RESUMO Introdução: o Transplante Hepático é atualmente o tratamento de escolha para diversas doenças terminais do fígado. Apesar do aumento de transplantes realizados, as filas de espera continuam aumentando. Com a finalidade de ampliar a oferta de órgãos, as equipes transplantadoras passaram a utilizar fígados até então rejeitados para transplantes devido ao risco aumentado de desfechos desfavoráveis. Objetivo: avaliar utilização de fígados de doadores de critério expandido. Métodos: estudo retrospectivo por meio de análise de prontuários. Classificaram-se os fígados utilizados em padrão ou critério expandido. Os grupos foram subdivididos em MELD baixo e alto. Foi realizada análise multivariada por regressão logística. Resultados: não houve diferença estatística com relação à mortalidade precoce, tardia e global entre os grupos. Observou-se menor sobrevida em pacientes com MELD alto (maior ou igual a 20) quando receberam enxertos de doadores de critério expandido. Foi observada a associação entre ocorrência de parada cardiorrespiratória e presença de bilirrubina total elevada no doador com maiores taxas de mortalidade em receptores de fígados de critério expandido. Conclusão: os resultados globais são semelhantes, porém o uso de fígado de doadores de critério expandido esteve associado a maior mortalidade em pacientes com MELD alto.

ABSTRACT Introduction: liver Transplantation is currently the treatment of choice for several terminal liver diseases. Despite the increase in performed transplants, the waiting lists continue to increase. In order to expand the supply of organs, transplantation teams have started to use previously rejected livers for transplants because of an increased risk of unfavorable outcomes. Objective: to evaluate the use of livers of expanded criterion donators. Methods: retrospective study of medical records. The livers were classified as normal or expanded criteria. The groups were divided in low and high MELD. A multivariate analysis was performed through logistic regression. Results: there was no statistical difference regarding early, late and global mortality between the groups. Decreased survival was observed in patients with high MELD (higher or equal to 20) when they received grafts from expanded criterion donators. The association between the occurrence of cardiorespiratory arrest and presence of elevated total bilirubin in donators was associated with higher mortality rates in expanded criterion livers. Conclusion: the overall results are similar, but expanded criteria liver donators was associated with higher mortality in patients with high MELD.

RESUMO Objetivo: conhecer o perfil epidemiológico dos pacientes submetidos à cirurgia do carcinoma bem diferenciado da tireoide no Hospital Universitário Cassiano Antônio Moraes da Universidade Federal do Espírito Santo, assim como os resultados oncológicos e as principais complicações pós-operatórias. Métodos: estudo transversal e retrospectivo de pacientes portadores de carcinoma bem diferenciado da tireoide operados no período de janeiro de 2008 a dezembro de 2015. Resultados: no período do estudo, dos 353 pacientes submetidos a tratamento cirúrgico da glândula tireoide, 95 eram portadores de CBDT. O carcinoma papilífero da tireoide foi o mais frequente (91,57%). A tireoidectomia total não associada a esvaziamento cervical foi o procedimento cirúrgico mais frequente (65,26%). As complicações pós-operatórias ocorreram em 6,31% dos pacientes, sendo o hematoma a mais frequente. O tempo médio de seguimento foi de 36,9 meses. A recidiva ocorreu em quatro pacientes (4,21%), sendo locorregional em todos os casos. Os fatores prognósticos analisados, como sexo, idade, tamanho do tumor, acometimento linfonodal, estadiamento, tipo de cirurgia, histologia e iodoterapia complementar não demonstraram significância estatística. Conclusão: o carcinoma papilífero da tireoide foi a neoplasia maligna mais frequente, acometendo o sexo feminino na faixa etária dos 49 anos mais frequentemente. A recidiva locorregional ocorreu em quatro pacientes. O hematoma foi a complicação mais frequente.

ABSTRACT Objective: to know the epidemiological profile of patients undergoing surgery for well-differentiated thyroid carcinoma at the Cassiano Antônio Moraes University Hospital of the Federal University of Espírito Santo, as well as the oncological results and the main postoperative complications. Methods: we conducted a cross-sectional, retrospective study of patients with well-differentiated thyroid carcinoma (WDTC) operated from January 2008 to December 2015. Results: During the study period, 95 of the 353 patients undergoing surgical treatment of the thyroid gland had WDTC. Papillary carcinoma was the most frequent (91.57%). Total thyroidectomy not associated with cervical emptying was the most frequent surgical procedure (65.26%). Postoperative complications occurred in 6.31% of patients, hematoma being the most frequent. The mean follow-up time was 36.9 months. Relapse occurred in four patients (4.21%), being locoregional in all cases. The prognostic factors analyzed, such as gender, age, tumor size, lymph node involvement, staging, type of surgery, histology and complementary iodine therapy did not show statistical significance. Conclusion: papillary carcinoma was the most common thyroid malignant neoplasm, affecting women in the 49-year-old age group more frequently. Loco-regional recurrence occurred in four patients. Hematoma was the most frequent complication.

