RESUMEN Objetivo: El objetivo principal de este estudio fue comparar los niveles de estrés y ansiedad en niños sometidos a procedimientos quirúrgicos con o sin presencia de los padres en la inducción de la anestesia mediante la medición de los niveles de cortisol salival y la aplicación del mYPAS. Método: Ensayo cuasi-aleatorio con niños de 5 a 12 años, con estado físico ASA I, II o III, sometidos a cirugía electiva. Según la disposición de los padres, se definieron como grupo acompañado o no acompañado. Se utilizaron pruebas de chi-cuadrado, exacta de Fisher, t de Student, Mann-Whitney, Hodges-Lehman y Spearman para los análisis estadísticos. Resultados: Se incluyeron 46 niños; el 63% eran niños en edad preescolar, en su mayoría acompañados por sus madres (80%). La puntuación mYPAS mediana fue de 37,5 (rango intercuartílico, 23,4–51,6) en niños no acompañados y de 55,0 (rango intercuartílico, 27,9–65,0) en niños acompañados, con una diferencia mediana estimada de +11,8 (IC del 95% de 0 a 23,4; p = 0,044). No hubo diferencias significativas en los niveles medios de cortisol salival. Conclusión: El nivel de ansiedad fue mayor en los niños acompañados. No hubo diferencias en los niveles de cortisol salival entre ambos grupos. Registro Brasileño de Ensayos Clínicos (ReBEC):RBR-9wj4qvy. Objetivo Método cuasialeatorio cuasi aleatorio 1 años I III electiva chicuadrado, chicuadrado chi cuadrado, cuadrado chi-cuadrado Fisher Student MannWhitney, MannWhitney Mann Whitney, Whitney Mann-Whitney HodgesLehman Hodges Lehman estadísticos Resultados 4 63 preescolar 80%. 80 80% . (80%) 375 37 37, rango intercuartílico 23,4–51,6 234516 23 51 6 550 55 55, 27,9–65,0 279650 27 9 65 118 11 8 +11, IC 95 23,4 234 0,044. 0044 0,044 044 0,044) Conclusión grupos ReBECRBR9wj4qvy. ReBECRBR9wj4qvy ReBECRBRwjqvy ReBEC RBR 9wj4qvy. 9wj4qvy wj qvy (ReBEC):RBR-9wj4qvy (80% 3 23,4–51, 23451 2 27,9–65, 27965 +11 23, 004 0,04 04 ReBECRBR wjqvy (80 23,4–51 2345 27,9–65 2796 +1 00 0,0 (8 23,4–5 27,9–6 279 + 0, ( 23,4– 27,9– 27,9 27,

ABSTRACT Objective: The main objective of this study was to compare stress and anxiety levels in children undergoing surgical procedures with or without parental presence at induction of anesthesia by measuring salivary cortisol levels and applying the mYPAS. Method: Quasi-randomized trial with children aged 5–12 year, with ASA physical status I, II, or III, undergoing elective surgery. According to parents’ willingness, the pair were defined as accompanied or unaccompanied group. Chi-square, Fisher’s exact tests, Student’s t test, Mann-Whitney, Hodges-Lehman and Spearman’s tests were used for statistical analyzes. Results: We included 46 children; 63% were preschool children mostly accompanied by their mothers (80%). The median mYPAS score was 37.5 (quartile range, 23.4–51.6) in unaccompanied children, and 55.0 (quartile range, 27.9–65.0) in accompanied children, with an estimated median difference of +11.8 (95% CI of 0 to 23.4; p = 0.044). There were no significant differences in the mean salivary cortisol levels. Conclusion: The level of anxiety was higher in accompanied children. There were no differences in salivary cortisol levels between both groups. Brazilian Registry of Clinical Trials (ReBEC):RBR-9wj4qvy. Objective Method Quasirandomized Quasi randomized 512 5 12 5–1 year I II III surgery parents willingness group Chisquare, Chisquare Chi square, square Chi-square Fishers Fisher s Students Student test MannWhitney, MannWhitney Mann Whitney, Whitney Mann-Whitney HodgesLehman Hodges Lehman Spearmans Spearman analyzes Results 4 63 80%. 80 80% . (80%) 375 37 37. quartile range 23.4–51.6 234516 23 51 6 550 55 55. 27.9–65.0 279650 27 9 65 118 11 8 +11. 95% 95 (95 23.4 234 0.044. 0044 0.044 044 0.044) Conclusion groups ReBECRBR9wj4qvy. ReBECRBR9wj4qvy ReBECRBRwjqvy ReBEC RBR 9wj4qvy. 9wj4qvy wj qvy (ReBEC):RBR-9wj4qvy 1 5– (80% 3 23.4–51. 23451 2 27.9–65. 27965 +11 (9 23. 004 0.04 04 ReBECRBR wjqvy (80 23.4–51 2345 27.9–65 2796 +1 ( 00 0.0 (8 23.4–5 27.9–6 279 + 0. 23.4– 27.9– 27.9 27.

