Revista brasileira de anestesiologia
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Rev Bras Anestesiol · May 2010
Case ReportsAnesthesia for emergency separation of omphalopagus conjoined twins.
The rate of mortality during the surgical separation of conjoined twins in the neonatal period is 50% and can reach up to 75% if it occurs in emergency situations. The planning of the surgical separation procedure is detailed and involves imaging assessment, evaluation of cross-circulation and even other surgical preparation procedures, such as skin expansion. ⋯ Surgical separation of conjoined twins in the neonatal period must be avoided due to the patients' organic system immaturity. However, emergency situations such as the one described herein can require the procedure to be carried out.
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Rev Bras Anestesiol · May 2010
Randomized Controlled Trial Comparative StudyComparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction.
Several classes of inotropic drugs with different hemodynamic effects are used in the treatment of low cardiac output in patients with diastolic dysfunction undergoing cardiac surgery. The objective of the present study was to compare the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in this population of patients. ⋯ Both inotropic drugs were similarly effective in restoring tissue blood flow and oxygen supply to adequate levels in patients with low cardiac output undergoing cardiac surgery.
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Rev Bras Anestesiol · May 2010
Evaluation of the influence of the codon 16 polymorphism of the Beta-2 adrenergic receptor gene on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid anesthesia.
The beta-2 adrenergic receptor gene has several polymorphisms. Recent studies have demonstrated the clinical importance of the latter. The objective of the present study was to evaluate the influence of the Arg16Gli polymorphism on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid block for Cesarean section. ⋯ The results show that the genetic variant Arg16Arg presents a lower incidence of arterial hypertension and that lower doses of ephedrine were necessary to reestablish normal arterial pressure in the patients with this genetic profile. We conclude that the Arg16Arg genotype confers better pressure stability to the parturients submitted to subarachnoid anesthesia for Cesarean section.
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The neuraxial techniques currently represent the most effective methods for pain control during labor and the epidural block using ultradiluted anesthetic solutions is considered the gold standard promoting adequate pain relief with minimum side effects. In some situations however the use of these techniques is limited by the existence of maternal contraindications, or structural or material obstacles. In these cases, the alternatives are still precarious and scarce offering little optimistic results and of dubious effectiveness. ⋯ The initial data show that remifentanil is a promising option to be employed in situations where the parturient cannot or does not want to receive the neuraxial analgesia.
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Rev Bras Anestesiol · May 2010
Randomized Controlled Trial Comparative StudyGeneral anesthesia versus spinal anesthesia for laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia. ⋯ Laparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.