Marcelo Lacava Pagnocca

O plantão noturno em anestesia reduz a latência ao sono

BACKGROUND AND OBJECTIVES Physicians in general, and anesthesiologists in particular, have long working hours. Residents of Anesthesiology may present significant fatigue and stress. This study aimed at investigating first and second year residents sleep latency after a period on duty. METHODS Participated in this study 11 residents in different situations: at 7:00 am, after a normal night sleep (> 7 h), without on duty period in the last 3 days (M1); at 7:00 am, after 24h of night work, without on duty period in the last 3 days (M2); and at 1:00 pm after 30h of work without on duty period in the last 3 days (M3). Continuous EEG was performed for all situations in adequate room to record sleep signals. Sleep latency (SL) was evaluated. RESULTS There has been significant shorter SL among residents after 24 or 30 hours without sleep. From residents after a normal night sleep the day before the evaluation, 36.4% presented pathological SL levels. CONCLUSIONS Periods on duty for 24 or 30 hours lead to SL values below 5 minutes, which are considered pathologic and reflect extreme fatigue of residents of Anesthesiology. It might be important to standardize the number of resting hours after duty periods.

Temperature Control in Conventional Abdominal Surgery: Comparison between Conductive and the Association of Conductive and Convective Warming

BACKGROUND AND OBJECTIVES Intraoperative hypothermia is a common complication, and its development is favored by abdominal surgeries. The efficacy of the association of conductive and convective warming methods in the prevention of hypothermia, and its effects during postoperative recovery were the objectives of this study. METHODS Forty-three patients of both genders, ages 18 to 88 years, undergoing xyphopubic laparotomy under general anesthesia and monitoring of the esophageal temperature were randomly divided in two groups, according to the warming method: COND (n = 24), circulating-water mattress at 37 degrees C on the back, and COND + CONV (n = 19), circulating-water mattress associated with warm air blanket at 42 degrees C over the thorax and upper limbs. Weight, gender age, duration of surgery and anesthesia, temperature on anesthetic induction (Mi), consecutive hours (M1, M2), end of surgery (Mes) and anesthesia (Mea), and admission (M(a-REC)) and discharge (M(d-REC)) from the post-anesthetic recovery room (PARR), besides the postoperative incidence of tremors and complaints of cold, were analyzed. RESULTS Both groups were similar regarding all parameters analyzed, except temperatures on M2, M3, M4, Mes, and Mea. The temperature of patients in the COND group decreased from the second hour of anesthetic induction on, but in the COND + CONV group it only happened in the fourth hour. Patients in the COND group presented hypothermia upon admission and discharge from the PARR. CONCLUSIONS The association of different warming methods delayed the beginning and reduced the severity of intraoperative hypothermia, but it did not reduce the complaints of feeling cold and tremors.JUSTIFICATIVA E OBJETIVOS: Hipotermia intra-operatoria e complicacao frequente, favorecida por operacao abdominal. A eficacia da associacao dos metodos de aquecimento por conducao e conveccao na prevencao de hipotermia e seus efeitos no periodo de recuperacao pos-operatoria foram os objetivos deste estudo. METODO: Quarenta e tres pacientes de ambos os sexos de 18 a 88 anos de idade, submetidos a laparotomia xifopubica sob anestesia geral e monitorizacao da temperatura esofagica, foram distribuidos de modo aleatorio em dois grupos de aquecimento: COND (n = 24), com colchao de circulacao de agua a 37°C no dorso e COND + CONV (n = 19), com a mesma condicao associada a manta de ar aquecido a 42°C sobre o torax e membros superiores. Analisados peso, sexo, idade, duracao da operacao e anestesia, temperaturas na inducao anestesica (Mi), horas consecutiva (M1, M2), final da operacao (Mfo) e anestesia (Mfa), entrada (Me-REC) e saida (Ms-REC) da recuperacao pos-anestesica (SRPA), alem das incidencias de tremores e queixas de frio no pos-operatorio. RESULTADOS: Os grupos foram semelhantes em todas as variaveis analisadas, exceto nas temperaturas em M2, M3, M4, Mfo e Mfa. O grupo COND reduziu a temperatura a partir da segunda hora da inducao anestesica, mas o grupo COND + CONV so na quarta hora. Em COND, observou-se hipotermia na entrada e saida da SRPA. CONCLUSOES: Associar metodos de aquecimento retardou a instalacao e diminui a intensidade da hipotermia intra-operatoria, mas nao reduziu a incidencia das queixas de frio e tremores.

