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1.
Leonardo Riedi de Andrade Yara Marcondes Machado Castiglia 《Brazilian Journal of Anesthesiology》2018,68(5):521-523
Background and objective
Some surgical procedures such as laryngoplasty require patients to remain conscious during the intraoperative phase in order to enable speech monitoring. Dexmedetomidine and remifentanil were used in this study, since they promote appropriate patient collaboration with facilitated awakening, and are rapidly eliminated.Case report
The patient complained of dysphonia, which had resulted from unilateral vocal fold paralysis after previous thyroidectomy. The surgical treatment was performed under local anesthesia in association with sedation using dexmedetomidine and remifentanil. The patient was stable and cooperative during the entire intraoperative period, without desaturation and with rapid postoperative awakening.Conclusion
Dexmedetomidine and remifentanil can be used for safe sedation; however, the presence of an anesthesiologist is required during the entire intraoperative period. 相似文献2.
Adriana Rodrigues Petra Alves Carla Hipólito Helena Salgado 《Brazilian Journal of Anesthesiology》2019,69(5):514-516
Background and objectivesOne‐lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position.Case reportWe present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound.ConclusionUS is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion. 相似文献
3.
Caetano Nigro Neto Emerson Domingos da Costa Francisco José Lucena Bezerra Mariana Suete Guimarães Ruy Jose Leonardo Izquierdo Saurith João Henrique Zucco Viesi 《Brazilian Journal of Anesthesiology》2018,68(5):437-441
Background and objectives
Aortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full‐face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation.Methods
A case series observational study that included five patients with critical aortic stenosis that underwent inhalational anesthesia with sevoflurane for transcatheter aortic valve replacement in a hybrid room of a teaching hospital. Standard monitors and bispectral index were used, followed by inhalational induction and placement of the Janus mask. Anesthesia was maintained with sevoflurane. Patients were transferred to intensive care unit after the procedure. Complications related to the mask use, transesofageal echocardiography accessibility and respiratory implications to the patients were recorded.Results
All procedures were uneventful and no major complications were observed intraoperatively. One patient presented CO2 retention (50 mmHg) and sevoflurane leak around the central opening of the mask, both without clinical significance.Conclusions
The use of inhalational anesthesia with the facial mask Janus is a safe and efficient alternative to general anesthesia with tracheal intubation for transcatheter aortic valve replacement and can easily accommodate the use of transesophageal echocardiography intraoperatively. 相似文献4.
José Carlos Rodrigues Nascimento David Silveira Marinho Rodrigo Dornfeld Escalante Bodiyabaduge Emmanuel M. Daya Pereira Junior Cristiane Gurgel Lopes Rogean Rodrigues Nunes 《Brazilian Journal of Anesthesiology》2018,68(6):645-649
Introduction
Advanced hepatic disease may – in addition to the widely recognized hemorrhagic complications – occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (ROTEM®).Case report
A 56 year‐old male patient diagnosed with alcohol cirrhosis using warfarin (2.5 mg.day?1) for partial portal vein thrombosis with the International Normalized Ratio (INR) of 2.14. At the beginning of surgery, the ROTEM® parameters were all normal. In the anhepatic phase, EXTEM and INTEM remained normal, but FIBTEM showed reduction of amplitude after 10 min and maximum clot firmness. Finally, in the neohepatic phase, there was a slight alteration in the hypocoagulability of most of the parameters of the EXTEM, INTEM and FIBTEM, besides a notable correction of the Coagulation Time (CT) in HEPTEM compared to the CT of the INTEM. Therefore, the patient did not receive any transfusion of blood products during surgery and in the postoperative period, being discharged on the 8th postoperative day.Discussion
Coagulation deficit resulting from cirrhosis distorts INR as a parameter of anticoagulation adequacy and as a determinant of the need for blood transfusion. Thus, thromboelastometry can provide important information for patient management. 相似文献5.