RESUMO Objetivo: O principal objetivo deste estudo foi comparar os níveis de estresse e ansiedade em crianças submetidas a procedimentos cirúrgicos com ou sem presença dos pais na indução da anestesia, medindo os níveis de cortisol salivar e aplicando o mYPAS. Método: Ensaio quaserandomizado com crianças de 5 a 12 anos, com estado físico ASA I, II ou III, submetidas a cirurgia eletiva. De acordo com a disposição dos pais, o par foi definido como grupo acompanhado ou não acompanhado. Foram utilizados testes de qui-quadrado, exato de Fisher, t de Student, Mann-Whitney, Hodges-Lehman e Spearman para as análises estatísticas. Resultados: Foram incluídas 46 crianças; 63% delas em idade préescolar, principalmente acompanhadas por suas mães (80%). A pontuação mYPAS mediana foi de 37,5 (intervalo interquartil, 23,4–51,6) em crianças não acompanhadas e de 55,0 (intervalo interquartil, 27,9–65,0) em crianças acompanhadas, com uma diferença mediana estimada de +11,8 (IC de 95% de 0 a 23,4; p = 0,044). Não houve diferenças significativas nos níveis médios de cortisol salivar. Conclusão: O nível de ansiedade foi maior em crianças acompanhadas. Não houve diferenças nos níveis de cortisol salivar entre os dois grupos. Registro Brasileiro de Ensaios Clínicos (ReBEC):RBR-9wj4qvy. Objetivo anestesia Método 1 anos I III eletiva quiquadrado, quiquadrado qui quadrado, quadrado qui-quadrado Fisher Student MannWhitney, MannWhitney Mann Whitney, Whitney Mann-Whitney HodgesLehman Hodges Lehman estatísticas Resultados 4 63 préescolar 80%. 80 80% . (80%) 375 37 37, intervalo interquartil 23,4–51,6 234516 23 51 6 550 55 55, 27,9–65,0 279650 27 9 65 118 11 8 +11, IC 95 23,4 234 0,044. 0044 0,044 044 0,044) Conclusão grupos ReBECRBR9wj4qvy. ReBECRBR9wj4qvy ReBECRBRwjqvy ReBEC RBR 9wj4qvy. 9wj4qvy wj qvy (ReBEC):RBR-9wj4qvy (80% 3 23,4–51, 23451 2 27,9–65, 27965 +11 23, 004 0,04 04 ReBECRBR wjqvy (80 23,4–51 2345 27,9–65 2796 +1 00 0,0 (8 23,4–5 27,9–6 279 + 0, ( 23,4– 27,9– 27,9 27,

Abstract Background There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome. Methods A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05. Results Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body. Conclusion Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence. 201 COVID19 COVID 19 (COVID-19 forms Therefore COVID19, 19, stay demographics SARSCoV2 SARSCoV SARS CoV (SARS-CoV-2 outcome crosssectional cross sectional COVID-1 hospitals s prospected SARS-CoV- considering care, , care) manner (ORs CIs (CIs studied 005 0 05 0.05 24 included 7 31.8% 318 31 8 (31.8% 269 69 2.6 95% 95 [95 14 1 4 1. 5.0 50 5 5.0] 302 02 3.0 (95 15 5.9. 59 5.9 . 9 5.9) body environments occurrence 20 COVID1 (COVID-1 (SARS-CoV- COVID- SARS-CoV 00 0.0 31.8 (31.8 26 6 2. [9 5. 30 3. (9 (COVID- (SARS-CoV 0. 31. (31. [ ( (COVID (31 (3

Abstract Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.mr-2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL-1 plus 0.5 μg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg-1 plus 0.5 mg.kg-1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0-0) vs. 0 (0-0) (p = 0.239) and 1 (0-1) vs. 3 (1-4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group - 2 (0-2) vs. 1 (0-1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 μg.kg-1.min-1 vs. 195 ± 44 μg.kg-1.min-1 (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery. Background TargetControlled Target Controlled (TCI Methods 11, 11 , (1:1) singleblind, singleblind single blind, blind single-blind parallelgroup parallel patients sexes 6 years kg.mr2, kgmr2 kgmr kg.mr 2, kg mr kg.mr-2 effectsite, effectsite effect site, site (effect-site μg.mL1 μgmL1 μgmL μg.mL μg mL μg.mL- 05 0. ( mg.kg1 mgkg1 mgkg mg.kg mg mg.kg- above. above . above) Results IQR (IQR 00 (0-0 vs 0.239 0239 239 01 (0-1 14 4 (1-4 0.001 0001 001 groups respectively 02 (0-2 01, 49 9 4. 1. 23 2. 16 234 (23 μg.kg1.min1 μgkg1min1 μgkgmin μg.kg 1.min min μg.kg-1.min- 19 0.040. 0040 0.040 040 0.040)) Conclusions adjustments However (1:1 mr2 kg.mr2 kg.mr- mL1 kg1 (0- 0.23 023 (1- 0.00 000 (2 min1 μg.kg1.min μgkg μgkg1min 1min μg.kg-1.min 004 0.04 04 0.040) (1: (0 0.2 0.0

