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Uses of magnesium sulfate in anesthesiology
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Gutiérrez-Román, Claudia I.

; Carrillo-Torres, Orlando

; Pérez-Meléndez, Emmanuel S.

Revista médica del Hospital General de México

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mar 2022, Volume 85 N. 1 Pages 25 - 33

Abstract: En | Text: En | PDF: En

Abstract Introduction: Magnesium sulfate heptahydrate (MgSO4 7H2O) is a divalent cation, pharmacologically its mechanism has been as a reversible blocker of the N-methyl-D-aspartate receptor (NMDAR) and therefore has been proposed in the use of anesthesiology. Objective: to describe its properties, its mechanism of action, the uses and the doses in anesthesiology. Methodology: A bibliographic review was carried out with keywords: anesthesia, magnesium sulfate, analgesia, muscle relaxation and organ protection in: PubMed, Science Direct, Embase and Cochrane Library. The articles considered most relevant and with the greatest evidence were selected. Results: A total of 244 articles were obtained, 210 were eliminated, a total of 34 articles remained. The bibliography reports the use of MgSO4 7H2O as an adjunct in sedation, analgesia, neuromuscular relaxation, motor relaxation in neuraxial anesthesia, prophylaxis for postoperative nausea and vomiting, as well as in pathologies that require its application prevenient to or during the anesthetic event (alterations in serum levels of Mg++, patients with treatment based on MgSO4 7H2O, bronchospasm, hypertensive uncontrolled, excessive bleeding and cardiac arrhythmias). Conclusions: The use of MgSO4 7H2O has shown useful pharmacokinetic and pharmacodynamic qualities in the management of the surgical patient patient such as analgesia, sedation, hemodynamic stability, decrease in PONV and decrease in the consumption of opioids and hypnotics, and it can also be applied as treatment of the patient's own pathologies.

https://doi.org/10.24875/hgmx.21000022 87 downloads

COMBINED VENOUS AND ARTERIAL RECONSTRUCTION IN THE TRIANGLE AREA AFTER TOTAL PANCREATODUODENECTOMY
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FERNANDES, Eduardo de Souza Martins

; MORAES-JUNIOR, Jose Maria Assunção

; VASQUES, Rodrigo Rodrigues

; BELOTTO, Marcos

; TORRES, Orlando Jorge Martins

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2022, Volume 35 elocation e1643

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0102-672020210002e1643

LIPIODOL LYMPHANGIOGRAPHY AND EMBOLIZATION OF CHYLOUS ASCITES AFTER PANCREATODUODENECTOMY
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Torres, Orlando Jorge Martins

; Valleta, Natália Helena

; Moraes-Junior, José Maria Assunção

; Falcão, Milena Vasconcelos

; Quariguasi, Joana Marques Lobo

; Faria, Igor Murad

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2022, Volume 35 elocation e1677

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0102-672020220002e1677

Eficacia terapéutica de la buprenorfina para tratamiento de dolor agudo postoperatorio en cirugía torácica por toracoscopía
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Posso-Sierra, Juan José

; Carrillo-Torres, Orlando

; Carrillo-Ruiz, José Damián

; Vega-Montiel, Verónica de La

; Gutiérrez-Román, Claudia I

Revista mexicana de anestesiología

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jun 2021, Volume 44 N. 2 Pages 98 - 104

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract: Introduction: Posterior pain in thoracoscopy has an 80% incidence. These procedures are done under general anesthesia or sedoanalgesia. The buprenorphin in dosage of 4 μg/kg it’s the foundation for post-operatory pain treatment, nevertheless, smaller dosage can be sufficient. The objective of this study is to demonstrate that a dosage of buprenorphin from 1-3 μg/kg provides suitable analgesia with less side effects during post-operatory in patients who underwent thoracoscopic surgery. Material and methods: We conducted a double-blind, prospective, transversal study, in 48 patients which underwent a thoracoscopy divided in 3 groups: A (1 μg/kg), B (2 μg/kg), and C (3 μg/kg) treated with buprenorphin. We studied side effects, pain intensity (NVE), and sedative effect (RASS) from 0 to 120 minutes postanesthesia. Results: Dosage from 1 to 3 μg/kg did not generate side effects. The analgesia effect is higher with 2 μg/kg (p = 0.019) and 3 μg/kg (p = 0.045). Dosage of 1 and 2 μg/kg have lower sedative effect. Conclusion: The multimodal analgesia was diminished by 200% inmidiate postsurgical pain. Dosage from 2-3 μg/kg of buprenorphine are effective for pain control with less side effects and a superficial sedative effect during post-operatory.

