Gabriel Magalhães Nunes Guimarães

Fatores de risco para as complicações após apendicectomias em adultos

BACKGROUND: Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults are poorly defined. Accurate presurgical assessment of the risk of preoperative complications and mortality is important in planning surgical therapy. METHODS: All patients undergoing surgical intervention for appendicitis from January 2003 and January 2004 were selected for study. Independent variables examined included 11 putative preoperative risk factors and 4 intraoperative process measures. Dependents variables were complications. Stepwise logistic regression analysis was used for construct models predicting complications. RESULTS: There was a high risk in female (OR=1,97, 95%, IC-1,19-3,13), in appendix with perforation (OR=4,67 95%, IC-2,43-8,94), appendix without perforation (OR=3,32, 95%, IC-1,72-6,38), drainage (OR=17,54, 95%,IC-4,83-63,77) and ASA II (OR=1,53, 95%, IC 2,52-15,89). CONCLUSION: Four factors, in the logistic regression analysis, predicted a high risk of complications after the surgical treatment of appendicitis: female, necrosis with or without ruptured appendix, drainage and ASA Class II.

Does previous chemotherapy‐induced nausea and vomiting predict postoperative nausea and vomiting?

Postoperative nausea and vomiting (PONV) remains a problem in the postoperative period. Previous PONV in oncology patients has recently been associated with chemotherapy‐induced nausea and vomiting (CINV). We assessed if CINV could improve Apfels heuristic for predicting PONV.

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.

Pharmacological assessment of the arterial baroreflex in a young healthy obese male with extremely low baseline muscle sympathetic nerve activity

Multi-unit microneurographic recordings of muscle sympathetic nerve activity (MSNA) in humans have shown sympathetic impulses to present as pulse-synchronous bursts under baroreflex control, increasing in response to spontaneous diastolic blood pressure (DBP) reductions and inhibited during elevations [1]. Studies commonly report large interindividual variability in baseline MSNA (42–84 bursts/100 heartbeats in upright sitting), which may in part be exacerbated by the supine posture (range increased to 10–83 bursts/100 heartbeats) [1]. The increase of low-end MSNA values when supine could be due to cardiopulmonary baroreceptor inhibition of MSNA via variable elevations in central venous pressure [1, 2] and/or from significant reductions in the magnitude of spontaneous blood pressure fluctuations [1, 3], which would induce a more tonic loading of the arterial baroreflex. Theoretically, if strong inhibitory mechanisms maintain baseline tonicity, we would expect some individuals to possess absent baseline MSNA. This has yet to be reported, potentially due to the mislabeling of individuals as failed microneurographic recordings. In this case report, testing followed written informed consent and study procedures were approved by the University of Brasilia institutional research committee in accordance with the Declaration of Helsinki. A young (32 years), obese (height 180 cm; weight 110 kg; BMI 34 kg/m2), unmedicated male, with no previously diagnosed medical conditions, was assessed. Using the microneurography technique in the right common fibular nerve, we observed near-absent baseline MSNA. Usually, microneurographic experiments are terminated when MSNA bursts are absent at baseline, as this often indicates distant microelectrode placement to active postganglionic muscle sympathetic efferent fibres. Indeed, we changed the microelectrode recording site multiple times during the 1 h search, repeatably finding nerves directed towards skeletal muscle (indicative by auditory feedback during tapping/palpation of the tibialis anterior/ peroneal muscles and absent auditory feedback from light stroking of skin on the dorsal foot/lower shank) with no detectable spontaneous bursts before suspecting absent baseline activity. We began the experimental protocol after observing large bursts during an apnea following a maximal expiratory effort (to evoke increases in MSNA) and no response to unexpected clapping (a startle maneuver which evokes skin sympathetic nerve activity). The protocol involved a 10 min baseline to ensure stability of the recording site, followed by an additional 10 min * Lauro C. Vianna lcvianna@unb.br

Comparação dos efeitos e das complicações de raquianestesia unilateral versus raquianestesia padrão em cirurgia ortopédica de membros inferiores

É sempre uma grande satisfação ver artigos publicados em nossa Revista Brasileira de Anestesiologia por pesquisadores de fora do Brasil.1 O tema proposto apesar de simples é muito interessante e de utilidade prática. Dou meus parabéns aos pesquisadores por fazerem este estudo. A diferença nas doses usadas entre os grupos (12,5 mg e 7,5 mg) justifica algumas diferenças que já conhecemos como a latência, mas também interfere na estabilidade hemodinâmica. Seria também interessante a comparação de doses iguais para inferir que o fato de o bloqueio ser unilateral e não de a dose ser menor é causa da maior estabilidade. Também tenho algumas sugestões: cuidado na forma de descrever a metodologia da análise estatística para o estudo não cair em descrédito. No método descreve-se que ‘‘Se a pressão sanguínea diminuísse em mais de 25% do valor basal e a frequência cardíaca caísse para menos de 50 bpm, o paciente era considerado como hipotenso ou bradicárdico, respectivamente’’ e posteriormente que ‘‘Para a análise estatística das alterações hemodinâmicas o teste t de Student pareado foi usado’’. Está escrito foi aplicado um teste para comparar variáveis numéricas em variáveis dicotômicas. O teste t de Student chama atenção por não fazer sentido nessa situação. O teste exato de Fisher é a opção simples e adequada.2 Felizmente o valor de p = 0,02 (precisamente 0,02493) é compatível com o teste adequado, o teste exato de Fisher.