Controle de temperatura em intervenção cirúrgica abdominal convencional: comparação entre os métodos de aquecimento por condução e condução associada à convecção

BACKGROUND AND OBJECTIVES Intraoperative hypothermia is a common complication, and its development is favored by abdominal surgeries. The efficacy of the association of conductive and convective warming methods in the prevention of hypothermia, and its effects during postoperative recovery were the objectives of this study. METHODS Forty-three patients of both genders, ages 18 to 88 years, undergoing xyphopubic laparotomy under general anesthesia and monitoring of the esophageal temperature were randomly divided in two groups, according to the warming method: COND (n = 24), circulating-water mattress at 37 degrees C on the back, and COND + CONV (n = 19), circulating-water mattress associated with warm air blanket at 42 degrees C over the thorax and upper limbs. Weight, gender age, duration of surgery and anesthesia, temperature on anesthetic induction (Mi), consecutive hours (M1, M2), end of surgery (Mes) and anesthesia (Mea), and admission (M(a-REC)) and discharge (M(d-REC)) from the post-anesthetic recovery room (PARR), besides the postoperative incidence of tremors and complaints of cold, were analyzed. RESULTS Both groups were similar regarding all parameters analyzed, except temperatures on M2, M3, M4, Mes, and Mea. The temperature of patients in the COND group decreased from the second hour of anesthetic induction on, but in the COND + CONV group it only happened in the fourth hour. Patients in the COND group presented hypothermia upon admission and discharge from the PARR. CONCLUSIONS The association of different warming methods delayed the beginning and reduced the severity of intraoperative hypothermia, but it did not reduce the complaints of feeling cold and tremors.JUSTIFICATIVA E OBJETIVOS: Hipotermia intra-operatoria e complicacao frequente, favorecida por operacao abdominal. A eficacia da associacao dos metodos de aquecimento por conducao e conveccao na prevencao de hipotermia e seus efeitos no periodo de recuperacao pos-operatoria foram os objetivos deste estudo. METODO: Quarenta e tres pacientes de ambos os sexos de 18 a 88 anos de idade, submetidos a laparotomia xifopubica sob anestesia geral e monitorizacao da temperatura esofagica, foram distribuidos de modo aleatorio em dois grupos de aquecimento: COND (n = 24), com colchao de circulacao de agua a 37°C no dorso e COND + CONV (n = 19), com a mesma condicao associada a manta de ar aquecido a 42°C sobre o torax e membros superiores. Analisados peso, sexo, idade, duracao da operacao e anestesia, temperaturas na inducao anestesica (Mi), horas consecutiva (M1, M2), final da operacao (Mfo) e anestesia (Mfa), entrada (Me-REC) e saida (Ms-REC) da recuperacao pos-anestesica (SRPA), alem das incidencias de tremores e queixas de frio no pos-operatorio. RESULTADOS: Os grupos foram semelhantes em todas as variaveis analisadas, exceto nas temperaturas em M2, M3, M4, Mfo e Mfa. O grupo COND reduziu a temperatura a partir da segunda hora da inducao anestesica, mas o grupo COND + CONV so na quarta hora. Em COND, observou-se hipotermia na entrada e saida da SRPA. CONCLUSOES: Associar metodos de aquecimento retardou a instalacao e diminui a intensidade da hipotermia intra-operatoria, mas nao reduziu a incidencia das queixas de frio e tremores.

[Use of forced-air to prevent intraoperative hypothermia].

OBJECTIVE: Hypothermia is a life-threatening event during the perioperative period. No consensus has been reached about the best active warming approach for such cases. Furthermore there is no consensus on the most appropriate time to warm a hypothermic patient. This study aimed to assess the efficacy of a forced-air blanket to warm patients at 38oC before and during surgery. Following utilization of the forced-air blanket, adverse effects were evaluated. METHODS: Patients submitted to orthopedic surgeries were divided into four groups of 15 patients. In the control group (Gcont), patients were not warmed with a forced-air blanket. In the preoperative group (Gpre), intraoperative group (Gintra), and total group (Gtotal), patients were warmed at 38°C, during 30 minutes before anesthetic induction, after anesthetic induction up to 120 minutes and before and after the induction, respectively. Parameters evaluated were central (tympanic) temperature, peripheral (skin) temperature, operating room temperature, variations in the hemodynamic conditions and warming-induced adverse effects. RESULTS: Only Gtotal did not show significant variation in central temperature. Central temperatures of Gtotal patients were significantly higher (p <0.05) than those of other groups at 60 and 120 min after induction. In Gcont, Gpre and Gintra, patients were hypothermic at 60 min. CONCLUSION: The forced-air blanket is effective to prevent intraoperative hypothermia when applied for a period ranging from 30 min before anesthetic induction to 120 min after anesthetic induction. In the conditions of this study, adverse effects were not observed.

Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado (BC) e uma tecnica muito utilizada em anestesia obstetrica. Porem nao ha na literatura padronizacao com relacao a tecnica, doses e anestesicos utilizados, alem da controversia sobre a possibilidade da adicao do opioide ao anestesico local causar bradicardia fetal e alteracao de sua vitalidade. O objetivo deste estudo foi identificar as tecnicas e anestesicos utilizados no Servico de Anestesiologia do Hospital Universitario da Universidade de Sao Paulo (USP) e avaliar se a utilizacao de sufentanil associado ao anestesico local no BC altera o Apgar dos recem-nascidos. METODO: Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitario da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5° e 10° minutos dos recem-nascidos. RESULTADOS: Dos 635 BC avaliados, 307 utilizaram sufentanil e anestesico local (Grupo SUF) e 328, so anestesico local (Grupo AL). Cento e vinte e sete (20%) foram realizados atraves da tecnica de agulha por dentro de agulha e os outros 508 (80%) foram realizados pela tecnica de duas puncoes. Nao foi verificada diferenca entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSOES: O sufentanil utilizado no bloqueio combinado nao alterou o Apgar dos recem-nascidos.BACKGROUND AND OBJECTIVES Combined spinal-epidural (CSE) is a very common obstetric technique. However, the literature does not present a standardization regarding the technique, doses, and anesthetics used, besides there is also the controversy about the possibility that the addition of opioids to the local anesthetic causes fetal bradycardia and affects its vitality. The aim of this study was to identify the techniques and anesthetics used in the Anesthesiology Service of the Hospital Universitário of Universidade de São Paulo (USP) and determine whether the use of sufentanil associated with the local anesthetic affects Apgar scores of newborns. METHODS The anesthesiology charts of patients submitted to CSE for labor analgesia over a 12-month period at the Hospital Universitário of USP were analyzed. The use and dose of sufentanil, the type of delivery, and Apgar scores in the 1st, 5th, and 10th minutes were recorded. RESULTS Of the 635 CSE analyzed, 307 used sufentanil and local anesthetic (SUF Group) and 328 only local anesthetic (LA Group). One hundred and twenty-seven (20%) were done using the needle through the needle technique and the other 508 (80%) used the double puncture technique. There were no differences in the Apgar scores in the 1st, 5th, and 10th minutes between both groups. CONCLUSIONS The use of sufentanil in the combined spinal-epidural did not change Apgar scores of the newborns.

Efeitos da hipertensão arterial induzida sobre a complacência e pressão de perfusão encefálica em hipertensão intracraniana experimental: comparação entre lesão encefálica criogênica e balão subdural

BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) may increase intracranial pressure (ICP) and decrease brain compliance (BC). Different injuries are applied to TBI models studying the same variables. Since they are indistinctly used, the objective was to compare ICP and BC in two different TBI models. METHODS This study involved 18 male dogs anesthetized, ventilated and randomly distributed in two groups: SB - subdural balloon (n = 9) and CI - cryogenic injury (n = 9). ICP, BC and cerebral perfusion pressure (CPP) were evaluated in five moments: end of preparation (M0), normal brain (M1), beginning of injury (M2), end of injury (M3) and established injury (M4). BC is ICP variation during induced hypertension (IH) in 50 mmHg in M1 and M4. CPP = Mean Blood Pressure (MBP) - ICP. Paired Students t test was used for the same group in different moments and Students t test was used for two different samples in the same moment between groups. RESULTS MBP was similar for both groups in all studied moments (p = 0.31 in M0; p = 0.25 in M1; p = 0.31 in M2; p = 0.19 in M3; p = 0.05 in M4). ICP was similar between groups in M0 (p = 0.27) and M1 (p = 0.21), however different in M2 (p < 0.001). ICP was similar for both groups in M3 (p = 0.39) and M4 (p = 0.98), increased for SB in M1 (p = 0.04) and M2 (p = 0.01), but not in M3 (p = 0.36) and M4 (p = 0.12). For CI, ICP has increased in M1 (p < 0.01), M3 (p < 0.001) and M4 (p < 0.001), but not in M2 (p = 0.18). There has been CPP increase in M1 (p < 0.001) and M4 (p < 0.001), with no difference between groups (p = 0.16 in M1 and p = 0.21 in M4). There has been decreased CPP in M2 for both groups (p < 0.001), however more severe for CI (p < 0.001). In M3, there has been increased CPP for SB (p = 0.02) and decreased CPP for CI (p = 0.01), what has made CPP similar for both groups (p = 0.43). CPP has equally increased in M4 for both groups (p = 0.16). CONCLUSIONS Induced hypertension (IH) effect on CI model is comparable to what has been observed in the SB model. This type of injury should be better studied to establish precision in the ratio between injury extension and BC decrease, which seems to be a gradual and evolving process, with not totally understood limits.BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) may increase intracranial pressure (ICP) and decrease brain compliance (BC). Different injuries are applied to TBI models studying the same variables. Since they are indistinctly used, the objective was to compare ICP and BC in two different TBI models. METHODS: This study involved 18 male dogs anesthetized, ventilated and randomly distributed in two groups: SB - subdural balloon (n = 9) and CI - cryogenic injury (n = 9). ICP, BC and cerebral perfusion pressure (CPP) were evaluated in five moments: end of preparation (M0), normal brain (M1), beginning of injury (M2), end of injury (M3) and established injury (M4). BC is ICP variation during induced hypertension (IH) in 50 mmHg in M1 and M4. CPP = Mean Blood Pressure (MBP) - ICP. Paired Students t test was used for the same group in different moments and Students t test was used for two different samples in the same moment between groups. RESULTS: MBP was similar for both groups in all studied moments (p = 0.31 in M0; p = 0.25 in M1; p = 0.31 in M2; p = 0.19 in M3; p = 0.05 in M4). ICP was similar between groups in M0 (p = 0.27) and M1 (p = 0.21), however different in M2 (p < 0.001). ICP was similar for both groups in M3 (p = 0.39) and M4 (p = 0.98), increased for SB in M1 (p = 0.04) and M2 (p = 0.01), but not in M3 (p = 0.36) and M4 (p = 0.12). For CI, ICP has increased in M1 (p < 0.01), M3 (p < 0.001) and M4 (p < 0.001), but not in M2 (p = 0.18). There has been CPP increase in M1 (p < 0.001) and M4 (p < 0.001), with no difference between groups (p = 0.16 in M1 and p = 0.21 in M4). There has been decreased CPP in M2 for both groups (p < 0.001), however more severe for CI (p < 0.001). In M3, there has been increased CPP for SB (p = 0.02) and decreased CPP for CI (p = 0.01), what has made CPP similar for both groups (p = 0.43). CPP has equally increased in M4 for both groups (p = 0.16). CONCLUSIONS: Induced hypertension (IH) effect on CI model is comparable to what has been observed in the SB model. This type of injury should be better studied to establish precision in the ratio between injury extension and BC decrease, which seems to be a gradual and evolving process, with not totally understood limits.

Short sleep latency in residents after a period on duty in anesthesia

BACKGROUND AND OBJECTIVES Physicians in general, and anesthesiologists in particular, have long working hours. Residents of Anesthesiology may present significant fatigue and stress. This study aimed at investigating first and second year residents sleep latency after a period on duty. METHODS Participated in this study 11 residents in different situations: at 7:00 am, after a normal night sleep (> 7 h), without on duty period in the last 3 days (M1); at 7:00 am, after 24h of night work, without on duty period in the last 3 days (M2); and at 1:00 pm after 30h of work without on duty period in the last 3 days (M3). Continuous EEG was performed for all situations in adequate room to record sleep signals. Sleep latency (SL) was evaluated. RESULTS There has been significant shorter SL among residents after 24 or 30 hours without sleep. From residents after a normal night sleep the day before the evaluation, 36.4% presented pathological SL levels. CONCLUSIONS Periods on duty for 24 or 30 hours lead to SL values below 5 minutes, which are considered pathologic and reflect extreme fatigue of residents of Anesthesiology. It might be important to standardize the number of resting hours after duty periods.

