Marcelo Vaz Perez

Exercises for Treatment of Nonspecific Low Back Pain

Summary Background and objectives Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. Content This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. Conclusion The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.

Malignant hyperthermia in Brazil: analysis of hotline activity in 2009

BACKGROUND AND OBJECTIVES Malignant hyperthermia (MH) is a pharmacogenetic disease that causes abnormal hypermetabolic reaction to halogenated anesthetics and/or depolarizing muscle relaxants. In Brazil, there is a hotline telephone service for MH since 1991, available 24 hours a day in São Paulo. This article analyzes the activity of the Brazilian hotline service for MH in 2009. METHODS Prospective analysis of all phone calls made to the Brazilian hotline service for MH from January to December 2009. RESULTS Twenty-two phone calls were received: 21 from the South/Southeast region of Brazil and one from the North region. Fifteen calls were requests for general information about MH. Seven were about suspected MH acute episodes, two of which were not considered as MH. In five episodes compatible with MH, all patients received halogenated volatile anesthetics (2, isoflurane; 3, sevoflurane) and one also used succinylcholine; there were four men and one woman, with a mean age of 18 years (2-27). The problems described in the five MH episodes were tachycardia (5), increased expired carbon dioxide (4), hyperthermia (3), acidemia (1), rhabdomyolysis (1), and myoglobinuria (1). One patient received dantrolene. All five patients with MH episodes were follow-up in the intensive care unit and recovered without sequelae. Susceptibility to MH was later confirmed in two patients by in vitro muscle contracture test. CONCLUSIONS The number of calls per year in the Brazilian hotline service for MH is still low. The characteristics of MH episode were similar to those reported in other countries. The knowledge of MH in Brazil needs to be increased.

Exercícios para tratamento de lombalgia inespecífica

BACKGROUND AND OBJECTIVES Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.JUSTIFICATIVA Y OBJETIVOS: La lumbalgia es un sindrome frecuente y provoca incapacidad y perdida en el trabajo. A pesar de que existen diversas causas, el tipo de lumbalgia mas frecuente es la inespecifica. Los ejercicios son a menudo usados para el tratamiento de la lumbalgia pero existen controversias en cuanto a su eficacia. El objetivo de este trabajo, fue hacer una revision sobre los ejercicios para el tratamiento de la lumbalgia inespecifica. CONTENIDO: Fueron descritas la definicion y la clasificacion de las lumbalgias. La incidencia y los mecanismos de la lumbalgia inespecifica, y los ejercicios empleados para su tratamiento tambien se relataron. CONCLUSIONES: Los tipos de ejercicios terapeuticos para la lumbalgia cronica o aguda que son mas eficaces todavia son bastante controversiales, sin embargo, los ejercicios terapeuticos son tal vez, el tratamiento conservador mas usado en todo el mundo.BACKGROUND AND OBJECTIVES: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT: This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION: The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.

Interscalene brachial plexus block: effects on pulmonary function

BACKGROUND AND OBJECTIVES The interscalene is one of the most common approaches used in brachial plexus block. However, the association of this approach with the ipsilateral blockade of the phrenic nerve has been demonstrated. The resulting diaphragmatic dysfunction causes changes in lung mechanics, which can be potentially deleterious in patients with limited respiratory reserve. The objective of the present study was to evaluate the repercussion of interscalene brachial plexus block on pulmonary function by measuring forced vital capacity (FVC). METHODS This is a double-blind study with 30 patients, physical status ASA I or II, randomly separated into two groups of 15 patients each; 0.5% ropivacaine (Ropi Group) or 0.5% bupivacaine with epinephrine (Bupi Group) was administered. A peripheral nerve stimulator was used, and 30 mL of the local anesthetic were administered. Four spirometries were done in each patient: before the blockade, 30 minutes, four hours, and six hours after the blockade. Patients were not sedated. RESULTS One patient in the Ropi Group and three patients in the Bupi Group were excluded from the study due to failure of the blockade. The Ropi Group showed maximal FVC reduction at 30 minutes (25.1%), with a tendency for recovery from this point on. With bupivacaine, the reduction in FVC was less important at the different study moments; an additional reduction was observed between 30 (15.8%) and four hours (17.3%), but it was not statistically significant. A tendency for recovery was observed from four hours on. In both groups, the FVC six hours after the blockade was still below baseline levels. CONCLUSIONS Interscalene block reduces FVC in most cases. Changes were more pronounced in the Ropivacaine group.

