Eunice Sizue Hirata

Spinal anesthesia for cesarean section. Use of hyperbaric bupivacaine (10mg) combined with different adjuvants.

BACKGROUND AND OBJECTIVES Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section. METHOD Prospective, randomized, blinded study of 96 patients allocated into four groups: Group I (no adjuvant), Group II (sufentanil 5.0 μg), Group III (morphine 100 μg), and Group IV (clonidine 75 μg). It was evaluated the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-fetal repercussions. RESULTS The onset of blockade was significantly faster in groups with adjuvants compared with Group I. Patients in Groups I and III reported pain during the perioperative period. Duration of analgesia was significantly higher in Group II and time to motor block recovery was significantly higher in Group IV. Pruritus occurred in Groups II and III. Sedation was significant in Group IV and there was prolonged arterial hypotension in Group IV. CONCLUSION Addition of sufentanil and clonidine to hyperbaric bupivacaine provided adequate anesthesia for cesarean section and good postoperative analgesia. Clonidine caused more perioperative sedation and longer time to motor block recovery. Pruritus was evident when opioids were used.

Influência da técnica anestésica nas alterações hemodinâmicas no transplante renal: estudo retrospectivo

JUSTIFICATIVA Y OBJETIVOS: El exito en el transplante renal (Tx) depende del tipo de donador, de la duracion de la isquemia fria y de los parametros hemodinamicos en la reperfusion. El objetivo de esta investigacion fue analizar la tecnica anestesica, la incidencia de alteraciones cardiovasculares y el aparecimiento de diuresis en el periodo perioperatorio de los Tx realizados en la UNICAMP. METODO: Se evaluo retrospectivamente Tx de adultos realizados entre enero de 2005 y abril de 2006. Se tuvieron en cuenta los datos demograficos, los examenes laboratoriales preoperatorios, tecnicas y agentes anestesicos, hidratacion, parametros hemodinamicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con analisis comparativo entre los subgrupos formados conforme a la tecnica anestesica empleada. Se usaron en el analisis estadistico el test t de Student (parametricos), Mann-Whitney (no parametricos), test del Cui-cuadrado y Exacto de Fisher para la comparacion de proporciones y analisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG) y 33 anestesia general asociada a la epidural (AG + Peri), 42 recibieron rinones de donantes vivos y 50 de fallecidos. No hubo diferencia (p < 0,05) en la mayoria de los parametros preoperatorios estudiados, con excepcion del origen del injerto (82% AG + Peri recibieron rinones de donante fallecido). La alteracion cardiovascular mas frecuente fue la hipotension arterial (30% AG y 48% AG + Peri, p < 0,05). El regimen de hidratacion no fue diferente entre los grupos (86,7 ± 30,2 mL.kg-1 AG y 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). El injerto del donante fallecido se correlaciono con una mayor inestabilidad hemodinamica y con un peor pronostico para la funcion inmediata del injerto, p < 0,01 y 0,01 respectivamente. Un volumen de hidratacion de 80 mL.kg-1 se asocio a la diuresis (OR = 2,94, IC95% 1,00-8,32). CONCLUSIONES: La tecnica anestesica empleada fue anestesia general, asociada o no a la epidural. La alteracion hemodinamica mas comun fue la hipotension arterial. Se mostraron beneficos con relacion a la diuresis por ser de un receptor de donante vivo y recibir una hidratacion de 80 mL.kg-1 de solucion fisiologica a 0,9%.BACKGROUND AND OBJECTIVES The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7+/- 30.2 mL.kg(-1) GA and 94.8 +/- 21.8 mL.kg(-1) GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg(-1) was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg(-1) of NS favored diuresis.

