Browsing by Author "Amorim, P."
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- [Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists]Publication . Susano, M.; Vasconcelos, L.; Lemos, T.; Amorim, P.; Abelha, F.Background and objectives: Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. Methods: We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. Results: We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. Conclusions: Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
- Analysis of electroencephalogram-derived indexes for anesthetic depth monitoring in pediatric patients with intellectual disability undergoing dental surgeryPublication . Silva, A.; Amorim, P.; Felix, L.; Abelha, F.; Mourão, J.Background: Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods: Seventeen patients (mean age, 9.6 ± 2.9 years) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed. Results: The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes. Conclusion: BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.
- Avaliação da hiperalgesia em relação com a administração peri-operatória de opióidesPublication . Brás, A.; Carvalho, A.; Carvalho, C.; Carvalho, M.; Dias, J.; Duarte, A.; Mendes, D.; Mendes, T.; Mesquita, M.; Pinto, A.; Santos, A.; Alves, S.; Amorim, P.
- Effects of acute bleeding followed by hydroxyethyl starch 130/0.4 or a crystalloid on propofol concentrations, cerebral oxygenation, and electroencephalographic and haemodynamic variables in pigsPublication . Silva, A.; Ortiz, A.; Venâncio, C.; Souza, A.; Ferreira, L.; Branco, P.; de Pinho, P.; Amorim, P.; Ferreira, D.Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES) or lactated Ringer's (LR) on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES; N = 6) or LR (GRL; N = 6). Bleeding caused a decrease of more than 50% in mean arterial pressure (P < 0.01) and a decrease in cerebral oximetry (P = 0.039), bispectral index, and electroencephalogram total power (P = 0.04 and P < 0.01, resp.), while propofol plasma concentrations increased (P < 0.01). Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P = 0.03) and the cerebral oxygenation (P = 0.008) decreased in the GLR and were significantly lower than in GHES (P = 0.02). Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.
- Eficácia de um novo índice de nocicepção na avaliação da dor no pós-operatório imediato: estudo clínico de doentes submetidos a cirurgia majorPublication . Mota, A.; Castro, A.; Amorim, P.
- ESTACIONARIDADE DURANTE ANESTESIA GERALPublication . Castro, A.; Nunes, C.; Almeida, F.; Amorim, P.
- Practical aspects of the use of target controlled infusion with remifentanil in neurosurgical patients: predicted cerebral concentrations at intubation, incision and extubationPublication . Ferreira, D.; Nunes, C.; Antunes, L.; Lobo, F.; Amorim, P.Abstract Remifentanil has important side effects and it is not easy to know what remifentanil concentrations should be used during different endpoints of anaesthesia. We analyzed the remifentanil predicted effect-site concentrations (RemiCe) at different events during neurosurgical procedures and assessed if the concentrations used were clinically adequate. BIS and haemodynamic parameters were collected every 5 seconds. Predicted cerebral concentration of propofol (PropCe) and RemiCe were analyzed immediately prior to respective stimulus, and 30, 60 and 90 seconds after. RemiCe were 2.2 +/- 0.3, 6 +/- 2.6 and 2.2 +/- 0.9 ng ml(-1) at intubation, incision and extubation, respectively. PropCe observed in the same periods were 5 +/- 1, 2.6 +/- 0.9 and 1 +/- 0.3 microg ml(-1), also respectively. The remifentanil concentrations used in our patients were lower than reported concentrations, while being clinically adequate to minimize the haemodynamic response to stimulation.
