Cátia Sousa Govêia

Use of Simple Clinical Predictors on Preoperative Diagnosis of Difficult Endotracheal Intubation in Obese Patients

BACKGROUND AND OBJECTIVES Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. METHODS Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. RESULTS Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. CONCLUSIONS The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy.

Anestesia peribulbar com ropivacaína: estudo da ação vasoconstritora

JUSTIFICATIVA Y OBJETIVOS: La anestesia peribulbar puede reducir el flujo sanguineo ocular (FSO) por elevacion de la presion intraocular (PIO) o por la accion de farmacos. La ropivacaina tiene una baja toxicidad y una accion vasoconstrictora intrinseca que todavia no ha sido comprobada sobre la vasculatura ocular. Medidas de la amplitud del pulso ocular (APO) permiten una evaluacion indirecta del FSO. El objetivo de este estudio es evaluar, via FSO, la accion vasoconstrictora de la ropivacaina en la anestesia peribulbar. METODO: Cuarenta pacientes, sometidos a bloqueo peribulbar con 7 mL de solucion anestesica, sin vasoconstrictor, fueron divididos aleatoriamente en dos grupos: Ropivacaina (n = 20) y bupivacaina (n = 20). Se evaluaron PIO, presion de perfusion ocular (PPO), APO, variables hemodinamicas y el grado de acinesia antes y a los 5 y 10 minutos posteriores al bloqueo peribulbar. Para la evaluacion de los parametros oculares, se utilizo el tonometro de contorno dinamico. La sedacion fue identica en los dos grupos. RESULTADOS: No se registro variacion significativa de los parametros hemodinamicos y de la intensidad del bloqueo motor. A los 5 y 10 minutos, se registro una diferencia de PIO, PPO y APO entre los grupos (p < 0,05). La variacion de la PIO a los 5 y 10 minutos fue, respectivamente, de -0,88% y -4,54% con ropivacaina y de 17,61% y 16,56% con bupivacaina. La alteracion de la PPO despues de 5 y 10 minutos fue de 1,5% y 4,2% con ropivacaina, y de -7% y -6% con bupivacaina. La APO vario -55,59% y -59,67% con ropivacaina a los 5 y 10 minutos, y -34,71% y -28,82% con bupivacaina. CONCLUSIONES: La ropivacaina redujo mas intensamente la amplitud del pulso ocular, a pesar de las pequenas alteraciones de PIO y PPO. La disminucion del flujo sanguineo ocular por la ropivacaina puede ser atribuida a su efecto vasoconstrictor

Ropivacaine in peribulbar anesthesia - vasoconstrictive properties.

BACKGROUND AND OBJECTIVES Peribulbar anesthesia can reduce ocular blood flow (OBF) by increasing intraocular pressure (IOP) or due to the action of drugs. Ropivacaine has low toxicity and intrinsic vasoconstrictive properties, yet to be proven on the ocular vasculature. Measurements of ocular pulse amplitude (OPA) allow the indirect evaluation of the OBF. The objective of the present study was to evaluate through the OBF the vasoconstrictive properties of ropivacaine in peribulbar anesthesia. METHODS Forty eyes undergoing peribulbar anesthesia with 7 mL of anesthetic solution without vasoconstrictor were randomly divided into two groups: ropivacaine (n = 20) and bupivacaine (n = 20). The IOP, ocular perfusion pressure (OPP), OPA, hemodynamic parameters, and the degree of akinesia before and 5 and 10 minutes after the blockade were evaluated. A dynamic contour tonometer was used to evaluate ocular parameters. Sedation was similar in both groups. RESULTS A significant variation in hemodynamic parameters and intensity of the motor blockade was not observed between groups. Differences in IOP, OPP, and OPA (p < 0.05) were observed between both groups at 5 and 10 minutes. The variation of IOP at 5 and 10 minutes was -0.88% and -4.54%, respectively with ropivacaine, and 17.61% and 16.56% with bupivacaine. The change in OPP after 5 and 10 minutes was 1.5% and 4.2% with ropivacaine, and -7% and -6% with bupivacaine. Ocular pulse amplitude varied -55.59% and -59.67% with ropivacaine at 5 and 10 minutes, and -34.71% and -28.82% with bupivacaine. CONCLUSIONS Ropivacaine reduced more intensely the ocular pulse amplitude despite little changes in IOP and OPP. The reduction in ocular blood flow caused by ropivacaine can be attributed to its vasoconstrictive effect.

