Correlação entre os formatos da orofaringe e hipofaringe e posicionamento em intubação endotraqueal difícil

Background and objectivePrediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro–hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation.MethodThe consecutive 500 ASA (I, II) adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, Specificity, Positive and Negative Predictive Values were also reported.ResultsCormack–Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack–Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications.ConclusionFriedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre‐anesthetic prediction of difficult intubation where its involvement in Multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.     

Eficácia da pré-oxigenação usando respiração em volume corrente: uma comparação dos sistemas Mapleson A,Bain e Circular

Background

Efficacy of preoxygenation depends upon inspired oxygen concentration, its flow rate, breathing system configuration and patient characteristics. We hypothesized that in actual clinical scenario, where breathing circuit is not primed with 100% oxygen, patients may need more time to achieve EtO₂ ≥ 90%, and this duration may be different among various breathing systems. We thus studied the efficacy of preoxygenation using unprimed Mapleson A, Bain's and Circle system with tidal volume breathing at oxygen flow rates of 5 L.min^?1 and 10 L.min^?1.

Comparação entre ventilação garantida por volume controlado por pressão e ventilação controlada por volume em pacientes obesos durante cirurgia laparoscópica ginecológica na posição de Trendelenburg

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.     

Nefropatia por IgA e polimiosite: uma rara associação

Polymyositis is a systemic and idiopathic inflammatory myopathy that, besides muscle manifestation, may occur with respiratory involvement, gastrointestinal tract and rarely renal involvement. In this latter, there are only two cases of IgA nephropathy, but both in dermatomyositis. On the other hand, we reported, for the first time, a case of IgA nephropathy in polymyositis.     

Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom

Background and objectives

There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in‐plane or out of plane needle approach may be used for catheterization. Transverse short‐axis classic approach is the most popular performed approach in literature. “Syringe‐Free” is a new described technique that is performed with oblique long‐axis approach. We aimed to compare performance of these two approaches.

Comparação entre o laser de baixa potência,ultrassom terapêutico e associação,na dor articular em ratos Wistar

IntroductionBoth therapeutic ultrasound as a low level laser therapy are used to control musculoskeletal pain, despite controversy about its effects, yet the literature is poor and also presents conflicting results on possible cumulative effects of techniques association. The aim was to compare the antinociceptive effects of low level laser therapy, therapeutic ultrasound and the association.Methods24 Wistar rats were divided into: GPL – induction of hyperesthesia in the right knee, and untreated; GUS – treated with therapeutic ultrasound (1 MHz, 0.4 W/cm²) GL – low intensity laser (830 nm, 8 J/cm²); GL+US – treated with both techniques. To produce the hyperesthesia 100 μl of 5% formalin solution were injected into the tibiofemoral joint space, which was assessed by von Frey filament digital before (EV1), 15 (EV2), 30 (EV3) and 60 (EV4) minutes after induction.ResultsIn comparison within groups, for the withdrawal threshold when the filament was applied to the knee, the back to baseline was observed only for GUS. Comparisons between groups were not different in EV3, and GL was higher than GPL. In EV4 the three groups effectively treated were higher than placebo. On withdrawal threshold on the plantar surface, GL showed return to baseline values already in EV3, and GUS and GL+US returned in EV4. Comparing the groups in EV3 there was a significantly lower threshold to compare GPL with GL and GUS (p <0.05), and there was only EV4 differences when comparing GPL with GUS.ConclusionBoth modalities showed antinociceptive effects.     

