Elaine Aparecida Felix Fortis

Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP

BACKGROUND Propofol is an accepted method of sedation for an ERCP and generally achieves deep sedation rather than conscious sedation, and dexmedetomidine has sedative properties of equivalent efficacy. OBJECTIVE To examine the hypothesis that dexmedetomidine is as effective as propofol combined with fentanyl for providing conscious sedation during an ERCP. DESIGN AND SETTING Randomized, blind, double-dummy clinical trial. PATIENTS Twenty-six adults, American Society of Anesthesiologists status I to III, underwent an ERCP. INTERVENTIONS Patients were randomized to receive either propofol (n = 14) (target plasma concentration range 2-4 microg/mL) combined with fentanyl 1 microg/kg, or dexmedetomidine (n = 12) 1 microg/kg for 10 minutes, followed by 0.2 to 0.5 microg/kg/min. Additional sedatives were used if adequate sedation was not achieved at the maximum dose allowed. MAIN OUTCOMES MEASUREMENTS The sedation level was assessed by the Richmond alertness-sedation scale and the demand for additional sedatives. Furthermore, heart rate, blood pressure, oxygen saturation, and respiratory rate were continuously assessed. RESULTS The relative risk (RR) was 2.71 (95% CI, 1.31-5.61) and the number of patients that needed to be treated (NNT) was 1.85 (95% CI, 1.19-4.21) to observe one additional patient with drowsiness 15 minutes after sedation in the dexmedetomidine group. Also, the RR was 9.42 (95% CI, 1.41-62.80), and the NNT was 1.42 (95% CI, 1.0-2.29) to require additional analgesic. However, there was also a greater reduction in blood pressure, a lower heart rate, and greater sedation after the procedure. CONCLUSIONS Dexmedetomidine alone was not as effective as propofol combined with fentanyl for providing conscious sedation during an ERCP. Furthermore, dexmedetomidine was associated with greater hemodynamic instability and a prolonged recovery.

Partial liquid ventilation with perfluorodecalin following unilateral canine lung allotransplantation in non–heart-heating donors

Abstract Background The purpose of this study was to evaluate canine lungs obtained from non–heart-beating donors after unilateral lung transplantation subjected to partial liquid ventilation with perfluorodecalin. Methods Twelve donor dogs were killed and kept under mechanical ventilation for 3 hours. Heart–lung blocs were harvested after retrograde pulmonary hypothermic flush with Perfadex. Left lung grafts were randomly transplanted into 12 weight-matched recipient animals. Animals were divided into 2 groups: control (standard mechanical ventilation, n = 6) and PLV (partial liquid ventilation, n = 6). Forty-five minutes after transplantation, the animals in the PLV group received perfluorodecalin (15 ml/kg) via orotracheal tube. All animals received volume-controlled ventilation (Fio 2 1.0, PEEP 5 cm H 2 O) over 6 consecutive hours. Thereafter, blood-gas analysis, ventilatory mechanics and hemodynamics were registered at 30-minute intervals. After 6 hours of reperfusion the animals were killed and the transplanted lungs were extracted to obtain the wet/dry weight ratio. Results There were significant differences in pulmonary arterial pressure, which were higher in control group animals ( p 2 than those in the PLV group ( p 2 ( p p Conclusions PLV with perfluorodecalin yields functional results compatible with life in this model. Nonetheless, pulmonary gas exchange and mechanics were superior after reperfusion in animals given conventional mechanical ventilation up to 6 hours after left lung allotransplantation.

Preoperative intravenous clonidine in the surgical treatment of cataract: evaluation of the clinical benefits