Resumen: Introducción: El dolor postoperatorio en toracoscopía tiene una incidencia del 80%. Estos procedimientos se realizan bajo anestesia general o sedoanalgesia. La buprenorfina en dosis de 4 μg/kg o más es un fármaco pilar para el tratamiento de dolor postoperatorio; sin embargo, dosis menores pueden ser suficientes. El objetivo de este estudio fue demostrar que dosis de 1-3 μg/kg de buprenorfina aporta una adecuada analgesia con menores efectos adversos durante el postoperatorio en pacientes sometidos a cirugía toracoscópica. Material y métodos: Se realizó el estudio prospectivo, transversal y doble ciego en 48 pacientes sometidos a toracoscopía, divididos en 3 grupos: A (1 μg/kg), B (2 μg/kg) y C (3 μg/kg) tratados con buprenorfina, se evaluaron efectos adversos, intensidad de dolor por escala verbal numérica (EVN) y sedación con escala de agitación-sedación de Richmond (RASS) de los 0 a los 120 minutos postanestesia. Resultados: Las dosis de 1 a 3 μg/kg de buprenorfina no ocasionaron efectos adversos. El mantenimiento de analgesia es mayor con 2 μg/kg (p = 0.019) y 3 μg/kg (p = 0.045). Las dosis de 1 y 2 μg/kg presentan un nivel de sedación menor. Conclusiones: La analgesia multimodal disminuyó un 200% el dolor postquirúrgico inmediato. Las dosis de 2-3 μg/kg de buprenorfina son efectivas para el control del dolor con menor incidencia de efectos adversos y un nivel de sedación superficial durante el postoperatorio.

127 downloads

Complicaciones postoperatorias por descontrol lipídico perioperatorio. Revisión sistemática
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Ramírez-Reyes, Liliana Georgina

; Carrillo-Torres, Orlando

; Brito-Ramírez, Fabiola

Revista mexicana de anestesiología

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mar 2021, Volume 44 N. 1 Pages 34 - 42

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract: Introduction: The alteration in lipid metabolism has been involved in the pathogenesis of postoperative complications primarily by inducing inflammatory processes that may affect morbidity, in addition an increase in vulnerability/sensitivity for ischemia reperfusion has been observed involved apoptosis by stress mediated by the endoplasmic reticulum. During the anesthetic procedure, serum lipid levels can affect the pharmacokinetics of various anesthetic agents. Objective: To determine if there is scientific evidence to prove or refute the development of complications in post-operated patients who present with lipid decontrol in the preoperative period. Methodology: A review was made in the literature through the search engines PubMed, ScienceDirect, and BiomedCentral. Results: With the search criteria, 17 studies were reviewed (controlled clinical trials, case and control studies, cohorts and basic experimental studies). Conclusions: Although it is necessary to improve the methodology of several articles reviewed and increase the number of them, in most of them a relationship was found between dyslipidemia with postoperative alterations that affect an increase in morbidity or mortality.

Resumen: Introducción: La alteración en el metabolismo de los lípidos se ha involucrado en la patogénesis de complicaciones postoperatorias, primordialmente por inducir procesos inflamatorios que pueden afectar la morbilidad, además se ha observado un aumento en la vulnerabilidad/sensibilidad por isquemia reperfusión implicada por apoptosis por estrés mediado por el retículo endoplásmico. Durante el procedimiento anestésico los niveles séricos de lípidos pueden afectar la farmacocinética de varios agentes anestésicos. Objetivo: Determinar si existe evidencia científica que compruebe o refute el desarrollo de complicaciones en pacientes postoperados que cursan con descontrol lipídico en el período preoperatorio. Metodología: Se realizó una revisión en la literatura mediante los buscadores PUBMED, ScienceDirect y BioMed Central. Resultados: Con los criterios de búsqueda se revisaron 17 estudios (ensayos clínicos controlados, estudios de casos y controles, cohortes y estudios experimentales básicos). Conclusiones: Aunque es necesario mejorar la metodología de varios artículos revisados y aumentar la cantidad de los mismos, en la mayor parte de ellos se encontró relación entre dislipidemia con alteraciones postoperatorias que inciden en un aumento de morbilidad o mortalidad.