Bupivacaína racêmica, levobupivacaína e ropivacaína em anestesia loco-regional para oftalmologia: um estudo comparativo

BACKGROUND AND OBJECTIVE: Racemic bupivacaine, used in peribulbar anesthesia owing to its high potential to promote motor blockade, presents a smaller safety margin for cardiotoxicity in relation to ropivacaine and levobupivacaine. The objective of this study was to compare the degree of motor blockade and alteration of intraocular pressure (IOP) produced by racemic bupivacaine, levobupivacaine and ropivacaine in peribulbar block. METHOD: Ninety seven patients, ASA physical status I and II, submitted to peribulbar anesthesia, were randomly allocated into three groups: group A-(n=16) receiving racemic bupivacaine 0.75% with epinephrine 1:200.000; group B -(n=16) levobupivacaine 0.75% with epinephrine 1:200.000; group C -(n=15) ropivacaine 0.75%. A single inferior injection peribulbar anesthesia was performed with 7ml of the anesthetic solution plus 280 UI of hyaluronidase. The IOP and the degree of motor blockade were registered five minutes before injection and 1,2,3,4,5 and 10 minutes after it. The motor blockade was evaluated according to Nicolls scale. For statistical analysis, Wilcoxons test, simple frequency analysis, and Student-t test were used. p<0.05 was considered significant. RESULTS: There were no significant differences between groups with respect to the degree of motor blockade. The IOP variation between the groups was not clinically significant. CONCLUSIONS: Considering the advanced age of most of these patients and the high concentrations of local anesthetics used in peribulbar blockade, the use of ropivacaine and levobupivacaine produces motor blockade as effective as racemic bupivacaine while minimising risks for cardiotoxicity.

Prevalência de síndrome de burnout entre os anestesiologistas do Distrito Federal

BACKGROUND burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference. OBJECTIVE evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District. METHOD cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data. RESULTS of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of three criteria to develop the syndrome and only 8.2% have a low risk to manifest it. CONCLUSION the prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.

Relação entre a infusão contínua de dexmedetomidina e a fração expirada de sevoflurano monitorizada pelo índice bispectral

