Luis Cláudio Araújo Ladeira

Use of Simple Clinical Predictors on Preoperative Diagnosis of Difficult Endotracheal Intubation in Obese Patients

BACKGROUND AND OBJECTIVES Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. METHODS Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. RESULTS Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. CONCLUSIONS The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy.

Prevalência de síndrome de burnout entre os anestesiologistas do Distrito Federal

BACKGROUND burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference. OBJECTIVE evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District. METHOD cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data. RESULTS of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of three criteria to develop the syndrome and only 8.2% have a low risk to manifest it. CONCLUSION the prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.

Relação entre a infusão contínua de dexmedetomidina e a fração expirada de sevoflurano monitorizada pelo índice bispectral

JUSTIFICATIVA Y OBJETIVOS: La asociacion de agentes venosos a la anestesia general inhalatoria proporciona mejor cualidad de analgesia e hipnosis. La dexmedetomidina es un agonista especifico alfa2-adrenergico con estas caracteristicas y reconocida por proporcionar estabilidad hemodinamica. El objetivo del estudio fue evaluar el efecto de la infusion continua de dexmedetomidina en la fraccion expirada de sevoflurano (FEsevo) en anestesia general, monitorizada por el analisis bispectral del EEG (BIS). METODO: Se estudio, de modo prospectivo, 24 pacientes adultos, de ambos sexos, estado fisico ASA I y II, sometidos a cirugias electivas sobre anestesia general, monitorizados con ECG, PANI, SpO2, PETCO2, FEsevo y BIS. Se procedio a la induccion venosa con alfentanil (30 µg.kg-1), tiopental (5 mg.kg-1) y vecuronio (0,1 mg.kg-1) e intubacion traqueal. Se iniciaron la administracion de sevoflurano (manutencion del BIS entre 40 y 60), la ventilacion controlada con volumen corriente de 10 ml.kg-1 y la manutencion de la PETCO2 entre 35 y 45 mmHg. En la fase de manutencion de la anestesia, despues de 60 minutos de la induccion anestesica (M60), fue iniciada la infusion continua de dexmedetomidina en 2 fases: infusion inicial (1 µg.kg-1) en 20 minutos; e, infusion de manutencion (0,5 µg.kg-1.h-1). La concentracion de sevoflurano fue ajustada para mantener el valor de BIS entre 40 y 60. Las variables de PA, FC, FEsevo, SpO2, PETCO2 y BIS fueron evaluadas en los tiempos pre-inducion (M-15), M15, M45, M75, M105 y M120. RESULTADOS: La asociacion de la dexmedetomidina a la anestesia general con sevoflurano proporciono reduccion significativa (p < 0,05) de la FEsevo de M45 (1,604 ± 0,485) a M105 (1,073 ± 0,457) y de M45 (1,604 ± 0,485) a M120 (1,159 ± 0,475). Las variables hemodinamicas analizadas presentaron diferencias estadisticamente significantes con p < 0,05, mas sin repercusiones clinicas. CONCLUSIONES: La asociacion de dexmedetomidina en infusion continua (0,5 µg.kg-1.h-1) a la anestesia general inhalatoria con sevoflurano proporciono reduccion de la fraccion expiratoria de sevoflurano, con estabilidad hemodinamica.BACKGROUND AND OBJECTIVES General inhalational anesthesia associated with intravenous agents provides analgesia and hypnosis of better quality. Dexmedetomidine is a specific a2-adrenergic agonist with these characteristics and is known by providing hemodynamic stability. This study aimed at evaluating the effects of dexmedetomidine continuous infusion on end-tidal sevoflurane concentration (ETsevo) in general anesthesia, monitored by EEG spectral index (BIS). METHODS Participated in this prospective study 24 adult patients of both genders, physical status ASA I and II submitted to elective surgery under general anesthesia and monitored by ECG, BP, SpO2, P ET CO2, ETsevo and BIS. Intravenous anesthesia was induced with alfentanil (30 microg.kg-1), thiopental (5 mg.kg-1) and vecuronium (0.1 mg.kg-1), followed by tracheal intubation. Then, sevoflurane (to maintain BIS between 40 and 60), controlled ventilation with tidal volume of 10 mL.kg-1 and P ET CO2 between 35 and 45 mmHg were started. During maintenance, 60 minutes after anesthetic induction (T60), continuous dexmedetomidine infusion was started in 2 phases: initial infusion (1 microg.kg-1) in 20 minutes; and maintenance infusion (0.5 microg.kg-1.h-1). Sevoflurane concentration was adjusted to maintain BIS between 40 and 60. BP, HR, ETsevo, SpO2, P ET CO2 and BIS were evaluated in the following moments before anesthetic induction (M-15), M15, M45, M75, M105 and M120. RESULTS The association of dexmedetomidine to general anesthesia with sevoflurane provided statistically significant ETsevo decrease (p < 0.05) from M45 (1.604 +/- 0.485) to M105 (1.073 +/- 0.457), and from M45 (1.604 +/- 0.485) to M120 (1.159 +/- 0.475). Hemodynamic parameters have shown statistically significant differences (p < 0.05), however without clinical repercussions. CONCLUSIONS The association of dexmedetomidine continuous infusion (0,5 microg.kg-1.h-1) to inhalational anesthesia with sevoflurane provided end-tidal sevoflurane concentration decrease while maintaining hemodynamic stability.

