Síndrome de Horner transitória após bloqueio paravertebral em injeção única

Background

Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck.

Vasculite associada à ANCA e leucemia linfocítica crônica: uma rara associação

The aim of the present work is to discuss the report of a patient who had simultaneous diagnosis of two rare diseases, vasculitis related to antineutrophil cytoplasmic antibodies and chronic lymphocytic leukemia. Both are diseases that may be multisystemic and thus cause diagnostic confusion. In this case, the patient had renal, pulmonary, hematological, and ocular symptoms, which could be secondary to vasculitis both as to leukemia. With the aid of imaging studies, pathological studies, immunohistochemistry and immunopheno- typing, we conclude that it was a combination of the two diseases. There are other reports in literature of this association, however, with pANCA positive, this is the first report of chronic lymphocytic leukemia associated with cANCA positive vasculitis.     

Implementação de atendimento ambulatorial para dor crônica: resultados preliminares

Background and objectivesPain is one of the most common reason for seeking medical care. This study aimed to analyze patients with chronic pain in Maricá, Rio de Janeiro State, Brazil.MethodsA transversal retrospective study with 200 patients, who were treated in ambulatory care in a public hospital from June 2014 to December 2015. The variables analyzed were: pain intensity, type of pain, anatomical location, diagnosis and treatment. The data were submitted to statistical analysis, the Fisher's exact test was applied, and the probability p was significant when ≤0.05.ResultsWe analyzed 200 patients with chronic pain, most of them female (83%). Mean age was 58.6 ± 13.01 years old. The patients were classified in groups by age, six groups with ten years of difference between them. Main age range was the 50‐59 years old group, with 49 females (32%) and 5 males (15%). About 65.5% of the total of patients (131) had severe pain (Numeric Rating Sacale was 9.01). Mixed pain was predominant, affecting 108 patients (92 females and 16 males, what represents 55% and 47% of the total of females and males, respectively, that participate in the study). The most prevalent anatomical pain (159 patients, 131 females and 28 males) was in the lower limbs. Lower back pain was present in 113 of the 200 patients (94 females and 19 males). In the 30‐39, 50‐59, 60‐69 years old group, the results for pain locations were significant: p = 0.01, p = 0.0069, p = 0.0003, respectively.ConclusionThe prevalence of chronic pain was associated with females in 50–59 years old and severe mixed pain. It was located mainly in lower limbs and lumbar region. The most frequent diagnosis was low back pain followed by fibromyalgia. The patients were informed about their disease and treatment.     

Condrólise de quadril em uma adolescente: evolução clínica e radiológica

Idiopathic chondrolysis of the hip is a rare condition of unknown etiology characterized by progressive destruction of the hyaline cartilage that covers the femoral head and acetabulum. Idiopathic chondrolysis of the hip has an insidious beginning and affects more often female adolescents. Patients report severe hip pain, mobility limitation, and even claudication. This study aimed at reporting one case of that rare disease: an 11-year-old female adolescent with chondrolysis, followed up for three years. Inflammatory activity tests were normal. Imaging tests (radiography, ultrasonography and magnetic resonance) were essential for the diagnosis. The treatment was based on pain control and preservation of the joint mobility, and included low-impact physical activity, non-steroidal anti-inflammatory drugs, and disease-modifying antirheumatic drugs, with good response after 12 months of treatment. Surgery was not necessary.     

Correção endovascular de lesão de artéria subclávia secundária à cateterismo de veia jugular interna: relato de caso

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.     

Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal

Background and objective

There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow‐up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District.

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.

Protocolo para avaliação física em portadores de síndrome de fibromialgia

IntroductionFibromyalgia Syndrome (FMS) is a chronic disease that causes pain and fatigue, presenting a negative impact on quality of life. Exercise helps maintaining physical fitness and influences directly on the improvement of quality of life.ObjectiveDevelop a protocol for health-related physical fitness assessment of patients with FMS with tests that are feasible and appropriate for this population.MethodAn exploratory and analytical literature review was performed, seeking to determine the tests used by the scientific community. With this in mind, we performed a literature revision through the use of virtual libraries databases: PubMed, Bireme, Banco de Teses e Dissertações da Capes and Biblioteca Digital Brasileira de Teses e Dissertações, published in between 1992-2012.ResultsA variety of tests was found; the following, by number of citations, stood out: Body Mass Index (BMI) and bioimpedance; 6-minute walk; handgrip strength (dynamometer, 1 RM [Repetition Maximum]); Sit and reach and Shoulder flexibility; Foot Up and Go, and Flamingo balance.ConclusionThese are the tests that should make up the protocol for the physical evaluation of FMS patients, emphasizing their ease of use.     