Hala Saad Abdel‐Ghaffar Nawal Gad Elrab Abdel‐Aziz Mohamed Fathy Mostafa Ahmed Kamal Osman Nehad Mohamed Thabet 《Brazilian Journal of Anesthesiology》2018,68(3):266-273
Objectives
We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra‐oral infra‐orbital nerve block in children undergoing cleft lip surgeries.Methods
Sixty patients were randomly allocated into two groups (n = 30), Group B received infra‐orbital nerve block with 2 mL of 0.25% Bupivacaine and Group BK received 0.5 mg.kg?1 Ketamine for each side added to 1 mL of 0.5% Bupivacaine solution diluted up to 2 mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four‐point Agitation scores, analgesic consumption and adverse effects.Results
Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p < 0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p < 0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67 ± 45.67 vs. 240.0 ± 0.0 mg, p < 0.04). The time to first oral intake was significantly reduced in Group BK (87.67 ± 15.41 vs. 27.33 ± 8.68 min, p < 0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45 min (0.86 ± 0.11 vs. 0.46 ± 0.16, p < 0.04) and in the first hour (h) postoperatively (1.40 ± 0.17 vs. 0.67 ± 0.14, p < 0.003). Higher parent satisfaction scores were recorded in Group BK (p < 0.04) without significant adverse effects.Conclusions
The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra‐orbital nerve block in children undergoing cleft lip repair surgeries. 相似文献6.
Jong Ho Kim Young Joon Kim Ji Su Jang Sung Mi Hwang 《Brazilian Journal of Anesthesiology》2019,69(4):413-416
Background and objectivesUltrasound‐guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life‐threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm.Case reportWe describe a case of the successful endovascular repair of right subclavian artery injury in a 75‐year‐old woman. Subclavian artery was injured secondary to ultrasound‐guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery.ConclusionUnder general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action. 相似文献
7.
Jimmy L. Moss Benjamin W. Brown Sher‐Lu Pai Klaus D. Torp Stephen Aniskevich 《Brazilian Journal of Anesthesiology》2018,68(5):535-538
We describe an unusual case of hyperacute hepatic failure following general anesthesia in a patient receiving a simultaneous kidney‐pancreas transplant. Despite an aggressive evaluation of structural, immunological, viral, and toxicological causes, a definitive cause could not be elucidated. The patient required a liver transplant and suffered a protracted hospital course. We discuss the potential causes of fulminant hepatic failure and the perioperative anesthesia management of her subsequent liver transplantation. 相似文献
8.
《Brazilian Journal of Anesthesiology》2020,70(1):55-58
BackgroundVeno‐venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno‐venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot‐obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography.Case reportA 39 year‐old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno‐venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus‐like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later.DiscussionThe diagnosis of veno‐venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno‐venous extracorporeal membrane oxygenation. 相似文献
9.
María Lema Tome Francisco Andrés De la Gala Patricia Piñeiro Luis Olmedilla Ignacio Garutti 《Brazilian Journal of Anesthesiology》2018,68(3):225-230
Introduction
In last few years, emphasis was placed in goal‐directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one‐lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation.Methods
Prospective observational study, 112 patients undergoing lung resection surgery with one‐lung ventilation periods were included. Intravenous fluid therapy with crystalloids was set at 2 mL.kg?1.h?1. Hypotension episodes were treated with vasoconstrictive drugs. Two‐lung ventilation was implemented with a TV of 8 mL.kg?1 and one‐lung ventilation was managed with a TV of 6 mL.kg?1. Invasive blood pressure was monitored. We recorded the following cardiorespiratory values: heart rate, mean arterial pressure, cardiac index, stroke volume index, airway peak pressure, airway plateau pressure and static lung compliance at 3 different times during surgery: immediately after lung collapse, 30 minutes after initiating one‐lung ventilation and after restoration of two‐lung ventilation.Results
Stroke volume variation values were influenced by lung collapse (before lung collapse14.6 (DS) vs. OLV 9.9% (DS), p < 0.0001); or after restoring two‐lung ventilation (11.01 (DS), p < 0.0001). During two‐lung ventilation there was a significant correlation between airwaypressures and stroke volume variation, however this correlation lacks during one‐lung ventilation.Conclusion
The decrease of stroke volume variation values during one‐lung ventilation with protective ventilatory strategies advices not to use the same threshold values to determine fluid responsiveness. 相似文献10.
