Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jan 2009
Case ReportsAnesthetic management of a patient with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Case report.
Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant disorder characterized by mucocutaneous and visceral vascular dysplasia associated with frequent episodes of epistaxis and gastrointestinal bleeding. The objective of this report was to describe the anesthesia of a patient with this syndrome. ⋯ Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder that leads to mucocutaneous and visceral vascular dysplasia. Perioperative blood loss can be greater than expected in patients with this syndrome. Since bleeding does not result from a defect in the coagulation cascade but from the surgical exposure of malformed vascular structures, perioperative conduct includes the use of antifibrinolytics, adequate homeostasis, and induced hypotension in the absence of contraindications. Preanesthetic evaluation should include the search for brain, lung, and gastrointestinal vascular malformation.
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Rev Bras Anestesiol · Jan 2009
Randomized Controlled Trial Comparative StudyEphedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus.
Hypotension during spinal block for cesarean section is secondary to the sympathetic blockade and aorto-caval compression by the uterus and it can be deleterious to both the fetus and the mother. Ephedrine and phenylephrine improve venous return after sympathetic blockade during the spinal block. The objective of this study was to compare the efficacy of ephedrine and phenylephrine in the prevention and treatment of maternal hypotension during spinal block and to evaluate their side effects and fetal changes. ⋯ Ephedrine was more effective than phenylephrine in the prevention of hypotension. Both drugs had similar incidence of side effects. Fetal repercussions were less frequent with phenylephrine and were transitory with the use of ephedrine.
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Rev Bras Anestesiol · Jan 2009
ReviewReview of the use of gabapentin in the control of postoperative pain.
Gabapentin has been used as adjuvant in the treatment of postoperative pain with a neuropathic component. It is responsible for the inhibition of central sensitization, decreasing postoperative pain. ⋯ Gabapentin, used before as well as before and after surgery, decreased pain severity and the need of analgesic supplementation.
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The bispectral index (BIS) is a multifactorial parameter derived from the electroencephalogram (EEG), which allows monitoring of the hypnotic component of anesthesia. It was obtained from the algorithm based on the analysis of a large number of EEGs from volunteers and patients undergoing sedation and general anesthesia with different anesthetic agents. The use of BIS to monitor the depth of anesthesia reduces the incidence of intraoperative awakening and recall, among other benefits. The objective of this review was to present clinical situations in which the BIS gives false results, either elevated or decreased, due to conditions related to the patient or anesthetic actions unforeseen when the algorithm was elaborated. ⋯ Although the BIS algorithm underwent several changes since its first version, the anesthesiologist should be aware of situations that cause false BIS readings to avoid complications, may it be secondary to anesthetic overdose or underdosing, which might cause intraoperative awakening and recall.
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Rev Bras Anestesiol · Jan 2009
Randomized Controlled TrialTemperature control in conventional abdominal surgery: comparison between conductive and the association of conductive and convective warming.
Intraoperative hypothermia is a common complication, and its development is favored by abdominal surgeries. The efficacy of the association of conductive and convective warming methods in the prevention of hypothermia, and its effects during postoperative recovery were the objectives of this study. ⋯ The association of different warming methods delayed the beginning and reduced the severity of intraoperative hypothermia, but it did not reduce the complaints of feeling cold and tremors.