[Relationship between dexmedetomidine continuous infusion and end-tidal sevoflurane concentration, monitored by bispectral analysis.].

JUSTIFICATIVA Y OBJETIVOS: La asociacion de agentes venosos a la anestesia general inhalatoria proporciona mejor cualidad de analgesia e hipnosis. La dexmedetomidina es un agonista especifico alfa2-adrenergico con estas caracteristicas y reconocida por proporcionar estabilidad hemodinamica. El objetivo del estudio fue evaluar el efecto de la infusion continua de dexmedetomidina en la fraccion expirada de sevoflurano (FEsevo) en anestesia general, monitorizada por el analisis bispectral del EEG (BIS). METODO: Se estudio, de modo prospectivo, 24 pacientes adultos, de ambos sexos, estado fisico ASA I y II, sometidos a cirugias electivas sobre anestesia general, monitorizados con ECG, PANI, SpO2, PETCO2, FEsevo y BIS. Se procedio a la induccion venosa con alfentanil (30 µg.kg-1), tiopental (5 mg.kg-1) y vecuronio (0,1 mg.kg-1) e intubacion traqueal. Se iniciaron la administracion de sevoflurano (manutencion del BIS entre 40 y 60), la ventilacion controlada con volumen corriente de 10 ml.kg-1 y la manutencion de la PETCO2 entre 35 y 45 mmHg. En la fase de manutencion de la anestesia, despues de 60 minutos de la induccion anestesica (M60), fue iniciada la infusion continua de dexmedetomidina en 2 fases: infusion inicial (1 µg.kg-1) en 20 minutos; e, infusion de manutencion (0,5 µg.kg-1.h-1). La concentracion de sevoflurano fue ajustada para mantener el valor de BIS entre 40 y 60. Las variables de PA, FC, FEsevo, SpO2, PETCO2 y BIS fueron evaluadas en los tiempos pre-inducion (M-15), M15, M45, M75, M105 y M120. RESULTADOS: La asociacion de la dexmedetomidina a la anestesia general con sevoflurano proporciono reduccion significativa (p < 0,05) de la FEsevo de M45 (1,604 ± 0,485) a M105 (1,073 ± 0,457) y de M45 (1,604 ± 0,485) a M120 (1,159 ± 0,475). Las variables hemodinamicas analizadas presentaron diferencias estadisticamente significantes con p < 0,05, mas sin repercusiones clinicas. CONCLUSIONES: La asociacion de dexmedetomidina en infusion continua (0,5 µg.kg-1.h-1) a la anestesia general inhalatoria con sevoflurano proporciono reduccion de la fraccion expiratoria de sevoflurano, con estabilidad hemodinamica.BACKGROUND AND OBJECTIVES General inhalational anesthesia associated with intravenous agents provides analgesia and hypnosis of better quality. Dexmedetomidine is a specific a2-adrenergic agonist with these characteristics and is known by providing hemodynamic stability. This study aimed at evaluating the effects of dexmedetomidine continuous infusion on end-tidal sevoflurane concentration (ETsevo) in general anesthesia, monitored by EEG spectral index (BIS). METHODS Participated in this prospective study 24 adult patients of both genders, physical status ASA I and II submitted to elective surgery under general anesthesia and monitored by ECG, BP, SpO2, P ET CO2, ETsevo and BIS. Intravenous anesthesia was induced with alfentanil (30 microg.kg-1), thiopental (5 mg.kg-1) and vecuronium (0.1 mg.kg-1), followed by tracheal intubation. Then, sevoflurane (to maintain BIS between 40 and 60), controlled ventilation with tidal volume of 10 mL.kg-1 and P ET CO2 between 35 and 45 mmHg were started. During maintenance, 60 minutes after anesthetic induction (T60), continuous dexmedetomidine infusion was started in 2 phases: initial infusion (1 microg.kg-1) in 20 minutes; and maintenance infusion (0.5 microg.kg-1.h-1). Sevoflurane concentration was adjusted to maintain BIS between 40 and 60. BP, HR, ETsevo, SpO2, P ET CO2 and BIS were evaluated in the following moments before anesthetic induction (M-15), M15, M45, M75, M105 and M120. RESULTS The association of dexmedetomidine to general anesthesia with sevoflurane provided statistically significant ETsevo decrease (p < 0.05) from M45 (1.604 +/- 0.485) to M105 (1.073 +/- 0.457), and from M45 (1.604 +/- 0.485) to M120 (1.159 +/- 0.475). Hemodynamic parameters have shown statistically significant differences (p < 0.05), however without clinical repercussions. CONCLUSIONS The association of dexmedetomidine continuous infusion (0,5 microg.kg-1.h-1) to inhalational anesthesia with sevoflurane provided end-tidal sevoflurane concentration decrease while maintaining hemodynamic stability.

