Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jul 2010
Randomized Controlled Trial Comparative StudyPhenylephrine for blood pressure control in elective cesarean section: therapeutic versus prophylactic doses.
Spinal block is commonly used in cesarean sections and, if some prophylactic measures are not taken, the incidence of hypotension is higher than 80%. The objective of this study was to compare the efficacy of the administration of therapeutic or prophylactic doses of phenylephrine to maintain blood pressure in patients undergoing spinal block for elective cesarean section. ⋯ According to the methodology used, this study showed that prophylactic continuous infusion of phenylephrine initiated immediately after the spinal block for cesarean section is more effective in reducing the incidence of hypotension and maternal and fetal side effects.
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Rev Bras Anestesiol · Jul 2010
Randomized Controlled Trial Comparative StudyHemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass.
To evaluate the efficacy of the combined infusion of dexmedetomidine and fentanyl on the hemodynamic response during cardiac surgery with cardiopulmonary bypass (CPB) in children. ⋯ Infusion of dexmedetomidine without bolus seems to be an effective adjuvant to fentanyl on the promotion of sedation and control of hemodynamic responses during surgery for congenital cardiopathies in children.
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Rev Bras Anestesiol · Jul 2010
Case ReportsUltrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient. Case reports.
The use of the ultrasound to guide the puncture in peripheral nerve blocks has become increasingly more frequent. With the lower probability of promoting vascular damage the ultrasound has become an interesting tool in peripheral nerve blocks especially in patients in use of anticoagulants or with coagulopathies. The objective of this article was to report two cases in which ultrasound-guided sciatic and femoral nerve blocks were performed in anticoagulated patients. ⋯ Anticoagulation imposes some restrictions to classical regional anesthetic techniques. With the development of ultrasound equipment and methods, it is now possible to accurately identify vascular and neural structures. This allows ultrasound-guided puncture to be more precise, both to achieve the area of interest and to minimize the risks of accidental vascular damage. Until now, peripheral block was not recommended in anticoagulated patients or in those with coagulopathies. However, considering that few reports on ultrasound-guided regional blocks in coagulopathies can be found in the literature, the safety of this technique in this condition has yet to be established.
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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
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.