Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Nov 2002
[Influence of propofol and etomidate on rocuronium-induced euromuscular block: evaluation with acceleromyography.].
Some hypnotics may interact with neuromuscular blockers and potentiate their effects. This study aimed at evaluating the influence of propofol and etomidate on rocuronium-induced neuromuscular block. ⋯ Propofol and etomidate had a similar behavior regarding time for rocuronium-induced neuromuscular block and tracheal intubation conditions.
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Rev Bras Anestesiol · Nov 2002
[Clinical experience with sedatives in the intensive care unit: a retrospective study.].
Among the most frequent indications for Intensive Care Unit patients sedation, one may mention artificial ventilation installation and maintenance, anxiety and uncomfortable or painful procedures. This retrospective study aimed at evaluating most common sedation indications and techniques for severe patients admitted to the Surgical Intensive Care Unit, Escola Paulista de Medicina (EPM/UNIFESP) during an 11-month period. ⋯ Sedation is a common therapeutic resource for intensive care and is widely used to help mechanical ventilation and to treat psychiatric disorders. Fentanyl, alone or in association with midazolam, was the most widely used agent.
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Rev Bras Anestesiol · Nov 2002
[Simplified sciatic nerve approach by the posterior route at the median gluteus-femoral sulcus region, with a neurostimulator.].
The sciatic nerve may be blocked by several routes, all of them with advantages and disadvantages. It is the largest human nerve in diameter and length, being the prolongation of the upper sacral plexus fascicle (L4, L5, S2 and S3). It leaves the pelvis through the foramen ischiadicum majus, passing below the piriform muscle and going down between the greater trochanter and the ischial tuberosity, continuing along the femoral dorsum, anterior to biceps femoris and semitendinous muscles, to the lower femoral third, where it is divided in two major branches called tibial and common fibular nerves. It becomes superficial at the lower border of the gluteus maximus muscle. Based on this anatomic description, we developed a posterior approach with the following advantages: easy identification of the surface anatomy, superficial level of the nerve at this location; and less discomfort to patients since a 5 cm needle may be used. ⋯ This new approach is effective and easy. However, it is not indicated when the cutaneous femoris posterior nerve anesthesia is necessary.
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BACKGROUNG AND OBJECTIVES: Double lumen tubes may determine different flow resistances. This disparity may result in non-homogeneous ventilation. This study aimed at comparing the resistive pressure of 37 FR double lumen tubes to distinct flows as compared to conventional adult tracheal tubes. ⋯ Resistive patterns of 37 FR and 7,5 mm tubes were very similar. Any double lumen branch occlusion significantly increases resistance, however in a similar way for both branches for flows below 0.5 L.s-1. These results suggest the use of low inspiratory flow to minimize ventilatory system resistive pressure when any branch of a double-lumen tube is occluded.
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Rev Bras Anestesiol · Nov 2002
[Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report.].
Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias) is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia. ⋯ The use of a patch with colloid solutions, such as dextran 40, is not well established, but there are some successful reports and it is our understanding that its potential should be further investigated.