Bloqueio do plexo braquial por via interescalênica: efeitos sobre a função pulmonar

JUSTIFICATIVA Y OBJETIVOS: La via interescalenica es uno de los accesos mas a menudo utilizados en el bloqueo del plexo braquial. Sin embargo, se ha demostrado una asociacion de esa tecnica con el bloqueo del nervio frenico ipsilateral. La disfuncion diafragmatica de resultas de esa asociacion, provoca alteraciones en la mecanica pulmonar, potencialmente perjudiciales en pacientes con una limitacion de la reserva ventilatoria. El objetivo del estudio fue evaluar la repercusion del bloqueo interescalenico sobre la funcion pulmonar por medio de la medida de la capacidad vital forzada (CVF). METODO: Estudio doble ciego, con 30 pacientes, estado fisico I o II (ASA), distribuidos aleatoriamente en dos grupos de 15. Se administro solucion a 0,5% de ropivacaina (Grupo Ropi) o bupivacaina a 0,5% con epinefrina (Grupo Bupi). El bloqueo fue realizado utilizando estimulador de nervio periferico e inyectando 30 mL de anestesico local. Cuatro espirometrias se hicieron en cada paciente: antes del bloqueo, 30 minutos, 4 y 6 horas despues. Los pacientes no recibieron sedacion. RESULTADOS: Un paciente del Grupo Ropi y tres pacientes del Grupo Bupi, quedaron excluidos del estudio por fallos de bloqueo. La reduccion de la CVF en el Grupo Ropi se hizo maxima a los 30 minutos (25,1%) y a partir de entonces, hubo una tendencia progresiva a la recuperacion. Ya con la bupivacaina, la reduccion de la CVF parecio ser menos acentuada en los diversos momentos estudiados; se observo una reduccion adicional entre 30 minutos (15,8%) y 4 horas (17,3%), siendo esa sin diferencia estadistica. A partir de 4 horas, se noto una tendencia a la recuperacion. En los dos grupos, despues de 6 horas de bloqueo, la CVF todavia estaba por debajo de los valores previos. CONCLUSIONES: El bloqueo interescalenico reduce la CVF en la mayoria de los casos; las alteraciones fueron mas acentuadas en el Grupo Ropivacaina.

Comparative evaluation of propofol in nanoemulsion with solutol and soy lecithin for general anesthesia

INTRODUCTION The vehicle for propofol in 1 and 2% solutions is soybean oil emulsion 10%, which may cause pain on injection, instability of the solution and bacterial contamination. Formulations have been proposed aiming to change the vehicle and reduce these adverse reactions. OBJECTIVES To compare the incidence of pain caused by the injection of propofol, with a hypothesis of reduction associated with nanoemulsion and the occurrence of local and systemic adverse effects with both formulations. METHOD After approval by the CEP, patients undergoing gynecological procedures were included in this prospective study: control (n=25) and nanoemulsion (n=25) groups. Heart rate, noninvasive blood pressure and peripheral oxygen saturation were monitored. Demographics and physical condition were analyzed; surgical time and total volume used of propofol; local or systemic adverse effects; changes in variables monitored. A value of p<0.05 was considered significant. RESULTS There was no difference between groups regarding demographic data, surgical times, total volume of propofol used, arm withdrawal, pain during injection and variables monitored. There was a statistically significant difference in pain intensity at the time of induction of anesthesia, with less pain intensity in the nanoemulsion group. CONCLUSIONS Both lipid and nanoemulsion formulations of propofol elicited pain on intravenous injection; however, the nanoemulsion solution elicited a less intense pain. Lipid and nanoemulsion propofol formulations showed neither hemodynamic changes nor adverse effects of clinical relevance.