Ana Catarina Azevedo Isabel Flor de Lima Vânia Brito Maria João Centeno Antero Fernandes 《Brazilian Journal of Anesthesiology》2018,68(1):104-108
The extensive use of central venous catheters (CVC) in a hospital environment leads to increased iatrogenic complications, as more catheters are used enclosed and its maintenance is prolonged. Several complications are known to be related to central venous catheter, of which the uncommon cardiac tamponade (CT), hardly recognized and associated with high mortality.We present a clinical case, with favorable outcome, of a patient who developed a CT 17 days after CVC placement, and try to reflect on the measures that can be taken to reduce its incidence, as well as the therapeutic approaches to practice in the presence of a suspected CT. 相似文献
11.
Fábio Caetano Oliveira Leme Eduardo Toshiyuki Moro Alexandre Alberto Fontana Ferraz 《Brazilian Journal of Anesthesiology》2018,68(3):299-302
Background and objectives
Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia.Case report
Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye.Conclusions
During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely. 相似文献12.
《Brazilian Journal of Anesthesiology》2020,70(6):678-681
BackgroundOpioid‐free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid‐free infusions with a nociception monitor may be the solution.Case reportWe describe the feasibility and potential limitations of titrating opioid‐free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient's nociception‐antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids.ConclusionPersonalizing opioid‐free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort. 相似文献
13.
Blanca Elena Rios Gomes Bica Danilo Garcia Ruiz Priscilla de Andrade Magalhães Marlúcia Guimarães Barcellos Mário Newton Leitão de Azevedo 《REV BRAS REUMATOL》2013,53(6):535-537
The authors report a rare association case of juvenile idiopathic arthritis (JIA) and osteo- genesis imperfecta (OI) in a 53 years-old female patient, present a literature review and dis- cuss the radiological aspects of the temporo-mandibular joint involvement. To our knowl- edge, this is the first case report of JIA an OI association. 相似文献
14.
《Brazilian Journal of Anesthesiology》2020,70(1):51-54
Cockayne syndrome is an autosomal recessive multi‐systemic disorder due to DNA repair failure. It was originally described in 1936 in children of small stature, retinal atrophy and deafness, characterized by dwarfism, cachexia, photosensitivity, premature aging and neurologic deficits. The most typical feature is described as birdlike facies: protruding maxilla, facial lipoatrophy, sunken eyes, large ears and thin nose. Difficult airway management with subglottic stenosis and risk of gastric content aspiration has been described. Although the clinical characteristics of Cockayne syndrome have been well described in pediatric publications, there is only one report in the literature on anesthesia for an obstetric patient. We report the case of a pregnant patient diagnosed with Cockayne syndrome, submitted successfully to spinal anesthesia for a cesarean section due to cephalopelvic disproportion. In view of the difficult decision between inducing general anesthesia in a patient with a likely difficult airway, or neuraxial anesthesia in a patient with cardiovascular, respiratory and neurocognitive limitations, we suggest tailored management to reach the best results for the mother and newborn. 相似文献
15.
Claudia Hurtado Nazal Andrea Araneda Vilches Carolina Vergara Marín Karen García Contreras Carla Napolitano Valenzuela Pedro Badía Ventí 《Brazilian Journal of Anesthesiology》2018,68(6):637-640
Background
General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration.Objectives
To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature.Case report
53 year‐old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis.Conclusions
Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential. 相似文献16.
The number of total hip arthroplasty cases performed each year continues to increase; accordingly, so does the number of revision total hip arthroplasty procedures. While our traditional method of analgesia for these patients has involved multimodal medications and a continuous lumbar plexus block, we report two cases of patients who received continuous lumbar erector spinae plane blocks. Both patients exhibited excellent pain control postoperatively and were able to discharge home on postoperative day one. This case report illustrates the possible utility of continuous erector spinae plane blocks for postoperative analgesia in the more frequently occurring revision total hip arthroplasty surgeries. 相似文献
17.