JUSTIFICATIVA Y OBJETIVOS: La clonidina ha sido utilizada en la anestesia por anadir propiedades analgesicas y sedativas, y por proporcionar una mayor estabilidad hemodinamica con reduccion de la presion intraocular. Este estudio evalua los efectos clinicos de la clonidina (2,5 µg.kg-1), por via venosa, en la presion Intraocular (PIO), en la hemodinamica y en la recuperacion postanestesica del tratamiento quirurgico de catarata. METODOS: Se realizo un ensayo clinico a doble ciego, controlado por placebo y con distribucion aleatoria, que incluyo pacientes que fuesen realizar operacion de catarata bajo bloqueo peribulbar. Despues de la monitorizacion, Momento 0 (M0), se realizaron las medidas iniciales de PIO, presion arterial media (PAM), frecuencia cardiaca (FC), SpO2 y el grado de sedacion (Ramsay), y entonces se administro el placebo (Grupo P) o la clonidina (Grupo C) por via venosa. Treinta minutos despues, Momento 1 (M1), se repetian las medidas y nuevamente al fin de la operacion, Momento 2 (M2). RESULTADOS: Entre M0 y M1, hubo una disminucion diferente de la PIO, 14,5% en el Grupo C y 5,25% en el P (p = 0,01), manteniendo sus medias reducidas en M2. La PAM del Grupo C se redujo un 17% de M0 a M1 y subio un 3,5% en el Grupo P (p < 0,001), con una recuperacion de la PAM del Grupo C hasta M2 (p = 0,17). La FC disminuyo 6,4% en el Grupo C y 1% en el Grupo P (p = 0,1) de M0 a M1. Se registro un aumento de la sedacion en el Grupo C con relacion al P (p < 0,001), sin embargo sin que ocurriera depresion respiratoria. El RR de hipertension arterial en el intraoperatorio del Grupo C fue 0,657 (IC95% 0,517 a 0,835), p < 0,01. No hubo diferencias con relacion a la incidencia de la taquicardia, hipoxemia, hipotension arterial, ni atraso del alta hospitalaria. CONCLUSIONES: La clonidina, en las condiciones de este estudio, fue un farmaco seguro y redujo la PIO y el riesgo de hipertension arterial intraoperatoria sin retardar el alta hospitalaria.BACKGROUND AND OBJECTIVES Clonidine has been used in anesthesia for its sedative and analgesic properties, and to achieve greater hemodynamic stability with reduction in intra-ocular pressure. This study evaluated the clinical effects of intravenous clonidine (2.5 microg.kg(-1)) on the intra-ocular pressure (IOP), hemodynamic parameters, and post-anesthetic recovery in the surgical treatment of cataract. METHODS This is a randomized, double-blind, placebo-controlled study that included patients undergoing cataract surgery under peribulbar block. After placement of monitoring devices, baseline (M0) values of IOP, mean arterial pressure (MAP), heart rate (HR), SpO2, and the degree of sedation (Ramsay) were determined. Afterwards, placebo (Group P) or clonidine (Group C) was administered intravenously. After 30 minutes, at Moment 1 (M1), measurements were repeated, and once again at the end of the surgery, at Moment 2 (M2). RESULTS The change in IOP between M0 and M1 was different for both groups, 14.5% in Group C and 5.25% in Group P (p = 0.01), and the means remained reduced until M2. Mean arterial pressure in Group C showed a 17% reduction from M0 to M1 and increased 3.5% in Group P (p < 0.001) and in Group C it showed a recovery at M2 (p = 0.17). The heart rate decreased 6.4% in Group C and 1% in Group P (p = 0.1) from M0 to M1. There was a greater sedation in Group C when compared with Group P (p < 0.001) but there was no cases of respiratory depression. The relative risk of intraoperative hypertension was 0.657 (CI 95% 0.517 to 0.835) in Group C, p < 0.01. Differences in the incidence of tachycardia, hypoxemia, hypotension, and increased hospital staying were not observed between both groups. CONCLUSIONS Clonidine, under the conditions of the present study, showed to be a safe drug and decreased IOP and the intraoperative risk of hypertension without delaying hospital discharge.

Ventilação líquida: revisão da literatura *

Atualmente, novas alternativas de ventilacao tem sido estudadas em quadros de insuficiencia respiratoria, com o objetivo de melhorar a oxigenacao e minimizar a agressao ao parenquima pulmonar. A utilizacao de perfluorocarbonos liquidos administrados diretamente na via aerea vem sendo ostensivamente estudada em modelos de lesao pulmonar e em alguns ensaios clinicos, demonstrando bons resultados com relacao a troca gasosa, mecânica ventilatoria e propriedades antiinflamatorias. Os PFCs sao substâncias que possuem baixa tensao superficial, alta densidade, sao insoluveis em agua, alem de permitirem alta difusao de oxigenio e gas carbonico. Esses compostos atuam recrutando alveolos colapsados, melhorando a oxigenacao, protegendo a arquitetura pulmonar e atuando como carreadores de impurezas, limpando a superficie alveolar de residuos da degradacao celular. Neste artigo de revisao sao apresentadas as diferentes modalidades ventilatorias com perfluorocarbonos e fornecidas informacoes sobre a utilizacao e o estado atual da ventilacao liquida.

