Mariana Moraes Pereira das Neves

An Evaluative Model to Assess the Organizational Efficiency in Training Corporations

In an organisation any optimization process of its issues faces increasing challenges and requires new approaches to the organizational phenomenon. Indeed, in this work it is addressed the problematic of efficiency dynamics through intangible variables that may support a different view of the corporations. It focuses on the challenges that information management and the incorporation of context brings to competitiveness. Thus, in this work it is presented the analysis and development of an intelligent decision support system in terms of a formal agenda built on a Logic Programming based methodology to problem solving, complemented with an attitude to computing grounded on Artificial Neural Networks. The proposed model is in itself fairly precise, with an overall accuracy, sensitivity and specificity with values higher than 90 %. The proposed solution is indeed unique, catering for the explicit treatment of incomplete, unknown, or even self-contradictory information, either in a quantitative or qualitative arrangement.

Analgesia pós-operatória para cesariana: a adição de clonidina à morfina subaracnóidea melhora a qualidade da analgesia?

JUSTIFICATIVA E OBJETIVOS: O mecanismo de acao analgesica a2-adrenergico tem sido explorado ha mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duracao dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adicao de clonidina na dose de 15 e 30 µg a raquianestesia, para cesariana, com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), melhora a qualidade da analgesia pos-operatoria. METODO: Foi realizado um estudo prospectivo e aleatorio com 60 pacientes divididas em tres grupos: BM - bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), BM15 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (15 µg) e BM30 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (30 µg), administradas separadamente. No peri-operatorio, foram anotados o consumo de efedrina e a avaliacao do recem-nascido pelo indice de Apgar. No pos-operatorio, a dor foi avaliada na 12a h pela Escala Analogica Visual, o tempo para solicitacao de analgesicos e efeitos colaterais pos-operatorios, como prurido, nauseas, vomitos, bradicardia, hipotensao arterial e sedacao. Os valores foram considerados significativos quando p < 0,05. RESULTADOS: Os grupos foram homogeneos. O consumo de efedrina e a avaliacao pelo indice de Apgar nao exibiram diferenca estatistica significativa entre os grupos. Os escores de dor e o tempo medio de analgesia mostraram diferenca entre os grupos BM e BM15/BM30 e nao houve diferenca com relacao a incidencia de efeitos colaterais pos-operatorios. CONCLUSOES: A adicao de clonidina na raquianestesia com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg) para cesariana, melhorou a qualidade da analgesia pos-operatoria, sem aumentar a incidencia de efeitos colaterais, sendo 15 µg de clonidina a dose sugerida.BACKGROUND AND OBJECTIVES The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 microg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) improves the quality of postoperative analgesia. METHODS We realized a prospective, randomized study that included 60 patients divided in 3 groups: BM - 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg), BM15 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (15 mg), and BM30 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (30 microg), administered separately. In the perioperative period the use of ephedrine and the newborns Apgar score were recorded. In the postoperative period, the pain was evaluated in the 12th h by the VAS, the length of time it took the patient to ask for analgesics, and the postoperative side effects, such as pruritus, nausea, vomiting, bradycardia, hypotension, and sedation. The values were considered significant when p < 0.05. RESULTS The groups were homogenous. The use of ephedrine and the evaluation by the Apgar score did not show statistically significant differences among the different groups. The pain scores and the average time to start analgesia showed differences among the groups BM and BM15/BM30, and there were no differences regarding the incidence of postoperative side effects. CONCLUSIONS The addition of clonidine to spinal anesthesia with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) for cesarean section improved the quality of the postoperative analgesia without increasing the incidence of side effects. We suggest that the dose of 15 microg of clonidine should be used.

