and was managed with low dose phenylephrine.Conclusions: This case series showed that inhalation induction is feasible and safe even in adult patientsundergoing cardiac surgery.

Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block.

BACKGROUND: The use of ultrasound (US) in regional anaesthesia enables a reduction in the local anaesthetic volume. The present study aimed to determine the minimum effective volume (MEV(90)) of 0.5% bupivacaine with epinephrine for interscalene brachial plexus block (ISBPB). METHODS: The volume of the anaesthetic was determined using a step-up/step-down method and was based on the outcome of the preceding block. A positive or negative block resulted in a 1 ml reduction or increase in volume, respectively. The success of the block was defined as the presence of motor block in three muscle groups and the absence of thermal and pain sensations in three dermatomes within 30 min of the injection. Diaphragmatic paralysis and analgesia were assessed at 30 min, 4, and 6 h. RESULTS: The MEV(90) for US-guided brachial plexus block under the conditions of the present study was 0.95 ml [R(2): 0.97, 95% confidence interval (CI): 0.6-1.22 ml]. The estimated maximum volume that did not cause diaphragmatic block was 4.29 ml (R(2): 0.84, 95% CI: 3.56-4.98 ml). Effective postoperative analgesia was achieved with 2.34 ml (R(2): 0.87, 95% CI: 0.48-11.47 ml). CONCLUSIONS: The MEV(90) of 0.5% bupivacaine with epinephrine (1:200 000) for US-guided ISBPB was 0.95 ml. Adequate postoperative analgesia and a reduced incidence of diaphragmatic block can be obtained using from 2.34 to 4.29 ml. ClinicalTrials.gov. Registry NCT01244932.

Estudo clínico näo comparativo do alfentanil / Alfentanyl non comparative clinical evaluation

Os autores avaliaram as repercussöes cardiorrespiratórias e a eficácia do bloqueio nociceptivo do alfentanil em pacientes ASA I e II, submetidos a cirurgias de pequeno e médio porte. Nas condiçöes deste estudo, foi observada estabilidade cardiovascular com bloqueio nociceptivo e tempo da recuperaçäo da consciência satisfatória, associados a intensa depressäo respiratória, necessitando de assistência ventilatória

Efeitos do cloridrato de morfina peridural na glicemia de pacientes submetidos a anestesia geral. / Effects of epidural morphine hydrochloride in glycemia of patients subjected to general anesthesia

Os autores estudaram as alteracoes glicemicas pre-operatorias de 36 pacientes com estado fisico ASA I, sem antecedentes diabeticos, com glicemia de jejum normal e que foram submetidos a cirurgias eletivas do abdomen superior.Os pacientes foram divididos em grupos A e B conforme eram levados ao centro cirurgico na hora da cirurgia ou uma hora antes, respectivamente.Os grupos A e B foram subdivididos em dois sub-grupos: A1 e B1 que constituiram o nosso grupos controle e A2 e B2 que receberam 5 mg de morfina no espaco peridural.No sub-grupo A2 injecao de cloridrato de morfina foi realizada logo apos a inducao anestesica e no sub-grupo B2, uma hora antes da inducao. A analise dos resultados mostrou aumentos significantes nos niveis glicemicos dos sub-grupos A1 e B2 e nas duas primeiras horas de cirurgia do sub-grupo A2 que se comportou depois de duas cirurgia, semelhante ao B2 cujos niveis glicemicos nao foram alterados significativamente

Tratamento da dor ocular cronica com infiltracao retrobulbar de metilmelubrina (dipirona). / Treatment of chronic pain of the eye with retrobulbar infiltration of methylmelubrin (dipyrone)

Os autores analisam os resultados do tratamento da dor ocular em olhos cegos, devidos a varias patologias, atraves de bloqueio do ganglio ciliar com infiltracao retrobulbar de metilmelubrina 50%. Nos primeiros casos foi utilizada metilmelubrina 50% sem anestesia local previa, e que provocava dor intensa e prolongada. Passou-se entao a fazer infiltracao previa com lidocaina 2%, que eliminou o desconforto apresentado pelos pacientes. Os resultados mostram que a injecao retrobulbar de metilmelubrina e um metodo eficiente de controle da dor ocular cronica e desprovido de efeitos colaterais e iatrogenicos importantes

Efeitos da injecao subaracnoidea de metilmelubrina sobre a medula do cao. / Effects of intrathecal injection of methylmelubrine on the spinal cord of dogs

Os autores estudaram experimentalmente o efeito da metilmelubrina sobre a medula do cao, com a finalidade de observar seu possivel efeito neurolitico. Os resultados mostraram necrose dos cornos anteriores e posteriores da area da medula que entrou em contato com a droga, com sinais irreversiveis durante o periodo de observacao dos animais

Ensino de anestesiologia na Escola Paulista de Medicina. / Teaching of anesthesiology at the Escola Paulista de Medicina

Os autores fazem uma exposicao da evolucao do ensino de Anestesiologia na Escola Paulista de Medicina em nivel de graduacao, especializacao e pos-graduacao (mestrado e doutorado). Discutem tambem os programas atuais dos respectivos niveis