Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Jan 2019
Randomized Controlled Trial[The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial].
Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. ⋯ Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.
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Rev Bras Anestesiol · Nov 2018
Review[Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications].
The emerging use of endovascular therapies for acute ischemic stroke, like intra-arterial thrombectomy, compels a better understanding of the anesthetic management required and its impact in global outcomes. This article reviews the available data on the anesthetic management of endovascular treatment, comparing general anesthesia with conscious sedation, the most used modalities, in terms of anesthetic induction and procedure duration, patient mobility, occlusion location, hemodynamic parameters, outcome and safety; it also focuses on the state-of-the-art on physiologic and pharmacologic neuroprotection. ⋯ General anesthesia and conscious sedation are both safe alternatives for anesthetic management of patients submitted to endovascular thrombectomy. No anesthetic management is universally recommended and hopefully the ongoing randomized clinical trials will shed some light on the best approach; meanwhile, the choice of anesthesia should be based on the patient's individual characteristics. Regarding neuroprotection, hemodynamic stability is currently the most important strategy, as no pharmacological method has been proven effective in humans.
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Rev Bras Anestesiol · Nov 2018
Case Reports[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case].
Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. ⋯ Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.
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Rev Bras Anestesiol · Nov 2018
Case Reports[Ultrasound-guided thoracic paravertebral block for closed loop ileostomy repair in severe COPD: a case report].
Ultrasound-guided thoracic paravertebral block is usually considered a good alternative to epidural thoracic for anesthesia and pain control in thoracic and breast surgery. Furthermore it has also been used during abdominal surgery lately, especially hepatic and renal surgery. However, its role is poorly defined in this context. The purpose of this report was to highlight the role of thoracic paravertebral block in providing effective anesthesia and analgesia during both the abdominal surgical intervention and pain control in post-operative period, avoiding possible complications which general anesthesia may arise, which are fairly common in patients with chronic obstructive pulmonary disease and similar comorbidities. ⋯ Thoracic paravertebral block may be a safe anesthetic method for abdominal surgery in those patients who would undergo potential severe complications by using general anesthesia.
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Rev Bras Anestesiol · Nov 2018
Randomized Controlled Trial Comparative Study[Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial].
Emergence agitation is a postoperative negative behavior that affects mainly children. We studied the effect of two different doses of dexmedetomidine on the incidence and degree of EA in children undergoing strabismus surgery. ⋯ Dexmedetomidine (0.5μg.kg-1) before emergence from general anesthesia resulted in a reduction in the incidence of emergence agitation compared to a dexmedetomidine (0.25μg.kg-1) but on the expense of recovery times without adverse effects.