Antonio Fernando Carneiro

Soroprevalência do vírus de hepatite B em anestesiologistas

BACKGROUND AND OBJECTIVES Anesthesiologists are especially exposed to blood and secretions. Hepatitis B virus infection is the major occupational risk for health care professionals. This study aimed at evaluating the prevalence of Ag-HBs, anti-HBs and anti-HBc among anesthesiologists of the city of Goiânia, as well as their vaccination status. METHODS Participated in this study 90 out of 200 anesthesiologists of the city of Goiânia. Samples were collected by the author and consisted of 10 ml blood of a peripheral vein identified at collection. Blood was analyzed in the first 24 hours, under optimal conservation conditions. The following markers were detected by immunoenzymatic essay: anti-HBc, anti-HBs and Ag-HBs. Participants were personally contacted by the author and gave their written consent to participate in the study. Absolute secrecy of results and questionnaire information was assured. RESULTS Analyzed material showed that 65 out of 90 (72.2%) were anti-HBs positive, as compared to 25 out of 90 (27.8%) who were negative. As to anti-HBc, 76 out of 10 (90.5%) were negative and 9 out of 90 (10%) were positive. No participant was Ag-HBs-positive. CONCLUSIONS This study has shown 72.2% serum prevalence for anti-HBs. The prevalence of Hepatitis-B infection among anesthesiologists was 8.9%, represented by 8 anti-HBc +/anti-HBs +. Based on these results, vaccination campaigns and successful prevention should be intensified.JUSTIFICATIVA Y OBJETIVOS: Los anestesiologistas estan particularmente expuestos al contacto con sangre y secreciones. La infeccion por el virus de la hepatitis B constituye el mayor riesgo ocupacional para los profesionales de la area de la salud. El objetivo de este estudio fue evaluar el soroprevalecimiento del Ag-HBs, anti-HBs y anti-HBc, asi como a situacion de vacunas de los anestesiologistas de la ciudad de Goiania. METODO: Participaron de la pesquisa 90 de los 200 anestesiologistas de la ciudad de Goiania. Las muestras fueron cogidas por el autor. Fueron retirados 10 ml de sangre de una vena periferica, identificadas en el momento de la colecta. El material fue analizado en las primeras 24 horas, bajo condiciones ideales de conservacion. Se realizo, a traves del ensayo inmunoenzimatico, la deteccion de los siguientes marcadores: anti-HBc, anti-HBs y Ag-HBs. Los participantes de la pesquisa fueron personalmente contactados por el autor, y por escrito consintieron con la realizacion del estudio. Garantizado el sigilo absoluto, tanto de los resultados, como las informaciones contenidas en el cuestionario aplicado. RESULTADOS: Los datos analizados mostraron que 65/90 (72,2%) fueron reagentes para el anti-HBs y 25/90 (27,8%) no reagentes. Cuanto al anti-HBc, 76/10 (90,5%) fueron no reagentes y 09/90 (10%) se mostraron reagentes. Ninguno de los participantes mostro positividad para Ag-HBs. CONCLUSIONES: Este estudio mostro una soroprevalencia para el anti-HBs de 72,2% (65/90). La prevalencia de la infeccion por el virus B entre los anestesiologistas fue de 8,9% representados por el 8 anti-HBc + / anti-HBs +. Con base en los resultados, campanas de vacunacion y planteamiento de medidas profilacticas deben ser intensificadas.

Reducing the concentration to 0.4% enantiomeric excess hyperbaric levobupivacaine (s75: r25) provides unilateral spinal anesthesia. Study with different volumes.

BACKGROUND AND OBJECTIVES Unilateral spinal anesthesia may be obtained with hypobaric or hyperbaric solution. The objective of this study was to compare different doses of enantiomeric excess hyperbaric levobupivacaine to achieve unilateral spinal anesthesia. METHOD One hundred and twenty patients were randomized to receive 4 mg, 6 mg or 8 mg of 0.4% enantiomeric excess levobupivacaine. The solutions were administered at the L3-L4, with the patient in a lateral position and kept at this position according to dose administration for 5, 10 or 15 minutes. Sensory block (pinprick) and motor block (scale 0-3) were compared between the operated and contralateral sides. RESULTS The onset of analgesia was rapid and comparable between groups. Sensory block was significantly higher in the operated than in nonoperated limb at all times of evaluation. Increasing the dose by 1 mL (2mg) corresponded to an increase of two segments in the mode for the operated side. In the operated side, motor block (MB = 3) of patients occurred in 31 (77.5%) with 4 mg, 38 (95%) with 6 mg, and 40 (100%) with 8 mg. There was a positive correlation between increased dose, blockade duration, and hypotension. All patients were satisfied with the technique used. CONCLUSIONS Spinal anesthesia with different volumes of enantiomeric excess hyperbaric bupivacaine (S75: R25) provided a 78% incidence of unilateral spinal block, with the smallest dose used (4 mg) the most efficient.