Estudo do esvaziamento gástrico e da distribuição intragástrica de uma dieta sólida através da cintilografia: diferenças entre os sexos

Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with different patterns of meal distribution between the proximal and distal gastric compartments. Eighteen healthy volunteers (nine males, mean age 35 +/- 9 years; nine females, mean age: 41 +/- 11 years) were studied in the morning, after ingestion of the solid test-meal (an omelette labeled with 185MBq of 99mTc-sulfur colloid). Simultaneous anterior and posterior images of the stomach were acquired immediately after ingestion of the meal and every 10 minutes for 120 minutes. Time versus activity curves were obtained for the whole, proximal and distal stomach. Gastric T1/2 was longer in women (96.1 +/- 17.2 min) than in men (79.9 +/- 17.8 min; P = 0.02). The analysis of the meal distribution inside the stomach showed no differences between males and females in proximal gastric emptying, but the meal retention in the distal compartment was significantly increased among women (P = 0.04). In conclusion, gastric emptying of a solid meal is slower in pre-menopausal women than in age-matched men, probably due to an increased retention of the meal in the distal compartment. This should be taken into consideration to avoid misleading diagnosis of gastroparesis for female patients.

Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study

JUSTIFICATIVA Y OBJETIVOS: El exito en el transplante renal (Tx) depende del tipo de donador, de la duracion de la isquemia fria y de los parametros hemodinamicos en la reperfusion. El objetivo de esta investigacion fue analizar la tecnica anestesica, la incidencia de alteraciones cardiovasculares y el aparecimiento de diuresis en el periodo perioperatorio de los Tx realizados en la UNICAMP. METODO: Se evaluo retrospectivamente Tx de adultos realizados entre enero de 2005 y abril de 2006. Se tuvieron en cuenta los datos demograficos, los examenes laboratoriales preoperatorios, tecnicas y agentes anestesicos, hidratacion, parametros hemodinamicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con analisis comparativo entre los subgrupos formados conforme a la tecnica anestesica empleada. Se usaron en el analisis estadistico el test t de Student (parametricos), Mann-Whitney (no parametricos), test del Cui-cuadrado y Exacto de Fisher para la comparacion de proporciones y analisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG) y 33 anestesia general asociada a la epidural (AG + Peri), 42 recibieron rinones de donantes vivos y 50 de fallecidos. No hubo diferencia (p < 0,05) en la mayoria de los parametros preoperatorios estudiados, con excepcion del origen del injerto (82% AG + Peri recibieron rinones de donante fallecido). La alteracion cardiovascular mas frecuente fue la hipotension arterial (30% AG y 48% AG + Peri, p < 0,05). El regimen de hidratacion no fue diferente entre los grupos (86,7 ± 30,2 mL.kg-1 AG y 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). El injerto del donante fallecido se correlaciono con una mayor inestabilidad hemodinamica y con un peor pronostico para la funcion inmediata del injerto, p < 0,01 y 0,01 respectivamente. Un volumen de hidratacion de 80 mL.kg-1 se asocio a la diuresis (OR = 2,94, IC95% 1,00-8,32). CONCLUSIONES: La tecnica anestesica empleada fue anestesia general, asociada o no a la epidural. La alteracion hemodinamica mas comun fue la hipotension arterial. Se mostraron beneficos con relacion a la diuresis por ser de un receptor de donante vivo y recibir una hidratacion de 80 mL.kg-1 de solucion fisiologica a 0,9%.BACKGROUND AND OBJECTIVES The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7+/- 30.2 mL.kg(-1) GA and 94.8 +/- 21.8 mL.kg(-1) GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg(-1) was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg(-1) of NS favored diuresis.

Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study

PURPOSE To evaluate the efficacy and side-effects of fentanyl and sufentanil combined with hyperbaric spinal bupivacaine in elective cesarean section. METHODS A prospective, randomized, double-blind study with 64 term parturients, distributed into 2 groups according to the opioid combined with hyperbaric bupivacaine 0.5% (10mg): GF - fentanyl (25 µg) and GS - sufentanil (5.0 µg). The latency and maximum sensory block level; degree and duration of motor block; duration and quality of analgesia; maternal-fetal repercussions were evaluated. This was an intention-to-treat analysis with a 5% significance level. RESULTS The latency period, maximum sensory block level, motor block degree and perioperative analgesia were similar in both groups. Motor block and analgesia had a longer duration in the sufentanil group. Maternal adverse effects and neonatal repercussions were similar. The incidence of hypotension was higher in the fentanyl group. In both groups, there was a predominance of patients who were awake and either calm or sleepy. CONCLUSIONS The addition of fentanyl and sufentanil to hyperbaric subarachnoid bupivacaine was shown to be effective for the performance of cesarean section, and safe for the mother and fetus. Analgesia was more prolonged with sufentanil.

Gastric emptying study by scintigraphy in patients with chronic renal failure

BACKGROUND AND OBJECTIVES This study had the purpose of studying gastric emptying in patients with chronic renal failure. MATERIAL AND METHOD Thirty patients with chronic renal failure were studied, 16 in conservative clinical treatment and 14 in hemodialysis for over six months. The control group (CTL) was composed of 18 asymptomatic volunteers. The method of gastric emptying study was scintigraphy. The standardized test meal was an omelet of three chicken eggs prepared with colloidal sulfur marked with 185 MBq of 99m technetium. Gastric retention curves were studied and T½ of gastric emptying was obtained from them. A T½ value corresponding to the average of T½ values of control group plus twice standard deviation was considered nornmal. Statistical tests used were χ(2) and Kruskal-Wallis. RESULTS There was no statistically significant difference with regard to total gastric retention curves and T½ of gastric emptying, which was similar in three studied groups. Nine patients had high T½ of gastric emptying, above 125 minutes. These patients were equally distributed among both genders and conservative clinical treatment and hemodialysis groups. CONCLUSIONS We concluded that gastric retention rate and T½ of gastric emptying in patients with chronic renal failure in conservative clinical treatment and hemodialysis does not differ from the healthy patients group. Hemodialysis does not seem to reduce the risk of gastric retention in patients with chronic renal failure.

O esvaziamento gástrico e a insuficiência renal crônica

BACKGROUND AND OBJECTIVES The first reference to delayed gastric emptying (GE) was made by Grodstein in 1979. Other studies have since been published, not always confirming his work. The importance of GE in anesthesia can be resumed by one of its main aspects, preoperative fasting. Delayed gastric emptying can lead to stasis and increase the risk of vomiting and aspiration. The possibility that uremic patients present delayed gastric emptying is fascinating. Gastric complaints are common in this patient population, and could be explained by the difficulty to empty the stomach. Despite the evidence, there is controversy in the literature regarding this subject. There is no consensus regarding the results. Differences in the methods of the studies could explain the results obtained in clinical and experimental trials. The objective of this study was to review a few important aspects of the dyspeptic syndrome in patients with chronic renal failure (CRF), emphasizing the delayed GE. CONTENTS The basic aspects of the physiology of GE, methods used more often to study GE, dyspeptic syndrome and uremia, and gastric emptying in chronic renal failure will be discussed. CONCLUSIONS Gastric emptying is a complex physiological process that transfers food from the stomach to the duodenum, whose mechanisms are yet to be fully characterized. Scintigraphy, using meals with radiolabelled drugs, is the exam used more often to study GE. An expressive percentage of the patients with end-stage renal disease also present delayed GE. It is possible that other mechanisms, besides uremia, involved in gastric motor function also play a role in this dysfunction.INTRODUCCION Y OBJETIVOS: La primera referencia de retardo en el vaciamiento gastrico (EG) fue hecha por Grodstein en 1979. Otros estudios fueron publicados posteriormente, y no siempre confirmando esa observacion. La importancia del EG en anestesia puede ser resumida un uno de sus aspectos principales, el ayuno preoperatorio. El retardo en el vaciamiento puede causar estasis y aumentar el riesgo de vomito y aspiracion pulmonar. La posibilidad de existir retardo del vaciamiento en uremicos nos atrae. Quejas dispepticas son comunes en estos pacientes y podrian ser explicadas por la dificultad de vaciamiento gastrico. A pesar de las evidencias, la literatura es muy controvertida en este aspecto. No existe un consenso en cuanto a los resultados obtenidos. Diferencias en el metodo de estudio utilizado podrian explicar esos resultados, observados en estudios clinicos y experimentales. El objetivo de este estudio fue ver nuevamente algunos aspectos importantes del sindrome dispeptico en pacientes con insuficiencia renal cronica (IRC) terminal, con enfasis en el retardo del EG. CONTENIDO: Se abordaran los aspectos basicos relacionados a la fisiologia del EG, los metodos mas empleados para el estudio del EG, el sindrome dispeptico y la uremia y el vaciamiento gastrico en la insuficiencia renal cronica. CONCLUSIONES: El EG es un proceso fisiologico complejo de transferencia del alimento del estomago para el duodeno, cuyos mecanismos todavia no se conocen bien. La cintilografia, utilizando comidas con radio farmacos, es el examen mas utilizado para el estudio del EG. Un porcentaje expresivo de pacientes con IRC terminal presenta retardo en el EG. Posiblemente otros mecanismos, ademas de la uremia, involucrando la funcion motora gastrica, estan involucrados en esta disfuncion.

