Clínica de Anestesiologia, Cuidados Intensivos e Emergência
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- Changes in cognitive function performance in patients after anesthesiaPublication . MACHADO, H.; PEREIRA, M.J.; ORFAO, J.; MENDONCA, D.; RIBEIRO, J.L.Acta Med Port. 2000 May-Jun;13(3):85-92. [Changes in cognitive function performance in patients after anesthesia]. [Article in Portuguese] Machado H, Pereira MJ, Orfão J, Mendonça D, Ribeiro JL. SourceServiço de Anestesiologia, Hospital Geral de Santo António, Porto. Abstract This study evaluates the mental performance of 112 patients (ASA grade 1 and 2) submitted to Orthopaedic, Urologic, Gynecologic, General and ENT surgery in Santo Antonio General Hospital. These patients received different types of anaesthesia: General Balanced Anaesthesia--GBA (n = 80), Total Intravenous Anaesthesia--TIVA (n = 17) and Regional Anaesthesia--RA (n = 15). Cognitive function was tested using the mini mental state test (MMS), which was done 24 hours before and 24 hours after anaesthesia. There was a high correlation between pre and postoperative MMS scores (R = 0.94). Patients in the GBA group show a significant (p < 0.001) decrease in cognitive performance 24 hours after surgery in comparison to the preoperative test. No differences were observed between the pre and postoperative MMS tests in the TIVA and RA groups. PMID: 11026145 [PubMed - indexed for MEDLINE]
- Duración y calidad de la analgesia postoperatoria después del bloqueo del plexo braquial para cirugía del hombro: ropivacaína 0,5% frente a ropivacaína 0,5% con clonidinaPublication . Esteves, S.; Sa, P.; Figueiredo, D.; Souto, A.Resumen OBJETIVOS: Algunos estudios han demostrado que la duración de los bloqueos nerviosos realizados con anestésicos locales puede ser prolongada con clonidina. En este estudio evaluamos la duración y la calidad de la analgesia proporcionada por el bloqueo del plexo braquial por vía interescalénica para cirugía del hombro, comparando la ropivacaína 0,5% con la ropivacaína 0,5% asociada a clonidina. PACIENTES Y MÉTODOS: Treinta pacientes fueron distribuidos en dos grupos en un estudio doble ciego. Grupo A - bloqueo realizado con ropivacaína 0,5%, 40 ml, y grupo B - ropivacaína 0,5%, 40 ml con clonidina (40 μg). Se procedió a la anestesia general con la administración de propofol e introducción de la mascarilla laríngea, siendo los pacientes mantenidos en ventilación espontánea con propofol en perfusión continua. Después de la estimulación nerviosa del plexo braquial fue administrado el (los) fármaco(s) seleccionado(s). El paciente fue instruido para recordar la hora de la reversión del bloqueo motor y sensitivo, y la analgesia postoperatoria fue evaluada a través de la escala visual analógica (EVA) a las 2, 4, 6, 8 y 24 horas. RESULTADOS: El tiempo medio de reversión del bloqueo sensitivo y motor y la evaluación del grado de dolor (EVA 0-10) a las 4, 6, 8 y 24 horas, no mostró diferencias estadísticamente significativas. CONCLUSIONES: La asociación de 40 μg de clonidina a 200 mg de ropivacaína 0,5% no prolonga el bloqueo sensitivo y motor y no mejora la calidad de la analgesia en el postoperatorio inmediato.
- International EMS systems: PortugalPublication . Gomes, E.; Araújo, R.; Soares-Oliveira, M.; Pereira, N.
- Patients' recollections of experiences in the intensive care unit may affect their quality of life.Publication . GRANJA, C.; LOPES, A.; MOREIRA, S.; DIAS, C.; COSTA‐PEREIRA, A.; CARNEIRO, A.; JMIP STUDY GROUPCrit Care. 2005 Apr;9(2):R96-109. Epub 2005 Jan 31. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group. Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristinagranja@oninet.pt Comment in: Crit Care. 2005 Apr;9(2):145-6. Abstract INTRODUCTION: We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL). METHODS: We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire. RESULTS: Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30). CONCLUSION: This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL. PMID: 15774056 [PubMed - indexed for MEDLINE]PMCID: PMC1175917Free PMC Article Images from this publication.See all images (1) Free text Figure 1Patients included in and excluded from the study. Survival and recollection questionnaire response rates.Patients' recollections of experiences in the intensive care unit may affect their quality of lifeCrit Care. 2005;9(2):R96-R109.