Control de temperatura en intervención quirúrgica abdominal convencional: comparación entre los métodos de calentamiento por conducción y conducción asociada a la convección

BACKGROUND AND OBJECTIVES Intraoperative hypothermia is a common complication, and its development is favored by abdominal surgeries. The efficacy of the association of conductive and convective warming methods in the prevention of hypothermia, and its effects during postoperative recovery were the objectives of this study. METHODS Forty-three patients of both genders, ages 18 to 88 years, undergoing xyphopubic laparotomy under general anesthesia and monitoring of the esophageal temperature were randomly divided in two groups, according to the warming method: COND (n = 24), circulating-water mattress at 37 degrees C on the back, and COND + CONV (n = 19), circulating-water mattress associated with warm air blanket at 42 degrees C over the thorax and upper limbs. Weight, gender age, duration of surgery and anesthesia, temperature on anesthetic induction (Mi), consecutive hours (M1, M2), end of surgery (Mes) and anesthesia (Mea), and admission (M(a-REC)) and discharge (M(d-REC)) from the post-anesthetic recovery room (PARR), besides the postoperative incidence of tremors and complaints of cold, were analyzed. RESULTS Both groups were similar regarding all parameters analyzed, except temperatures on M2, M3, M4, Mes, and Mea. The temperature of patients in the COND group decreased from the second hour of anesthetic induction on, but in the COND + CONV group it only happened in the fourth hour. Patients in the COND group presented hypothermia upon admission and discharge from the PARR. CONCLUSIONS The association of different warming methods delayed the beginning and reduced the severity of intraoperative hypothermia, but it did not reduce the complaints of feeling cold and tremors.JUSTIFICATIVA E OBJETIVOS: Hipotermia intra-operatoria e complicacao frequente, favorecida por operacao abdominal. A eficacia da associacao dos metodos de aquecimento por conducao e conveccao na prevencao de hipotermia e seus efeitos no periodo de recuperacao pos-operatoria foram os objetivos deste estudo. METODO: Quarenta e tres pacientes de ambos os sexos de 18 a 88 anos de idade, submetidos a laparotomia xifopubica sob anestesia geral e monitorizacao da temperatura esofagica, foram distribuidos de modo aleatorio em dois grupos de aquecimento: COND (n = 24), com colchao de circulacao de agua a 37°C no dorso e COND + CONV (n = 19), com a mesma condicao associada a manta de ar aquecido a 42°C sobre o torax e membros superiores. Analisados peso, sexo, idade, duracao da operacao e anestesia, temperaturas na inducao anestesica (Mi), horas consecutiva (M1, M2), final da operacao (Mfo) e anestesia (Mfa), entrada (Me-REC) e saida (Ms-REC) da recuperacao pos-anestesica (SRPA), alem das incidencias de tremores e queixas de frio no pos-operatorio. RESULTADOS: Os grupos foram semelhantes em todas as variaveis analisadas, exceto nas temperaturas em M2, M3, M4, Mfo e Mfa. O grupo COND reduziu a temperatura a partir da segunda hora da inducao anestesica, mas o grupo COND + CONV so na quarta hora. Em COND, observou-se hipotermia na entrada e saida da SRPA. CONCLUSOES: Associar metodos de aquecimento retardou a instalacao e diminui a intensidade da hipotermia intra-operatoria, mas nao reduziu a incidencia das queixas de frio e tremores.

Bloqueo combinado para analgesia de parto: ¿la adición de sufentanil al anestésico local influye en el apgar de los reciÿn nacidos?