Gastric emptying and chronic renal failure

BACKGROUND AND OBJECTIVES The first reference to delayed gastric emptying (GE) was made by Grodstein in 1979. Other studies have since been published, not always confirming his work. The importance of GE in anesthesia can be resumed by one of its main aspects, preoperative fasting. Delayed gastric emptying can lead to stasis and increase the risk of vomiting and aspiration. The possibility that uremic patients present delayed gastric emptying is fascinating. Gastric complaints are common in this patient population, and could be explained by the difficulty to empty the stomach. Despite the evidence, there is controversy in the literature regarding this subject. There is no consensus regarding the results. Differences in the methods of the studies could explain the results obtained in clinical and experimental trials. The objective of this study was to review a few important aspects of the dyspeptic syndrome in patients with chronic renal failure (CRF), emphasizing the delayed GE. CONTENTS The basic aspects of the physiology of GE, methods used more often to study GE, dyspeptic syndrome and uremia, and gastric emptying in chronic renal failure will be discussed. CONCLUSIONS Gastric emptying is a complex physiological process that transfers food from the stomach to the duodenum, whose mechanisms are yet to be fully characterized. Scintigraphy, using meals with radiolabelled drugs, is the exam used more often to study GE. An expressive percentage of the patients with end-stage renal disease also present delayed GE. It is possible that other mechanisms, besides uremia, involved in gastric motor function also play a role in this dysfunction.INTRODUCCION Y OBJETIVOS: La primera referencia de retardo en el vaciamiento gastrico (EG) fue hecha por Grodstein en 1979. Otros estudios fueron publicados posteriormente, y no siempre confirmando esa observacion. La importancia del EG en anestesia puede ser resumida un uno de sus aspectos principales, el ayuno preoperatorio. El retardo en el vaciamiento puede causar estasis y aumentar el riesgo de vomito y aspiracion pulmonar. La posibilidad de existir retardo del vaciamiento en uremicos nos atrae. Quejas dispepticas son comunes en estos pacientes y podrian ser explicadas por la dificultad de vaciamiento gastrico. A pesar de las evidencias, la literatura es muy controvertida en este aspecto. No existe un consenso en cuanto a los resultados obtenidos. Diferencias en el metodo de estudio utilizado podrian explicar esos resultados, observados en estudios clinicos y experimentales. El objetivo de este estudio fue ver nuevamente algunos aspectos importantes del sindrome dispeptico en pacientes con insuficiencia renal cronica (IRC) terminal, con enfasis en el retardo del EG. CONTENIDO: Se abordaran los aspectos basicos relacionados a la fisiologia del EG, los metodos mas empleados para el estudio del EG, el sindrome dispeptico y la uremia y el vaciamiento gastrico en la insuficiencia renal cronica. CONCLUSIONES: El EG es un proceso fisiologico complejo de transferencia del alimento del estomago para el duodeno, cuyos mecanismos todavia no se conocen bien. La cintilografia, utilizando comidas con radio farmacos, es el examen mas utilizado para el estudio del EG. Un porcentaje expresivo de pacientes con IRC terminal presenta retardo en el EG. Posiblemente otros mecanismos, ademas de la uremia, involucrando la funcion motora gastrica, estan involucrados en esta disfuncion.

