Fabricio Tavares Mendonça

Os efeitos da lidocaína e do sulfato de magnésio na atenuação da resposta hemodinâmica à intubação orotraqueal: estudo unicêntrico, prospectivo, duplamente encoberto e aleatorizado

BACKGROUND AND OBJECTIVES Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. METHODS This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18 to 65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30mg·kg-1 of magnesium sulphate and Group L, 2mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. RESULTS In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. CONCLUSION Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to tracheal intubation: single-center, prospective, double-blind, randomized study

BACKGROUND AND OBJECTIVES Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. METHODS This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18-65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30mg·kg-1 of magnesium sulphate and Group L, 2mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. RESULTS In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. CONCLUSION Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Systemic Lidocaine for Perioperative Analgesia: A Literature Review

Intravenous lidocaine has been increansingly used as pain treatment in anesthesiology. The aim of this study was to review the scientific literature on the use of lidocaine for perioperative analgesia, a recent technique and still under study to demonstrate its clinical implications.

[Dissection of the wired endotracheal tube's lumen during general anesthesia: a case report].

OBJECTIVE The aim of this study is to report a case of a clinically significant obstruction during mechanical ventilation caused by the dissection of the wired endotracheal tubes lumen during general anesthesia in a pediatric patient. CASE REPORT A12-years old patient undergoing general anesthesia for open appendectomy was intubated with a wired endotracheal tube and difficult removal of the guide. After starting the mechanical ventilation, there was increased expiratory fraction of CO2 and need for increased inspiratory pressure. Chance of complications with higher incidences were raised and treated unsuccessfully. Finally, during patient reintubation, the dissection of the endotracheal tube lumen was observed, and ventilation was restored to normal. CONCLUSION Anesthesia involves numerous possible complications. Suspicion and constant vigilance are essential for early diagnosis and treatment of any threat to the individual integrity. This case is relevant for emphasizing a possible very rare complication related to airway, which can quickly cause hypoxia and irreversible damage. Thus, this case contributes to the detection of this complication more frequently.

Carta à editora em resposta a “Avaliação da eficácia de lidocaína e sulfato de magnésio para reduzir os efeitos hemodinâmicos desencadeados pela laringoscopia/intubação”

The authors of the letter titled ‘‘Evaluation of the efficacy of lidocaine and magnesium sulphate in reducing the hemodynamic effects triggered by intubation/laryngoscopy’’ point out some limitations of our study.1 They report that a single center study with a small number of individuals is not representative of a larger population. Our study was performed with a properly calculated sample size based on variance, effect difference, alpha error, and previously determined power. Despite the loss to followup of some patients, a greater number of patients were randomized to avoid loss of study power. Thus, as demonstrated by the analyses, it was possible to find satisfactory results with the applied method. The fact that the study was conducted in a single center does not necessarily constitute a deficiency. The difference between single-center and multicenter studies is generally based on sample size.2 The hospital in which the study was performed is a large reference center encompassing a broad spectrum of patients and clinical specialties and also provides research support. In addition, performing anesthesia and collecting data become less subject to bias. The authors of the letter suggest that bolus infusion of the study drugs would have reached peak effects more quickly; however, the option for pump infusion was made to prevent the occurrence of side effects, including hypotension, which still occurred in 54% of lidocaine patients and 28% of magnesium sulphate patients, even under slow infusion.3 It was not our intention to administer drugs whose effect lasted longer than six minutes. However, all patients were followed after this period and all maintained adequate hemodynamic stability. At the end of the study time, mean SBP of patients in Group L was 97 mmHg, representing 18% reduction in the mean SBP measured after anxiolysis (SBP = 119 mmHg). The mean SBP of patients in Group M was 105 mmHg, which represented 14% decrease in mean SBP measured after anxiolysis (SBP = 123 mmHg). Arterial hypotension was considered when BP values were lower than 20% of baseline values or SBP <90 mmHg.4 Therefore, the studied patients had blood pressure values compatible with those of the intraoperative period.

Anesthetic management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC): The importance of hydro-electrolytic and acid-basic control

Highlights • Intraoperative chemotherapy represents a real challenge for the hole perioperative team.• The elevation of body temperature is associated with an increased intra-abdominal pressure and severe hemodinamic disorders.• Blood loss, significant fluid mobilization, deterioration of gaseous exchanges should be expected and treated promptly.

Gestão de Via Aérea Difícil em Anestesia para Criança com Síndrome de Hurler

Management of difficult airway for intubation in children with Hurley syndrome Background and objectives. Hurler syndrome, also called mucopolysaccharidosis type I, is a hereditary progressive degenerative disorder resulting in the buildup of glycosaminoglycans, which leads to neurological, orthopedic and gastrointestinal alterations. The aim of this study is to present the technique of retrograde intubation using easily accessible materials as an important alternative to flexible broncoscopy. Correspondência: Fabrício Tavares Mendonça. Hospital de Base do Distrito Federal, Unidade de Anestesiologia e Medicina Perioperatória, SMHS quadra 101 – Área Especial, Asa Sul. CEP 70335-900. Telefone: 61 33151588 Internet: fabricio.tavares@me.com Os autores declaram não haver conflito de interesses. Jordana Alverne de Aguiar. Médica residente em Anestesiologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil Rúbia Garcia Dusi. Preceptora em Anestesiologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil Fabrício Tavares Mendonça. Instrutor Título Superior em Anestesiologia pela Sociedade Brasileira de Anestesiologia do Centro de Ensino e Treinamento do Hospital de Base do Distrito Federal, Brasilia, DF, Brasil Mariana Campos Reis. Médica residente em Anestesiologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil Lucas Macedo da Graça Medeiros de Queiroz. Médico residente em Anestesiologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil Jordana Alverne de Aguiar, Rúbia Garcia Dusi, Fabrício Tavares Mendonça, Mariana Campos Reis e Lucas Macedo da Graça Medeiros de Queiroz DOI 10.14242/2236-5117.2016v51n34a290p277 Fabrício Tavares Mendonça • Gestão de via aérea difícil em criança com síndrome de Hurler

Estudo comparativo entre cetamina e morfina peridural em pacientes submetidas à mastectomia

BACKGROUND AND OBJECTIVES: This study aimed at comparing epidural thoracic S(+) ketamine and morphine, both associated to ropivacaine, for mastectomy procedures. METHODS: This is a prospective study with 26 patients aged between 18 and 70 years, submitted to mastectomy, who were divided into two equal groups. Group M (morphine) patients have received 12 mL of 0.75% ropivacaine associated to 2 mg preservative-free morphine; Group K (ketamine) patients have received 12 mL of 0.75% ropivacaine associated to 50 mg of preservative-free S(+) ketamine. We have evaluated hemodynamic parameters, need for vasopressors, drugs for sedation, pain visual analog scale in the first 24 hours, analgesic and antiemetic consumption, and incidence of nausea and vomiting. RESULTS: There has been no statistical difference between groups in demographics, systolic and diastolic blood pressure, amount of local anesthetics or need for vasopressors. The ketamine group has demanded more midazolam to control sedation (p = 0.0005). This group had lower pain scores at post-anesthetic care unit discharge (p = 0.0018), 12 hours after procedure (p = 0.0001) and 24 hours later (p = 0.0094). The morphine group had higher pain scores at post-anesthetic care unit, 12 and 24 postoperative hours, and has demanded more postoperative analgesics (dipirone, p = 0.0009) and antiemetics (metoclopramide, p = 0.0032). CONCLUSION: It has been observed that S(+) ketamine in the evaluated dose was hemodynamically safe and effective, with better performance to control postoperative pain, generating less analgesic consumption as well as lower incidence of nausea and vomiting.