SA - Artigos publicados em revistas indexadas na Pubmed/Medline
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- Adrenal Crisis During Cesarean Section in a Patient With Primary Adrenal InsufficiencyPublication . Pestana, Inês; Guimarães, Henrique; Saraiva, Alexandra; Veiga, Dalila; Machado, HumbertoCongenital adrenal hyperplasia (CAH) is a type of primary adrenal insufficiency (AI) that predisposes to adrenal crisis (AC) during stress. We describe a case of a primipara with CAH who was admitted in labor. To prevent AC, glucocorticoid replacement was given according to guidelines. Due to fetal decelerations, an emergency C-section was performed under general anesthesia following which refractory hypotension emerged. The diagnosis of AC was considered, and hydrocortisone was given with sustained hemodynamic improvement. AC is a life-threatening emergency whose diagnosis requires a high index of suspicion. Despite adequate steroid coverage, additional stressors may precipitate AC, so it is of paramount importance that anesthesiologists consider this emergency
- [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.
- Anaesthesiology trainees and their needs: a Romanian perspective. Results from a European surveyPublication . Valeanu, L.; Stefan, M.; Fernandes, D.; Rauseo, M.; Matias, B.; Predoi, C.; Bubenek, S.; Filipescu, D.Anaesthesiology training is going through continuous transformations worldwide. Recent data from a European Survey on anaesthesiology postgraduate trainees and their concerns have been published for the first time, following an initiative by the European Society of Anaesthesiology. Among the responders of this survey, 10.8% were represented by Romanian trainees. The main needs of the Romanian anaesthesiology trainees who completed the questionnaire were, in descending order educational contents/EDAIC, technical skills, exchange programmes, residency workload, residency costs and autonomy transition. Another observation coming from the analysed data is that Romanian anaesthesiologists in training are highly concerned and interested in the field of intensive care medicine. The results also pinpoint to the high costs associated with continuous medical education, leading to a high incentive for workforce migration.
- 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.
- Anesthesia for craniotomy with intraoperative awakening: how to avoid respiratory depression and hypertension?Publication . LOBO, F.; AMORIM, P.Anesthesia for craniotomy with intraoperative awakening: how to avoid respiratory depression and hypertension? Lobo FA, Amorim P. Comment on Anesth Analg. 2005 Aug;101(2):502-8, table of contents. PMID: 16632860 [PubMed - indexed for MEDLINE]
- Awakening after sugammadex: jumping to conclusions?Publication . Salgado-Seixas, F; Pereira, R; Pereira, M; Madeira, I
- Beyond the Usual: Pantoprazole-Induced Anaphylaxis During Peribulbar AnesthesiaPublication . Palha Ribeiro, Antonio; Gonçalves, Ana; Mateus, Carolina; Mexêdo, CarlosProton-pump inhibitors (PPIs) are one of the most prescribed drugs in the world. Although they are remarkably safe, with minimal adverse effects, it has rarely been reported as a cause of anaphylaxis. Hence, we report the case of a 69-year-old patient who experienced intravenous pantoprazole-induced anaphylaxis during peribulbar block anesthesia for mechanical vitrectomy
- Bioelectrical impedance analysis of body composition for the anesthetic induction dose of propofol in older patientsPublication . M Araujo, Ana; Machado, H.; Falcão, A.; Soares-da-Silva, P.Background: Older people are currently the fastest growing segment of the worldwide population. The present study aimed to estimate propofol dose in older patients based on size descriptors measured by bioelectrical impedance analysis (BIA). Methods: A cross sectional study in adult and older patients with body mass index equal to or lower than 35 kg/m2 was carried out. BIA and Clinical Frail Scale scoring were performed during pre-operative evaluation. Propofol infusion was started at 2000 mg/h until loss of consciousness (LOC) which was defined by "loss of eye-lash reflex" and "loss of response to name calling". Total dose of propofol at LOC was recorded. Propofol plasma concentration was measured using gas chromatography/ion trap-mass spectrometry. Results: Forty patients were enrolled in the study. Total propofol dose required to LOC was lower in Age ≥ 65 group and a higher plasma propofol concentration was measured in this group. 60% of old patients were classified as "apparently vulnerable" or "frail" and narrow phase angle values were associated with increasing vulnerability scores. In the Age ≥ 65 group, the correlation analysis showed that the relationship between propofol dose and total body weight (TBW) scaled by the corresponding phase angle value is stronger than the correlation between propofol dose and TBW or fat free mass (FFM). Conclusions: This study demonstrates that weight-based reduction of propofol is suitable in older patients; however FFM was not seen to be more effective than TBW to predict the propofol induction dose in these patients. Guiding propofol induction dose according to baseline frailty score should also be considered to estimate individualized dosage profiles. Determination of phase angle value appears to be an easy and reliable tool to assess frailty in older patients.