https://doi.org/10.35366/97775 124 downloads

Characterising four Sarconesiopsis magellanica (Diptera: Calliphoridae) larval fat body-derived antimicrobial peptides
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Pérez, Cindy

; Díaz-Roa, Andrea

; Bernal, Yuly

; Arenas, Nelson E

; Kalume, Dario Eluan

; Côrtes, Luzia Monteiro de Castro

; da Silva Junior, Pedro I

; Varela, Yahson

; Patarroyo, Manuel A

; Torres, Orlando

; Bello, Felio J

Memórias do Instituto Oswaldo Cruz

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2021, Volume 116 elocation e200587

Abstract: En | Text: En | PDF: En

BACKGROUND The inappropriate use of antibiotics has led to the accelerated growth of resistance to antibiotics. The search for new therapeutic strategies (i.e., antimicrobial peptides-AMPs) has thus become a pressing need. OBJECTIVE Characterising and evaluating Sarconesiopsis magellanica larval fat body-derived AMPs. METHODS Fat body extracts were analysed by reversed-phase high-performance liquid chromatography (RP-HPLC); mass spectrometry was used for characterising the primary structure of the AMPs so found. ProtParam (Expasy) was used for analysing the AMPs’ physico-chemical properties. Synthetic AMPs’ antibacterial activity was evaluated. FINDINGS Four new AMPs were obtained and called sarconesin III, IV, V and VI. Sarconesin III had an α-helix structure and sarconesins IV, V and VI had linear formations. Oligomer prediction highlighted peptide-peptide interactions, suggesting that sarconesins III, V and VI could form self-aggregations when in contact with the microbial membrane. AMPs synthesised from their native molecules’ sequences had potent activity against Gram-positive bacteria and, to a lesser extent, against Gram-negative and drug-resistant bacteria. Sarconesin VI was the most efficient AMP. None of the four synthetic AMPs had a cytotoxic effect. MAIN CONCLUSIONS S. magellanica larval fat body-derived antimicrobial peptides are an important source of AMPs and could be used in different antimicrobial therapies and overcoming bacterial resistance.

https://doi.org/10.1590/0074-02760200587

Analysis of tissue inflammatory response, fibroplasia, and foreign body reaction between the polyglactin suture of abdominal aponeurosis in rats and the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone and polyester/porcine collagen meshes
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Ribeiro, Waston Gonçalves

; Nascimento, Adriana Carneiro Corrêa

; Ferreira, Larissa Brito

; Marchi, Danilo Dallago De

; Rego, Gustavo Moraes

; Maeda, Carlos Toshinori

; Silva, Gyl Eanes Barros

; Artigiani Neto, Ricardo

; Torres, Orlando Jorge Martins

; Pitombo, Marcos Bettini

Acta Cirúrgica Brasileira

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2021, Volume 36 N. 7 elocation e360706

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia, and proportion of type I/III collagen between closure of abdominal wall aponeurosis using polyglactin suture and intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes or suture with polyglactin (sham) after creation of defect in the abdominal wall. Twenty-one days later, histological analysis was performed after staining with hematoxylin-eosin and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and higher number of gigantocytes (p < 0.05) than the sham group, which had a better fibroplasia with a higher proportion of type I/III collagen than the tissue separating meshes (p < 0.05). There were no statistically significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and polyester/porcine collagen meshes determined a more intense tissue inflammatory response with exuberant foreign body reaction, immature fibroplasia and low tissue proportion of type I/III collagen compared to suture with polyglactin of abdominal aponeurosis. However, there were no significant differences in relation to the polypropylene mesh group.

https://doi.org/10.1590/acb360706

Protocolo de manejo de la vía aérea en pacientes con sospecha o diagnóstico de SARS-CoV-2/COVID-19
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Forero-Vega, Jhonn Sebastián

; Carrillo-Torres, Orlando

; Salamanca-Sana, Yessica Tatiana

; Camacho-Vacherón, Verónica

Revista mexicana de anestesiología

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dec 2020, Volume 43 N. 4 Pages 225 - 229

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract: In recent days, various protocols have been published for the prevention of transmission of the COVID-19 virus during manipulation of the airway. The article describes a form for airway management that is used in some hospitals in the Boyacá Colombia and Mexico City. This consists of nine phases that describe from the preparation of the medical equipment to be used, as well as the medical personnel that will perform the procedure, to the removal of the endotracheal tube. These phases are: placement of personal protective equipment, preparation, pre-oxygenation, induction, intubation, confirmation, aspiration tube, extubation and removal and disposal of material.