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado (BC) e uma tecnica muito utilizada em anestesia obstetrica. Porem nao ha na literatura padronizacao com relacao a tecnica, doses e anestesicos utilizados, alem da controversia sobre a possibilidade da adicao do opioide ao anestesico local causar bradicardia fetal e alteracao de sua vitalidade. O objetivo deste estudo foi identificar as tecnicas e anestesicos utilizados no Servico de Anestesiologia do Hospital Universitario da Universidade de Sao Paulo (USP) e avaliar se a utilizacao de sufentanil associado ao anestesico local no BC altera o Apgar dos recem-nascidos. METODO: Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitario da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5° e 10° minutos dos recem-nascidos. RESULTADOS: Dos 635 BC avaliados, 307 utilizaram sufentanil e anestesico local (Grupo SUF) e 328, so anestesico local (Grupo AL). Cento e vinte e sete (20%) foram realizados atraves da tecnica de agulha por dentro de agulha e os outros 508 (80%) foram realizados pela tecnica de duas puncoes. Nao foi verificada diferenca entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSOES: O sufentanil utilizado no bloqueio combinado nao alterou o Apgar dos recem-nascidos.BACKGROUND AND OBJECTIVES Combined spinal-epidural (CSE) is a very common obstetric technique. However, the literature does not present a standardization regarding the technique, doses, and anesthetics used, besides there is also the controversy about the possibility that the addition of opioids to the local anesthetic causes fetal bradycardia and affects its vitality. The aim of this study was to identify the techniques and anesthetics used in the Anesthesiology Service of the Hospital Universitário of Universidade de São Paulo (USP) and determine whether the use of sufentanil associated with the local anesthetic affects Apgar scores of newborns. METHODS The anesthesiology charts of patients submitted to CSE for labor analgesia over a 12-month period at the Hospital Universitário of USP were analyzed. The use and dose of sufentanil, the type of delivery, and Apgar scores in the 1st, 5th, and 10th minutes were recorded. RESULTS Of the 635 CSE analyzed, 307 used sufentanil and local anesthetic (SUF Group) and 328 only local anesthetic (LA Group). One hundred and twenty-seven (20%) were done using the needle through the needle technique and the other 508 (80%) used the double puncture technique. There were no differences in the Apgar scores in the 1st, 5th, and 10th minutes between both groups. CONCLUSIONS The use of sufentanil in the combined spinal-epidural did not change Apgar scores of the newborns.

Combined spinal-epidural for labor analgesia: does the addition of sufentanil to the local anesthetic influence apgar scores of the newborns?

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado (BC) e uma tecnica muito utilizada em anestesia obstetrica. Porem nao ha na literatura padronizacao com relacao a tecnica, doses e anestesicos utilizados, alem da controversia sobre a possibilidade da adicao do opioide ao anestesico local causar bradicardia fetal e alteracao de sua vitalidade. O objetivo deste estudo foi identificar as tecnicas e anestesicos utilizados no Servico de Anestesiologia do Hospital Universitario da Universidade de Sao Paulo (USP) e avaliar se a utilizacao de sufentanil associado ao anestesico local no BC altera o Apgar dos recem-nascidos. METODO: Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitario da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5° e 10° minutos dos recem-nascidos. RESULTADOS: Dos 635 BC avaliados, 307 utilizaram sufentanil e anestesico local (Grupo SUF) e 328, so anestesico local (Grupo AL). Cento e vinte e sete (20%) foram realizados atraves da tecnica de agulha por dentro de agulha e os outros 508 (80%) foram realizados pela tecnica de duas puncoes. Nao foi verificada diferenca entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSOES: O sufentanil utilizado no bloqueio combinado nao alterou o Apgar dos recem-nascidos.BACKGROUND AND OBJECTIVES Combined spinal-epidural (CSE) is a very common obstetric technique. However, the literature does not present a standardization regarding the technique, doses, and anesthetics used, besides there is also the controversy about the possibility that the addition of opioids to the local anesthetic causes fetal bradycardia and affects its vitality. The aim of this study was to identify the techniques and anesthetics used in the Anesthesiology Service of the Hospital Universitário of Universidade de São Paulo (USP) and determine whether the use of sufentanil associated with the local anesthetic affects Apgar scores of newborns. METHODS The anesthesiology charts of patients submitted to CSE for labor analgesia over a 12-month period at the Hospital Universitário of USP were analyzed. The use and dose of sufentanil, the type of delivery, and Apgar scores in the 1st, 5th, and 10th minutes were recorded. RESULTS Of the 635 CSE analyzed, 307 used sufentanil and local anesthetic (SUF Group) and 328 only local anesthetic (LA Group). One hundred and twenty-seven (20%) were done using the needle through the needle technique and the other 508 (80%) used the double puncture technique. There were no differences in the Apgar scores in the 1st, 5th, and 10th minutes between both groups. CONCLUSIONS The use of sufentanil in the combined spinal-epidural did not change Apgar scores of the newborns.