Sistemas de classificação da gravidade da doença e mortalidade após cirurgia não cardíaca

Background

Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non‐cardiac surgery.

Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados

Background and objectives

Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM^® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery.

Impacto da hipotensão e hipoperfusão global sobre o delírio pós‐operatório: um estudo piloto com idosos submetidos à cirurgia aberta do cólon

Background

Post‐operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri‐operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri‐operative with the appearance of post‐operative delirium.

Valor preditivo das citocinas plasmáticas para lesão renal aguda após cirurgia de ressecção pulmonar: estudo observacional prospectivo

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.     

Papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose: estudo observacional retrospectivo

Background and objectivesThe study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis.MethodsRetrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC‐FMRP?USP). Medical charts of patients submitted to elective correction of scoliosis between January 1996 and December 2016 were analyzed. Variables assessed were: age, weight, sex, presence of comorbidities, data regarding anesthesia and surgery, lab data, adverse events and blood transfusion rate. The final sample consisted of 33 procedures performed by the same anesthesiologist and same surgeon, divided into two groups: Hemodilution Group (n = 16) and Control Group (n = 17). Indication of acute normovolemic hemodilution was determined by patient refusal of blood transfusion for religious reasons.ResultsThe sample was statistically homogeneous and the groups were compared in terms of the attributes analyzed. The volume of homologous blood used by the Hemodilution Group was significantly lower than the Control Group (p = 0.0016). The percentage of patients who required transfusion was 12.5% in the Hemodilution Group, while it was 70.69% (p = 0.0013) in the Control Group. Upon hospital discharge, mean values of hemoglobin and hematocrit between groups did not present significant differences (p = 0.0679; p = 0.1027, respectively).ConclusionsAcute normovolemic hemodilution, in scoliosis correction surgeries reduces blood transfusion rates, meeting patient needs without increasing adverse events or infection rates.     

O efeito de epinefrina,norepinefrina e fenilefrina no tratamento da hipotensão pós‐raquianestesia: estudo clínico comparativo

Background and objectivesLimited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal‐hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal‐hypotension and ephedrine requirement during cesarean delivery.MethodsOne hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 μg.mL^‐1 (n = 40), epinephrine 5 μg.mL^‐1 (n = 40), phenylephrine 100 μg.mL^‐1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of iv ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded.ResultsThere was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p < 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p = 0.001).ConclusionThere is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered as an alternative agent for management of spinal hypotension.     

Correlação entre síndrome da apneia obstrutiva e via aérea difícil na cirurgia otorrinolaringológica

Introduction

ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply.

Uso da buprenorfina transdérmica na dor aguda pós‐operatória: revisão sistemática

Background and objectivesPostoperative pain is still a major concern in several surgical procedures. Multimodal analgesia is best for postoperative pain management; however, opioid therapy is still the main treatment for pain after surgical procedures. Transdermal buprenorphine is a partial μ agonist opioid widely used for chronic pain syndromes, with limited evidence for acute postoperative pain. A systematic review of studies examining transdermal buprenorphine for acute pain management after surgery was conducted.ContentsData from PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL via EBSCOhost, and LILACS were reviewed, including randomized clinical trials that evaluated total postoperative pain, postoperative analgesic consumption, drug‐related side effects and patient satisfaction with analgesia regimen. Data from nine studies (615 patients) were included in this review. Most studies initiated transdermal buprenorphine use 6 to 48 hours before surgery, maintaining use from 1 to 8 days after the procedure. Most studies showed lower or similar postoperative pain scores, postoperative analgesic consumption and patient satisfaction comparing buprenorphine to placebo, tramadol, celecoxib, flurbiprofen and parecoxib. The incidence of side effects varied between studies, with most showing no increase in drug‐related side effects with buprenorphine use, except one study, which compared buprenorphine to oral tramadol, and one to transdermal fentanyl. However, most results were derived from evidence with an overall high or unclear risk of bias.ConclusionsAlthough more studies are necessary, initial results show that transdermal buprenorphine seems to be an effective and safe opioid choice for management of acute postoperative pain.     