- Clinical variables related to propofol effect‐site concentrations at recovery of consciousness after neurosurgical proceduresPublication . NUNES, C.S.; FERREIRA, D.A.; ANTUNES, L.; AMORIM, P.J Neurosurg Anesthesiol. 2005 Apr;17(2):110-4. Clinical variables related to propofol effect-site concentrations at recovery of consciousness after neurosurgical procedures. Nunes CS, Ferreira DA, Antunes L, Amorim P. CECAV, Universidade de Trás-os-Montes de Alto Douro, Vila-Real, Portugal. ccnunes@fc.up.pt Abstract Target controlled infusion (TCI) systems and computer data acquisition software are increasingly used in anesthesia. It was hypothesized that the use of such systems might allow retrieval of information useful to anticipate the effect-site concentrations of propofol at which patients would recover from anesthesia. The goal of the study was to identify variables related to propofol effect-site concentrations at recovery of consciousness (ROC). Sixteen patients with a Glasgow of 15, ASA 1 or 2, subjected to neurosurgical procedures, received TIVA with TCI propofol and remifentanil. Data were collected every 5 seconds from Datex AS3 and Aspect A200XP (BIS). Effect-site TCI was used for propofol (initial effect target 5.0 microg/ml) and for remifentanil (initial plasma target 2.5 ng/ml). All clinical events were noted. Variables possibly related to propofol effect-site concentration at ROC were selected. Data are expressed as mean +/- SD. Effect-site propofol concentration at ROC was 1.3 +/- 0.5 microg/ml. A positive correlation was found between propofol effect-site concentration at ROC and: age (49.3 +/- 17 years) (P = 0.003); mean remifentanil dose during surgery (0.11 +/- 0.05 microg/kg/min) (P = 0.003); mean propofol dose during surgery (0.12 +/- 0.03 mg/kg/min) (P = 0.046); and remifentanil effect-site concentration at ROC (2.85 +/- 2.06 ng/ml) (P = 0.002). Propofol effect-site concentrations were not correlated with: weight, height, LBM, duration of anesthesia, minimum BIS at induction (30.4 +/- 6.8), time till minimum BIS (4.7 +/- 2.2 min), mean and median BIS during surgery (38.2 +/- 4.5 and 37.8 +/- 5.3). BIS-related variables were not useful as ROC predictors. Only drug variables and age correlated with propofol effect-site concentrations at ROC. PMID: 15840999 [PubMed - indexed for MEDLINE]
- Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI).Publication . Kindgen-Milles, D.; Journois, D.; Fumagalli, R.; Vesconi, S.; Maynar, J.; Marinho, A.; Bolgan, I.; Brendolan, A.; Formica, M.; Livigni, S.; Maio, M.; Marchesi, M.; Mariano, F.; Monti, G.; Moretti, E.; Silengo, D.; Ronco, C.We found 1 article by title matching your search: Crit Care. 2005 Aug;9(4):R396-406. Epub 2005 Jun 14. Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI). Kindgen-Milles D, Journois D, Fumagalli R, Vesconi S, Maynar J, Marinho A, Bolgan I, Brendolan A, Formica M, Livigni S, Maio M, Marchesi M, Mariano F, Monti G, Moretti E, Silengo D, Ronco C. Anesthesiology Clinic, University of Düsseldorf, Germany. Kindgen-Milles@med.uni-duesseldorf.de Abstract INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration. PMID: 16137353 [PubMed - indexed for MEDLINE]PMCID: PMC1269446Free PMC Article Images from this publication.See all images (4) Free text Figure 1Flowchart of the DO-RE-MI observational study. All incident patients admitted to the intensive care unit (ICU) and requiring renal replacement therapy (RRT) will be followed up during RRT. At discharge, primary and secondary end-points will be recorded. All data will be entered in electronic case re...Study protocol: The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI)Crit Care. 2005;9(4):R396-R406.
- Radial basis function neural networks versus fuzzy models to predict return of consciousness after general anesthesiaPublication . NUNES, C.S.; MENDONCA, T.F.; AMORIM, P.; FERREIRA, D.A.; ANTUNES, L.M.Conf Proc IEEE Eng Med Biol Soc. 2004;2:865-8. Radial basis function neural networks versus fuzzy models to predict return of consciousness after general anesthesia. Nunes CS, Mendonca TF, Amorim P, Ferreira DA, Antunes LM. Dept. of Appl. Math., Porto Univ., Portugal. Abstract This work presents two modelling techniques to predict return of consciousness (ROC) after general anaesthesia, considering the effect concentration of the anaesthetic drug at awakening. First, several clinical variables were statistically analysed to determine their correlation with the awakening concentration. The anaesthetic and the analgesic mean dose during surgery, and the age of the patient, proved to have significantly high correlation coefficients. Variables like the mean bispectral index value during surgery, duration of surgery did not present a statistical relation with ROC. Radial basis function (RBF) neural networks were trained relating different sets of clinical values with the anaesthetic drug effect concentration at awakening. Secondly, fuzzy models were built using an adaptive network-based fuzzy inference system (ANFIS) also relating different sets of variables. Clinical data was used to train and test the models. The fuzzy models and RBF neural networks proved to have good prediction properties and balanced results. PMID: 17271814 [PubMed]
- Regular clinical use bispectral índex monitoring may result in lighter depth of anesthesia as reflected in average higher bispectral index valuesPublication . NUNES, C.S.; FERREIRA, D.A.; ANTUNES, L.M.; AMORIM, P.Anesthesiology. 2005 Dec;103(6):1320-1. Regular clinical use bispectral index monitoring may result in lighter depth of anesthesia as reflected in average higher bispectral index values. Nunes CS, Ferreira DA, Antunes LM, Amorim P. PMID: 16306760 [PubMed - indexed for MEDLINE]
- Efeito da exposição prolongada a ruído ocupacional na função respiratória de trabalhadores da indústria têxtilPublication . Cardoso, A.; Oliveira, M.; Silva, A.; Águas, A.; Sousa-Pereira, A.Vibroacoustic disease is a pathology caused by long occupational exposure to large pressure amplitude and low frequency noise. It is a systemic disease, with evolvement of respiratory structures. The exposure workers to this noise of textile industry may favour alterations in lung function. We studied 28 women working more than ten years in cotton-mill rooms to evaluate their lung function, including Spirometry, forced oscillation technique (I.O.S.) and Diffusion capacity. These results were compared with those of 30 women of similar ages not exposed to similar noise and not presenting respiratory disease. Statistical significance (P<0.05) was found with FEV25, R5 and Delta Rs5-Rs20. There was a resistance frequency dependence in 36% of the population exposed to noise, not statistically confirmed. Neither restriction nor changes in diffusing capacity where detected. CONCLUSION: The analysis of global alterations of lung function parameters suggests small airways aggression by noise. However we cannot definitively exclude the influence of cotton dust inhalation in itself which effects could be increased by the loss of ciliated cells and impairment of airways clearance caused by noise.
- 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.