Ocorre alta incidência de células da pele na primeira e terceira gotas do líquido cefalospinal em raquianestesia

JUSTIFICATIVA E OBJETIVOS: Algunos fragmentos de piel durante las punciones subaracnoideas pueden desarrollar tumores epidermoides intraespinales. El objetivo de este estudio fue verificar la incidencia de celulas epiteliales que refluyen junto con la primera y tercera gotas de liquido cefalorraquideo de los pacientes sometidos a la raquianestesia. METODO: Se obtuvieron muestras de la primera y tercera gotas de liquido cefalorraquideo en 39 pacientes adultos sometidos a la raquianestesia con una aguja 25G Quincke, siendo confeccionadas cuatro laminas: de la primera gota, de la tercera gota, de la aguja y una cuarta lamina control con una gota de suero fisiologico. Las laminas fueron examinadas de forma aleatoria por el patologo. RESULTADOS: Se identificaron celulas epiteliales escamosas en 35 (89,7%) de las muestras de la primera gota, en 34 (87,2%) de la tercera gota y en 24 (61,5%) de las agujas espinales. La tercera gota tuvo como promedio un mayor numero de celulas que la primera gota (p = 0,046). Las celulas epiteliales nucleadas fueron encontradas en una (2,56%) de las muestras de la primera gota, en cuatro (10,25%) de la tercera gota y en una (2,56%) de las agujas espinales. La tercera gota presento como promedio, un mayor numero de celulas nucleadas que la primera gota sin diferencias estadisticas (p = 0,257). CONCLUSIONES: Encontramos un alto porcentaje de celulas epiteliales que refluyen en la primera (89,7%) y en la tercera (87,2%) gotas del liquido cefalorraquideo y en las agujas utilizadas (61,5%). Y aunque hayamos usado agujas de pequeno calibre, desechables y con un mandril bien adaptado, se encontraron celulas de la piel.

There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia

BACKGROUND AND OBJECTIVES Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the fi rst and third drops of CSF of patients undergoing spinal anesthesia. METHODS Samples of the fi rst and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the fi rst drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS Squamous epithelial cells were identified in 35 (89.7%) samples from the fi rst drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the fi rst drop (p = 0.046). Nucleated epithelial cells were found in a sample of the fi rst drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than fi rst drop with no statistical difference (p = 0.257). CONCLUSIONS High percentage of epithelial cells was found in the fi rst (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.BACKGROUND AND OBJECTIVES Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. METHODS Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257). CONCLUSIONS High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.

Diminuição da concentração da levobupivacaína em excesso enantiomérico (S75: R25) para 0,4% hiperbárica proporciona raquianestesia unilateral: estudo com diferentes volumes

JUSTIFICATIVA Y OBJETIVOS: La Raquianestesia unilateral se puede obtener con una solucion hipobarica o hiperbarica. El objetivo de este estudio, fue comparar las diferentes dosis de levobupivacaina en exceso enantiomerico hiperbarico para poder obtener la raquianestesia unilateral. PACIENTES Y METODO: Ciento veinte pacientes fueron aleatoriamente separados para recibir 4 mg, 6 mg u 8 mg de levobupivacaina en exceso enantiomerico al 0,4%. Las soluciones fueron administradas entre L3-L4, en posicion lateral permaneciendo en esa posicion en 5, 10 o 15 minutos de acuerdo con la dosis usada. Los bloqueos sensitivo (picada de aguja) y motor (escala de 0 a 3) se compararon entre el lado que seria operado y el lado contralateral. RESULTADOS: El inicio de la analgesia fue rapido y se comparo entre los grupos. En todos los momentos de las evaluaciones, el bloqueo sensitivo en el miembro operado fue significativamente mas alto que en el miembro no operado. El aumento de 1 mL (2 mg) en la dosis correspondio a un aumento de los segmentos en la moda en el lado operado. En el lado operado, el bloqueo motor completo (BM = 3) se dio en 31 (77,5%) de los pacientes con 4 mg, 38 (95%) con 6 mg y 40 (100%) con 8 mg. Hubo una correlacion positiva entre el aumento de la dosis, la duracion del bloqueo y la hipotension. Todos los pacientes alcanzaron una excelente satisfaccion con la tecnica usada. CONCLUSIONES: La raquianestesia con diferentes volumenes de la solucion de levobupivacaina en exceso enantiomerico (S75:R25) hiperbarica, proporciono una incidencia de un 78% de unilateralidad del bloqueo espinal, siendo la menor dosis usada (4 mg) la mas eficiente.

