Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Mar 2008
Total intravenous anesthesia as a target-controlled infusion. An evolutive analysis.
Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. ⋯ The advent of new infusion pumps with pharmacokinetic models of remifentanil, sufentanil and propofol opens a new chapter in TIVA and aligns Brazil with the world tendency in TCI. Those systems will allow TCI of hypnotics and opioids concomitantly. However, the most important conclusion refers to the economy, since drugs used in those pumps will not be restricted to only one drug company, similar to what happened with propofol. Nowadays, TCI devices for the use of propofol and opioids, which accept any pharmaceutical presentation, with the advantage of changing the concentration of the drug in the syringe according to the dilution desired are available.
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Rev Bras Anestesiol · Mar 2008
Case ReportsAcute pulmonary edema associated with obstruction of the airways. Case report.
Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. ⋯ Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages.
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Rev Bras Anestesiol · Mar 2008
Hemodynamic impact of alveolar recruitment maneuver in patients evolving with cardiogenic shock in the immediate postoperative period of myocardial revascularization.
Alveolar recruitment maneuver (ARM) with pressures of 40 cmH2O in the airways is effective in the reversal of atelectasis after myocardial revascularization (MR); however, there is a lack of studies evaluating the hemodynamic impact of this maneuver in patients who evolve with cardiogenic shock after MR. The objective of this study was to test the hemodynamic tolerance to ARM in patients who develop cardiogenic shock after MR. ⋯ In patients who evolved to cardiogenic shock and hypoxemia after MR, ARM improved oxygenation and was well tolerated hemodynamically.
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Rev Bras Anestesiol · Mar 2008
Case ReportsPhrenic nerve block after interscalene brachial plexus block. Case report.
Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercussions in a patient with chronic renal failure who had an extensive arteriovenous fistula created under perivascular interscalene brachial plexus block. ⋯ In this case, the patient developed complete paralysis of the phrenic nerve with respiratory symptoms. Although invasive treatment was not necessary, it is necessary to alert anesthesiologists to restrict the indication of this technique.
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Rev Bras Anestesiol · Mar 2008
Simulation of ultrasound-guided peripheral nerve block: learning curve of CET-SMA/HSL Anesthesiology residents.
The use of ultrasound imaging in peripheral nerve block has been increasing. However, there are few reports in the literature on the learning curve of the ultrasound technique. The objective of this report was to evaluate the learning curve of CET-SMA/HSL Anesthesiology residents of ultrasound-guided peripheral block using an experimental agar model. ⋯ This study allows us to conclude that the longer training of ultrasound-guided peripheral nerve block in an experimental model improved the learning curve of the technique.