Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jul 2009
Randomized Controlled Trial Comparative Study[Efficacy of intraoperative methadone and clonidine in pain control in the immediate postoperative period after the use of remifentanil].
Due to its pharmacokinetic characteristics, remifentanil does not promote residual analgesia in the immediate postoperative period. The objective of this study was to compare the efficacy of methadone and clonidine in the control of postoperative pain of videolaparoscopic surgeries under total intravenous anesthesia with target-controlled remifentanil infusion. ⋯ Methadone was more effective than clonidine in the control of postoperative pain in videolaparoscopic surgeries under total intravenous anesthesia with remifentanil; and using clonidine was not better than not using it.
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Rev Bras Anestesiol · Jul 2009
Randomized Controlled Trial Comparative Study[A comparative study between bupivacaine and clonidine associated with bupivacaine in cervical plexus block for carotid endarterectomy].
Neurological evaluation can be done during cervical plexus block for endarterectomy, which also maintains postoperative analgesia. The objective of this study was to compare the analgesic effects of clonidine associated with bupivacaine to those of bupivacaine in cervical plexus block. ⋯ The association of 150 (1/4)g of clonidine and bupivacaine in cervical plexus block for carotid endarterectomy did not improve significantly the analgesic effects evaluated by pain severity, time until the first analgesic supplementations and amount of supplementary analgesics.
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Rev Bras Anestesiol · Jul 2009
Randomized Controlled Trial Comparative Study[Intraoperative volume replacement: crystalloids versus colloids in surgical myocardial revascularization without cardiopulmonary bypass].
The use of crystalloids or colloids for volume replacement in large size surgeries is controversial. The objective of this study was to compare the effects of the intraoperative administration of crystalloids (normal saline - NS) with those of colloids (modified fluid gelatin) for surgical myocardial revascularization (SMR) without cardiopulmonary bypass (CPB). ⋯ The use of colloids represented here by modified fluid gelatin associated with crystalloids or the use of crystalloids alone did not change the postoperative prognosis of patients undergoing SMR without CPB. Perhaps maintenance of the hemodynamic balance during the surgery is more important than the type of fluid administered.
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Rev Bras Anestesiol · Jul 2009
[The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids].
Intravenous or epidural patient-controlled analgesia (PCA) is a safe and effective technique in the treatment of postoperative pain. However, the use of opioids is not devoid of risks,and respiratory depression represents the most feared complication. The objective of the present study was to describe the incidence of respiratory depression associated with postoperative analgesia with the intravenous or epidural administration of opioids and the characteristics of the patients who developed this complication. ⋯ The incidence of respiratory depression was similar to that described in the literature; it is more frequent in children and adolescents, and with intravenous PCA.
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Rev Bras Anestesiol · Jul 2009
Case Reports[Subarachnoid blockade for cesarean section in a patient with ventriculoperitoneal shunt: case report].
Patients with ventriculoperitoneal shunt (VPS) represent an additional concern when neuroaxis block is indicated, especially in obstetrics. Currently, a consensus on the anesthetic technique of choice in those cases does not exist in the literature. The objective of this report was to describe the case of a cesarean section under subarachnoid blockade in a patient with VPS. ⋯ The anesthetic approach of obstetric patients with VPS is complex, and the risk and benefits of anesthetic techniques, as well as the circumstances that led to this indication, should be considered at the time of the indication. Successful of neuroaxis block in patients with neurological diseases has been reported. As for VPS, formal contraindication for neuroaxis block does not exist in the literature. Cases should be individualized. In the present report, due to an obstetric emergency and the neurologic condition of the patient, a decision to use neuroaxis blockade was made. The technique provided adequate management of the airways, good maternal-fetal condition, and postoperative analgesia. The evolution was favorable and the patient did not show any neurologic changes secondary to the technique used.