Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jun 2002
[Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study].
There are still many questions involving study designs, data analyses and samples size which regard to the demonstration of the benefits of regional anesthesia on patients outcome. Database analysis and data acquisition in general cost less and require less time as compared to large randomized controlled trials. This retrospective study compares continuous spinal anesthesia, combined spinal-epidural and single shot spinal anesthesia for hip surgery in elderly patients during a 4-year period, to determine possible advantages and disadvantages of the three techniques. ⋯ Retrospective studies usually less and demand less time as compared to controlled studies. This retrospective study has shown that regional anesthesia techniques are related to a low mortality rate in the first postoperative month and to a low incidence of complications.
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This study shows the constant infraclavicular fossa presence, aiming at using it as a pathway for infraclavicular brachial plexus block. Determining the point where brachial plexus fascicles may be located within the fossa, the authors have proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle). The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. ⋯ Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.
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Rev Bras Anestesiol · Jun 2002
[Spinal anesthesia for outpatient pediatric surgery in 1 - 5 years old children with 0.5% isobaric enantiomeric mixture of bupivacaine (S75-R25)].
Commercially available bupivacaine is a racemic mixture of S(-) and R(+) enantiomers. Although the S(-) bupivacaine enantiomer is less toxic than R(+) bupivacaine to cardiovascular and central nervous systems, its relative efficacy has not yet been determined in spinal anesthesia for pediatric surgery. The aim of this study was to evaluate the effects of spinal anesthesia with a 0.5% isobaric mixture of S(-) bupivacaine(75%) + R(+) bupivacaine(25%) in 40 children aged 1 to 5 years scheduled for outpatient surgery. ⋯ Isobaric 0.5% levobupivacaine (R25-S75) induces a safe spinal anesthesia in patients aged 1 to 5 years scheduled for outpatient procedures, with a high success rate, short-lasting motor block, relatively low incidence of side effects and at a lower cost. Headache seems to be rare in patients below five years of age when a thin needle is used. Our results have shown that spinal anesthesia is a safe and easy technique for children between 1 and 5 years of age in outpatient procedures.
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Rev Bras Anestesiol · Apr 2002
Influence of dexmedetomidine upon sevoflurane end-expiratory concentration. Evaluation by bispectral index, suppression rate and electroencephalographic power spectral analysis.
Dexmedetomidine, an alpha2-adrenergic agonist, has been described as being able to decrease the demand for both venous and inhalational agents. This study aimed at evaluating the influence of Dexmedetomidine upon sevoflurane end-expiratory concentration (EC) with monitoring the depth of anesthesia. ⋯ Dexmedetomidine was effective in decreasing sevoflurane end-expiratory concentration while maintaining hemodynamic stability without impairing time for hospital discharge, in addition to promoting an earlier emergence.
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Rev Bras Anestesiol · Apr 2002
Postoperative analgesia in pediatric patients: comparative study among local anesthetics, opioids and non-steroidal anti-inflammatory drugs.
The treatment of postoperative pain in children has been given special attention in the last decades. This study aimed at analyzing postoperative analgesia in children, considering analgesia quality and duration, evaluation methods reliability and the incidence of side effects resulting from different analgesia techniques. ⋯ Spinal opioids are safe and effective for postoperative analgesia in children, but when compared to bupivacaine, there have been no significant differences and a higher incidence of side effects. Rectal diclofenac was not effective as a single analgesic as compared to other techniques.