Anestesia para cesárea em gestante com síndrome de Cockayne: relato de caso

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.     

Provável embolia letal por gás argônio durante ressecção de fístula cutânea biliar ‐ relato de caso

BackgroundThe Argon Beam Coagulator (ABC) achieves hemostasis but has potential complications in the form of argon gas embolisms. Risk factors for embolisms have been identified and ABC manufacturers have developed guidelines for usage of the device to prevent embolism development.Case reportA 49 year‐old male with history of recurrent cholangiocarcinoma status post resection presented for resection of a cutaneous biliary fistula. Shortly after initial use of the ABC, the patient underwent cardiac arrest. After resuscitation, air bubbles were observed in the left ventricle via Transesophageal Echo (TEE).ConclusionAlthough argon embolisms have been described more commonly during laparoscopies, this patient most likely experienced an argon gas embolism during an open resection of a cutaneous biliary fistula via the biliary tract or vein with possible transpulmonary passage of the embolism. Consequently, a high degree of suspicion should be maintained for an argon gas embolism during ABC use in laparoscopic, open, and cutaneous surgeries.     

Avaliação da agregação plaquetária em presença de anticorpos antifosfolípides: anti-β2GP1 e anticardiolipina

IntroductionThe antiphospholipid syndrome (APS) is an autoimmune condition characterized by recurrent arterial and venous thrombosis, besides obstetric complications. The pathogenesis is associated with the presence of antiphospholipid and/or anti-b2-glicoprotein I (anti-b2GPI) antibodies that appear to change the anticoagulant activity of b2GPI. Antibody-induced dimerization of b2GPI seems to be related to the induction of platelet aggregation, contributing to the development of thrombosis in APS.ObjectivesThe objective of the present study is to demonstrate the influence of antiphospholipid antibodies in platelet aggregation tests with different agonists (ADP, collagen, and adrenaline).MethodsWe analyzed platelet aggregation tests with different agonists (ADP, collagen, adrenalin) when normal platelets were exposed to serum with different concentrations of antiphospholipid antibodies.ResultsResults demonstrated a significant inhibition in adrenalin- and ADP-induced platelet aggregation curves (P < 0.05) in all antibody concentrations tested when compared to the control. The paradox between the prothrombotic state and the presence of autoantibodies that show anticoagulant activity in vitro was demonstrated in the literature, making it difficult to understand the pathophysiologic mechanism of the antiphospholipid syndrome.ConclusionResults showed that anticardiolipin and anti-b2GPI antibodies-rich serum, both of which belonging to the IgG class, can interfere with platelet aggregation curves.     

Estudo randomizado e controlado de uma intervenção terapêutica grupal em pacientes com síndrome fibromiálgica

ObjectiveTo evaluate the efficacy of a weekly interdisciplinary program (WIP) consisted of educational activities, physical therapy, stretching, ergonomics, posture guidance combined with cognitive behavioral strategies and approaches to psychosocial and occupational factors in order to determine whether this intervention would be effective to short and medium‐term improvement of symptoms in these patients.MethodsThis was a single‐center study, randomized single blind controlled trial with a sample test group (T), with a diagnosis of FMS (n = 12), and a control group (C) subjected to Pain Clinic referral (n = 15). The instruments used at two different times were the Fibromyalgia Impact Questionnaire (FIQ), Visual Analogue Scale (VAS) and Post‐Sleep Protocol (PSI). To assess quality of life, we used the SF‐12.ResultsIn samples, both groups were predominantly female, mean age of 42.5 ± 9.8 years, 43% married, average schooling of 8.3 ± 4.5 years. It was reported a mean of 4.2 years pain and an average of two years for the diagnosis of SFM from the group T. There was statistical difference between the groups in terms of efficacy post intervention WIP, in almost all outcome measures.ConclusionIt was found that weekly interdisciplinary program (WIP) has contributed to improving the quality of life of patients with fibromyalgia.     

A ação analgésica da lidocaína intravenosa no tratamento da dor crônica: uma revisão de literatura

BackgroundPain is a public health problem, greatly impairing quality of life. Almost 80% of patients with chronic pain reported that their pain interferes with activities of daily living, and two thirds reported that the pain causes negative impact on their personal relationships. The physical and functional disability, whether temporary or permanent, compromises the professional activity and causes work absenteeism, increasing costs of health systems.ObjectivesThe aim of this review is to analyze, based on the literature, the analgesic effect of lidocaine administered intravenously for the treatment of chronic pain and to evaluate the reduction of pain intensity in patients with chronic pain, focusing on musculoskeletal and neuropathic etiology.MethodologyThe method used was a review of the literature, consisting in searching the scientific literature on the efficacy of intravenous lidocaine infusion in the treatment of patients with chronic pain.ContentOf the 19 studies reviewed, 12 had results that confirm the analgesic effect of intravenous lidocaine in patients with chronic pain. Most authors used doses of 5 mg/kg infused for 30 minutes or more, producing significant analgesia with variable duration (minutes to weeks).ConclusionsBased on the literature review, it is not possible to uniformly specify the most effective and safe dose of lidocaine administered intravenously for the treatment of neuropathic or musculoskeletal pain. As for effectiveness, the intravenous infusion of lidocaine as an alternative for the treatment of chronic pain of various etiologies seems very promising, but further studies need to be conducted.     

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.     

Anestesia geral sem opioide e recuperação induzida da anestesia em paciente com distrofia miotônica tipo‐1: relato de caso

Myotonic dystrophy type‐1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine‐based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.     

A aplicação desnecessária de cateterização venosa central em pacientes cirúrgicos

Background and objectives

Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement.

Tamponamento cardíaco: uma complicação rara da cateterização venosa central – relato de um caso clínico

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.     

Memória olfativa de curta duração e função olfativa após anestésicos inalatórios: estudo clínico randomizado

Background and objectivesThis clinical trial aimed to evaluate the effects of two different inhalation anesthetic agents on postoperative olfactory memory and olfactory function in patients who underwent micro laryngeal surgery.MethodsThis randomized prospective controlled study consisted of 102 consecutive patients with a voice disorder. The patients underwent micro laryngeal surgery for voice disorders under general anesthesia. Patients who did not meet inclusion criteria and/or declined to participate (n = 34) were excluded from the study. Patients were divided into two groups. Four patients from Group 1 and four patients from Group 2 were lost to follow‐up. Group 1 (n = 30) received sevoflurane, and Group 2 (n = 30) received desflurane during anesthesia. We compared the results by performing the pre‐op and post‐op Connecticut Chemosensory Clinical Research Center Olfactory test.ResultsThirty‐three patients (55%) were male and 27 (45%) were female. The mean age was 48.18 ± 13.88 years (range: 19‐70 years). Preoperative and postoperative olfactory functions did not show a significant difference within the groups postoperatively (p > 0.05). Preoperative and postoperative olfactory memory showed a significant decrease 3 hours after the surgery (p < 0.05).ConclusionsOlfactory functions and memory were not affected by desflurane in the early postoperative period. Although sevoflurane did not affect olfactory functions, it had a temporary negative effect on olfactory memory in the early postoperative period.     

Síndrome de abstinência de ropivacaína: relato de caso

Introduction and objectivesRopivacaine is a long‐acting local anesthetic that causes prolonged anesthesia and is beneficial for a wide variety of surgeries. Systemic toxicity has been reported after usage of high dose ropivacaine or inadvertent intravascular administration. We report a case of ropivacaine withdrawal, which to our knowledge has not been previously described in the literature.Case reportThe patient presented to our department with uncontrolled belt‐like upper‐abdominal pain, self‐rated as a 9/10 on the numeric rating scale. We decided to use continuous epidural analgesia with ropivacaine through a multi‐port epidural catheter. Pain was well controlled for one month without significant adverse effects. However, ropivacaine unexpectedly ran out and two hours later the patient developed agitation, generalized tremor, tachycardia, and tachypnea. These symptoms resolved 30 minutes after reinitiating epidural ropivacaine.DiscussionOur hypothesis of ropivacaine withdrawal was related to the timing of symptoms in relation to drug administration over two episodes. The possible mechanism of the observed withdrawal syndrome is upregulation of voltage‐gated sodium channels after prolonged inhibition, resulting in increase in sodium influx and genetic variation.     

Anestesia geral para Síndrome de Crisponi: relato de caso

Crisponi syndrome is a rare and severe heritable disorder characterised by muscle contractions, trismus, apnea, feeding troubles, and unexplained high fever spikes with multiple organ failure. Here we report perioperative care for endoscopic gastrostomy of a 17 month‐old female child with Crisponi syndrome. Temperature in the surgery room was strictly monitored and maintained at 19 °C. The patient was exposed to both inhaled and intravenous anesthetic agents. Surgical and perioperative periods were uneventful. Episodes of fever in Crisponi syndrome arise from CRLF1 mutation, which differs from the physiological pathway underlying malignant hyperthermia.