RESUMO Objetivos: analisar possíveis efeitos negativos do Transtorno do Déficit de Atenção e Hiperatividade (TDAH) no sucesso da cirurgia bariátrica. Métodos: foram avaliados 40 pacientes submetidos à cirurgia bariátrica e com acompanhamento pós-operatório regular mínimo de um ano. Todos foram submetidos ao questionário preconizado na quarta edição do Diagnostic and Statistical Manual (DSM-IV) da Associação Americana de Psiquiatria para TDAH e analisados os dados pós operatórios. Resultados : quinze (38%) pacientes apresentaram questionário positivo para TDAH. Os pacientes com TDAH apresentaram IMC maior do que os pacientes sem o transtorno (45,8x40,9 Kg/m2; p=0,017), mantendo-se a diferença em todas as etapas do pós-operatório. Não foi encontrada diferença estatisticamente significativa no sucesso da cirurgia (33,3% x 66,7%; p=0,505), e na redução do IMC (30,71% x 31,88%; p=0,671) após um ano do procedimento. Conclusão : pacientes com TDAH apresentam maior IMC, entretanto, a presença do TDAH não apresenta influência no sucesso da cirurgia bariátrica e na redução do IMC.

ABSTRACT Objective: to analyze possible negative effects of Attention Deficit Hyperactivity Disorder (ADHD) on the success of bariatric surgery. Methods: we evaluated forty patients undergoing bariatric surgery and with regular post-operative follow-up of at least one year. To all, we applied the questionnaire advocated in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association for ADHD, as well as analyzed their postoperative data. Results: fifteen (38%) patients presented a positive questionnaire for ADHD. Patients with ADHD presented higher BMI than patients without the disorder (45.8 vs. 40.9 kg/m2, p=0.017), and the difference remained in all postoperative stages. There was no statistically significant difference in surgery success (33.3% x 66.7%, p=0.505) or in BMI reduction (30.71% x 31.88%, p=0.671) one year after the procedure. Conclusion: ADHD patients have a higher BMI. However, the presence of ADHD does not influence the success of bariatric surgery and the reduction of BMI.

OBJETIVO: comparar o conhecimento dos estudantes de Medicina da Liga do Trauma (LT) com os alunos Não Ligantes do Trauma (NLT), sobre os temas do atendimento ao trauma que os acadêmicos possuem maior domínio, avaliando a performance do conhecimento dos dois grupos.MÉTODOS: estudo transversal, analítico, descritivo. Aplicou-se teste de conhecimento para os alunos do terceiro ao 12º período. Desses, foram sorteados cinco acadêmicos de cada período, constituindo dois grupos: 50 no LT e 50 no NLT. Foram aplicados dois testes contento 30 questões para cada prova com os temas: atendimento pré-hospitalar, sequência mnemônica ABCDE do trauma, condutas avançadas e imagem no trauma. Avaliou-se a performance dos estudantes por grupo de períodos da graduação: cadeira básica (3º - 5º período), clínica (6º -8º) e internato (9º - 12º).RESULTADOS: no primeiro teste, a média de acertos do grupo LT foi 20,64±3,17 e 14,76± 5,28 no NLT (p<0,005). No segundo teste, a média do LT foi 21,52±3,64 e 15,36±5,29 no NLT (p<0,005). O grupo LT teve maior média de acerto nas três cadeiras da graduação (p<0,05), nos dois testes.CONCLUSÃO:o grupo LT teve maior média de acerto em relação ao NLT e melhor aproveitamento dos temas estudados em todas as fases do curso médico.

OBJECTIVE: to compare the knowledge of medical students between those who are members of the Trauma League (TL) and those from a non-Trauma League (NTL) group of the Federal University of Espírito Santo (UFES).METHODS: cross-sectional, analytical and descriptive study. Two knowledge tests, with 30 questions each, were applied to students from 3rd to 12th period, randomly selecting five students per period, with 50 students in the TL group and 50 in NTL. The questionnaire topics were: pre-hospital care, the mnemonic ABCDE trauma sequence, advanced trauma and imaging. The students' performances were evaluated by graduation-period group: basic (3rd-5th period), intermediary/clinical (6th-8th) and internship (9th-12th).RESULTS: in the first test the average accuracy of the TL group was 20.64 ± 3.17, while for the NTL group, it was 14.76 ± 5.28 (p<0.005). In the second test the average accuracy for the TL group was 21.52 ± 3.64, while for the NTL group, the average was 15.36 ± 29.5 (p<0.005). When divided into graduation periods, it was observed that the TL group showed a higher average across all three groups (p<0.05) in both tests.CONCLUSION: the students who attended the academic league activities have greater knowledge of the issues that are considered relevant to patient trauma care. In all periods of undergraduate academic training, the TL group had greater knowledge of the subject than the NTL group.

