Pedro Wanderley de Aragão

Pressão arterial do anestesiologista durante o ato anestésico-cirúrgico no período matutino

BACKGROUND AND OBJECTIVES Systemic arterial hypertension affects approximately 20% of the world population, depending on the interaction between genetic predisposition and environmental factors. Stresses inherent to the anesthesiologists work might reflect in the cardiovascular system, influencing professionals blood pressure. This study aimed at verifying whether the practice of anesthesia is a triggering factor for anesthesiologists blood pressure changes during surgical anesthetic procedures. METHODS Participated in these study 10 anesthesiologists, each one inducing 10 spinal anesthesias for cesarean section. Blood pressure was measured in five different moments, in a total of 50 readings one each anesthesiologist. The first measure was recorded soon after the anesthesiologists arrival in the operating center and was called M1; the second, before lumbar puncture and was called M2; the third, immediately after needle removal from the puncture site and was called M3; the forth reading, M4, was obtained immediately after fetal extraction; and the last value, M5, at end of skin suture. RESULTS There has been anesthesiologists blood pressure increase in moments M3 and M4. CONCLUSIONS The anesthetic practice is responsible for significant changes in anesthesiologists blood pressure and is a direct function of moments of higher risk for the patient during surgical anesthetic procedures.JUSTIFICATIVA E OBJETIVOS: A hipertensao arterial sistemica incide em aproximadamente 20% da populacao mundial, dependendo da interacao entre a predisposicao genetica e fatores ambientais. As condicoes de estresse inerentes ao trabalho do anestesiologista podem se manifestar no aparelho cardiovascular, influenciando na pressao arterial do profissional que a pratica. O objetivo deste estudo foi verificar se a pratica da anestesia e fator desencadeante da variacao da pressao arterial no anestesiologista durante o ato anestesico cirurgico. METODO: Participaram do estudo dez anestesiologistas, cada um realizando dez anestesias raquidianas para parto cesariano. Foram registradas cinco medidas da pressao arterial em cinco momentos diferentes, no total de 50 afericoes por anestesiologista. A primeira, realizada apos descanso previo de cinco minutos da chegada do anestesiologista ao centro cirurgico, denominado M1. A segunda, antes da realizacao da puncao lombar, M2. A terceira, logo apos a retirada da agulha do local da puncao onde foi realizado o bloqueio, M3. A quarta, imediatamente apos a retirada do feto, M4. E a ultima afericao, ao termino da sutura da pele, M5. RESULTADOS: Ocorreu elevacao na pressao arterial do anestesiologista nos momentos M3 e M4. CONCLUSOES: A pratica anestesica realizada e responsavel por alteracao significativa da pressao arterial do anestesiologista e esta diretamente relacionada com os momentos de maior risco para o paciente durante o ato anestesico cirurgico.

Epidural caudal block: evaluation of length of analgesia with the association of lidocaine, fentanyl and clonidine