Abstract Background: Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. Methods: The sample included 64 persons with ASD, aged 2-59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5 mg.kg−1, maximum 15 mg) or oral midazolam (0.5 mg.kg−1) associated with oral S(+)-ketamine (3 mg.kg−1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. Results: According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. Conclusion: The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism. Background ASD . (ASD) Noncollaborative Non collaborative behaviors aggressiveness population Thereby Methods 6 259 59 2-5 years anesthesia parallel doubleblinded, doubleblinded double blinded, blinded double-blinded 0.5 05 0 5 (0. mgkg1 mgkg mg kg mg.kg−1 S+ketamine Sketamine S + 3 ( 30 mg. events Results , 3) (RR 32 3. 95% 95 (95 [95 132 1.3 7.76 776 7 76 205 2.0 114 14 1.1 3.68. 368 3.68 68 3.68) Conclusion autism (ASD 25 2- 0. (0 mg.kg− 9 (9 [9 13 1. 7.7 77 20 2. 11 36 3.6 mg.kg [ 7.

Abstract Background: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client’s perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. Methods: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. Results: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team’s level of concern and speed of response in relieving the patient’s pain. Conclusion: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care. Background mortality clients client s perspective Therefore perianesthetic peri anesthetic Perianaesthetic Peri anaesthetic Methods crosssectional cross sectional 121 age, age (age sex education status, status , status) type, type (type time experience, experience experience) specialty Results cold urinate site teams team Conclusion studied variables 12 1

Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury. (FGF animals humans (AKI onpump pump 0.5 05 0 5 (0. L.min−1 Lmin1 Lmin L min 1 2.0 (2. L.min−1. . 24hour hour 24 monitored Kidney Outcomes surgeryassociated CSAAKI. CSAAKI CSA (CSA-AKI) 12 29.5% 295 (29.5% 31.5% 315 31 (31.5% p= p (p 0.774. 0774 0.774 774 0.774) 6.1% 61 6 (6.1% 1.6% 16 (1.6% AKI. 0. (0 L.min− 2. (2 (CSA-AKI 29.5 (29.5 31.5 3 (31.5 077 0.77 77 6.1 (6.1 1.6 (1.6 ( L.min 29. (29. 31. (31. 07 0.7 7 6. (6. 1. (1. (29 (31 (6 (1 (3

Abstract Background The influence of different crystalloid solutions infused during deceased-donor kidney transplant on the incidence of delayed graft function remains unclear. We investigated the influence of Plasma-Lyte® vs. 0.9% saline on the incidence of delayed graft function in deceased-donor kidney transplant recipients. Methods We conducted a single-blind randomized controlled trial of 104 patients aged 18 to 65 years who underwent deceased-donor kidney transplant under general anesthesia. Patients were randomly assigned to receive either Plasma-Lyte® (n = 52) or 0.9% saline (n = 52), at the same infusion volume, for intraoperative fluid replacement. The primary outcome was the occurrence of delayed graft function. Secondary outcomes included metabolic and electrolytic changes at the end of surgery. Results Two patients in the Plasma-Lyte® group and one in the 0.9% saline group died postoperatively and were not included for analysis. The incidence of delayed graft function in Plasma-Lyte® and 0.9% saline groups were 60.0% (95% Confidence Interval [95% CI 46.2-72.4]) and 74.5% (95% CI 61.1-84.4), respectively (p= 0.140). Mean (standard deviation) values of immediate postoperative pH and serum chloride levels in Plasma-Lyte® and 0.9% saline groups were 7.306 (0.071) and 7.273 (0.061) (p= 0.013), and 99.6 (4.2) mEq.L-1 and 103.3 (5.6) mEq.L-1, respectively (p< 0.001). All other postoperative metabolic and electrolyte variables were not statistically different at the immediate postoperative period (p> 0.05). Conclusion In deceased-donor kidney transplant recipients, the incidence of delayed graft function is not influenced by Plasma-Lyte® or 0.9% saline used for intraoperative fluid replacement.