Anesthesia for Duchenne muscular dystrophy patients: case reports

JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD), uma doenca rara, progressiva e incapacitante, e discutir sobre a conduta anestesica. O comprometimento das funcoes pulmonar e cardiaca, a possibilidade de ocorrencia de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pos-operatoria sao alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediatrico com diagnostico de DMD e rabdomiossarcoma, agendado para exerese da lesao e esvaziamento cervical ampliado. Na avaliacao pre-anestesica (anamnese, exame clinico e exames complementares) nao foram detectadas alteracoes, exceto pela tumoracao cervical. Optou-se pela tecnica venosa total, com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. O procedimento cirurgico teve duracao de 180 minutos, sem intercorrencias. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnostico de DMD e colelitiase com indicacao cirurgica, cuja avaliacao pre-operatoria revelou pneumopatia restritiva grave, com diminuicoes da capacidade e da reserva respiratorias, sendo necessario o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubacao traqueal com sedacao minima e anestesia topica, seguida pela tecnica venosa total com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. Ao termino, o paciente foi extubado ainda na sala de operacoes e imediatamente colocado no BIPAP nasal. Encaminhado a UTI, com alta no 2o PO e alta hospitalar no 3o PO. CONCLUSOES: A anestesia venosa total com infusao continua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opcao segura e eficiente nos portadores de DMD.BACKGROUND AND OBJECTIVES Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD) patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists. CASE REPORTS First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day. CONCLUSIONS Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.

Anestesia em paciente portador de distrofia muscular de Duchenne: relato de casos

JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD), uma doenca rara, progressiva e incapacitante, e discutir sobre a conduta anestesica. O comprometimento das funcoes pulmonar e cardiaca, a possibilidade de ocorrencia de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pos-operatoria sao alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediatrico com diagnostico de DMD e rabdomiossarcoma, agendado para exerese da lesao e esvaziamento cervical ampliado. Na avaliacao pre-anestesica (anamnese, exame clinico e exames complementares) nao foram detectadas alteracoes, exceto pela tumoracao cervical. Optou-se pela tecnica venosa total, com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. O procedimento cirurgico teve duracao de 180 minutos, sem intercorrencias. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnostico de DMD e colelitiase com indicacao cirurgica, cuja avaliacao pre-operatoria revelou pneumopatia restritiva grave, com diminuicoes da capacidade e da reserva respiratorias, sendo necessario o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubacao traqueal com sedacao minima e anestesia topica, seguida pela tecnica venosa total com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. Ao termino, o paciente foi extubado ainda na sala de operacoes e imediatamente colocado no BIPAP nasal. Encaminhado a UTI, com alta no 2o PO e alta hospitalar no 3o PO. CONCLUSOES: A anestesia venosa total com infusao continua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opcao segura e eficiente nos portadores de DMD.BACKGROUND AND OBJECTIVES Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD) patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists. CASE REPORTS First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day. CONCLUSIONS Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.

Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?

JUSTIFICATIVA E OBJETIVOS: O mecanismo de acao analgesica a2-adrenergico tem sido explorado ha mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duracao dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adicao de clonidina na dose de 15 e 30 µg a raquianestesia, para cesariana, com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), melhora a qualidade da analgesia pos-operatoria. METODO: Foi realizado um estudo prospectivo e aleatorio com 60 pacientes divididas em tres grupos: BM - bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), BM15 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (15 µg) e BM30 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (30 µg), administradas separadamente. No peri-operatorio, foram anotados o consumo de efedrina e a avaliacao do recem-nascido pelo indice de Apgar. No pos-operatorio, a dor foi avaliada na 12a h pela Escala Analogica Visual, o tempo para solicitacao de analgesicos e efeitos colaterais pos-operatorios, como prurido, nauseas, vomitos, bradicardia, hipotensao arterial e sedacao. Os valores foram considerados significativos quando p < 0,05. RESULTADOS: Os grupos foram homogeneos. O consumo de efedrina e a avaliacao pelo indice de Apgar nao exibiram diferenca estatistica significativa entre os grupos. Os escores de dor e o tempo medio de analgesia mostraram diferenca entre os grupos BM e BM15/BM30 e nao houve diferenca com relacao a incidencia de efeitos colaterais pos-operatorios. CONCLUSOES: A adicao de clonidina na raquianestesia com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg) para cesariana, melhorou a qualidade da analgesia pos-operatoria, sem aumentar a incidencia de efeitos colaterais, sendo 15 µg de clonidina a dose sugerida.BACKGROUND AND OBJECTIVES The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 microg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) improves the quality of postoperative analgesia. METHODS We realized a prospective, randomized study that included 60 patients divided in 3 groups: BM - 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg), BM15 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (15 mg), and BM30 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (30 microg), administered separately. In the perioperative period the use of ephedrine and the newborns Apgar score were recorded. In the postoperative period, the pain was evaluated in the 12th h by the VAS, the length of time it took the patient to ask for analgesics, and the postoperative side effects, such as pruritus, nausea, vomiting, bradycardia, hypotension, and sedation. The values were considered significant when p < 0.05. RESULTS The groups were homogenous. The use of ephedrine and the evaluation by the Apgar score did not show statistically significant differences among the different groups. The pain scores and the average time to start analgesia showed differences among the groups BM and BM15/BM30, and there were no differences regarding the incidence of postoperative side effects. CONCLUSIONS The addition of clonidine to spinal anesthesia with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) for cesarean section improved the quality of the postoperative analgesia without increasing the incidence of side effects. We suggest that the dose of 15 microg of clonidine should be used.