OBJETIVO: Verificar a eficiência da punção com agulha de Veress no hipocôndrio esquerdo, a acurácia dos testes descritos para o correto posicionamento intraperitoneal da ponta da agulha de Veress em população não selecionada. MÉTODOS: Noventa e um pacientes, sem quaisquer critérios de exclusão, consecutivamente agendados para procedimentos videolaparoscópicos, tiveram a parede abdominal puncionada no hipocôndrio esquerdo. Os pacientes receberam anestesia geral e ventilação controlada mecânica segundo o protocolo. Após a punção foram utilizadas cinco provas para testar o posicionamento da ponta da agulha no interior da cavidade peritoneal: prova da aspiração - PA, da resistência à infusão - Pres, da recuperação do líquido infundido - Prec, prova do gotejamento - PG, e a prova da pressão intraperitoneal inicial - PPII. Os resultados foram considerados para cálculo da sensibilidade (S) e da especificidade (E) e valores preditivos positivos (VPP) e valores preditivos negativos (VPN). Métodos inferenciais estatísticos foram utilizados na análise dos achados. RESULTADOS: Ocorreram 13 fracassos. A PA teve E=100% e VPN=100%. Pres teve S=100%; E=0; VPP=85,71% VPN= não se aplica. Prec: S=100%; E= 53,84%; VPP= 92,85%; VPN= 100%. PG: S=100%; E= 61,53%; VPP= 93,97% VPN= 100%. Na PPII, a S, E, VPP e VPN foram de 100%. CONCLUSÃO: A punção no hipocôndrio esquerdo é eficiente, as provas realizadas orientam o cirurgião a despeito do gênero, IMC ou operações prévias.

Objective: To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test - AT; resistance to infusion - Pres; recovery of the infused fluid - Prec, dripping test - DT, and test of initial intraperitoneal pressure - IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. Results: There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%. Conclusion: The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.

OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group). MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure - maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

OBJECTIVE: To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic® ring sleeve gastrectomy. METHODS: This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 ± 1.50 kg/m² (range: 40-45 kg/m²), a mean age of 36.7 ± 9.4 years and a mean waist circumference of 118.7 ± 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3%), and glucose intolerance was observed in 4 patients (12.1%). Mean plasma fasting glucose levels were 109.77 ± 44.19 mg/dl (75-320) in the preoperative period. All Silastic® ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery. RESULTS: The mean weight of the patients decreased from 107.69 ± 6.57 kg to 70.52 ± 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 ± 2.42 kg/m² (p < 0.001), and the mean waist circumference decreased to 89.87 cm ± 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 ± 14.2%. Fasting glucose levels were reduced to 80.94 ± 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients. CONCLUSION: Silastic® ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients.

O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês) e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por videolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m², submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias). Foram divididas em dois grupos, GI - grupo inspirômetro (n=13) e GE, grupo EPAP (n=15). A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós-operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório.

The aim of this study was to compare the effect of expiratory positive airway pressure (EPAP) and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m², undergoing laparoscopic gastric bypass surgery (hospitalized for two days) were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion prior to, and on the second post-operative day. Before surgery patients were divided into two groups, SG - spirometer group (n=13), and EG - EPAP group (n=15). Motor physical therapy was standardized for both groups; respiratory therapy (both modalities) started on the day of surgery, in 15-minute sessions. Post-operative results showed similar reduction, in both groups, in the values of vital capacity, forced vital capacity, maximum voluntary ventilation, and inspiratory reserve volume. No changes were found in tidal volume values in SG, neither in expiratory reserve volume in EG. Diaphragmatic and thoracoabdominal motion were less harmed in SG. After bariatric surgery thus incentive spirometry had better effect in maintaining tidal volume, as well as on diaphragmatic and thoracoabdominal motion; while EPAP proved more efficient in re-establishing expiratory reserve volume in the postoperative period.

INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m² who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m². Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 ± 3.89 years and a mean BMI of 41.1 ± 3.46 kg/m², and the non-obese group presented a mean age of 23.9 ± 2.97 years and a mean body mass index of 21.91 ± 1.81 kg/m². There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 ± 0.47 L vs. 1.87 ± 0.42 L), a lower expiratory reserve volume (0.52 ± 0.32 L vs. 1.15 ± 0.32 L), and a maximal voluntary ventilation (108.5 ± 13.3 L/min vs. 122.6 ± 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation.

OBJETIVO: Avaliar provas de posicionamento da agulha de Veress no hipocôndrio esquerdo na criação do pneumoperitônio. MÉTODO: Em cem pacientes puncionados no hipocôndrio esquerdo, provas de posicionamento da agulha foram avaliadas, considerando-as positivas quando, na prova da aspiração (PA), material orgânico era aspirado; na prova da resistência (PRes), exercia-se pequena força no êmbolo da seringa à infusão de líquido; na prova da recuperação (PRec), não se recobrava o líquido infundido; na do gotejamento (PG), as gotas escoavam rapidamente e, na prova da pressão intraperitoneal inicial (PPII), os níveis eram = 8mmHg. PA positiva denunciava iatrogenia, enquanto que PRes, PRec, PG e PPII positivas indicavam que a ponta da agulha estava adequadamente posicionada na cavidade peritoneal. Foram calculadas a sensibilidade (S) e a especificidade (E) das provas, e os seus valores preditivos positivos (VPP) e negativos (VPN), mediante correlação dos resultados verdadeiro-positivos (a), falso-positivos (b), falso negativos (c) e verdadeiro-negativos (d), segundo as fórmulas: S=[a/(a+c)]x100; E=[d/(b+d)]x100; VPP=[a/(a+b)]x100; VPN=[d(c+d)]x100. RESULTADOS: Na PA, constatou-se que S e VPP não puderam ser aplicados, e E=100% e VPN=100%. Na PRes, S=0%, E=100%, VPP=não existiu e VPN=90%. Tanto na PRec quanto na PG, S=50%, E=100%, VPP=100% e VPN=94,7%. Na PPII, obteve-se que S, E, VPP e VPN=100%. CONCLUSÕES: Na punção no hipocôndrio esquerdo, PA negativa garante ausência de lesões; a PRes é insegura quanto ao mau posicionamento da agulha, mas indica corretamente o bom; a PRec e a PG não reconhecem bem o adequado posicionamento, mas detectam com segurança o inadequado; a PPII acusa com segurança tanto o mau quanto o bom posicionamento da agulha, sendo a prova mais confiável dentre as estudadas.

BACKGROUND: To evaluate tests for Veress needle tip placement intraperitoneally in the left hypochondrium for creating a pneumoperitoneum. METHODS: Needle tip placement tests were evaluated in one hundred patients using the left hypochondrium area. It was considered positive when: aspiration test (PA) -returned organic material; resistance test (PRes) - a low pressure was pushed on the syringe for the liquid infusion; recovery test (PRec) - no liquid was recovered after infusion; dripping test (PG) - drops drained quickly; test for initial intraperitoneal pressure (PPII) - levels were <= 8mmHg. Positive PA suggested bowel injury, while positive PRes, PRec, PG and PPII indicated that needle tip was adequately located in the peritoneal cavity. The Sensitivity ( SE) and Specificity ( SP ), as well as their predictive positive values (PPV) and predictive negative values ( PNV) of these tests were calculated using results correlation which were true-positives (a), false-positives (b), false-negatives (c) and true-negatives (d), accordingly to the formulas: SE =[a/ (a+c)]x100; SP =[d/(b+d)]x100; PPV=[a/(a+b)]x100; PNV=[d(c+d)]x100. RESULTS: If a positive PA had returned, SE and PPV did not fit, and SP=100% and PNV =100%. In the PRes, SE =0%, SP =100%, PPV = did not exist and PNV =90%. Both in the PRec and in the PG, results were for SE =50%, SP =100%, PPV =100% and PNV =94.7%. In the PPII test results were for SE, PPV and PNV =100%. CONCLUSION: Left hypochondrium negative PA guaranteed that bowel was not perforated; PRes test is a not accurate test for detection of the needle tip bad placement, however it accurately indicates its good positioning; PRec and the PG tests do not detect the adequate positioning, but they detect very well the inadequate positioning; PPII test shows with reliability both bad and good positioning of the needle, being the most trustworthy test among those studied.