BACKGROUND AND OBJECTIVES The association of different substances to local anesthetics aims to improve the blockade quality and prolonging analgesia. The aims of this study were to compare the effectiveness of the association of clonidine, clonidine and fentanyl, and fentanyl, to lidocaine for postoperative analgesia. METHODS Participated in this study 64 patients aged 23 years or above, physical status ASA I or II, undergoing to orificial proctologic surgery under epidural caudal anesthesia. Patients were distributed in 4 groups of 16: group I (lidocaine alone); group II (lidocaine and fentanyl); group III (lidocaine, fentanyl and clonidine); and group IV (lidocaine and clonidine). The quality of sensory and motor blockade were compared. RESULTS There has been no difference in onset and maximum block level among groups. Absence of motor block was the most frequent result, found in about 64% of patients. Analgesia length was different among groups, being more significant in group III. CONCLUSIONS Clonidine, associated or not to fentanyl, has prolonged postoperative analgesia after epidural caudal blockade with lidocaine.JUSTIFICATIVA Y OBJETIVOS: La asociacion de diferentes substancias a los anestesicos locales es hecha con el objetivo de mejorar la cualidad del bloqueo y prolongar la duracion de la analgesia. El objetivo de este trabajo fue comparar la eficacia de la asociacion de clonidina, clonidina y fentanil y de fentanil a la lidocaina, en el tiempo de analgesia pos-operatoria. METODO: El estudio envolvio 64 pacientes con edad igual o superior a 23 anos, estado fisico I o II (ASA), escalados para cirugia proctologica orificial, sometidos a anestesia peridural sacral. Los pacientes fueron distribuidos en 4 grupos de 16: grupo I (lidocaina aislada), grupo II (lidocaina y fentanil), grupo III (lidocaina, fentanil y clonidina) y grupo IV (lidocaina y clonidina). Se compararon las caracteristicas de los bloqueos sensitivo y motor. RESULTADOS: No hubo diferencia entre la latencia, bien como en el nivel maximo de bloqueo entre los grupos. La ausencia de bloqueo motor fue el resultado mas frecuente, encontrado en cerca de 64% de los pacientes. El intervalo de analgesia fue diferente entre los grupos, siendo mas significativo en el grupo III. CONCLUSIONES: El uso de la clonidina, asociada o no al fentanil, prolongo el tiempo de analgesia pos-operatoria en la anestesia peridural sacral con lidocaina.

Avaliação comparativa entre metaraminol, fenilefrina e efedrina na profilaxia e no tratamento da hipotensão em cesarianas sob raquianestesia

Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50μg+50μg/min); metaraminol group (0.25mg+0.25mg/min); ephedrine group (4mg+4mg/min). Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

Efeito da ropivacaína na recaptação neuronal de noradrenalina em músculo liso

JUSTIFICATIVA Y OBJETIVOS: Ademas de la accion anestesica local, la ropivacaina presenta un efecto vasoconstrictor, clinicamente significativo y puede ser observado cuando de la anestesia infiltrativa, con esto lo hace un anestesico importante en el bloqueo del campo. Este trabajo tuvo por objetivo caracterizar el mecanismo de accion constrictor de la ropivacaina en musculo liso. METODO: En preparaciones separadas del conducto deferente de ratones fueron construidas curvas concentracion-efecto de noradrenalina en la ausencia o en la presencia de la ropivacaina. En otra serie de experimentos los ratones fueron tratados con reserpina (10 mg.kg-1, por la via intraperitoneal) para evaluar la reactividad de los conductos deferentes a la tiramina o noradrenalina, en la ausencia o presencia de la ropivacaina. RESULTADOS: La ropivacaina en las concentraciones de 5 o 10 µg.mL-1 potencio el efecto maximo (Emax) de la noradrenalina en un 47% y 35%, respectivamente, mientras que en las concentraciones de 50 o 100 µg.mL-1 inhibio el efecto maximo producido por este agonista. En conductos deferentes separados de ratones reserpinizados, la ropivacaina (10 o 20 µg.mL-1) potencio (150% y 25%, respectivamente) las contracciones inducidas por la noradrenalina, mientras que las concentraciones de 50 o 100 µg.mL-1 no alteraron las respuestas a la noradrenalina. CONCLUSIONES: Los resultados logrados permiten concluir que la ropivacaina bloquea la recaptacion neuronal de noradrenalina por los terminales nerviosos simpaticos.BACKGROUND AND OBJECTIVES In addition to local anesthetic action, ropivacaine has clinically significant vasoconstrictor effects, which may be observed at infiltrative anesthesia, making it an important anesthetic for field blockade. This study aimed at characterizing the constrictor mechanism of ropivacaine on smooth muscles. METHODS Norepinephrine concentration-effect curves in the absence or presence of ropivacaine were plotted on isolated preparations of vas deferens of rats. In another series of experiments rats were treated with reserpine (10 mg.kg-1, i.p.) to evaluate vas deferens reactivity to tyramine or norepinephrine, in the absence or presence of ropivacaine. RESULTS Ropivacaine 5 or 10 microg.mL-1 potentiated maximum norepinephrine effect (Emax) in 47% and 35%, respectively, while higher concentrations (50 or 100 microg.mL-1) inhibited its maximum effect. In isolated vas deferens of rats treated with reserpine, ropivacaine (10 or 20 microg.mL-1) potentiated (150% and 25%, respectively) norepinephrine-induced contractions, while higher concentrations (50 or 100 microg.mL-1) have not changed responses to norepinephrine. CONCLUSIONS Ropivacaine blocks neuronal norepinephrine reuptake by sympathetic nerve terminals.

