10 semanas de treinamento de força melhoram quais capacidades físicas em adolescentes fisicamente ativos? / 10 weeks of strength training improve what physical capabilities in physically active adolescents?

o estudo teve como objetivo verificar as adaptações geradas pelo treinamento de força (TF) nos parâmetros neuromusculares e na composição corporal de adolescentes. A amostra foi composta por 10 adolescentes do sexo masculino (16,4 ± 1,0 anos), o protocolo de treinamento de força teve duração de 10 semanas com 3 sessões semanais, divididos em treinos A e B. Para comparação do desempenho, foram avaliadas variáveis antropométricas e composição corporal (estatura, peso, índice de massa corporal e percentual de gordura), bem como, neuromusculares, por meio da resistência muscular de membros superiores (teste de flexão de braços), força explosiva de membros inferiores (teste de salto horizontal), flexibilidade (teste de sentar e alcançar), e força muscular (supino, puxada e leg press 45º). Para comparar os resultados pré e pós intervenção foram utilizadas as diferenças de médias estandardizadas e seus respectivos intervalos de confiança (IC= 90%) e as probabilidades (maior/similar/menor). Foram encontrados aumentos substanciais entre os períodos pré e pós intervenção, para a resistência muscular localizada de membros superiores (92/7/1, Likely), um impacto benéfico de força no supino (86/11/2, Likely), puxada (82/15/3, Likely) e leg press 45° (84/14/2, Likely), e redução em média de 3% na gordura corporal. Os resultados contribuem para uma reflexão crítica em relação ao incentivo a prática de TF em adolescentes, pois com supervisão adequada, planejamento, individualização das cargas de treino e educação técnica correta de cada exercício, os riscos foram suprimidos e os benefícios amplificados.(AU)

Our aim was to investigate the adaptations caused by strength training (ST) in neuromuscular parameters and body composition of adolescents. The sample consisted of 10 male adolescents (16.4 ± 1.0 years) and the strength training protocol lasted 10 weeks with 3 weekly sessions, divided into training sessions A and B. Anthropometric variables and body composition (height, weight, body mass index and percentage of fat) as well as neuromuscular performance (upper limb endurance strength, horizontal jump height, flexibility and muscle strength in bench-press, lat pull-down and 45º leg press exercises). Pre- and post-intervention results were compared using standardized mean differences and their respective confidence intervals (CI = 90%) and likelihood (greater / similar / lower). Substantial increases were found between the pre- and post-intervention periods for upper-limb muscle endurance (92/7/1, Likely) and bench press (86/11/2, Likely), lat pull-down (82 / 15/3, Likely) and leg press (84/14/2, Likely) strength, while a beneficial reduction of 3% in body fat was observed. The results contribute to a critical reflection regarding the incentive to practice ST in adolescents. With proper supervision, planning, individualization of training loads and correct technical education of each exercise, the potential risks were suppressed and the benefits amplified.(AU)

Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial / Aplicação de protocolo e avaliação da incidência de curarização residual pós-operatória na ausência de aceleromiografia intraoperatória - Ensaio clínico randomizado

Abstract Objective Evaluate the incidence of postoperative residual curarization (PORC) in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). Methods Randomized clinical trial with 122 patients allocated into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6 mg·kg-1 and 10 mg, respectively); the use of rocuronium was avoided in the final 45 min; blockade reversal with neostigmine (50 µg·kg-1); time ≥15 min between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio <1.0. Results The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35 mg·kg-1·h-1, p = 0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0 min, p < 0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31 mg·kg-1·h-1, p = 0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0 min, p ≤ 0.01). Conclusion The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.

Resumo Objetivo Avaliou-se a incidência de curarização residual pós-operatória (CRPO) na sala de recuperação pós-anestésica (SRPA) após emprego de protocolo e ausência de aceleromiografia (AMG) intraoperatória. Métodos Ensaio clínico, aleatório, com 122 pacientes, distribuídas em dois grupos: protocolo e controle. Protocolo: dose inicial e adicionais de rocurônio foram de 0,6 mg.kg-1 e 10 mg, respectivamente; evitou-se o uso de rocurônio nos 45 minutos finais; reversão do bloqueio com neostigmina (50 µg.kg-1); tempo ≥ 15 minutos entre reversão e extubação. Controle: doses inicial e adicional de rocurônio, reversão do bloqueio, dose de neostigmina e momento da extubação decididos pelo anestesiologista. Foi usada AMG na SRPA e considerado CRPO razão T4/T1 < 1,0. Resultados A incidência de CRPO foi menor no grupo protocolo em relação ao controle (25% vs. 45,2%; p = 0,02). No grupo controle, a dose total de rocurônio foi maior em pacientes com CRPO em relação àqueles sem CRPO (0,43 vs. 0,35 mg.kg-1.h-1; p = 0,03) e o intervalo entre a última administração de rocurônio e a neostigmina foi menor (75,0 vs. 101,0 min; p < 0,01). No grupo protocolo não houve diferença dos parâmetros analisados (com CRPO vs. sem CRPO). Considerando toda a população de estudo e a presença ou não de CRPO, a dose total de rocurônio foi maior em pacientes com CRPO (0,42 vs. 0,31 mg.kg-1.h-1; p = 0,01), enquanto o intervalo entre a última administração de rocurônio e a neostigmina foi menor (72,5 vs. 99,0 min; p ≤ 0,01). Conclusão A sistematização proposta reduziu a incidência de CRPO na SRPA na ausência de AMG intraoperatória.

[Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial]. / Aplicação de protocolo e avaliação da incidência de curarização residual pós­operatória na ausência de aceleromiografia intraoperatória ­ Ensaio clínico randomizado.