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.

Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis

BACKGROUND AND OBJECTIVES Sevoflurane is often used in pediatric anesthesia and is associated with high incidence of psychomotor agitation. In such cases, dexmedetomidine (DEX) has been used, but its benefit and implications remain uncertain. We assessed the effects of DEX on agitation in children undergoing general anesthesia with sevoflurane. METHOD Meta-analysis of randomized clinical and double-blind studies, with children undergoing elective procedures under general anesthesia with sevoflurane, using DEX or placebo. We sought articles in English in PubMed database using the following terms: Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurante), and agitation (Psychomotor Agitation). Duplicate articles with children who received premedication and used active control were excluded. It was adopted random effects model with DerSimonian-Laird testing and odds ratio (OR) calculation for dichotomous variables, and standardized mean difference for continuous variables, with their respective 95% confidence interval (CI). RESULTS Of 146 studies identified, 10 were selected totaling 558 patients (282 in DEX group and 276 controls). The use of DEX was considered a protective factor for psychomotor agitation (OR=0.17; 95% CI 0.13-0.23; p<0.0001) and nausea and vomiting in PACU (OR=0.49; 95% CI 0.35-0.68; p<0.0001). Wake-up time and PACU discharge time were higher in the dexmedetomidine group. There was no difference between groups for extubation time and duration of anesthesia. CONCLUSION Dexmedetomidine reduces psychomotor agitation during wake-up time of children undergoing general anesthesia with sevoflurane.

Uso de preditores clínicos simples no diagnóstico pré-operatório de dificuldade de intubação endotraqueal em pacientes portadores de obesidade

JUSTIFICATIVA Y OBJETIVOS: A pesar de la incidencia similar de dificultad a la laringoscopia en obesos y no obesos, existen relatos de dificultad de intubacion endotraqueal en obesos. Alternativas de diagnostico y prevision de dificultad de intubacion en el preoperatorio pueden ayudar a disminuir las complicaciones anestesicas en los individuos obesos. El objetivo del estudio fue identificar los predictores para el diagnostico de la via aerea dificil en pacientes obesos, por medio de la correlacion con los metodos clinicos de evaluacion preanestesica y la polisomnografia. Tambien comparamos la incidencia de dificultad a la ventilacion bajo mascarilla facial y a la laringoscopia entre obesos y no obesos, verificando los predictores mas prevalentes. METODOS: Estudio observacional, prospectivo y comparativo con 88 pacientes adultos, sometidos a la anestesia general. En el periodo preoperatorio, se evaluo el cuestionario sobre predictores clinicos del sindrome de la apnea obstructiva del sueno (SAOS) y los parametros anatomicos. Durante la anestesia, investigamos una dificultad para la ventilacion bajo mascarilla facial y laringoscopia. Para el analisis, la estadistica descriptiva y el test de correlacion. RESULTADOS: Los pacientes fueron ubicados en dos grupos, 43 obesos y 45 no obesos. El estado fisico, la prevalencia de ronquidos, la hipertension, la diabetes mellitus, la circunferencia cervical y le indice de Mallampati fueron mas elevados en los obesos. Los pacientes obesos tenian una mayor incidencia de dificultad de ventilacion bajo mascarilla y laringoscopia. Ninguna variable clinica o anatomica tuvo correlacion con la dificultad de ventilacion bajo mascarilla en los grupos. En los obesos, el diagnostico de SAOS arrojo una fuerte correlacion con la dificultad a la laringoscopia. CONCLUSIONES: Los diagnosticos clinico y polisomnografico de SAOS fueron utiles para el diagnostico preoperatorio de dificultad a la laringoscopia. Los pacientes obesos son mas propensos a la dificultad de ventilacion bajo mascarilla y laringoscopia.

