Júlio César Garcia de Alencar

Bispectral index and other processed parameters of electroencephalogram: an update

BACKGROUND AND OBJECTIVES The processed analysis of electroencephalogram became extremely important to monitor nervous system, being used to obtain a better anesthetic adequacy. The objective was to conduct a review about each processed parameter, defining its real importance. CONTENT A review was conducted showing mathematical, physical and clinical aspects as well as their correlations and updates, presenting new integrated parameters. CONCLUSIONS An adequate analysis of processed parameters of electroencephalogram may provide more intraoperative safety as well as result in a better outcome for the patient.

Endothelial dysfunction after pregnancy-induced hypertension

To carry out long‐term analysis of the presence of endothelial dysfunction after the development of pregnancy‐induced hypertension (PIH).

Anesthetics, cerebral protection and preconditioning.

BACKGROUND AND OBJECTIVES Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents. CONTENT Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use. CONCLUSIONS The brain has the ability to protect itself against ischemia when stimulated. The elucidation of this mechanism enables the application of preconditioning inducing substances (some anesthetics), other drugs, and non-pharmacological measures, such as hypothermia, aimed at inducing tolerance to ischemic lesions.

Influence of Total Intravenous Anesthesia, Entropy and Laparoscopy on Oxidative Stress

BACKGROUND AND OBJECTIVES Recent studies have correlated postoperative mortality with anesthetic mortality, especially with the depth of anesthesia and systolic blood pressure (SBP). The aim of this study is to evaluate the effects of the depth of total intravenous anesthesia (TIVA) using remifentanil and propofol, performed with monitoring of response entropy (RE) on blood concentrations of oxidative stress markers (TBARS and glutathione) during laparoscopic operations. METHOD Twenty adult patients, ASA I, BMI 20-26 kg.m(-2), aged 20 to 40 years, were randomly distributed into two groups: Group I underwent anesthetic-surgical procedure with RE maintained between 45 and 59, and Group II underwent anesthetic-surgical procedure with RE between 30 and 44. In both groups, the remifentanil and propofol infusion was controlled by the effector site (Es), adjusted to maintain RE desired values (Groups I and II) and always assessing the suppression rate (SR). Patients were evaluated in six periods: M1 (immediately before anesthesia), M2 (before tracheal intubation [TI]), M3 (5-minutes after TI), M4 (immediately before pneumoperitoneum [PPT]), M5 (1-minute after PPT), and M6 (1-hour after the operation). The following parameters were assessed at all times: SBP, DBP, HR, RE, SR, TBARS, and glutathione. RESULTS We found increases in TBARS and glutathione in M5, both in Group I and Group II (p<0.05), with higher values in Group II, and SR in three patients in Group II, immediately after PPT. CONCLUSIONS Increased markers in Group I (M5) suggests an increase in anaerobic metabolism (AM) in the splanchnic circulation while the highest values seen in Group II (GII > GI in M5, p<0.05%) suggest interference of another factor (deep anesthesia) responsible for the increase in AM, probably as a result of increased autonomic nervous system depression and minor splanchnic self-regulation.

Índice bispectral e outros parâmetros processados do eletroencefalograma: uma atualização

JUSTIFICATIVA Y OBJETIVOS: El analisis procesado del electroencefalograma se convirtio en algo extremadamente importante en el monitoreo del sistema nervioso, siendo utilizado para lograr una mejor adecuacion anestesica. El objetivo fue realizar una revision sobre cada uno de los parametros procesados, definiendo su real importancia. CONTENIDO: Se realizo una revision mostrando los aspectos matematicos, fisicos y clinicos, como tambien sus correlaciones y actualizaciones, y presentando nuevos parametros integrados. CONCLUSIONES: El analisis adecuado de los parametros procesados del electroencefalograma, puede proporcionar una mayor seguridad intraoperatoria como tambien un mejor resultado para el paciente

Pregnancy-induced hypertension syndrome and cardiovascular risk

Objetivo: caracterizar o perfil de risco cardiovascular em longo prazo de mulheres com historia de sindrome hipertensiva da gestacao (SHG) e compara-lo ao de mulheres com historico de gestacao normotensa. Metodos: este e um estudo de coorte retrospectivo que incluiu 60 mulheres que deram a luz na MEAC-UFC entre os anos de 1992 e 2002 (seguimento medio de 15,2 anos). O grupo de exposicao (GE) foi composto por 30 mulheres em qualquer categoria de SHG, e o grupo de nao exposicao (GNE) compreendeu 30 mulheres sem historia de patologia obstetrica. Foram avaliados os dados antropometricos e laboratoriais associados ao risco cardiovascular e calculados o escore Framingham (variaveis dependentes). Para variaveis quantitativas, foram usados o teste t de Student e o teste de Mann-Whitney. Para variaveis qualitativas, aplicou-se o teste exato de Fisher. Considerou-se a significância estatistica como p<0,05. Resultados: GE apresentou valores mais altos de IMC (p=0,03, OR=1,13, IC 1,00-1,3), PAS (p=0,03, OR=1,03, IC 1,00-1,06), LDL-C (p=0,02, OR=1,02, IC 1,00-1,04) e glicose de jejum (p=0,02, OR=1,03, IC 1,00-1,07), alem de valores mais altos no escore de Framingham (p=0,03, OR=1,09, IC 1,00-1,19). As mulheres em GE usaram medicamentos anti-hipertensivos com mais frequencia (p=0,03, OR=5,2, IC 1,3-21,2). Conclusao: foi encontrado um perfil de risco cardiovascular desfavoravel nas pacientes com historia de SHG em comparacao com as mulheres sem esse historico.