OBJECTIVE: Evaluate the incidence of postoperative residual curarization (PORC) in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). METHODS: Randomized clinical trial with 122 patients allocated into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6mg.kg-1 and 10mg, respectively); the use of rocuronium was avoided in the final 45minutes; blockade reversal with neostigmine (50µg.kg-1); time ≥ 15minutes between reversion and extubation. CONTROL: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio<1.0. RESULTS: The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p=0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35mg.kg-1.h-1, p=0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0min, p<0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31mg.kg-1.h-1, p=0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0min, p ≤ 0.01). CONCLUSION: The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.

Use of neuromuscular blockers in Brazil / Uso de bloqueadores neuromusculares no Brasil

ABSTRACTThe objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers, focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of neuromuscular blockers. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main neuromuscular blockers used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to neuromuscular blockers were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to neuromuscular blockers. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.

RESUMOO objetivo desta pesquisa foi avaliar como os anestesiologistas brasileiros estão usando os bloqueadores neuromusculares (BNM), com foco na forma de estabelecer o diagnóstico da curarização residual pós-operatória e a incidência de complicações atribuídas ao uso de BNM. Um questionário foi enviado a anestesiologistas convidando-os a participar da pesquisa (tabela 1). A coleta online de dados permaneceu aberta de março de 2012 a junho de 2013. Durante o período de estudo foram coletadas 1.296 respostas. Rocurônio, atracúrio e cisatracúrio foram os principais bloqueadores neuromusculares usados em casos de cirurgia eletiva. Succinilcolina e rocurônio foram os principais BNM usados em casos de cirurgia de emergência. Menos de 15% dos anestesiologistas referiram que usam frequentemente monitores da função neuromuscular. Apenas 18% dos envolvidos no estudo referiram que todos os locais de trabalho têm tal monitor. A maioria dos entrevistados afirmou que usa somente o critério clínico para avaliar se o paciente está recuperado do relaxante. A maioria dos entrevistados também relatou que sempre usa algum tipo de reversão de bloqueio neuromuscular. As principais complicações atribuídas aos BNM foram curarização residual e bloqueio prolongado. Houve relato por 18 anestesiologistas de óbito atribuído a BNM. O bloqueio residual ou prolongado se registra, possivelmente, como consequência do alto índice do uso de critérios clínicos para diagnosticar se o paciente está recuperado ou não do bloqueio motor e, como um corolário, o baixo uso de monitores da transmissão neuromuscular na prática diária.

Use of neuromuscular blockers in Brazil.

The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers, focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of neuromuscular blockers. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main neuromuscular blockers used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to neuromuscular blockers were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to neuromuscular blockers. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.

Neuromuscular profile of Handball players during a short-term condensed competition in Brazil / Perfil neuromuscular de atletas de handebol durante curta competição no Brasil

Abstract The aim of this study was to assess the neuromuscular profile of handball (TH) players during a short-term condensed competition. Nine TH athletes (age: 23 ± 3 years; height: 176.2 ± 10.5 cm; mass: 75.3 ± 8.6 kg) played 5 handball matches in 5 consecutive days and had exercise-induced muscle damage (EIMD) markers such as soreness (SOR), thigh circumference (CIR), knee range of motion (ROM) and countermovement jump height (CMJ) collected before the first match and at the end of each day of competition. Changes over time in these markers were analyzed. Significant changes were found for all EIMD markers assessed. CMJ significantly decreased at the fourth day of competition when compared to baseline (0.41 ± 0.03 m vs. 0.45 ± 0.02 m). ROM decreased on the first day of competition and remained stable until the last day of competition (baseline: 126.5 ± 7.2º; 1st day: 115.8 ± 5.9º; 2nd day: 115 ± 7º; 3rd day: 113.9 ± 8.8º; 4th day: 114.4 ± 8.6º). SOR and CIR were increased at the second day of competition and remained altered thereafter. It was concluded that the characteristics of short-term condensed competition have led TH athletes to significant EIMD. If not avoided, EIMD might lead to reductions in performance in the most important (final) matches.

Resumo O objetivo do presente estudo foi medir o perfil neuromuscular de jogadores de handebol durante uma competição em formato de jogos. Nove jogadores de handebol (idade: 23 ± 3 anos; estatura: 176,2 ± 10,5 cm; massa: 75,3 ± 8,6 kg) jogaram cinco partidas da modalidade em cinco dias consecutivos e tiveram marcadores de DM [como percepção subjetiva de dor (PSD), circunferência da coxa (CIR), amplitude de movimento do joelho (ADM) e altura de salto com contra-movimento (AS)] coletados antes da primeira partida e ao final de cada dia de competição. Mudanças ao longo do tempo nesses marcadores foram analisadas. Alterações significantes foram encontradas para todos os marcadores de DM coletados. A AS diminuiu significantemente durante o quarto dia de competição, quando comparado ao valor basal (0,41 ± 0,03 m vs. 0,45 ± 0,02 m). A ADM diminuiu após o primeiro dia de competição e permaneceu comprometida até o último dia (basal: 126,5 ± 7,2º; 1o dia: 115,8 ± 5,9º; 2o dia: 115 ± 7º; 3odia: 113,9 ± 8,8º; 4o dia: 114,4 ± 8,6º). A PSD e a CIR apresentaram aumento durante o segundo dia de competição e permaneceram alteradas até o final da mesma. Concluímos que a característica condensada das competições de handebol no Brasil leva a um quadro de DM significante. Se não evitado, o DM pode levar a comprometimentos no desempenho nas partidas mais importantes da competição (finais).

[Use of neuromuscular blockers in Brazil]. / Uso de bloqueadores neuromusculares no Brasil.

The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers (NMB), focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of NMB. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main NMB used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to NMB were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to NMB. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.