Relación entre la infusión continua de dexmedetomidina y la fracción expirada de sevoflurano monitorizada por el índice bispectral

JUSTIFICATIVA Y OBJETIVOS: La asociacion de agentes venosos a la anestesia general inhalatoria proporciona mejor cualidad de analgesia e hipnosis. La dexmedetomidina es un agonista especifico alfa2-adrenergico con estas caracteristicas y reconocida por proporcionar estabilidad hemodinamica. El objetivo del estudio fue evaluar el efecto de la infusion continua de dexmedetomidina en la fraccion expirada de sevoflurano (FEsevo) en anestesia general, monitorizada por el analisis bispectral del EEG (BIS). METODO: Se estudio, de modo prospectivo, 24 pacientes adultos, de ambos sexos, estado fisico ASA I y II, sometidos a cirugias electivas sobre anestesia general, monitorizados con ECG, PANI, SpO2, PETCO2, FEsevo y BIS. Se procedio a la induccion venosa con alfentanil (30 µg.kg-1), tiopental (5 mg.kg-1) y vecuronio (0,1 mg.kg-1) e intubacion traqueal. Se iniciaron la administracion de sevoflurano (manutencion del BIS entre 40 y 60), la ventilacion controlada con volumen corriente de 10 ml.kg-1 y la manutencion de la PETCO2 entre 35 y 45 mmHg. En la fase de manutencion de la anestesia, despues de 60 minutos de la induccion anestesica (M60), fue iniciada la infusion continua de dexmedetomidina en 2 fases: infusion inicial (1 µg.kg-1) en 20 minutos; e, infusion de manutencion (0,5 µg.kg-1.h-1). La concentracion de sevoflurano fue ajustada para mantener el valor de BIS entre 40 y 60. Las variables de PA, FC, FEsevo, SpO2, PETCO2 y BIS fueron evaluadas en los tiempos pre-inducion (M-15), M15, M45, M75, M105 y M120. RESULTADOS: La asociacion de la dexmedetomidina a la anestesia general con sevoflurano proporciono reduccion significativa (p < 0,05) de la FEsevo de M45 (1,604 ± 0,485) a M105 (1,073 ± 0,457) y de M45 (1,604 ± 0,485) a M120 (1,159 ± 0,475). Las variables hemodinamicas analizadas presentaron diferencias estadisticamente significantes con p < 0,05, mas sin repercusiones clinicas. CONCLUSIONES: La asociacion de dexmedetomidina en infusion continua (0,5 µg.kg-1.h-1) a la anestesia general inhalatoria con sevoflurano proporciono reduccion de la fraccion expiratoria de sevoflurano, con estabilidad hemodinamica.BACKGROUND AND OBJECTIVES General inhalational anesthesia associated with intravenous agents provides analgesia and hypnosis of better quality. Dexmedetomidine is a specific a2-adrenergic agonist with these characteristics and is known by providing hemodynamic stability. This study aimed at evaluating the effects of dexmedetomidine continuous infusion on end-tidal sevoflurane concentration (ETsevo) in general anesthesia, monitored by EEG spectral index (BIS). METHODS Participated in this prospective study 24 adult patients of both genders, physical status ASA I and II submitted to elective surgery under general anesthesia and monitored by ECG, BP, SpO2, P ET CO2, ETsevo and BIS. Intravenous anesthesia was induced with alfentanil (30 microg.kg-1), thiopental (5 mg.kg-1) and vecuronium (0.1 mg.kg-1), followed by tracheal intubation. Then, sevoflurane (to maintain BIS between 40 and 60), controlled ventilation with tidal volume of 10 mL.kg-1 and P ET CO2 between 35 and 45 mmHg were started. During maintenance, 60 minutes after anesthetic induction (T60), continuous dexmedetomidine infusion was started in 2 phases: initial infusion (1 microg.kg-1) in 20 minutes; and maintenance infusion (0.5 microg.kg-1.h-1). Sevoflurane concentration was adjusted to maintain BIS between 40 and 60. BP, HR, ETsevo, SpO2, P ET CO2 and BIS were evaluated in the following moments before anesthetic induction (M-15), M15, M45, M75, M105 and M120. RESULTS The association of dexmedetomidine to general anesthesia with sevoflurane provided statistically significant ETsevo decrease (p < 0.05) from M45 (1.604 +/- 0.485) to M105 (1.073 +/- 0.457), and from M45 (1.604 +/- 0.485) to M120 (1.159 +/- 0.475). Hemodynamic parameters have shown statistically significant differences (p < 0.05), however without clinical repercussions. CONCLUSIONS The association of dexmedetomidine continuous infusion (0,5 microg.kg-1.h-1) to inhalational anesthesia with sevoflurane provided end-tidal sevoflurane concentration decrease while maintaining hemodynamic stability.