Clonidina por vía venosa en el preoperatorio del tratamiento quirúrgico de catarata: evaluación del beneficio clínico

JUSTIFICATIVA Y OBJETIVOS: La clonidina ha sido utilizada en la anestesia por anadir propiedades analgesicas y sedativas, y por proporcionar una mayor estabilidad hemodinamica con reduccion de la presion intraocular. Este estudio evalua los efectos clinicos de la clonidina (2,5 µg.kg-1), por via venosa, en la presion Intraocular (PIO), en la hemodinamica y en la recuperacion postanestesica del tratamiento quirurgico de catarata. METODOS: Se realizo un ensayo clinico a doble ciego, controlado por placebo y con distribucion aleatoria, que incluyo pacientes que fuesen realizar operacion de catarata bajo bloqueo peribulbar. Despues de la monitorizacion, Momento 0 (M0), se realizaron las medidas iniciales de PIO, presion arterial media (PAM), frecuencia cardiaca (FC), SpO2 y el grado de sedacion (Ramsay), y entonces se administro el placebo (Grupo P) o la clonidina (Grupo C) por via venosa. Treinta minutos despues, Momento 1 (M1), se repetian las medidas y nuevamente al fin de la operacion, Momento 2 (M2). RESULTADOS: Entre M0 y M1, hubo una disminucion diferente de la PIO, 14,5% en el Grupo C y 5,25% en el P (p = 0,01), manteniendo sus medias reducidas en M2. La PAM del Grupo C se redujo un 17% de M0 a M1 y subio un 3,5% en el Grupo P (p < 0,001), con una recuperacion de la PAM del Grupo C hasta M2 (p = 0,17). La FC disminuyo 6,4% en el Grupo C y 1% en el Grupo P (p = 0,1) de M0 a M1. Se registro un aumento de la sedacion en el Grupo C con relacion al P (p < 0,001), sin embargo sin que ocurriera depresion respiratoria. El RR de hipertension arterial en el intraoperatorio del Grupo C fue 0,657 (IC95% 0,517 a 0,835), p < 0,01. No hubo diferencias con relacion a la incidencia de la taquicardia, hipoxemia, hipotension arterial, ni atraso del alta hospitalaria. CONCLUSIONES: La clonidina, en las condiciones de este estudio, fue un farmaco seguro y redujo la PIO y el riesgo de hipertension arterial intraoperatoria sin retardar el alta hospitalaria.BACKGROUND AND OBJECTIVES Clonidine has been used in anesthesia for its sedative and analgesic properties, and to achieve greater hemodynamic stability with reduction in intra-ocular pressure. This study evaluated the clinical effects of intravenous clonidine (2.5 microg.kg(-1)) on the intra-ocular pressure (IOP), hemodynamic parameters, and post-anesthetic recovery in the surgical treatment of cataract. METHODS This is a randomized, double-blind, placebo-controlled study that included patients undergoing cataract surgery under peribulbar block. After placement of monitoring devices, baseline (M0) values of IOP, mean arterial pressure (MAP), heart rate (HR), SpO2, and the degree of sedation (Ramsay) were determined. Afterwards, placebo (Group P) or clonidine (Group C) was administered intravenously. After 30 minutes, at Moment 1 (M1), measurements were repeated, and once again at the end of the surgery, at Moment 2 (M2). RESULTS The change in IOP between M0 and M1 was different for both groups, 14.5% in Group C and 5.25% in Group P (p = 0.01), and the means remained reduced until M2. Mean arterial pressure in Group C showed a 17% reduction from M0 to M1 and increased 3.5% in Group P (p < 0.001) and in Group C it showed a recovery at M2 (p = 0.17). The heart rate decreased 6.4% in Group C and 1% in Group P (p = 0.1) from M0 to M1. There was a greater sedation in Group C when compared with Group P (p < 0.001) but there was no cases of respiratory depression. The relative risk of intraoperative hypertension was 0.657 (CI 95% 0.517 to 0.835) in Group C, p < 0.01. Differences in the incidence of tachycardia, hypoxemia, hypotension, and increased hospital staying were not observed between both groups. CONCLUSIONS Clonidine, under the conditions of the present study, showed to be a safe drug and decreased IOP and the intraoperative risk of hypertension without delaying hospital discharge.

Clonidina por via venosa no pré-operatório do tratamento cirúrgico de catarata: avaliação do benefício clínico

