Avaliação do tempo de atraso do índice bispectral na resposta à indução da anestesia: estudo observacional

Background and objectivesAccording to the manufacturer, the Bispectral Index (BIS) has a processing time delay of 5–10 s. Studies addressing this have suggested longer delays. We evaluated the time delay in the Bispectral Index response.MethodsBased on clinical data from 45 patients, using the difference between the predicted and the real BIS, calculated during a fixed 3 minutes period after the moment the Bispectral Index dropped below 80 during the induction of general anesthesia with propofol and remifentanil.ResultsThe difference between the predicted and the real BIS was in average 30.09 ± 18.73 s.ConclusionOur results may be another indication that the delay in BIS processing may be much longer than stated by the manufacture, a fact with clinical implications.     

Tradução e validação do Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) para o idioma português do Brasil

ObjectiveTo translate and validate the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) into Brazilian Portuguese.MethodsCertified translators translated and back‐translated Quest. Content validity (CVI) was determined by 5 experts and, after the final version of B‐Quest, a pre‐test was applied to users of manual wheelchairs, walkers and crutches. The psychometric properties were tested to assure the validity of items and the reliability and stability of the scale.ResultsData were obtained from 121 users of the above‐mentioned devices. Our study showed a CVI of 91.66% and a satisfactory factor analysis referent to the two‐dimensional structure of the instrument that ensured the representativeness of the items. The Cron‐bach's alpha of the items device, service and total score of B‐Quest were 0.862, 0.717 and 0.826, respectively. Test‐retest stability conducted after a time interval of 2 months was analyzed using Spearman's correlation test, which showed high correlation (ρ >0.6) for most items.ConclusionThe study suggests that the B‐Quest is a reliable, representative, and valid instrument to measure the satisfaction of users of assistive technology in Brazil.     

How do I do it? Passing a Pedicled Flap Through a Subcutaneous Tunnel

Latissimus dorsi myocutaneous flaps are used to cover body structures or replace tissue that has been lost due to trauma, infection, or surgical excision for tumor. Transfer of these flaps from donor to recipient site is a vital step of surgery as forceful passage of flap may cause damage to blood supply of flap or devitalize the tissue by excessive shearing force. Use of polyvinyl chloride bag for transfer of latissimus dorsi flap through subcutaneous tunnel has been found to be very effective in dealing with this problem.     

Eficácia do escore simplificado preditivo de dificuldade de intubação e da altura tiromentoniana em cirurgias de cabeça e pescoço: estudo observacional

Background and objectivesIn this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies.MethodsOne hundred fifty‐three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion, and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined.ResultsA total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT.ConclusionsThe current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.     

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.     

Efeito do bloqueio do gânglio estrelado direito guiado por ultrassom na fibrilação atrial perioperatória em pacientes submetidos a lobectomia pulmonar: estudo controlado randomizado

ObjectiveTo observe the effects of preoperative right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy.MethodsTwo hundred patients who underwent a scheduled lobectomy were randomly divided into the S and C groups. The S group was injected with 4 mL of 0.2% ropivacaine under ultrasound guidance, and the C group did not receive stellate ganglion block. The patients underwent continuous ECG monitoring, and the incidences of atrial fibrillation and other types of arrhythmias were recorded from the start of surgery to 24 hours after surgery.ResultsThe respective incidences of atrial fibrillation in the S group and the C group were 3% and 10% (p = 0.045); other atrial arrhythmias were 20% and 38% (p = 0.005); and ventricular arrhythmia were 28% and 39% (p = 0.09).ConclusionsThe results of the study indicated that preoperative right stellate ganglion block can effectively reduce the incidence of intraoperative and postoperative atrial fibrillation.     

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.     

Associação entre o polimorfismo rs7700944 no gene TIM-4 e artrite reumatoide em Zahedan,sudeste do Irã

IntroductionRecently, an association between rheumatoid arthritis (RA) and the rs7700944 G>A variant in the T-cell immunoglobulin and mucin domains 4 (TIM-4) has been reported.ObjectiveThe present study aimed at investigating the impact of that polymorphism on susceptibility to RA in a sample of the Iranian population.Patients and methodsThis case-control study was conducted on 120 patients with RA and 120 healthy subjects. The rs7700944 polymorphism in the TIM-4 gene was determined using tetra amplification refractory mutation system-polymerase chain reaction (T-ARMSPCR) assay.ResultsNo significant difference was observed regarding the rs7700944 polymorphism of the TIM-4 gene between patients with RA and normal individuals. In females, no significant association was found between the groups concerning the rs7700944 polymorphism of the TIM-4 gene. In males, the GA+AA genotype increased the risk of RA in comparison with the GG genotype (OR = 5.15, 95% CI = 1.30-20.48, P = 0.020). Furthermore the results showed that the rs7700944 A allele increased the risk of RA (OR = 4.39, 95% CI = 1.43-13.54, P = 0.009).ConclusionOur results do not support an association between the rs7700944 polymorphism of the TIM-4 gene and RA. An interaction between this polymorphism and sex suggests a sex-specific association between this single nucleotide polymorphism and RA, which remains to be fully elucidated.     

Lesão do nervo mandibular bilateral após ventilação com máscara: um relato de caso

Background and objectives

Nerve injury following mask ventilation is a rare but serious anesthetic complication. The majority of reported cases are associated with excessive pressure applied to the face mask, long duration of mask ventilation, excessive digital pressure behind the mandible to relieve airway obstruction and pressure exerted by the plastic oropharyngeal airway.

I think I have a good idea: what do I do with it?

The orthopaedic device industry is an ever changing market, often guided by creative surgeons who have the common goal of creating a solution to a problem. While being a surgeon-inventor can be both a challenging and rewarding process, there are several steps that the individual must follow to create intellectual property. This article serves as a guide to the novice surgeon-inventor; intended to be used as an early stage reference for those interested in taking their "solution to a problem" to the device industry.