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

BACKGROUND AND OBJECTIVES: Reducing postoperative pain in hemorrhoidectomy is still a challenge. This prospective, randomized, double-blind study was conducted to compare bilateral pudendal blockade with peripheral nerve stimulator to relieve postoperative pain with the method commonly used. METHOD: 200 patients scheduled for hemorrhoidectomy were randomly divided into Control Group and Pudendal Group. Bilateral pudendal block was performed with levobupivacaine enantiomeric excess (S75:R25) after location with a peripheral nerve stimulator. The parameters evaluated were pain intensity, duration of analgesia, rescue analgesia, complications, patient satisfaction and pain at first defecation. Data were recorded at 6, 12, 18 and 24 hours after the surgery. RESULTS: Bilateral pudendal nerves with mean 23.4±4.4 hours provided better relief of postoperative pain (p<0.001), reducing the need for analgesics and residual analgesia for more than 24 hours in 41% of patients. All patients in Pudental Group had spontaneous micturition versus 96 in the control group. There was no local or systemic complications. CONCLUSIONS: Bilateral blockade of the pudendal nerve using a neurostimulator provided better pain relief with less need for rescue dose and no local or systemic complications.

Serum prevalence of hepatitis B virus in anesthesiologists

BACKGROUND AND OBJECTIVES Anesthesiologists are especially exposed to blood and secretions. Hepatitis B virus infection is the major occupational risk for health care professionals. This study aimed at evaluating the prevalence of Ag-HBs, anti-HBs and anti-HBc among anesthesiologists of the city of Goiânia, as well as their vaccination status. METHODS Participated in this study 90 out of 200 anesthesiologists of the city of Goiânia. Samples were collected by the author and consisted of 10 ml blood of a peripheral vein identified at collection. Blood was analyzed in the first 24 hours, under optimal conservation conditions. The following markers were detected by immunoenzymatic essay: anti-HBc, anti-HBs and Ag-HBs. Participants were personally contacted by the author and gave their written consent to participate in the study. Absolute secrecy of results and questionnaire information was assured. RESULTS Analyzed material showed that 65 out of 90 (72.2%) were anti-HBs positive, as compared to 25 out of 90 (27.8%) who were negative. As to anti-HBc, 76 out of 10 (90.5%) were negative and 9 out of 90 (10%) were positive. No participant was Ag-HBs-positive. CONCLUSIONS This study has shown 72.2% serum prevalence for anti-HBs. The prevalence of Hepatitis-B infection among anesthesiologists was 8.9%, represented by 8 anti-HBc +/anti-HBs +. Based on these results, vaccination campaigns and successful prevention should be intensified.JUSTIFICATIVA Y OBJETIVOS: Los anestesiologistas estan particularmente expuestos al contacto con sangre y secreciones. La infeccion por el virus de la hepatitis B constituye el mayor riesgo ocupacional para los profesionales de la area de la salud. El objetivo de este estudio fue evaluar el soroprevalecimiento del Ag-HBs, anti-HBs y anti-HBc, asi como a situacion de vacunas de los anestesiologistas de la ciudad de Goiania. METODO: Participaron de la pesquisa 90 de los 200 anestesiologistas de la ciudad de Goiania. Las muestras fueron cogidas por el autor. Fueron retirados 10 ml de sangre de una vena periferica, identificadas en el momento de la colecta. El material fue analizado en las primeras 24 horas, bajo condiciones ideales de conservacion. Se realizo, a traves del ensayo inmunoenzimatico, la deteccion de los siguientes marcadores: anti-HBc, anti-HBs y Ag-HBs. Los participantes de la pesquisa fueron personalmente contactados por el autor, y por escrito consintieron con la realizacion del estudio. Garantizado el sigilo absoluto, tanto de los resultados, como las informaciones contenidas en el cuestionario aplicado. RESULTADOS: Los datos analizados mostraron que 65/90 (72,2%) fueron reagentes para el anti-HBs y 25/90 (27,8%) no reagentes. Cuanto al anti-HBc, 76/10 (90,5%) fueron no reagentes y 09/90 (10%) se mostraron reagentes. Ninguno de los participantes mostro positividad para Ag-HBs. CONCLUSIONES: Este estudio mostro una soroprevalencia para el anti-HBs de 72,2% (65/90). La prevalencia de la infeccion por el virus B entre los anestesiologistas fue de 8,9% representados por el 8 anti-HBc + / anti-HBs +. Con base en los resultados, campanas de vacunacion y planteamiento de medidas profilacticas deben ser intensificadas.