Brazilian Consensus on perioperative hemodynamic therapy goal guided in patients undergoing noncardiac surgery: fluid management strategy - produced by the São Paulo State Society of Anesthesiology (Sociedade de Anestesiologia do Estado de São Paulo - SAESP)

Enis Donizetti Silvaa,b,c, Albert Carl Perrinod, Alexandre Teruyae,f,g, Bobbie Jean Sweitzerh, Chiara Scaglioni Tessmer Gatto i, Claudia Marquez Simõesa,b,j, Ederlon Alves Carvalho Rezendek, Filomena Regina Barbosa Gomes Galas j, Francisco Ricardo Lobol,m, João Manoel da Silva Juniork, Leandro Ultino Taniguchin,o, Luciano Cesar Pontes de Azevedoa,o,p, Ludhmila Abrahão Hajjara,i,j, Luiz Antônio Mondadoriq, Marcelo Gama de Abreur, Marcelo Vaz Perezs,t, Regina El Dibu, Paulo do Nascimento Junioru, Roseny dos Reis Rodrigues f,p, Suzana Margareth Lobol,m,v, Rogean Rodrigues Nunesc,w,x, Murillo Santucci Cesar de Assunçãof,∗

Consenso Brasileiro sobre terapia hemodinâmica perioperatória guiada por objetivos em pacientes submetidos a cirurgias não cardíacas: estratégia de gerenciamento de fluidos – produzido pela Sociedade de Anestesiologia do Estado de São Paulo (SAESP)

Enis Donizetti Silva , Albert Carl Perrino, Alexandre Teruya, Bobbie Jean Sweitzer, Chiara Scaglioni Tessmer Gatto , Claudia Marquez Simões , Ederlon Alves Carvalho Rezende , Filomena Regina Barbosa Gomes Galas , Francisco Ricardo Lobo , João Manoel da Silva Junior , Leandro Ultino Taniguchi, Luciano Cesar Pontes de Azevedo , Ludhmila Abrahão Hajjar , Luiz Antônio Mondadori, Marcelo Gama de Abreu , Marcelo Vaz Perez , Regina El Dib, Paulo do Nascimento Junior, Roseny dos Reis Rodrigues , Suzana Margareth Lobo , Rogean Rodrigues Nunes c,w,x e Murillo Santucci Cesar de Assunção f,∗

Exercises for nonspecific low back pain treatment

BACKGROUND AND OBJECTIVES Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.JUSTIFICATIVA Y OBJETIVOS: La lumbalgia es un sindrome frecuente y provoca incapacidad y perdida en el trabajo. A pesar de que existen diversas causas, el tipo de lumbalgia mas frecuente es la inespecifica. Los ejercicios son a menudo usados para el tratamiento de la lumbalgia pero existen controversias en cuanto a su eficacia. El objetivo de este trabajo, fue hacer una revision sobre los ejercicios para el tratamiento de la lumbalgia inespecifica. CONTENIDO: Fueron descritas la definicion y la clasificacion de las lumbalgias. La incidencia y los mecanismos de la lumbalgia inespecifica, y los ejercicios empleados para su tratamiento tambien se relataron. CONCLUSIONES: Los tipos de ejercicios terapeuticos para la lumbalgia cronica o aguda que son mas eficaces todavia son bastante controversiales, sin embargo, los ejercicios terapeuticos son tal vez, el tratamiento conservador mas usado en todo el mundo.BACKGROUND AND OBJECTIVES: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT: This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION: The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.

Ejercicios para el tratamiento de la lumbalgia inespecífica

BACKGROUND AND OBJECTIVES Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.JUSTIFICATIVA Y OBJETIVOS: La lumbalgia es un sindrome frecuente y provoca incapacidad y perdida en el trabajo. A pesar de que existen diversas causas, el tipo de lumbalgia mas frecuente es la inespecifica. Los ejercicios son a menudo usados para el tratamiento de la lumbalgia pero existen controversias en cuanto a su eficacia. El objetivo de este trabajo, fue hacer una revision sobre los ejercicios para el tratamiento de la lumbalgia inespecifica. CONTENIDO: Fueron descritas la definicion y la clasificacion de las lumbalgias. La incidencia y los mecanismos de la lumbalgia inespecifica, y los ejercicios empleados para su tratamiento tambien se relataron. CONCLUSIONES: Los tipos de ejercicios terapeuticos para la lumbalgia cronica o aguda que son mas eficaces todavia son bastante controversiales, sin embargo, los ejercicios terapeuticos son tal vez, el tratamiento conservador mas usado en todo el mundo.BACKGROUND AND OBJECTIVES: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT: This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION: The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.