JUSTIFICATIVA Y OBJETIVOS: La asociacion de agentes venosos a la anestesia general inhalatoria proporciona mejor cualidad de analgesia e hipnosis. La dexmedetomidina es un agonista especifico alfa2-adrenergico con estas caracteristicas y reconocida por proporcionar estabilidad hemodinamica. El objetivo del estudio fue evaluar el efecto de la infusion continua de dexmedetomidina en la fraccion expirada de sevoflurano (FEsevo) en anestesia general, monitorizada por el analisis bispectral del EEG (BIS). METODO: Se estudio, de modo prospectivo, 24 pacientes adultos, de ambos sexos, estado fisico ASA I y II, sometidos a cirugias electivas sobre anestesia general, monitorizados con ECG, PANI, SpO2, PETCO2, FEsevo y BIS. Se procedio a la induccion venosa con alfentanil (30 µg.kg-1), tiopental (5 mg.kg-1) y vecuronio (0,1 mg.kg-1) e intubacion traqueal. Se iniciaron la administracion de sevoflurano (manutencion del BIS entre 40 y 60), la ventilacion controlada con volumen corriente de 10 ml.kg-1 y la manutencion de la PETCO2 entre 35 y 45 mmHg. En la fase de manutencion de la anestesia, despues de 60 minutos de la induccion anestesica (M60), fue iniciada la infusion continua de dexmedetomidina en 2 fases: infusion inicial (1 µg.kg-1) en 20 minutos; e, infusion de manutencion (0,5 µg.kg-1.h-1). La concentracion de sevoflurano fue ajustada para mantener el valor de BIS entre 40 y 60. Las variables de PA, FC, FEsevo, SpO2, PETCO2 y BIS fueron evaluadas en los tiempos pre-inducion (M-15), M15, M45, M75, M105 y M120. RESULTADOS: La asociacion de la dexmedetomidina a la anestesia general con sevoflurano proporciono reduccion significativa (p < 0,05) de la FEsevo de M45 (1,604 ± 0,485) a M105 (1,073 ± 0,457) y de M45 (1,604 ± 0,485) a M120 (1,159 ± 0,475). Las variables hemodinamicas analizadas presentaron diferencias estadisticamente significantes con p < 0,05, mas sin repercusiones clinicas. CONCLUSIONES: La asociacion de dexmedetomidina en infusion continua (0,5 µg.kg-1.h-1) a la anestesia general inhalatoria con sevoflurano proporciono reduccion de la fraccion expiratoria de sevoflurano, con estabilidad hemodinamica.BACKGROUND AND OBJECTIVES General inhalational anesthesia associated with intravenous agents provides analgesia and hypnosis of better quality. Dexmedetomidine is a specific a2-adrenergic agonist with these characteristics and is known by providing hemodynamic stability. This study aimed at evaluating the effects of dexmedetomidine continuous infusion on end-tidal sevoflurane concentration (ETsevo) in general anesthesia, monitored by EEG spectral index (BIS). METHODS Participated in this prospective study 24 adult patients of both genders, physical status ASA I and II submitted to elective surgery under general anesthesia and monitored by ECG, BP, SpO2, P ET CO2, ETsevo and BIS. Intravenous anesthesia was induced with alfentanil (30 microg.kg-1), thiopental (5 mg.kg-1) and vecuronium (0.1 mg.kg-1), followed by tracheal intubation. Then, sevoflurane (to maintain BIS between 40 and 60), controlled ventilation with tidal volume of 10 mL.kg-1 and P ET CO2 between 35 and 45 mmHg were started. During maintenance, 60 minutes after anesthetic induction (T60), continuous dexmedetomidine infusion was started in 2 phases: initial infusion (1 microg.kg-1) in 20 minutes; and maintenance infusion (0.5 microg.kg-1.h-1). Sevoflurane concentration was adjusted to maintain BIS between 40 and 60. BP, HR, ETsevo, SpO2, P ET CO2 and BIS were evaluated in the following moments before anesthetic induction (M-15), M15, M45, M75, M105 and M120. RESULTS The association of dexmedetomidine to general anesthesia with sevoflurane provided statistically significant ETsevo decrease (p < 0.05) from M45 (1.604 +/- 0.485) to M105 (1.073 +/- 0.457), and from M45 (1.604 +/- 0.485) to M120 (1.159 +/- 0.475). Hemodynamic parameters have shown statistically significant differences (p < 0.05), however without clinical repercussions. CONCLUSIONS The association of dexmedetomidine continuous infusion (0,5 microg.kg-1.h-1) to inhalational anesthesia with sevoflurane provided end-tidal sevoflurane concentration decrease while maintaining hemodynamic stability.

[Relationship between dexmedetomidine continuous infusion and end-tidal sevoflurane concentration, monitored by bispectral analysis.].