Soroprevalecimiento del virus de la hepatitis B en anestesiologistas

BACKGROUND AND OBJECTIVES Anesthesiologists are especially exposed to blood and secretions. Hepatitis B virus infection is the major occupational risk for health care professionals. This study aimed at evaluating the prevalence of Ag-HBs, anti-HBs and anti-HBc among anesthesiologists of the city of Goiânia, as well as their vaccination status. METHODS Participated in this study 90 out of 200 anesthesiologists of the city of Goiânia. Samples were collected by the author and consisted of 10 ml blood of a peripheral vein identified at collection. Blood was analyzed in the first 24 hours, under optimal conservation conditions. The following markers were detected by immunoenzymatic essay: anti-HBc, anti-HBs and Ag-HBs. Participants were personally contacted by the author and gave their written consent to participate in the study. Absolute secrecy of results and questionnaire information was assured. RESULTS Analyzed material showed that 65 out of 90 (72.2%) were anti-HBs positive, as compared to 25 out of 90 (27.8%) who were negative. As to anti-HBc, 76 out of 10 (90.5%) were negative and 9 out of 90 (10%) were positive. No participant was Ag-HBs-positive. CONCLUSIONS This study has shown 72.2% serum prevalence for anti-HBs. The prevalence of Hepatitis-B infection among anesthesiologists was 8.9%, represented by 8 anti-HBc +/anti-HBs +. Based on these results, vaccination campaigns and successful prevention should be intensified.JUSTIFICATIVA Y OBJETIVOS: Los anestesiologistas estan particularmente expuestos al contacto con sangre y secreciones. La infeccion por el virus de la hepatitis B constituye el mayor riesgo ocupacional para los profesionales de la area de la salud. El objetivo de este estudio fue evaluar el soroprevalecimiento del Ag-HBs, anti-HBs y anti-HBc, asi como a situacion de vacunas de los anestesiologistas de la ciudad de Goiania. METODO: Participaron de la pesquisa 90 de los 200 anestesiologistas de la ciudad de Goiania. Las muestras fueron cogidas por el autor. Fueron retirados 10 ml de sangre de una vena periferica, identificadas en el momento de la colecta. El material fue analizado en las primeras 24 horas, bajo condiciones ideales de conservacion. Se realizo, a traves del ensayo inmunoenzimatico, la deteccion de los siguientes marcadores: anti-HBc, anti-HBs y Ag-HBs. Los participantes de la pesquisa fueron personalmente contactados por el autor, y por escrito consintieron con la realizacion del estudio. Garantizado el sigilo absoluto, tanto de los resultados, como las informaciones contenidas en el cuestionario aplicado. RESULTADOS: Los datos analizados mostraron que 65/90 (72,2%) fueron reagentes para el anti-HBs y 25/90 (27,8%) no reagentes. Cuanto al anti-HBc, 76/10 (90,5%) fueron no reagentes y 09/90 (10%) se mostraron reagentes. Ninguno de los participantes mostro positividad para Ag-HBs. CONCLUSIONES: Este estudio mostro una soroprevalencia para el anti-HBs de 72,2% (65/90). La prevalencia de la infeccion por el virus B entre los anestesiologistas fue de 8,9% representados por el 8 anti-HBc + / anti-HBs +. Con base en los resultados, campanas de vacunacion y planteamiento de medidas profilacticas deben ser intensificadas.