Comparação entre a posição de rampa e posição olfativa durante intubação traqueal: revisão sistemática e meta‐análise

ObjectivesPositioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position.MethodsPubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from inception until January 2020. Our primary outcomes included laryngeal exposure as measured by Cormack‐Lehane Grade 1 or 2 (CLG 1/2), CLG 3 or 4 (CLG 3/4), and first attempt success at intubation. Secondary outcomes were intubation time, use of airway adjuncts, ancillary maneuvers and complications during ETI.ResultsSeven studies met our inclusion criteria, of which 4 were RCTs and 3 were cohort studies. The meta‐analysis was conducted by pooling the effect estimates for all 4 included RCTs (n = 632). There were no differences found between ramping and sniffing positions for odds of CLG 1/2, CLG 3/4, first attempt success at intubation, intubation time, use of ancillary airway maneuvers and use of airway adjuncts, with evidence of high heterogeneity across studies. However, the ramping position in surgical patients is associated with increased likelihood of CLG 1/2 (OR = 2.05, 95% CI 1.26 to 3.32, p = 0.004) and lower likelihood of CLG 3/4 (OR = 0.49, 95% CI 0.30 to 0.79, p = 0.004), moderate quality of evidence.ConclusionOur meta‐analysis demonstrated that the ramping position may benefit surgical patients undergoing ETI by improving laryngeal exposure. Large‐scale well‐designed multicentre RCTs should be carried out to further elucidate the benefits of the ramping position in the surgical and intensive care unit patients.     

Correlação entre variáveis demográficas e clínicas,e a gravidade da fibromialgia

IntroductionFibromyalgia (FM) is a rheumatic condition characterized by a picture of gener- alized chronic pain, hyperalgesia and allodynia. Symptoms such as fatigue, sleep disorders, morning stiffness, headache and paresthesia can also be present. It is also associated with other comorbidities, such as depression, anxiety, irritable bowel syndrome, myofascial pain syndrome and nonspecific urethral syndrome. Few studies have addressed the evolution of FM, especially regarding medium and long-term evolution, such as why some patients do better than others, despite the fact of being submitted to the same treatment.ObjectiveTo determine whether there is a correlation between demographic and clinical variables and FM severity.Material and methodsSixty women who met the classification criteria for FM of the Ameri- can College of Rheumatology of 1990 were divided into three groups, according to the sever- ity established by the Fibromyalgia Impact Questionnaire (FIQ): severe (70-100), moderate (50 to 70) and mild (0 to 50).ResultsNine demographic and clinical variables were assessed, with a significant differ- ence (P <0.05) being observed only in the groups showing higher FIQ scores with the pres- ence of depression and workers’ compensation interests.ConclusionThe impact of FM measured by the FIQ is directly correlated with the severity of depression and the presence of workers’ compensation interests.     

Bloqueio do plano abdominal transverso guiado por ultrassom em pacientes submetidos à colecistectomia laparoscópica: comparação da eficácia de bupivacaína e levobupivacaína no controle da dor pós‐operatória

Background and objective

The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound‐guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.

Relação entre o nível de hemoglobina e a atividade da doença em pacientes com artrite reumatoide

ObjectivesThis study aims to investigate the relationship of hemoglobin level with disease activity in patients with rheumatoid arthritis (RA).Patients and methodsThe hemoglobin level, the 66/68 joint count, the Disease Activity Score 28 joints (DAS28), the Health Assessment Questionnaire (HAQ), the Visual Analog Scales (VAS), the Modified Sharp Score (MSS), and the disease duration in 89 patients with RA were used to analyze the possible relationship. The World Health Organization (WHO) criteria for anemia uses a hemoglobin threshold of < 120 g/L for women and < 130 g/L for men. Pregnant or breastfeeding patients, patients with a history of other inflammatory or no inflammatory arthritis, malignancies, chronic infectious and inflammatory diseases and other diseases in the stage of decompensation were excluded from the study.ResultsAnemia was observed in 64% of the patients (1^st group); the other group (2^nd group) had normal levels of hemoglobin. There was a statistically significant negative correlation between hemoglobin level and swollen and tender joints’ count, DAS28, HAQ score, VAS, MSS, and disease duration (p < 0.001). DAS28, HAQ score, VAS, MSS, swollen and tender joints’ count and disease duration were significantly (p < 0.001) higher in 1^st versus 2^nd group.ConclusionIn conclusion, we determined that low hemoglobin level was significantly related to disability and impairment, disease activity, articular damage, pain and disease duration in RA patients in our study. We believe that by keeping disease activity under control, therefore preventing articular damage, the disability in RA patients can be lessened or possibly even eliminated.     

