Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Mar 2019
Review Case Reports[Negative pressure pulmonary edema: report of case series and review of the literature].
Negative pressure pulmonary edema occurs by increased intrathoracic negative pressure following inspiration against obstructed upper airway. The pressure generated is transmitted to the pulmonary capillaries and exceeds the pressure of hydrostatic equilibrium, causing fluid extravasation into the pulmonary parenchyma and alveoli. In anesthesiology, common situations such as laryngospasm and upper airway obstruction can trigger this complication, which presents considerable morbidity and requires immediate diagnosis and propaedeutics. Upper airway patency, noninvasive ventilation with positive pressure, supplemental oxygen and, if necessary, reintubation with mechanical ventilation are the basis of therapy. ⋯ The anesthesiologists should prevent the patient from perform a forced inspiration against closed glottis, in addition to being able to recognize and treat cases of negative pressure pulmonary edema.
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Rev Bras Anestesiol · Mar 2019
Case Reports[Severe bradycardia and asystole associated with sugammadex: case report].
Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. ⋯ Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution.
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Rev Bras Anestesiol · Mar 2019
Randomized Controlled Trial[Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy].
Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. ⋯ The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.
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Rev Bras Anestesiol · Mar 2019
Randomized Controlled Trial Comparative Study[Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement].
Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. ⋯ This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.
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Rev Bras Anestesiol · Mar 2019
[Should maternal anesthesia delay breastfeeding? A systematic review of the literature].
The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anesthesia and, due to the lack of information, many of them interrupt breastfeeding after anesthesia. There are limited data available regarding anesthetics transfer to breast milk. This review aims to develop some considerations and recommendations based on available literature. ⋯ Most of the anesthetic drugs are safe for nursing mothers and offer low risk to the breastfed neonates when administered in single-dose. However, high-dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. Moreover, diazepam and meperidine should be avoided in nursing women. Finally, anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects.