Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Sep 2008
Incidence and prophylaxis of nausea and vomiting in post-anesthetic recovery in a tertiary teaching hospital.
Postoperative nausea and vomiting (PONV) is frequent and potentially a severe complication that increases the length of anesthetic recovery and causes patient dissatisfaction. The evaluation of the risk of PONV and institution of prophylactic measures aiming the well-being of patients and cost reduction are frequent in the medical literature. This observational study evaluated the incidence, risk factors, and adjustment and effectivity of the prophylaxis of PONV in the recovery room of a tertiary teaching school. ⋯ The concerns of the anesthesiologists of the institution with PONV were evident. However, the absence of correlation between risk and prophylaxis suggests an empirical and ineffective procedure. Factors that were not evaluated were suggested by the absence between PONV and the use of antiemetic drugs. The orientation for anesthesiologists regarding more effective prophylactic measures can improve care of the population assisted.
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Rev Bras Anestesiol · Jul 2008
Randomized Controlled Trial Comparative StudyComparison of the plasma levels of 50% enantiomeric excess (S75/R25) 0.5% bupivacaine combined with 1:200,000 epinephrine between the parasacral and infragluteal sciatic nerve blocks.
Local anesthetics (LA) are safe drugs when the proper dose and localization are used. The rate of absorption of the local anesthetic depends on its mass and blood flow at the site of the injection. The objective of this study was to analyze the plasma concentration of 50% enantiomeric excess (S75R25) 0.5% bupivacaine combined with 1:200,000 epinephrine in the parasacral (PS) and infragluteal (IG) sciatic nerve block (SNB). ⋯ Cmax of 0.5 % bupivacaine (S75/R25) with 1:200,000 in the parasacral approach was higher when compared with the infragluteal SNB.
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Rev Bras Anestesiol · Jul 2008
Biography Historical ArticleEulogy to August Karl Gustav Bier on the 100th anniversary of intravenous regional block and the 110th anniversary of the spinal block.
August Karl Gustav Bier introduced two important techniques in regional block: intravenous regional block and subarachnoid block, widely used nowadays. Since the first one celebrates its 100th anniversary and the second its 110th anniversary, it is only fair that we pay homage to this extraordinary physician who created them. ⋯ A. K. G. Bier created and introduced two notable and still current methods of regional blocks in Anesthesiology and was a great defender of the preservation of the environment. Therefore, since this year we celebrate the 100th anniversary of intravenous regional block, his biography deserves to be told as a tribute to this important German physician.
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Rev Bras Anestesiol · Jul 2008
Case ReportsSubdural hematoma after inadvertent dura mater puncture. Case report.
Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In those situations, imaging exams are extremely useful. The objective of this report was to present the case of a patient who developed subdural hematoma after accidental puncture of the dura mater during epidural block. CASE REPORT A 47-year old male patient, 147 kg, 1.90 m, physical status ASA II, was admitted for abdominal dermolipectomy after undergoing gastroplasty. The dura mater was accidentally punctured during the epidural block. The patient developed postdural puncture headache treated with an epidural blood patch, with partial improvement of his symptoms. However, it was followed by worsening of the headache and an MRI showed the presence of an intracranial subdural hematoma, which was treated clinically The patient evolved with progressive improvement of the symptom and full recovery after 30 days. ⋯ Subdural hematoma is a rare, but severe, complication of dura mater puncture. It is difficult to diagnose, but it should always be remembered when post-dural puncture headache shows no resolution or even worsens after an epidural blood patch. An imaging exam is fundamental for the diagnosis of this rare complication.