Resumen: En los últimos días se han publicado diversos protocolos para la prevención de la transmisión del virus COVID-19 durante la manipulación de la vía aérea. El artículo describe una forma para el manejo de la vía aérea que es utilizado en algunos hospitales de la zona de Boyacá en Colombia y en la Ciudad de México. Este consta de un total de nueve fases que describen desde la preparación del equipo médico a utilizar, así como del personal médico que realizará el procedimiento, hasta el retiro del tubo endotraqueal. Estas fases son: colocación del equipo de protección personal, preparación, preoxigenación, inducción, intubación, confirmación, sonda de aspiración, extubación y retiro y desecho de material.

https://doi.org/10.35366/94933 41 downloads

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA
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COIMBRA, Felipe Jose F

; TORRES, Orlando Jorge M

; ALIKHANOV, Ruslan

; AGARWAL, Anil

; PESSAUX, Patrick

; FERNANDES, Eduardo de Souza M

; QUIREZE-JUNIOR, Claudemiro

; ARAUJO, Raphael Leonardo C

; GODOY, André Luis

; WAECHTER, Fabio Luis

; RESENDE, Alexandre Prado de

; BOFF, Marcio Fernando

; COELHO, Gustavo Rego

; REZENDE, Marcelo Bruno de

; LINHARES, Marcelo Moura

; BELOTTO, Marcos

; MORAES-JUNIOR, Jose Maria A

; AMARAL, Paulo Cezar G

; PINTO, Rinaldo Danesi

; GENZINI, Tercio

; LIMA, Agnaldo Soares

; RIBEIRO, Heber Salvador C

; RAMOS, Eduardo José

; ANGHINONI, Marciano

; PEREIRA, Lucio Lucas

; ENNE, Marcelo

; SAMPAIO, Adriano

; MONTAGNINI, André Luis

; DINIZ, Alessandro

; JESUS, Victor Hugo Fonseca de

; SIROHI, Bhawna

; SHRIKHANDE, Shailesh V

; PEIXOTO, Renata D`Alpino

; KALIL, Antonio Nocchi

; JARUFE, Nicolas

; SMITH, Martin

; HERMAN, Paulo

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 1 elocation e1496

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

https://doi.org/10.1590/0102-672020190001e1496

10.

VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS?
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VALADÃO, José Aparecido

; LEAL, Plinio da Cunha

; OLIVEIRA, Eduardo José Silva Gomes de

; TORRES, Orlando Jorge Martins

; PINTO, Luis Eduardo Veras

; MARCHI, Danilo Dallago De

; GAMA-FILHO, Ozimo Pereira

; SANTO, Marco Aurelio

; NASSIF, Paulo Afonso Nunes

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 2 elocation e1513

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: A gastrectomia vertical ampliada é uma variação da técnica da gastrectomia vertical, necessitando de estudos a fim de elucidar a segurança em relação ao refluxo gastroesofágico. Objetivo: Analisar comparativamente gastrectomia vertical (GV) e gastrectomia vertical ampliada (GVA) em ratos com obesidade induzida por dieta cafeteria em relação à presença de esofagite de refluxo, perda de peso e alterações macroscópicas relacionadas aos procedimentos. Método: Trinta ratos Wistar foram randomizados em três grupos, e após período de indução de obesidade por meio de dieta cafeteria de 28 dias, foram submetidos a operação simulada (grupo controle GC), gastrectomia vertical (grupo GV) e gastrectomia vertical ampliada (grupo GVA). Os animais foram acompanhados por 28 dias no pós-operatório e, após a eutanásia, foi realizada a pesquisa de esofagite de refluxo através de avaliação histopatológica. Peso e avaliação macroscópica foram as outras variáveis de estudo, sendo o peso aferido semanalmente e a avaliação macroscópica no momento da eutanásia. Resultados: Todos os animais apresentaram algum grau de inflamação e a presença de ao menos um critério de inflamação, porém, não houve diferença estatisticamente significante na análise entre os grupos. Em relação à perda de peso, os animais do GC apresentaram aumento gradativo durante todo experimento evoluindo para super-obesidade ao término do estudo, enquanto os dos grupos GV e GVA tiveram reganho de peso após a primeira semana do pós-operatório, porém, reganho menos acentuado se comparável ao GC, tanto para GV quanto para GVA. Conclusões: Não há diferença em relação à esofagite de refluxo entre GV e GVA, bem como em relação às alterações macroscópicas. Ambas as técnicas têm capacidade de controlar a evolução do peso no pós-operatório em relação ao grupo controle.

ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

https://doi.org/10.1590/0102-672020190001e1513

11.

ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL
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SAMPAIO, Mauricio Adam Feitosa

; SAMPAIO, Simone Losekann Pereira

; LEAL, Plinio da Cunha

; MOURA, Ed Carlos Rey

; ALVARES, Lívia Goreth Galvão Serejo

; DE-OLIVEIRA, Caio Marcio Barros

; TORRES, Orlando Jorge Martins

; MARTINS, Marília da Glória

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 3 elocation e1544

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: No Brasil, a abordagem baseada em metas foi nomeada de Projeto ACERTO e tem obtido bons resultados quando aplicada em operações eletivas com diminuição do tempo de internação, retorno mais precoce as atividades sem incremento de morbimortalidade. Objetivo: Analisar o impacto do ACERTO na assistência prestada em operações de emergência. Métodos: Foi realizado um estudo de intervenção em hospital de trauma. Foram comparados 452 pacientes submetidos à operações de emergência e acompanhados pelo serviço de cirurgia geral no período de outubro a dezembro de 2018 (fase pré-ACERTO, n=243) e no período de março a junho de 2019 (fase pós-ACERTO, n=209). Foram avaliados: reintrodução da dieta, volume de hidratação venosa pós-operatória infundido, tempo de uso de catéteres, sondas e drenos, analgesia pós-operatória, prevenção de vômitos pós-operatórios, mobilização precoce e fisioterapia. Resultados: Após a implantação do ACERTO houve reintrodução mais precoce da dieta, foi atingido o aporte calórico ideal mais precocemente, retirada mais precoce da hidratação venosa, maior prescrição de analgesia pós-operatória, de profilaxia de vômitos pós-operatórios e maior prescrição de fisioterapia e mobilização precoce em todos (p<0,01); na análise multivariada não houve alteração nas taxas de complicações observadas pré e pós-ACERTO (10,7% vs. 7,7% (p=0,268) e houve diminuição do tempo de internação pós-ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusão: A implantação do projeto ACERTO diminuiu o tempo de internação hospitalar, melhorou a assistência médica prestada sem incremento das taxas de complicações avaliadas.

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

https://doi.org/10.1590/0102-672020200003e1544

12.

RISK FACTORS ASSOCIATED WITH HEPATIC ARTERY THROMBOSIS: ANALYSIS OF 1050 LIVER TRANSPLANTS
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PINTO, Luis Eduardo Veras

; COELHO, Gustavo Rego

; COUTINHO, Madalena Maria Silva

; TORRES, Orlando Jorge Martins

; LEAL, Plinio Cunha

; VIEIRA, Ciro Bezerra

; GARCIA, José Huygens Parente

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 4 elocation e1556

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Trombose de artéria hepática é importante causa de falência de enxerto e complicações biliares. Fatores de risco para trombose estão relacionados aos aspectos técnicos da anastomose arterial e fatores não cirúrgicos. Objetivo: Avaliar os fatores de risco para o desenvolvimento de trombose de artéria hepática. Métodos: A amostra consta de 1050 casos de transplante hepático. Foi realizado estudo retrospectivo e transversal, e as variáveis foram avaliadas em doadores e receptores. Resultados: A análise univariada mostrou que as variáveis relacionadas a trombose de artéria hepática são: MELD e tempo de isquemia quente. Na análise multivariada, o MELD=14.5 e tempo de isquemia quente =35 min foram fatores de risco independentes para trombose de artéria hepática. No teste de prevalência para avaliação do tipo de anastomose como variável, foi observado que a sutura contínua tem maior risco de trombose quando comparada com aquela em pontos separados. Conclusão: Tempo de isquemia quente prolongado, MELD calculado e idade do recipiente foram fatores de risco independentes para trombose de artéria hepática após transplante de fígado em adultos. Pacientes submetidos à anastomose com sutura contínua apresentaram mais trombose quando comparados com a em pontos separados. Retransplante por trombose está associado com maior mortalidade.