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

JUSTIFICATIVA Y OBJETIVOS: La asociacion de anestesicos locales (AL) a adyuvantes por via subaracnoidea mejora la calidad del bloqueo y prolonga la duracion de la analgesia. Se evaluaron los efectos maternos y las repercusiones neonatales de la asociacion de sufentanil, morfina y clonidina a la bupivacaina hiperbarica en la cesarea electiva. METODO: Estudio prospectivo, randomizado, encubierto, con 96 pacientes distribuidas en cuatro grupos: GI (sin adyuvante); GII (sufentanil; 5,0 µg); GIII (morfina; 100 µg); y GIV (clonidina; 75 µg). Se evaluaron: el inicio y el nivel de bloqueo sensitivo; analgesia peroperatoria; el grado y el tiempo para la regresion del bloqueo motor; la duracion de la analgesia; la sedacion; y las repercusiones materno-fetales. RESULTADOS: El inicio del bloqueo fue significativamente menor en los grupos con adyuvantes en comparacion con el Grupo I. En el perioperatorio, los pacientes de los Grupos I y III dijeron sentir dolor. La duracion de la analgesia fue significativamente mayor en el Grupo II y el tiempo para el desbloqueo motor fue significativamente mayor en el Grupo IV. El prurito aparecio en los grupos II y III. La sedacion fue significativa en el Grupo IV. La hipotension arterial se prolongo en el Grupo IV. CONCLUSIONES: La adicion de sufentanil y clonidina a la bupivacaina hiperbarica proporciono una adecuada anestesia para la cesarea como tambien una buena analgesia postoperatoria. La clonidina causo mas sedacion perioperatoria y un mayor tiempo para el desbloqueo motor. El prurito fue evidente cuando se usaron los opioides.

Estudo do esvaziamento gástrico por cintilografia em pacientes com insuficiência renal crônica

BACKGROUND AND OBJECTIVES: This study had the purpose of studying gastric emptying in patients with chronic renal failure. MATERIAL AND METHOD: Thirty patients with chronic renal failure were studied, 16 in conservative clinical treatment and 14 in hemodialysis for over six months. The control group (CTL) was composed of 18 asymptomatic volunteers. The method of gastric emptying study was scintigraphy. The standardized test meal was an omelet of three chicken eggs prepared with colloidal sulfur marked with 185 MBq of 99 m technetium. Gastric retention curves were studied and T½ of gastric emptying was obtained from them. A T½ value corresponding to the average of T½ values of control group plus twice standard deviation was considered nornmal. Statistical tests used were χ2 and Kruskal-Wallis. RESULTS: There was no statistically significant difference with regard to total gastric retention curves and T½ of gastric emptying, which was similar in three studied groups. Nine patients had high T½ of gastric emptying, above 125 minutes. These patients were equally distributed among both genders and conservative clinical treatment and hemodialysis groups. CONCLUSIONS: We concluded that gastric retention rate and T½ of gastric emptying in patients with chronic renal failure in conservative clinical treatment and hemodialysis does not differ from the healthy patients group. Hemodialysis does not seem to reduce the risk of gastric retention in patients with chronic renal failure