Anestésicos, precondicionamento e proteção cerebral

JUSTIFICATIVA Y OBJETIVOS: Diversos estudios han demostrado el pre-condicionamiento cerebral como un mecanismo protector frente a una situacion de estres. Estan descritos algunos factores determinantes del PC, como tambien la neuroproteccion proporcionada por los agentes anestesicos y no anestesicos. CONTENIDO: Se hizo la revision con base en los principales articulos de la literatura que engloban la fisiopatologia de la isquemia-reperfusion y la lesion neuronal, y los factores no farmacologicos (inflamacion, glucemia y temperatura), y farmacologicos relacionados con el cambio de la respuesta a la isquemia-reperfusion, ademas de la neuroproteccion inducida por el uso de los anestesicos. CONCLUSIONES: El cerebro tiene la capacidad de protegerse contra la isquemia cuando se le estimula. La elucidacion de ese mecanismo posibilita la aplicacion de sustancias inductoras del precondicionamiento cerebral, como algunos anestesicos, otros farmacos y medidas no farmacologicas, como la hipotermia, con el fin de inducir la tolerancia a las lesiones isquemicas.

Abordagem cirúrgica de neurofibroma gigante

Neurofibromatosis is a disease of genetic origin with autosomal dominant inheritance that is classified into 3 types: neurofibromatosis type I (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis. The main characteristics of NF1 are cafe-au-lait spots, dermal and plexiform neurofibromas, false dermal and plexiform neurofibromas, false axillary or inguinal ephelides, and Lisch nodules. This study describes the case of a 26-year-old man who presented with small cutaneous nodules, present since he was 3 years old, and cafe-au-lait spots of different sizes distributed diffusely. At the age of 13, the patient developed a mass in the back and abdomen that subsequently developed into a rapidly growing voluminous mass, which hindered walking and caused social isolation. The surgical treatment consisted of the excision of the tumor in 2 phases, with a 2-month interval between procedures. Although a cure for neurofibromatosis has not been discovered, surgical removal is indicated in cases of neurological involvement, pain, disfigurement, possible involvement of adjacent structures, and suspicion of malignancy. Partial resection is acceptable if total removal is not possible. In the present case, surgical treatment was an excellent choice because it enabled the complete excision of the lesion, with satisfactory wound healing and aesthetic results, as well as the improvement of the quality of life of the patient.

Técnica simples e segura para a reconstrução areolopapilar com tatuagem intradérmica

BACKGROUND: The final step in the creation of the neo-breast is reconstruction of the nipple-areolar complex (NAC), which is aimed toward bringing the appearance of the NAC closer to that of the contralateral breast following mastectomy. NAC restoration has historically been a stepwise procedure, in which reconstruction of the nipple by the use of grafts or local flaps was followed by reconstruction of the areola to achieve the correct color. Currently, the popularity of the areolar tattoo is increasing compared to traditional techniques. The aim of this study was to describe the technique and equipment used for intra-dermal tattooing in mastectomized patients at the Plastic Surgery and Reconstructive Microsurgery Service of the Walter Cantidio University Hospital (Fortaleza, CE, Brazil). METHODS: This study describes the steps of the repair procedure by using permanent areolar tattooing with conventional equipment from a professional tattoo artist. The procedure was used in 10 patients undergoing post-mastectomy breast reconstruction. RESULTS: The advantages of this method included the technical simplicity of the procedure, the ability to use this procedure in outpatients, and the lack of morbidity of the donor areas. CONCLUSIONS: Tattooing the NAC is a safe, fast procedure with low morbidity and good results of breast reconstruction.

Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo

BACKGROUND AND OBJECTIVES: Recent studies have correlated postoperative mortality with anesthetic mortality, especially with the depth of anesthesia and systolic blood pressure (SBP). The aim of this study is to evaluate the effects of the depth of total intravenous anesthesia (TIVA) using remifentanil and propofol, performed with monitoring of response entropy (RE) on blood concentrations of oxidative stress markers (TBARS and glutathione) during laparoscopic operations. METHOD: Twenty adult patients, ASA I, BMI 20-26 kg.m-2, aged 20 to 40 years, were randomly distributed into two groups: Group I underwent anesthetic-surgical procedure with RE maintained between 45 and 59, and Group II underwent anesthetic-surgical procedure with RE between 30 and 44. In both groups, the remifentanil and propofol infusion was controlled by the effector site (Es), adjusted to maintain RE desired values (Groups I and II) and always assessing the suppression rate (SR). Patients were evaluated in six periods: M1 (immediately before anesthesia), M2 (before tracheal intubation [TI]), M3 (5-minutes after TI), M4 (immediately before pneumoperitoneum [PPT]), M5 (1-minute after PPT), and M6 (1-hour after the operation). The following parameters were assessed at all times: SBP, DBP, HR, RE, SR, TBARS, and glutathione. RESULTS: We found increases in TBARS and glutathione in M5, both in Group I and Group II (p GI in M5, p < 0.05%) suggest interference of another factor (deep anesthesia) responsible for the increase in AM, probably as a result of increased autonomic nervous system depression and minor splanchnic self-regulation.