Brazilian journal of anesthesiology (Elsevier)
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The aim of this paper is to report a case in which the damage control resuscitation (DCR) approach was successfully used to promote hemostatic resuscitation in a polytraumatized patient with severe hemorrhagic shock. ⋯ : The ideal management of traumatic hemorrhagic shock is not yet established, but the rapid control of bleeding and perfusion recovery and well-defined therapeutic protocols are fundamental to prevent progression of coagulopathy and refractory shock.
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Case Reports
Bronchial injury and pneumothorax after reintubation using an airway exchange catheter.
We report a case of pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC) in a patient with a head and neck cancer. ⋯ Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma--caused by oxygen supplement or jet ventilation through AEC--concern for insertion technique can minimize life threatening complications and increase the safety of AEC.
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Strumpell-Lorrain disease--or familial spastic paraplegia (FSP)--is a rare hereditary neurological disorder, mainly characterized by variable degrees of stiffness and weakening of the muscles, with cognitive impairment, deafness, and ataxia in the more severe cases. We describe two female siblings with FSP programmed for cholecystectomy and subtotal colectomy, respectively, and also how we dealt with the anesthetic management in both cases and review the literature on this disease in relation to anesthesia.
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Observational Study
Malignant hyperthermia in Brazil: analysis of hotline activity in 2009.
Malignant hyperthermia (MH) is a pharmacogenetic disease that causes abnormal hypermetabolic reaction to halogenated anesthetics and/or depolarizing muscle relaxants. In Brazil, there is a hotline telephone service for MH since 1991, available 24 hours a day in São Paulo. This article analyzes the activity of the Brazilian hotline service for MH in 2009. ⋯ The number of calls per year in the Brazilian hotline service for MH is still low. The characteristics of MH episode were similar to those reported in other countries. The knowledge of MH in Brazil needs to be increased.
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There is not an ideal predictor of weaning from mechanical ventilation (MV). In a large meta-analysis, despite methodological limitations, respiratory rate (RR) was considered a promising predictor. The aim of this study was to evaluate RR as a predictor of weaning failure from MV. ⋯ RR was an effective predictor of weaning failure. The best cut-off point was RR > 24 rpm, which differed from those reported in the literature (35 and 38 rpm). Only 6% of patients were reintubated, but RR or other weaning criteria did not identify them.