Cristina Monteserín Matesanz Francisco de la Gala Lisa Rancan Patricia Piñeiro Carlos Simón Alberto Tejedor Elena Vara Jorge L. Gonzalez‐Cantero Ignacio Garutti 《Brazilian Journal of Anesthesiology》2019,69(3):242-252
Background and objectivesPatients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury.MethodsWe prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra‐operative periods of one‐lung ventilation. Fiberoptic broncho‐alveolar lavage was performed in each lung before and after one‐lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. Acute kidney injury was diagnosed within 48 h of surgery based estabilished criteria for its diagnosis. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re‐admission, and short‐term and long‐term mortality.ResultsThe incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery, but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin‐6 at 6 h was the most predictive cytokine of acute kidney injury (cut‐off point at 4.89 pg.mL?1).ConclusionsIncreased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin‐6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery. 相似文献
18.
《REV BRAS REUMATOL》2014,54(6):474-482
IntroductionRheumatoid arthritis (RA) is a disease characterized by inflammation of the synovial membrane. Several authors have investigated the role of positron emission tomography (PET) with fluorine‐18 fluorodeoxyglucose (18F‐FDG) in RA.ObjectivesTo systematically review the current literature on the role of 18F‐FDG PET in the diagnosis, determination of disease activity and assessment of treatment response in patients with RA.MethodsSearches were conducted in Medline, Cochrane Library, Lilacs, Pubmed and Scopus in Portuguese, English and Spanish languages, using the keywords «rheumatoid arthritis», «synovitis», «FDG», «PET», «glycolytic metabolism» and «disease activity».Results142o articles were initially identified, of which only 40 were related directly to the subject. Twelve original articles and three case reports that met the inclusion criteria were selected.DiscussionThe presence of activated macrophages and fibroblasts in pannus are responsible for the intense periarticular uptake of 18F‐FDG. The uptake patterns do not allow the differential diagnosis with other arthritides. The uptake intensity and the number of joints involved are metabolic parameters of disease activity that correlate well with the composite indices. Longitudinal studies of PET have proven useful in assessing the response to treatment with anti‐TNF. When performed early, PET can predict the therapeutic response.ConclusionAlthough the actual role of this new technique for the investigation of RA is not yet established, 18F‐FDG PET is a promising tool in determining the activity and prediction of response to treatment of patients with RA. 相似文献
19.
《Brazilian Journal of Anesthesiology》2019,69(6):553-560
Background and objectivesThe aim of this study was to investigate the efficacy of the pressure‐controlled, volume‐guaranteed (PCV‐VG) and volume‐controlled ventilation (VCV) modes for maintaining adequate airway pressures, lung compliance and oxygenation in obese patients undergoing laparoscopic hysterectomy in the Trendelenburg position.MethodsPatients (104) who underwent laparoscopic gynecologic surgery with a body mass index between 30 and 40 kg.m-2 were randomized to receive either VCV or PCV‐VG ventilation. The tidal volume was set at 8 mL.kg-1, with an inspired oxygen concentration of 0.4 with a Positive End‐Expiratory Pressure (PEEP) of 5 mmHg. The peak inspiratory pressure, mean inspiratory pressure, plateau pressure, driving pressure, dynamic compliance, respiratory rate, exhaled tidal volume, etCO2, arterial blood gas analysis, heart rate and mean arterial pressure at 5 minutes after induction of anesthesia in the and at 5, 30 and 60 minutes, respectively, after pneumoperitoneum in the Trendelenburg position were recorded.ResultsThe PCV‐VG group had significantly decreased peak inspiratory pressure, mean inspiratory pressur, plateau pressure, driving pressure and increased dynamic compliance compared to the VCV group. Mean PaO2 levels were significantly higher in the PCV‐VG group than in the VCV group at every time point after pneumoperitoneum in the Trendelenburg position.ConclusionsThe PCV‐VG mode of ventilation limited the peak inspiratory pressure, decreased the driving pressure and increased the dynamic compliance compared to VCV in obese patients undergoing laparoscopic hysterectomy. PCV‐VG may be a preferable modality to prevent barotrauma during laparoscopic surgeries in obese patients. 相似文献
20.
Rocco D’Andrea Guido Gambetti Lorenzo Querci Beatrice Amodei Amedeo Bianchini 《Brazilian Journal of Anesthesiology》2018,68(6):650-652