JUSTIFICATIVA Y OBJETIVOS: La asociacion de agentes venosos a la anestesia general inhalatoria proporciona mejor cualidad de analgesia e hipnosis. La dexmedetomidina es un agonista especifico alfa2-adrenergico con estas caracteristicas y reconocida por proporcionar estabilidad hemodinamica. El objetivo del estudio fue evaluar el efecto de la infusion continua de dexmedetomidina en la fraccion expirada de sevoflurano (FEsevo) en anestesia general, monitorizada por el analisis bispectral del EEG (BIS). METODO: Se estudio, de modo prospectivo, 24 pacientes adultos, de ambos sexos, estado fisico ASA I y II, sometidos a cirugias electivas sobre anestesia general, monitorizados con ECG, PANI, SpO2, PETCO2, FEsevo y BIS. Se procedio a la induccion venosa con alfentanil (30 µg.kg-1), tiopental (5 mg.kg-1) y vecuronio (0,1 mg.kg-1) e intubacion traqueal. Se iniciaron la administracion de sevoflurano (manutencion del BIS entre 40 y 60), la ventilacion controlada con volumen corriente de 10 ml.kg-1 y la manutencion de la PETCO2 entre 35 y 45 mmHg. En la fase de manutencion de la anestesia, despues de 60 minutos de la induccion anestesica (M60), fue iniciada la infusion continua de dexmedetomidina en 2 fases: infusion inicial (1 µg.kg-1) en 20 minutos; e, infusion de manutencion (0,5 µg.kg-1.h-1). La concentracion de sevoflurano fue ajustada para mantener el valor de BIS entre 40 y 60. Las variables de PA, FC, FEsevo, SpO2, PETCO2 y BIS fueron evaluadas en los tiempos pre-inducion (M-15), M15, M45, M75, M105 y M120. RESULTADOS: La asociacion de la dexmedetomidina a la anestesia general con sevoflurano proporciono reduccion significativa (p < 0,05) de la FEsevo de M45 (1,604 ± 0,485) a M105 (1,073 ± 0,457) y de M45 (1,604 ± 0,485) a M120 (1,159 ± 0,475). Las variables hemodinamicas analizadas presentaron diferencias estadisticamente significantes con p < 0,05, mas sin repercusiones clinicas. CONCLUSIONES: La asociacion de dexmedetomidina en infusion continua (0,5 µg.kg-1.h-1) a la anestesia general inhalatoria con sevoflurano proporciono reduccion de la fraccion expiratoria de sevoflurano, con estabilidad hemodinamica.BACKGROUND AND OBJECTIVES General inhalational anesthesia associated with intravenous agents provides analgesia and hypnosis of better quality. Dexmedetomidine is a specific a2-adrenergic agonist with these characteristics and is known by providing hemodynamic stability. This study aimed at evaluating the effects of dexmedetomidine continuous infusion on end-tidal sevoflurane concentration (ETsevo) in general anesthesia, monitored by EEG spectral index (BIS). METHODS Participated in this prospective study 24 adult patients of both genders, physical status ASA I and II submitted to elective surgery under general anesthesia and monitored by ECG, BP, SpO2, P ET CO2, ETsevo and BIS. Intravenous anesthesia was induced with alfentanil (30 microg.kg-1), thiopental (5 mg.kg-1) and vecuronium (0.1 mg.kg-1), followed by tracheal intubation. Then, sevoflurane (to maintain BIS between 40 and 60), controlled ventilation with tidal volume of 10 mL.kg-1 and P ET CO2 between 35 and 45 mmHg were started. During maintenance, 60 minutes after anesthetic induction (T60), continuous dexmedetomidine infusion was started in 2 phases: initial infusion (1 microg.kg-1) in 20 minutes; and maintenance infusion (0.5 microg.kg-1.h-1). Sevoflurane concentration was adjusted to maintain BIS between 40 and 60. BP, HR, ETsevo, SpO2, P ET CO2 and BIS were evaluated in the following moments before anesthetic induction (M-15), M15, M45, M75, M105 and M120. RESULTS The association of dexmedetomidine to general anesthesia with sevoflurane provided statistically significant ETsevo decrease (p < 0.05) from M45 (1.604 +/- 0.485) to M105 (1.073 +/- 0.457), and from M45 (1.604 +/- 0.485) to M120 (1.159 +/- 0.475). Hemodynamic parameters have shown statistically significant differences (p < 0.05), however without clinical repercussions. CONCLUSIONS The association of dexmedetomidine continuous infusion (0,5 microg.kg-1.h-1) to inhalational anesthesia with sevoflurane provided end-tidal sevoflurane concentration decrease while maintaining hemodynamic stability.

[Hematoma after epidural anesthesia: conservative treatment. Case report.].

