João Paulo Jordão Pontes

Frequency of hepatitis B immunity and occupational exposures to body fluids among brazilian medical students at a public university

In the present study the frequencies of immunity against hepatitis B (HB) and of potentially contaminating accidents among medical students of a Brazilian public university were evaluated. Of all the 400 students who should have been immunized, 303 (75.7%), 66.3% of whom were women, answered an anonymous, self-administered questionnaire. Serum anti-HBs were determined in 205 of them and titers ≥ 10 UI/L were considered to be protective. A total of 86.8% of students had received three doses of HB vaccine. The frequency of immunity among women (96.4%) was higher (p = 0.04) than that among men (87.7%). Among those who did not have immunity, 12/13 (92.3%) had been vaccinated before entering medical school. Only 11% of the students with complete vaccination had previously verified serological response to the vaccine. A total of 23.6% reported having been somehow exposed to blood or secretions. Among final-year students, this frequency was 45.0%, being similar among men (47.8%) and women (43.2%). Of all these accidents, 57.7% were due to body fluids coming in contact with mucosa and 42.3% due to cut and puncture accidents. The results from this study show that: 1) the frequency of immunity against HB is high among the evaluated medical students, although verification of response to vaccination is not a concern for them; 2) anti-HBs titers should be verified after complete vaccination and on a regular basis, especially by men; and 3) the frequency of potentially contaminating accidents is high.

Pneumothorax Post Brachial Plexus Block Guided by Ultrasound: a Case Report

BACKGROUND AND OBJECTIVES Brachial plexus block is used for upper limbs anesthesia. The use of ultrasound-guided (USG) technique for blockade has become popular in recent years, facilitating its execution by providing real-time images of the plexus and surrounding structures while minimizing complications. The purpose of this report is to describe a case of pneumothorax following ultrasound-guided interscalene block. CASE REPORT Male patient, 49 years old, weight 62kg and height 1.72m, slender, smoker, asymptomatic, ASA II E. The patient underwent surgical repair of right ulna open fracture through USG-guided interscalene brachial plexus block with axillary supplementation. After sedation and antisepsis, the linear probe of the USG apparatus was placed perpendicular to the interscalene groove (12 Hz), and stimucath A50 introduced in plane. After visualization of nerve trunks, 20mL of ropivacaine 0.5% was administered with axillary block supplementation (same volume and concentration of anesthetic). At the end of surgery, the patient complained of respiratory-dependent chest pain associated with dyspnea and decreased pulse oximetry (91% in room air), but hemodynamic stable (BP=130/70 and HR=84 bpm). Although pulmonary auscultation was normal, chest X-ray showed the presence of right pneumothorax. Water seal chest drainage was performed, after which the patient reported improvement of symptoms and was discharged from hospital in good general condition after 8 days. CONCLUSION Despite the dynamic visualization of cervical structures with USG, interscalene block may result in pneumothorax. An unusual higher pleural dome due to the hyperinflated lung (smoking) probably facilitated the accidental pleural puncture.

SBA recommendations for regional anesthesia safety in patients taking anticoagulants.

We conducted searches in multiple databases (Medline 1965-2012; Cochrane Library, Lilacs) and cross-references with the collected material to identify studies with better methodological design, followed by a critical evaluation of their contents and classification according to the strength of evidence. We conducted searches between August and December 2012. The following strategies were used for searches in PubMed:

Avaliação e manejo perioperatório de pacientes com diabetes melito. Um desafio para o anestesiologista

Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patients history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patients routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control.

Pre-operative management of medication for diabetes mellitus treatment

Diabetes mellitus (DM) is characterized by changes in carbohydrate metabolism, causing hyperglycemia and increased perioperative morbidity and mortality. It comes along with diverse and progressive physiological changes and for anesthetic management should be emphasized multiple systems and their possible complications. Anamnesis, physical examination and complementary exams are important in the preoperative management, especially Glycosylated Hemoglobin (HbA1c) measure that has a high predictive value for diabetes complications and has become consensual parameter to proceed with surgery. Surgical planning aims to reduce the period of fasting and maintenance of patient’s normal routine. Type I DM patients need, even in perioperative fasting, exogenous supply of insulin to match physiological demand and avoid ketoacidosis. Type II DM patients are treated with multiple injectable and / or oral drugs, and are vulnerable to develop hyperosmolar hyperglycemic state. Thus, management of hypoglycemic agents and different types of insulin is essential, in addition to determining the time of surgery and therefore the number of missed meals to adjust the dose or suspending the diabetes drugs. Current evidence suggests, almost unanimously, the surgical safety target of in-hospital glucose, Pre-operative management of medication for diabetes mellitus treatment João Paulo Jordão Pontes1, Ana Luíza Pereira Saramago1, Mateus Meira Vasconcelos1, Nubia Rodrigues Batista1 Manejo pré-operatório das medicações para tratamento do diabetes mellitus DOI: 10.5935/2238-3182.20170020

Pneumotórax pós-bloqueio de plexo braquial guiado por ultrassonografia: relato de caso

BACKGROUND AND OBJECTIVES: Brachial plexus block is used for upper limbs anesthesia. The use of ultrasound-guided (USG) technique for blockade has become popular in recent years, facilitating its execution by providing real-time images of the plexus and surrounding structures while minimizing complications. The purpose of this report is to describe a case of pneumothorax following ultrasound-guided interscalene block. < CASE REPORT: Male patient, 49 years old, weight 62 kg and height 1.72 m, slender, smoker, asymptomatic, ASA II E. The patient underwent surgical repair of right ulna open fracture through USG-guided interscalene brachial plexus block with axillary supplementation. After sedation and antisepsis, the linear probe of the USG apparatus was placed perpendicular to the interscalene groove (12 Hz), and stimucath A50 introduced in plane. After visualization of nerve trunks, 20 mL of ropivacaine 0.5% was administered with axillary block suplementation (same volume and concentration of anesthetic). At the end of surgery, the patient complained of respiratory-dependent chest pain associated with dyspnea and decreased pulse oximetry (91% in room air), but hemodynamic stable (BP = 130/70 and HR = 84 bpm). Although pulmonary auscultation was normal, chest X-ray showed the presence of right pneumothorax. Water seal chest drainage was performed, after which the patient reported improvement of symptoms and was discharged from hospital in good general condition after 8 days. CONCLUSION: Despite the dynamic visualization of cervical structures with USG, interscalene block may result in pneumothorax. An unusual higher pleural dome due to the hyperinflated lung (smoking) probably facilitated the accidental pleural puncture.