International Standard ISO 9001 – A Soft Computing View

In order to add value to ISO 9001, a Quality Management Systems that assess, measure, documents, improves, and certify processes to increase productivity, i.e., that transforms business at any level. On the one hand, this work focuses on the development of a decision support system, which will allow companies to be able to meet the needs of customers by fulfilling requirements that reflect either the effectiveness or the non-effectiveness of an organization. On the other hand, many approaches for knowledge representation and reasoning have been proposed using Logic Programming (LP), namely in the area of Model Theory or Proof Theory. In this work it is followed the proof theoretical approach in terms of an extension to the LP language to knowledge representation and reasoning. The computational framework is centered on Artificial Neural Networks to evaluate customer’s satisfaction and the degree of confidence that one has on such a happening.

A Case-Base Approach to Workforces’ Satisfaction Assessment

It is well known that human resources play a valuable role in a sustainable organizational development. Indeed, this work will focus on the development of a decision support system to assess workers’ satisfaction based on factors related to human resources management practices. The framework is built on top of a Logic Programming approach to Knowledge Representation and Reasoning, complemented with a Case Based approach to computing. The proposed solution is unique in itself, once it caters for the explicit treatment of incomplete, unknown, or even self-contradictory information, either in terms of a qualitative or quantitative setting. Furthermore, clustering methods based on similarity analysis among cases were used to distinguish and aggregate collections of historical data or knowledge in order to reduce the search space, therefore enhancing the cases retrieval and the overall computational process.

International Standard ISO 9001 an Artificial Intelligence View

ISO 9001 is recognized as a Quality Management Systems standard, i.e., it is the primary phase of a process of constant enhancement that will provide an organisation with the necessary management tools to improve working practices. Indeed, it provides a framework and a set of principles aimed at ensuring a common sense approach to the management of an organization in order to consistently satisfy customers and other stakeholders. Therefore, and in order to add value to ISO 9001, this work focuses on the development of a decision support system, which will allow companies to be able to meet the needs of customers by fulfilling requirements that reflect either the effectiveness or the non-effectiveness of an organization. The procedures for knowledge representation and reasoning used are based on an extension to the Logic Programming language, allowing the handling of incomplete, contradictory and even forbidden data, information and/or knowledge. The computational framework is centred on Artificial Neural Networks to evaluate customer???s satisfaction and the degree of confidence that one has on such a happening.

Analgesia postoperatória para cesárea: ¿la adición de clonidina a la morfina subaracnoidea mejora la calidad de la analgesia?

