Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Sep 2012
Randomized Controlled Trial Comparative StudyReducing the concentration to 0.4% enantiomeric excess hyperbaric levobupivacaine (s75: r25) provides unilateral spinal anesthesia. Study with different volumes.
Unilateral spinal anesthesia may be obtained with hypobaric or hyperbaric solution. The objective of this study was to compare different doses of enantiomeric excess hyperbaric levobupivacaine to achieve unilateral spinal anesthesia. ⋯ Spinal anesthesia with different volumes of enantiomeric excess hyperbaric bupivacaine (S75: R25) provided a 78% incidence of unilateral spinal block, with the smallest dose used (4 mg) the most efficient.
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Rev Bras Anestesiol · Sep 2012
Review Case ReportsRetropharyngeal hematoma secondary to minor blunt neck trauma: case report.
The development of a retropharyngeal hematoma following a blunt trauma is a rare occurrence. However, a space-occupying lesion in this area can be life-threatening and requires rapid assessment and treatment. This is clinically important because of the close proximity of the retropharyngeal space to the upper airway. Any swelling in the the posterior pharyngeal space may prompt it to bulge anteriorly into the airway and cause its obstruction. ⋯ A 86-year-old woman fell from a height of 1.5m and hit her neck on stairs and was admitted to our trauma department. A computerized tomography scan and a lateral neck x-ray to observe the soft tissue revealed a large retropharyngeal mass extending from the base of the skull down to the level of the lung. The patient was kept under observation and the hematoma reduced spontaneously in the following seven days although the patient died on the tenth day from pulmonary infection. The report emphasizes that early drainage of a retropharyngeal hematoma should be considered in similar cases. Although rarely encountered, retropharyngeal hematoma is a problem that can be faced in an emergency department.
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Rev Bras Anestesiol · Sep 2012
Randomized Controlled TrialAnalgesic efficacy of the intra-articular administration of S(+)- ketamine in patients undergoing total knee arthroplasty.
Total knee arthroplasty (TKA) is associated with significant postoperative pain. Many intra-articular (IA) agents have been used for postoperative analgesia with inconsistent outcomes. Ketamine's enantiomer S(+), S(+)- ketamine, was recently introduced commercially, with higher analgesic potency and less side effects than the racemic form. An experimental prospective randomized double-blind study was conducted to evaluate the analgesic efficacy of intra-articular S(+)- ketamine in patients undergoing primary TKA. ⋯ In this study, with this sample, the analgesic effect of IA S(+)- ketamine was not superior to saline solution in the postoperative period of TKA.
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JUSTIFICATIONS AND OBJECTIVES: regional analgesia plays an important role in multimodal pain management in critically ill patients, minimizing patient discomfort and reducing the associated physiological and psychological stress. Lower doses of systemic opioids reduce some of its side effects, such as withdrawal syndrome, possible psychological changes, and gastrointestinal dysfunction. Despite these benefits, its use is controversial, as patients in intensive care units often have contraindications, such as coagulopathy, hemodynamic instability, and difficulty in neurological assessment and implementation of regional technique. ⋯ The authors present a review of regional analgesia in intensive care, focusing on the main advantages and limitations of its use in critically ill patients, and describe the most commonly used regional techniques and its applicability.
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Rev Bras Anestesiol · Sep 2012
Randomized Controlled TrialEffects of preoperative sublingual misoprostol on uterine tone during isoflurane anesthesia for cesarean section.
Misoprostol would reduce the uterine bleeding after cesarean delivery without harmful effects on either mother or baby. We aimed to evaluate the effects of preoperative misoprostol on maternal blood loss, uterine tone, and the need for additional oxytocin after cesarean delivery under isoflurane anesthesia. ⋯ Preoperative administration of sublingual misoprostol 400μg is safe and effective in attenuating the maternal bleeding and uterine atony from isoflurane anesthesia for cesarean delivery.