Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jan 2010
Randomized Controlled TrialAnalgesic efficacy of the intra-articular administration of high doses of morphine in patients undergoing total knee arthroplasty.
Although the efficacy of intraarticular (IA) morphine is still controversial, it has been shown that higher doses promote better results and consequently decrease postoperative analgesic consumption, characterizing a dose-dependent peripheral action. A controlled, randomized, double-blind study was undertaken to evaluate the efficacy of the intra-articular administration of 10 mg of morphine in patients undergoing total knee arthroplasty. ⋯ The treatment group had lower NS than the control group in M1 and M2, while significant differences were not observed in the other moments. The time until the first request of analgesics was significantly higher in the treatment group, and analgesic consumption in the first 24 hours was also lower in this group. The incidence of side effects did not differ between both groups. We concluded that the postoperative IA administration of 10 mg of morphine promoted a longer period without rescue analgesics and reduced their consumption in the first 24 hours.
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The objective of this study was to review the literature and to question the concept that obese patients should be considered as having a potential full stomach and, therefore, question how the airways, considered as of difficult access due to obesity, should be approached during anesthetic induction. ⋯ Studies in the literature demonstrate that gastric emptying is not slowed in obese patients as previously believed, and gastric contents are not greater in this patient population; intubation can, therefore, be safely done after anesthesia. Although obesity alone does not lead to failure to intubate, other signs can be used to predict difficult intubations.
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Rev Bras Anestesiol · Jan 2010
Comparative Study Clinical TrialUse of the ultrasound to determine the level of lumbar puncture in pregnant women.
An imaginary line connecting both iliac crests is used to determine the vertebral level for lumbar puncture. This line crosses the spine at the level of L4 or the L4-L5 space. This anatomical reference can be inaccurate in a large proportion of patients. The objective of the present study was to determine whether the identification of the L3-L4 space by the physical exam differs from that of the ultrasound in obese and non-obese pregnant women. ⋯ The L3-L4 space is correctly identified in a low percentage of obese and non-obese pregnant women. Spinal ultrasound can reduce the incidence of mistaken identification of the L3-L4 space in obese and non-obese pregnant women.
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Rev Bras Anestesiol · Jan 2010
Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals.
The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective of this study was to validate this system and determine its discriminatory power in surgical patients in Brazil. ⋯ The SAPS 3 system is valid for the Brazilian population of surgical patients, being a useful indicator of critical patients and to determine greater care in this group.
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Rev Bras Anestesiol · Nov 2009
Randomized Controlled Trial Comparative StudyEpidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodynamic effects on total hip arthroplasty.
Anesthesia for total hip arthroplasty (THA) is a challenge due to the advanced age and associated diseases of patients. The objective of this study was to evaluate whether the efficacy of the nociceptive blockade, secondary hemodynamic effects, difficulty to execute the technique, and influence in intraoperative bleeding of lumbar plexus block combined with general anesthesia is equivalent to epidural lumbar block in patients undergoing THA. ⋯ Nociceptive blockade, which was not associated with hemodynamic instability when combined with general anesthesia, was more effective in epidural block. Lumbar plexus block proved to be a useful technique when combined with general anesthesia when epidural block is contraindicated.