Lidocaína em cirurgia oncológica: o papel do bloqueio dos canais de sódio dependentes de voltagem. Revisão narrativa

BackgroundThe current evidence suggests that oncological surgery, which is a therapy used in the treatment of solid tumors, increases the risk of metastasis. In this regard, a wide range of tumor cells express Voltage‐Gated Sodium Channels (VGSC), whose biological roles are not related to the generation of action potentials. In epithelial tumor cells, VGSC are part of cellular structures named invadopodia, involved in cell proliferation, migration, and metastasis. Recent studies showed that lidocaine could decrease cancer recurrence through its direct effects on tumor cells and immunomodulatory properties on the stress response.ObjectiveThe aim of this narrative review is to highlight the role of VGSC in tumor cells, and to describe the potential antiproliferative effect of lidocaine during the pathogenesis of metastasis.ContentsA critical review of literature from April 2017 to April 2019 was performed. Articles found on PubMed (2000 − 2019) were considered. A free text and MeSH‐lidocaine; voltage‐gated sodium channels; tumor cells; invadopodia; surgical stress; cell proliferation; metastasis; cancer recurrence − for articles in English, Spanish and Portuguese language − was used. A total of 62 were selected.ConclusionIn animal studies, lidocaine acts by blocking VGSC and other receptors, decreasing migration, invasion, and metastasis. These studies need to be replicated in humans in the context of oncological surgery.     

Eficácia de bupivacaína e associação com dexmedetomidina em bloqueio do plano transverso abdominal guiado por ultrassom na dor após cirurgia abdominal

Background and objectives

We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery.

Bloqueio contínuo do plano do eretor da espinha lombar para o controle da dor pós‐operatória em procedimento de revisão de cirurgia do quadril: relato de caso

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.     

Comparação da analgesia pós‐operatória com uso de metadona versus morfina em cirurgia cardíaca

Background and objectives

Pain is an aggravating factor of postoperative morbidity and mortality. The aim of this study was to compare the effects of methadone versus morphine using the numerical rating scale of pain and postoperative on‐demand analgesia in patients undergoing myocardial revascularization.

Os efeitos condrotóxicos e apoptóticos de levobupivacaína e bupivacaína na articulação do joelho de coelhos

Background

A single dose injection or continuous infusion of local anesthetics into the joint space is considered to be a well‐defined analgesia technique. The aim of this study was to investigate the chondrotoxic and apoptotic effects of single‐dose intra‐articular injection of levobupivacaine and bupivacaine on rabbit knee joint tissues.

Dissecção de aorta pós‐troca valvar mitral: o papel da ecocardiografia intraoperatória no diagnóstico

According to the most recent guidelines, the use of intraoperative transesophageal echocardiography in valvular surgeries is well established, as well as its use in the diagnosis, management, and rescue of perioperative complications. The aim of this case report is to illustrate a condition in which its intraoperative use had a positive influence on the outcome.     

Relação entre consumo de tabaco e concentração de monóxido de carbono na expiração com complicações respiratórias perioperatórias

Background

The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies.

Determinação da massa residual em ventrículo esquerdo por ecocardiografia transesofágica intraoperatória após ressecção de mixoma gigante e flutuante em átrio esquerdo

Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48‐year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected.     

Hematoma progressivo na região anterior do pescoço após tratamento endovascular de aneurisma da artéria cerebral média

Background

Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.

Avaliação da qualidade da recuperação e do estado de saúde no pós‐operatório de cirurgias eletivas

Purpose

Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery.

Índice de Analgesia/Nocicepção: avaliação da dor aguda pós‐operatória

Background and objectivesPatient self‐rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values.MethodsA total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated‐based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15^th minute of arrival to the Postoperative Care Unit the patients’ pain was rated on a 0-10 point Numerical Rating Scale. The patients’ heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined.ResultsThe study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤ 3, compared with Numerical Rating Scale > 3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p < 0.001). A significant negative linear relationship (r2 = ‐0.312, p = 0.001) was observed between analgesia nociception index and Numerical Rating Scale.ConclusionAnalgesia nociception index measurements at postoperative period after volatile agent and opioid‐based anesthesia correlate well with subjective Numerical Rating Scale scores.