Cardiopulmonary bypass (CPB) with extracorporeal circulation produces changes in the immune system accompanied by an increase in proinflammatory cytokines and a decrease in anti-inflammatory cytokines. We hypothesize that dexmedetomidine (DEX) as an anesthetic adjuvant modulates the inflammatory response after coronary artery bypass graft surgery with mini-CPB. In a prospective, randomized, blind study, 12 patients (4 females and 8 males, age range 42-72) were assigned to DEX group and compared with a conventional total intravenous anesthesia (TIVA) group of 11 patients (4 females and 7 males). The endpoints used to assess inflammatory and biochemical responses to mini-CPB were plasma interleukin (IL)-1, IL-6, IL-10, interferon (INF)-γ, tumor necrosis factor (TNF)-α, C-reactive protein, creatine phosphokinase, creatine phosphokinase-MB, cardiac troponin I, cortisol, and glucose levels. These variables were determined before anesthesia, 90 min after beginning CPB, 5 h after beginning CPB, and 24 h after the end of surgery. Endpoints of oxidative stress, including thiobarbituric acid reactive species and delta-aminolevulinate dehydratase activity in erythrocytes were also determined. DEX+TIVA use was associated with a significant reduction in IL-1, IL-6, TNF-α, and INF-γ (P<0.0001) levels compared with TIVA (two-way ANOVA). In contrast, the surgery-induced increase in thiobarbituric acid reactive species was higher in the DEX+TIVA group than in the TIVA group (P<0.01; two-way ANOVA). Delta-aminolevulinate dehydratase activity was decreased after CPB (P<0.001), but there was no difference between the two groups. DEX as an adjuvant in anesthesia reduced circulating IL-1, IL-6, TNF-α, and INF-γ levels after mini-CPB. These findings indicate an interesting anti-inflammatory effect of DEX, which should be studied in different types of surgical interventions.

The prevalence of uncontrolled and controlled asthma, and the factors associated with uncontrolled asthma were investigated in a cross-sectional study. Patients aged 11 years with confirmed asthma diagnosis were recruited from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. Patients were excluded if they had other chronic pulmonary disease. They underwent an evaluation by a general questionnaire, an asthma control questionnaire (based on the 2006 Global Initiative for Asthma guidelines), assessment of inhaled device technique and pulmonary function tests. Asthma was controlled in 48 of 275 patients (17.5%), partly controlled in 74 (26.9%) and uncontrolled in 153 (55.6%). In the univariate analysis, asthma severity was associated with asthma control (P < 0.001). Availability of asthma medications was associated with asthma control (P = 0.01), so that most patients who could purchase medications had controlled asthma, while patients who depend on the public health system for access to medications had lower rates of controlled asthma. The use of inhaled corticosteroid was lower in the uncontrolled group (P < 0.001). Logistic regression analysis identified three factors associated with uncontrolled asthma: severity of asthma (OR = 5.33, P < 0.0001), access to medications (OR = 1.97, P = 0.025) and use of inhaled corticosteroids (OR = 0.17, P = 0.030). This study showed a high rate of uncontrolled asthma in patients who attended an outpatient asthma clinic. Severity of asthma, access to medications and adequate use of inhaled corticosteroids were associated with the degree of asthma control.

It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001) and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

OBJETIVO: O uso de opióides, principalmente no tratamento da dor intensa aguda (pacientes no pós-operatório) e da dor crônica em pacientes oncológicos, tem sido subestimado na prática clínica em geral. Este trabalho tem o objetivo de verificar o perfil de prescrição de opióides (meperidina e morfina) no Hospital de Clínicas de Porto Alegre (HCPA), RS. MATERIAIS E MÉTODOS: Análise da conduta das equipes médicas, pela revisão de 1.107 prescrições, relativas a 445 pacientes internados no HCPA, entre 20 de maio e 20 de julho de 1993. Os parâmetros básicos de análise, para conduta, incluíam: padrão de uso, a dose do fármaco, intervalo entre doses e analgésicos simultâneos. DISCUSSÃO E RESULTADOS: Foram encontradas apenas 6,5% de prescrições consideradas adequadas em relação aos parâmetros dose, intervalo e padrão, analisados conjuntamente. O padrão se necessário foi responsável por 74% do total de prescrições. CONCLUSÕES: Os resultados obtidos durante a realização do trabalho permitem-nos concluir que não há um manejo adequado da dor, tanto aguda como crônica, nos pacientes internados no HCPA.

OBJECTIVE: Opiates use, mainly in the treatment of acute intense pain (post-surgical patients) and chronic pain in oncologic patients has been usually underestimated in general clinical practice. This paper has the objective to assess the pattern of opiates use (Meperidin and Morphine), that is being used in Hospital de Clínicas de Porto Alegre, Rio Grande do Sul (Brazil). MATERIAL AND METHOD: Medical teams prescriptions were analyzed using the following parameters: pattern of use, dose, interval and the use of concomitant analgesics. 1,107 prescriptions were analyzed, related to 445 inpatients, in the period from May to July of 1993. RESULTS AND DISCUSSION: Only 6.5% of all prescriptions were considered correct. The pattern if necessary was responsible for 74% of all prescriptions. CONCLUSIONS: Pain, either acute or chronic, is not being adequately managed in our hospital.