Associação entre perfusão periférica,microcirculação e mortalidade em sepse: uma revisão sistemática

Although increasing evidence supports the monitoring of peripheral perfusion in septic patients, no systematic review has been undertaken to explore the strength of association between poor perfusion assessed in microcirculation of peripheral tissues and mortality. A search of the most important databases was carried out to find articles published until February 2018 that met the criteria of this study using different keywords: sepsis, mortality, prognosis, microcirculation and peripheral perfusion. The inclusion criteria were studies that assessed association between peripheral perfusion/microcirculation and mortality in sepsis. The exclusion criteria adopted were: review articles, animal/pre‐clinical studies, meta‐analyzes, abstracts, annals of congress, editorials, letters, case‐reports, duplicate and articles that did not present abstracts and/or had no text. In the 26 articles were chosen in which 2465 patients with sepsis were evaluated using at least one recognized method for monitoring peripheral perfusion. The review demonstrated a heterogeneous critically ill group with a mortality‐rate between 3% and 71% (median = 37% [28%–43%]). The most commonly used methods for measurement were Near‐Infrared Spectroscopy (NIRS) (7 articles) and Sidestream Dark‐Field (SDF) imaging (5 articles). The vascular bed most studied was the sublingual/buccal microcirculation (8 articles), followed by fingertip (4 articles). The majority of the studies (23 articles) demonstrated a clear relationship between poor peripheral perfusion and mortality. In conclusion, the diagnosis of hypoperfusion/microcirculatory abnormalities in peripheral non‐vital organs was associated with increased mortality. However, additional studies must be undertaken to verify if this association can be considered a marker of the gravity or a trigger factor for organ failure in sepsis.     

Correlação entre a profundidade do espaço peridural medida no intraoperatório e a estimada por RM ou US: estudo observacional

Background and objectivesTo assess the agreement between the epidural depth measured from the surgical site with the epidural depths estimated with magnetic resonance imaging (MRI) and ultrasound scanning.MethodsFifty patients of either sex, scheduled for L4‐5 lumbar disc surgery under general anesthesia were enrolled in this prospective observational study, and the results of 49 patients were analyzed. The actual epidural depth was measured from the surgical site with a sterile surgical scale. The MRI‐derived epidural depth was measured from the MRI scan. The ultrasound estimated epidural depth was measured from the ultrasound image obtained just before surgery.ResultsThe mean epidural depth measured from the surgical site was 53.80 ± 7.67 mm, the mean MRI‐derived epidural depth was 54.06 ± 7.36 mm, and the ultrasound‐estimated epidural depth was 53.77 ± 7.94 mm. The correlation between the epidural depth measured from the surgical site and MRI‐derived epidural depth was 0.989 (r² = 0.979, p < 0.001), and the corresponding correlation with the ultrasound‐estimated epidural depth was 0.990 (r² = 0.980, p < 0.001).ConclusionsBoth ultrasound‐estimated epidural depth and MRI‐derived epidural depth have a strong correlation with the epidural depth measured from the surgical site. Preprocedural MRI‐derived estimates of epidural depth are slightly deeper than the epidural depth measured from the surgical site, and the ultrasound estimated epidural depths are somewhat shallower. Although both radiologic imaging techniques provided reliable preprocedural estimates of the actual epidural depth, the loss of resistance technique cannot be discarded while inserting epidural needles.     

Sedação com dexmedetomidina e remifentanil em anestesia local para monitoração intraoperatória da fala: um relato de caso

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.

A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro

Introduction

Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital‐acquired infection pathogens of ephedrine alone or combined with propofol.

Efeito da inclinação da mesa e flexão da coluna sobre a janela acústica da coluna lombar em mulheres grávidas

Study objective

The purpose of this study was to assess whether application of dorsal table tilt and body rotation to a parturient seated for neuraxial anesthesia increased the size of the paramedian target area for neuraxial needle insertion.

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.