ABSTRACT Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.

https://doi.org/10.1590/0102-672020200004e1556

13.

Reflexiones sobre el uso de opioides para el tratamiento del dolor crónico no-oncológico en México
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Covarrubias-Gómez, Alfredo

; Templos-Estebán, Luz A

; Esquer-Guzmán, Héctor M

; Carrillo-Torres, Orlando

; Pavón-Sánchez, Rodrigo A

; Arriaga-Morales, Ernesto

; Ferretiz-López, Giancarlo

; Sámano-García, Marcela

; Suárez-García, Irma B

; Baez-Baez, Jorge U

; Salinas-Palacios, Cinthia K

; Gutiérrez-Salmerón, Claudia

; Valencia-Flores, Yosemit

; Otero-Lamas, Margarita

Revista mexicana de anestesiología

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dec 2019, Volume 42 N. 4 Pages 312 - 314

Abstract: Es | Text: Es | PDF: Es

191 downloads

14.

Sevoflurano aplicado localmente: una alternativa analgésica y terapéutica en úlceras cutáneas crónicas de difícil manejo
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López-Riascos, Suleydi Daniela

; Rivas-Ramírez, Christian

; Carrillo-Torres, Orlando

Revista mexicana de anestesiología

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dec 2019, Volume 42 N. 4 Pages 268 - 274

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract: Chronic ulcers in the lower limbs are frequent, mainly in pathologies of vascular origin and cause a decrease in the patients’ quality of life, due to the time and cost of the treatment, especially when they are refractory to conventional therapeutic and analgesic measures. Those who present these lesions usually suffer from comorbidities that require multiple drugs for their control, so it is necessary to use alternatives, which reduce the risk of drug interactions and adverse effects. One of them is considered the local application of sevoflurane, as an anesthetic technique in the surgical lavage and/or debridement of ulcers, due to the rapid, intense and long-lasting analgesia it produces.

Resumen: Las úlceras crónicas en miembros inferiores son frecuentes, principalmente en patologías de origen vascular; causan una disminución en la calidad de vida de los pacientes por el tiempo y el costo del tratamiento, más aún cuando son refractarias a las medidas terapéuticas y analgésicas convencionales. Quienes presentan estas lesiones, generalmente padecen comorbilidades que requieren múltiples fármacos para su control, por lo cual, es necesario utilizar alternativas que disminuyan el riesgo de interacciones farmacológicas y efectos adversos. Una de ellas se considera la aplicación local de sevoflurano como técnica anestésica en el lavado y/o desbridamiento quirúrgico de las úlceras, debido a la analgesia rápida, intensa y duradera que produce.

155 downloads

15.

Comparing 8 mg versus 16 mg of dexamethasone as coadjuvant treatment for acute post-operative pain: A randomized controlled clinical trial
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Rascón-Martínez, Dulce María

; Olua-Estrada, Jennifer

; Castellanos-Olivares, Antonio

; Carrillo-Torres, Orlando

Revista médica del Hospital General de México

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sep 2019, Volume 82 N. 3 Pages 140 - 146

Abstract: En | Text: En | PDF: En

Background: Glucocorticoids (IEA) have an analgesic effect by suppressing the release of inflammatory mediators that induce hyperalgesia, such as tumor necrosis factor-alpha, interleukin 8, and interleukin 6. Objectives: The objectives of this study were to compare two dosages of dexamethasone (DXM) (8 vs. 16 mg) as coadjuvant in the management of acute post-operative pain in patients undergoing ear, nose, and throat surgery. Materials and Methods: We included 80 patients in a double-blind clinical trial, divided into three groups that compared two different dosages of DXM with a control group that did not receive DXM, although all groups received intravenous (IV) analgesics. The post-operative pain report was assessed using a numeric rating scale, a post-operative pain visual analog scale (VAS), and recovery time 24-h after surgery. Descriptive statistics were used to apply the Chi-square test and ANOVA test for numerical variables. Results: Pain in Group 2 compared to Group 1 and Group 3 was less during recovery, after 1 h, and 24 h with p < 0.05 as with the post-operative pain VAS, p < 0.05. Opioid consumption was similar in the three groups. Conclusions: DXM 16 mg + Metamizole 1 g IV yields better analgesic effects compared to DXM 8 mg + metamizole 1 g in the immediate post-operative period and at 24 h.

https://doi.org/10.24875/hgmx.m19000013 30 downloads

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