- Bioelectrical impedance analysis of body composition for the anesthetic induction dose of propofol in older patientsPublication . Araujo, A.; Machado, H.; Falcão, A.; Soares-da-Silva, P.BACKGROUND: Older people are currently the fastest growing segment of the worldwide population. The present study aimed to estimate propofol dose in older patients based on size descriptors measured by bioelectrical impedance analysis (BIA). METHODS: A cross sectional study in adult and older patients with body mass index equal to or lower than 35 kg/m2 was carried out. BIA and Clinical Frail Scale scoring were performed during pre-operative evaluation. Propofol infusion was started at 2000 mg/h until loss of consciousness (LOC) which was defined by "loss of eye-lash reflex" and "loss of response to name calling". Total dose of propofol at LOC was recorded. Propofol plasma concentration was measured using gas chromatography/ion trap-mass spectrometry. RESULTS: Forty patients were enrolled in the study. Total propofol dose required to LOC was lower in Age ≥ 65 group and a higher plasma propofol concentration was measured in this group. 60% of old patients were classified as "apparently vulnerable" or "frail" and narrow phase angle values were associated with increasing vulnerability scores. In the Age ≥ 65 group, the correlation analysis showed that the relationship between propofol dose and total body weight (TBW) scaled by the corresponding phase angle value is stronger than the correlation between propofol dose and TBW or fat free mass (FFM). CONCLUSIONS: This study demonstrates that weight-based reduction of propofol is suitable in older patients; however FFM was not seen to be more effective than TBW to predict the propofol induction dose in these patients. Guiding propofol induction dose according to baseline frailty score should also be considered to estimate individualized dosage profiles. Determination of phase angle value appears to be an easy and reliable tool to assess frailty in older patients.
- [Can we find predictive factors of postoperative vomiting after day surgery?]Publication . Lemos, P.; Monteiro, M.; Fonseca, L.; Regalado, A.Abstract A retrospective analyses of patients submitted to surgery on a day basis was made through our database. The goal of the study was to identify risk factors of postoperative vomiting associated to day surgery. 2115 patients operated between January 2003 and November 2004 on our day surgery unit were included. 70 patients (3,3%) suffered at least on episode of postoperative vomiting. Several factors were analysed: age, sex, surgical speciality, ASA physical status, anaesthetic technique and the duration of anesthesia. Chi-Square Test was used for testing each factor individually. Differences were considered significant when p <0,05. Logistic regression was then used to identify the multivariate association strength of these factors. The female sex (Odds ratio =4,94) and the duration of anesthesia when longer than 180 minutes (Odds ratio =8,13), had been associated to a higher incidence of postoperative vomiting, while loco-regional technique (Odds ratio = 0,15) and sedation with local anaesthesia (Odds ratio =0,09) had been associated with a lower incidence. Authors evidence the importance of the identification of postoperative vomiting risk factors that will allow us to establish better guidelines on postoperative nausea and vomiting prophylaxis in these patients and to improve the quality of our clinical care and the satisfaction of our patients. Através da análise do registo informatizado de dados dos doentes operados em regime de ambulatório, os autores procuraram identificar factores de risco que se encontrassem associados a uma maior incidência de vómitos no pós-operatório (VPO). Incluíram-se 2115 doentes submetidos a cirurgia entre Janeiro de 2003 e Novembro de 2004, tendo 70 doentes sofrido pelo menos um episódio de VPO (3,3%). Foram consideradas variáveis a analisar, a idade, o sexo, a especialidade cirúrgica, o estado físico (ASA), a técnica anestésica e a duração da anestesia. Procedeu-se à análise estatística de cada factor individualmente através da aplicação do χ2, seguindo-se a utilização de uma regressão logística para identificar a força de associação multivariável desses factores. O sexo feminino (Odds ratio =4,94) e a duração da anestesia quando superior a 180 minutos (OR =8,13), associaram-se a uma maior incidência de VPO enquanto a técnica loco-regional (OR =0,15) e a sedação com anestesia local (OR =0,09) se associaram a uma menor incidência daqueles. Os autores evidenciam a importância deste tipo de trabalhos na identificação de factores de risco que possam levar à criação de escalas de risco que orientem com maior racionalidade económica, a intervenção terapêutica profiláctica das náuseas e vómitos no pós-operatório.