JUSTIFICATIVA Y OBJETIVOS: La clonidina ha sido utilizada en la anestesia por anadir propiedades analgesicas y sedativas, y por proporcionar una mayor estabilidad hemodinamica con reduccion de la presion intraocular. Este estudio evalua los efectos clinicos de la clonidina (2,5 µg.kg-1), por via venosa, en la presion Intraocular (PIO), en la hemodinamica y en la recuperacion postanestesica del tratamiento quirurgico de catarata. METODOS: Se realizo un ensayo clinico a doble ciego, controlado por placebo y con distribucion aleatoria, que incluyo pacientes que fuesen realizar operacion de catarata bajo bloqueo peribulbar. Despues de la monitorizacion, Momento 0 (M0), se realizaron las medidas iniciales de PIO, presion arterial media (PAM), frecuencia cardiaca (FC), SpO2 y el grado de sedacion (Ramsay), y entonces se administro el placebo (Grupo P) o la clonidina (Grupo C) por via venosa. Treinta minutos despues, Momento 1 (M1), se repetian las medidas y nuevamente al fin de la operacion, Momento 2 (M2). RESULTADOS: Entre M0 y M1, hubo una disminucion diferente de la PIO, 14,5% en el Grupo C y 5,25% en el P (p = 0,01), manteniendo sus medias reducidas en M2. La PAM del Grupo C se redujo un 17% de M0 a M1 y subio un 3,5% en el Grupo P (p < 0,001), con una recuperacion de la PAM del Grupo C hasta M2 (p = 0,17). La FC disminuyo 6,4% en el Grupo C y 1% en el Grupo P (p = 0,1) de M0 a M1. Se registro un aumento de la sedacion en el Grupo C con relacion al P (p < 0,001), sin embargo sin que ocurriera depresion respiratoria. El RR de hipertension arterial en el intraoperatorio del Grupo C fue 0,657 (IC95% 0,517 a 0,835), p < 0,01. No hubo diferencias con relacion a la incidencia de la taquicardia, hipoxemia, hipotension arterial, ni atraso del alta hospitalaria. CONCLUSIONES: La clonidina, en las condiciones de este estudio, fue un farmaco seguro y redujo la PIO y el riesgo de hipertension arterial intraoperatoria sin retardar el alta hospitalaria.BACKGROUND AND OBJECTIVES Clonidine has been used in anesthesia for its sedative and analgesic properties, and to achieve greater hemodynamic stability with reduction in intra-ocular pressure. This study evaluated the clinical effects of intravenous clonidine (2.5 microg.kg(-1)) on the intra-ocular pressure (IOP), hemodynamic parameters, and post-anesthetic recovery in the surgical treatment of cataract. METHODS This is a randomized, double-blind, placebo-controlled study that included patients undergoing cataract surgery under peribulbar block. After placement of monitoring devices, baseline (M0) values of IOP, mean arterial pressure (MAP), heart rate (HR), SpO2, and the degree of sedation (Ramsay) were determined. Afterwards, placebo (Group P) or clonidine (Group C) was administered intravenously. After 30 minutes, at Moment 1 (M1), measurements were repeated, and once again at the end of the surgery, at Moment 2 (M2). RESULTS The change in IOP between M0 and M1 was different for both groups, 14.5% in Group C and 5.25% in Group P (p = 0.01), and the means remained reduced until M2. Mean arterial pressure in Group C showed a 17% reduction from M0 to M1 and increased 3.5% in Group P (p < 0.001) and in Group C it showed a recovery at M2 (p = 0.17). The heart rate decreased 6.4% in Group C and 1% in Group P (p = 0.1) from M0 to M1. There was a greater sedation in Group C when compared with Group P (p < 0.001) but there was no cases of respiratory depression. The relative risk of intraoperative hypertension was 0.657 (CI 95% 0.517 to 0.835) in Group C, p < 0.01. Differences in the incidence of tachycardia, hypoxemia, hypotension, and increased hospital staying were not observed between both groups. CONCLUSIONS Clonidine, under the conditions of the present study, showed to be a safe drug and decreased IOP and the intraoperative risk of hypertension without delaying hospital discharge.

Vascular endothelial growth factor gene therapy induces early re-establishment of canine bronchial circulation §,§§

OBJECTIVE To evaluate the usefulness of gene therapy with human vascular endothelial growth factor 165 (phVEGF(165)) to promote the early re-establishment of systemic arterial perfusion in canine bronchi deprived of bronchial circulation. METHODS To disrupt bronchial circulation, dogs were submitted to transversal bronchotomy dividing the left mainstem bronchus into a proximal and a distal portion. phVEGF(165) (VEGF group, n=8) or physiologic saline solution (control group, n=8) were then delivered to the left distal bronchus. After that, the airway was reconstituted with interrupted suture. On day 3, nine dogs (four VEGF and five controls) were euthanized and their left distal bronchi were harvested to evaluate VEGF(165) gene expression by reverse transcription-polymerase chain reaction. In the other dogs (four VEGF and three controls), a microvascular dye was injected through the canine aorta to verify the re-establishment of arterial blood supply to the distal bronchus. Additionally, VEGF immunohistochemistry was performed in distal airway specimens. RESULTS Microvascular dye was observed in 100% of specimens transfected with phVEGF(165) compared to none in controls. VEGF gene expression (p<0.01) and VEGF protein expression (p<0.05) were higher in VEGF(165)-treated bronchi. CONCLUSIONS Local transfection with phVEGF(165) promoted the early re-establishment of systemic arterial perfusion to bronchi previously deprived of bronchial circulation. Gene therapy with phVEGF(165) may be a useful tool to restore bronchial circulation by promoting early airway angiogenesis.