OBJETIVO: Avaliar a eficácia e segurança da punção alternativa no hipocôndrio esquerdo. MÉTODOS: Sessenta e dois pacientes distribuídos aleatoriamente em dois grupos foram estudados prospectivamente: grupo HE, punção no hipocôndrio esquerdo (n=30) e grupo LM, punção na linha média do abdome (n=32). Foram avaliados os testes de posicionamento da agulha, o número de tentativas frustradas e a duração da instalação do pneumoperitônio. Os fluxos correntes, as pressões intraperitoneais e os volumes injetados foram registrados a cada 20 segundos, até 12 mmHg. RESULTADOS: O número de resultados positivos aos testes de posicionamento da agulha foi semelhante em ambos os grupos. Ocorreram duas tentativas infrutíferas de punção no grupo LM e uma no grupo HE. O tempo necessário para o estabelecimento do pneumoperitônio foi, em média, 3 minutos e 46 segundos para o Grupo HE e 4 minutos e 2 segundos para o grupo LM. As médias dos fluxos, das pressões e dos volumes foram respectivamente equivalentes entre os grupos.. CONCLUSÃO: A punção no HE foi tão eficaz no estabelecimento do pneumoperitônio quanto a punção na LM do abdome.

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

OBJETIVO: Avaliar a possibilidade do estabelecimento de parâmetros fidedignos do adequado posicionamento da ponta da agulha de Veress no interior da cavidade peritoneal durante o estabelecimento do pneumoperitônio. MÉTODO: Em 100 pacientes selecionados a ponta da agulha de Veress foi introduzida na cavidade peritoneal e o insuflador foi programado para fluxo de 1,2L/min e pressão máxima final para 12mmHg. No início da insuflação e a cada 20 segundos a pressão intraperitoneal (PI) e o total do volume injetado até aquele momento (TVI) eram registrados. Os dados foram tratados por correlações estatísticas entre momentos e PI, e momentos e TVI. Também foi estabelecida a previsão dos valores de PI e TVI no final de cada um dos quatro primeiros minutos de insulflação, utilizando-se os modelo estimados: PI = 2,3083 + 0,0266 x tempo + 8,3x10-5 x tempo³ - 2,44x10-7 x tempo³ ; TVI = 0,813 + 0,0157 x tempo. RESULTADOS: A PI e o TVI mostraram correlação entre momentos pré-estabelecidos da criação do pneumoperitônio, sendo constatado um ajuste forte: PI = -2E - 07 x tempo³ + 8E - 05 x tempo² + 0,0266 x tempo + 2,3083, com coeficiente de explicação (R2) = 0,8011; TVI = 0,0157 x tempo + 0,1813, com R2 = 0,9604. A previsão de PI e TVI mostrou: PI(mmHg): 1min=4,15; 2min=6,27; 3min=8,36; 4min=10,10 e TVI(L): 1min=1,12; 2min=2,07; 3min=3,01; 4min=3,95. CONCLUSÕES: Parâmetros fidedignos para PI e TVI , quando a ponta da agullha de Veress se encontra na cavidade peritoneal, em dados momentos da insuflação podem ser estabelecidos durante a criação do penumoperitônio.

BACKGROUND: To evaluate the possibility of establishing reliable parameters for the appropriate positioning of Veress needle tip in the peritoneal cavity during pneumoperitoneum creation. METHODS: In 100 selected patients Veress needle tip were introduced in the peritoneal cavity and the insufflators were programmed for a flow of 1,2L/min and with final maximum pressure of 12mmHg. At the beginning of the insufflation and at every 20 seconds the intraperitoneal pressure (IP) and the total volume injected (TVI) were recorded. Data was treated by statistical correlation between moments and IP, and moments and TVI. The forecast values of IP and TVI at the end of each one of the four first insufflation minutes were also established, using the following estimated formulas: IP = 2.3083 + 0.0266 x time + 8.3x10-5 x time³ - 2.44x10-7 x time³; TVI = 0.813 + 0.0157 x time. RESULTS: IP and TVI showed a correlation between pre-established moments of pneumoperitoneum creation when a strong adjustment became apparent: IP = -2E - 07 x time³ + 8E - 05 x time² + 0.0266 x time + 2.3083, with a coefficient of explanation: (R2) = 0.8011; TVI = 0.0157 x time + 0.1813, with R2=0.9604. The forecast of IP and TVI showed: IP (mmHg): 1min=4.15; 2 min=6.27; 3 min=8.36; 4 min=10.10 and TVI (L): 1min=1.12; 2 min=2.07; 3 min=3.01; 4 min=3.95. CONCLUSION: Reliable parameters for IP and TVI can be established during pneumoperitoneum creation when the Veress needle tip is located in the peritoneal cavity in a given insufflation moment.