BACKGROUND AND OBJECTIVES Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000). It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale), reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural sac. Ten hours after the epidural puncture, there was no regression of neurological signs and symptoms. It was decided, then, to treat the patient with a continuous infusion of methylprednisolone (5.3 mg.kg-1 in the first hour and 1.4 mg.kg-1.h-1 in the following 23 hours). Eight hours after the beginning of the treatment, the patient recovered thermal and pain sensitivity and presented total regression of the motor blockade. On the 12th hour, she was walking and complained of pain in the surgical wound. The epidural hematoma was not visualized in a CT scan done 14 hours after the beginning of the treatment. The patient was discharged 86 hours after the beginning of the treatment without neurological deficits. A CT scan done after 7 months showed a completely normal spinal canal. CONCLUSIONS The efficacy of the conservative approach demonstrated that it is an important alternative to surgery in specific cases. The evaluation of the progression or stabilization of the neurological deficit, especially 8 hours after the epidural puncture, is essential in choosing the treatment.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresion espinal despues de la anestesia peridural es una complicacion neurologica grave, a pesar de la pequena incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresion quirurgica de urgencia. Recientemente, en casos especificos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacion neurologica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacion neurologica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 anos, estado fisico ASA I, sin ningun historial de coagulopatia o terapia anticoagulante, sometida a la anestesia peridural con puncion unica, en L2-L3, para tratamiento quirurgico de varices en los miembros inferiores. Ocho horas despues de la anestesia regional, todavia presentaba bloqueo motor completo (escala de Bromage), reduccion de las sensibilidades termica y dolorosa por debajo del nivel L3, hiperalgesia en la region plantar izquierda, preservacion de los reflejos tendinosos y ausencia de dolor lumbar. La tomografia computadorizada revelo hematoma peridural en L2 con compresion del saco dural. Diez horas despues de la puncion peridural no habia progresion de las senales y sintomas neurologicos. Se opto entonces por el tratamiento con metilprednisolona en infusion venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes). Ocho horas despues del inicio del tratamiento, la paciente recupero las sensibilidades termica y dolorosa y la regresion total del bloqueo motor. En la 12a hora, deambulaba y referia dolor en la herida operada. El hematoma peridural no se visualizo en una nueva tomografia computadorizada en la 14a hora despues del inicio del tratamiento. La paciente recibio alta hospitalaria 86 horas despues del inicio del tratamiento conservador, sin comprometimiento neurologico. Una tomografia computadorizada de control despues de 7 meses, mostro el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervencion quirurgica en casos especificos. La evaluacion de la progresion o estabilizacion del comprometimiento neurologico, particularmente despues de la 8a hora posterior a la puncion peridural, es esencial para la eleccion del tratamiento.

Hematoma após anestesia peridural: tratamento conservador. Relato de caso

BACKGROUND AND OBJECTIVES Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000). It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale), reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural sac. Ten hours after the epidural puncture, there was no regression of neurological signs and symptoms. It was decided, then, to treat the patient with a continuous infusion of methylprednisolone (5.3 mg.kg-1 in the first hour and 1.4 mg.kg-1.h-1 in the following 23 hours). Eight hours after the beginning of the treatment, the patient recovered thermal and pain sensitivity and presented total regression of the motor blockade. On the 12th hour, she was walking and complained of pain in the surgical wound. The epidural hematoma was not visualized in a CT scan done 14 hours after the beginning of the treatment. The patient was discharged 86 hours after the beginning of the treatment without neurological deficits. A CT scan done after 7 months showed a completely normal spinal canal. CONCLUSIONS The efficacy of the conservative approach demonstrated that it is an important alternative to surgery in specific cases. The evaluation of the progression or stabilization of the neurological deficit, especially 8 hours after the epidural puncture, is essential in choosing the treatment.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresion espinal despues de la anestesia peridural es una complicacion neurologica grave, a pesar de la pequena incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresion quirurgica de urgencia. Recientemente, en casos especificos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacion neurologica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacion neurologica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 anos, estado fisico ASA I, sin ningun historial de coagulopatia o terapia anticoagulante, sometida a la anestesia peridural con puncion unica, en L2-L3, para tratamiento quirurgico de varices en los miembros inferiores. Ocho horas despues de la anestesia regional, todavia presentaba bloqueo motor completo (escala de Bromage), reduccion de las sensibilidades termica y dolorosa por debajo del nivel L3, hiperalgesia en la region plantar izquierda, preservacion de los reflejos tendinosos y ausencia de dolor lumbar. La tomografia computadorizada revelo hematoma peridural en L2 con compresion del saco dural. Diez horas despues de la puncion peridural no habia progresion de las senales y sintomas neurologicos. Se opto entonces por el tratamiento con metilprednisolona en infusion venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes). Ocho horas despues del inicio del tratamiento, la paciente recupero las sensibilidades termica y dolorosa y la regresion total del bloqueo motor. En la 12a hora, deambulaba y referia dolor en la herida operada. El hematoma peridural no se visualizo en una nueva tomografia computadorizada en la 14a hora despues del inicio del tratamiento. La paciente recibio alta hospitalaria 86 horas despues del inicio del tratamiento conservador, sin comprometimiento neurologico. Una tomografia computadorizada de control despues de 7 meses, mostro el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervencion quirurgica en casos especificos. La evaluacion de la progresion o estabilizacion del comprometimiento neurologico, particularmente despues de la 8a hora posterior a la puncion peridural, es esencial para la eleccion del tratamiento.

Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal

BACKGROUND AND OBJECTIVE There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District. METHOD A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%. RESULTS Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables. CONCLUSIONS There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.