JUSTIFICATIVA E OBJETIVOS: O mecanismo de acao analgesica a2-adrenergico tem sido explorado ha mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duracao dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adicao de clonidina na dose de 15 e 30 µg a raquianestesia, para cesariana, com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), melhora a qualidade da analgesia pos-operatoria. METODO: Foi realizado um estudo prospectivo e aleatorio com 60 pacientes divididas em tres grupos: BM - bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg), BM15 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (15 µg) e BM30 - bupivacaina hiperbarica a 0,5% (12,5 mg), morfina (100 µg) e clonidina (30 µg), administradas separadamente. No peri-operatorio, foram anotados o consumo de efedrina e a avaliacao do recem-nascido pelo indice de Apgar. No pos-operatorio, a dor foi avaliada na 12a h pela Escala Analogica Visual, o tempo para solicitacao de analgesicos e efeitos colaterais pos-operatorios, como prurido, nauseas, vomitos, bradicardia, hipotensao arterial e sedacao. Os valores foram considerados significativos quando p < 0,05. RESULTADOS: Os grupos foram homogeneos. O consumo de efedrina e a avaliacao pelo indice de Apgar nao exibiram diferenca estatistica significativa entre os grupos. Os escores de dor e o tempo medio de analgesia mostraram diferenca entre os grupos BM e BM15/BM30 e nao houve diferenca com relacao a incidencia de efeitos colaterais pos-operatorios. CONCLUSOES: A adicao de clonidina na raquianestesia com bupivacaina hiperbarica a 0,5% (12,5 mg) e morfina (100 µg) para cesariana, melhorou a qualidade da analgesia pos-operatoria, sem aumentar a incidencia de efeitos colaterais, sendo 15 µg de clonidina a dose sugerida.BACKGROUND AND OBJECTIVES The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 microg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) improves the quality of postoperative analgesia. METHODS We realized a prospective, randomized study that included 60 patients divided in 3 groups: BM - 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg), BM15 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (15 mg), and BM30 - 0.5% hyperbaric bupivacaine (12.5 mg), morphine (100 microg), and clonidine (30 microg), administered separately. In the perioperative period the use of ephedrine and the newborns Apgar score were recorded. In the postoperative period, the pain was evaluated in the 12th h by the VAS, the length of time it took the patient to ask for analgesics, and the postoperative side effects, such as pruritus, nausea, vomiting, bradycardia, hypotension, and sedation. The values were considered significant when p < 0.05. RESULTS The groups were homogenous. The use of ephedrine and the evaluation by the Apgar score did not show statistically significant differences among the different groups. The pain scores and the average time to start analgesia showed differences among the groups BM and BM15/BM30, and there were no differences regarding the incidence of postoperative side effects. CONCLUSIONS The addition of clonidine to spinal anesthesia with 0.5% hyperbaric bupivacaine (12.5 mg) and morphine (100 microg) for cesarean section improved the quality of the postoperative analgesia without increasing the incidence of side effects. We suggest that the dose of 15 microg of clonidine should be used.

Anestesia en un paciente portador de distrofia muscular de Duchenne: relato de casos

JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD), uma doenca rara, progressiva e incapacitante, e discutir sobre a conduta anestesica. O comprometimento das funcoes pulmonar e cardiaca, a possibilidade de ocorrencia de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pos-operatoria sao alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediatrico com diagnostico de DMD e rabdomiossarcoma, agendado para exerese da lesao e esvaziamento cervical ampliado. Na avaliacao pre-anestesica (anamnese, exame clinico e exames complementares) nao foram detectadas alteracoes, exceto pela tumoracao cervical. Optou-se pela tecnica venosa total, com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. O procedimento cirurgico teve duracao de 180 minutos, sem intercorrencias. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnostico de DMD e colelitiase com indicacao cirurgica, cuja avaliacao pre-operatoria revelou pneumopatia restritiva grave, com diminuicoes da capacidade e da reserva respiratorias, sendo necessario o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubacao traqueal com sedacao minima e anestesia topica, seguida pela tecnica venosa total com remifentanil em infusao continua e propofol em infusao alvo-controlada, sem a utilizacao de bloqueadores neuromusculares. Ao termino, o paciente foi extubado ainda na sala de operacoes e imediatamente colocado no BIPAP nasal. Encaminhado a UTI, com alta no 2o PO e alta hospitalar no 3o PO. CONCLUSOES: A anestesia venosa total com infusao continua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opcao segura e eficiente nos portadores de DMD.BACKGROUND AND OBJECTIVES Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD) patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists. CASE REPORTS First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day. CONCLUSIONS Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.