- Total Intravenous Anesthesia for Neurosurgical Procedures in Narcoleptic Patients: Two Case ReportsPublication . Pedrosa, S.; Lareiro, N.; Amorim, P.INTRODUCTION: Narcoleptic patients may be at increased risk of prolonged emergence, postoperative hypersomnia, apneic episodes, and sleep paralysis after general anesthesia. Modafinil is the first-line treatment, however, the implication it has on general anesthesia is not clear. This report present 2 cases of narcoleptic patients medicated with modafinil that were submitted to total intravenous anesthesia for neurosurgical procedures. CASE PRESENTATION: Informed consent was obtained from both patients. Clinical information was obtained from patients' interviews and medical records. Intraoperative data was collected using Datex Ohmeda, Bispectral index, Entropy, and LiDCO rapid monitors, and exported to excel sheets to allow its analysis. Both patients maintained modafinil on the day of surgery and were not administered sedative premedication. Propofol was administered by bolus during induction of anesthesia. In one of the patients, the predicted cerebral concentration of propofol required for loss of consciousness was high. Anesthesia was maintained with remifentanil and propofol by target controlled infusion and titrated according to bispectral index (BIS), entropy, and analgesia nociception index (ANI). During the surgical procedure, the patients did not require vasopressors. Emergence from anesthesia was very fast and no narcoleptic event occurred postoperatively. CONCLUSIONS: Sedative premedication should be avoided and the use of short-acting anesthetic agents, such as propofol and remifentanil through target-controlled infusion most likely improves titration of anesthesia. The continuation of modafinil preoperatively might have contributed to the rapid emergence, yet, might also have been responsible for the high cerebral concentration of propofol that was required for loss of consciousness in one of the patients.
- Using the post‐operative quality recovery scale to evaluate recovery with different neuromuscular blocking reversal agentsin the Portuguese population ‐ interim analysis results: 1AP3‐8Publication . Gomes, B.; Lagarto, F.; Bismarck, A.; Rodrigues, N.; Nogueira, M.; Amorim, P.Background and Goal of Study: Post-operative Quality Recovery Scale (PQRS), is the first scale evaluating several domains of postoperative recovery. The objectives of this study were to compare overal and physiologic, cognitive, and functional domains of post-operative recovery af ter elective surgical procedures using neostigmine or sugammadex as neuromuscular blocking (NMB) reversal agents, to validate the use of PQRS in the Portuguese population and to objectively assess muscular strength recovery. Materials and Methods: Prospective multicenter observational study comparing postoperative recovery between 2 cohorts of 50 adult patients submitted to elective surgical procedures with general anesthesia using Nondepolarizing Muscle Relaxants and NMB reversal with neostigmine or sugammadex. Measurements obtained using Portuguese version of PQRS at dif ferent timepoint: baseline,15 minutes (T15), 40 minutes (T40), one and three days af ter surgery. Full recovery defined as return to values identical or higher than those measured at baseline, prior to surgery. Muscular strength measured with KERN- MAP® Dynamometer. Ethics Committees approval was obtained. Statistics used linear T-Test, Qui Square and Fisher exact test, data presented as mean±SD for continuous variables. Interim analysis results presented Results and Discussion: Thirty patients received neostigmine and 21 sugammadex. Age and BMI 50.4±11.8 and 28.6±5.6 in the neostigmine group and 38.2±12.7 and 24.7± 4.5 in the sugammadex group (p< 0,001). Overall response rate at T15 was 86% for neostigmine and 95% for sugammadex (p= 0.22). Dif ferences in favor of sugammadex group noted in nociceptive and emotional domains, 80 vs 100% respectively (p=0.04). Overall response rate at T40 was 80% for neostigmine and 65% for sugammadex (p=0.33), primarily reflecting constraints on activities of daily life. Muscular strength did not dif fer. Improvements in recovery scores from T15 to T40 were observed in both groups, without significant dif ferences . Postoperative assessments were feasible using PQRS at T15 and T40 and seem appropriate for comparisons between postoperative recovery domains and overall recovery . These preliminary results suggest nociceptive and emotional domains recovery at T15 may be faster with sugammadex. Conclusion: The results support the adopted PQRS validation process and the potential of this scale as a tool for the evaluation of post operative recovery evaluation in the Portuguese population