Browsing by Author "Gomes, B."
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- [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]Publication . Pinho, S.; Lagarto, F.; Gomes, B.; Costa, L.; Nunes, C.; Oliveira, C.Background and objectives: Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients' allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. Methods: A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. Results: A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p<0.001; CR-POSSUM: 4.4% vs. 15.9%, p<0.001). Both scores were found to be predictors of immediate postoperative destination (p<0.001). Concerning immediate high-dependency units/intensive care units admission, CR-POSSUM showed a strong association (AUC 0.78, p=0.034) with a ≥9.16 cut-off point (sensitivity: 62.5%; specificity: 75.2%), outperforming SAS (AUC 0.67, p=0.048), with a ≤7 cut-off point (sensitivity: 67.3%; specificity: 56.1%). Conclusions: Both CR-POSSUM and SAS were associated with the clinical decision to admit a patient to the high-dependency units/intensive care units immediately after surgery. CR-POSSUM alone showed a better discriminative capacity.
- Evaluation of patients' discomfort regarding regional anesthesia: 8AP6‐7Publication . Gomes, B.; Sá Couto, P.; Amadeu, E.Background and Goal of Study: Regional anesthesia may cause physical and psychological discomfort. 50% of patients scheduled for urologic procedures undergo regional anesthesia, and their comfort represents a concern to the anesthesiologist. This study aims to: 1. identify factors related to patients’ discomfort regarding regional anesthesia(position for anesthesia and surgery procedures, puncture site pain, room temperature, audio-visual perception, sensitive/motor blockade); 2. Evaluate patients’ satisfaction with anesthesia. Materials and Methods: Af ter approval from the Hospital Ethics Committee all patients over 18years old, scheduled for urologic surgery, understanding Portuguese and anesthetized with spinal anesthesia were included. Patients in day case surgery or with incomplete medical records were excluded. We performed a questionnaire(with closed ended questions) in the first 24 hours af ter surgery and consulted anesthesia records. We asked yes or no questions, used a 1-10 scale to evaluate pain and a 1-4 scale to evaluate satisfaction. Because there isn’t a valid questionnaire in the literature to evaluate what we aimed to, we created one based on multiple articles1,2. Results and Discussion: 50patients were included; mean age 65 years old (min.32, max.89); 78% males and 70% ASAII. 75%denied discomfort during positioning for back puncture and 58% referred cold during anesthesia or surgery. One person was uncomfortable in the surgical position and no one considered being awake uncomfortable; sensitive/motor blockade was uncomfortable for 22%. Spinal was more painful than the venous puncture for32%; for 50%venous puncture was more painful and for 18%pain was similar. Patients were satisfied or very satisfied with the anesthetic technique and would choose the same technique in the future in 98% of cases. Conclusion: Although this questionnaire is not validated, it allowed us to understand that cold during anesthesia/surgery is a problem for most patients but this is easily solved. It also showed us that most patients are not uncomfortable with positioning during procedures, being awake and not feeling the legs.Interestingly only about one third of the patients thought that the back puncture was more painful than the venous puncture. In general we consider spinal anesthesia a good choice for these patients and we are satisfied that patients don’t find it uncomfortable and are also satisfied
- 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