Bloqueio peridural sacral: avaliação da duração da analgesia com o uso associado de lidocaína, fentanil e clonidina

BACKGROUND AND OBJECTIVES The association of different substances to local anesthetics aims to improve the blockade quality and prolonging analgesia. The aims of this study were to compare the effectiveness of the association of clonidine, clonidine and fentanyl, and fentanyl, to lidocaine for postoperative analgesia. METHODS Participated in this study 64 patients aged 23 years or above, physical status ASA I or II, undergoing to orificial proctologic surgery under epidural caudal anesthesia. Patients were distributed in 4 groups of 16: group I (lidocaine alone); group II (lidocaine and fentanyl); group III (lidocaine, fentanyl and clonidine); and group IV (lidocaine and clonidine). The quality of sensory and motor blockade were compared. RESULTS There has been no difference in onset and maximum block level among groups. Absence of motor block was the most frequent result, found in about 64% of patients. Analgesia length was different among groups, being more significant in group III. CONCLUSIONS Clonidine, associated or not to fentanyl, has prolonged postoperative analgesia after epidural caudal blockade with lidocaine.JUSTIFICATIVA Y OBJETIVOS: La asociacion de diferentes substancias a los anestesicos locales es hecha con el objetivo de mejorar la cualidad del bloqueo y prolongar la duracion de la analgesia. El objetivo de este trabajo fue comparar la eficacia de la asociacion de clonidina, clonidina y fentanil y de fentanil a la lidocaina, en el tiempo de analgesia pos-operatoria. METODO: El estudio envolvio 64 pacientes con edad igual o superior a 23 anos, estado fisico I o II (ASA), escalados para cirugia proctologica orificial, sometidos a anestesia peridural sacral. Los pacientes fueron distribuidos en 4 grupos de 16: grupo I (lidocaina aislada), grupo II (lidocaina y fentanil), grupo III (lidocaina, fentanil y clonidina) y grupo IV (lidocaina y clonidina). Se compararon las caracteristicas de los bloqueos sensitivo y motor. RESULTADOS: No hubo diferencia entre la latencia, bien como en el nivel maximo de bloqueo entre los grupos. La ausencia de bloqueo motor fue el resultado mas frecuente, encontrado en cerca de 64% de los pacientes. El intervalo de analgesia fue diferente entre los grupos, siendo mas significativo en el grupo III. CONCLUSIONES: El uso de la clonidina, asociada o no al fentanil, prolongo el tiempo de analgesia pos-operatoria en la anestesia peridural sacral con lidocaina.

Effect of ropivacaine on neuronal norepinephrine reuptake in smooth muscle.

JUSTIFICATIVA Y OBJETIVOS: Ademas de la accion anestesica local, la ropivacaina presenta un efecto vasoconstrictor, clinicamente significativo y puede ser observado cuando de la anestesia infiltrativa, con esto lo hace un anestesico importante en el bloqueo del campo. Este trabajo tuvo por objetivo caracterizar el mecanismo de accion constrictor de la ropivacaina en musculo liso. METODO: En preparaciones separadas del conducto deferente de ratones fueron construidas curvas concentracion-efecto de noradrenalina en la ausencia o en la presencia de la ropivacaina. En otra serie de experimentos los ratones fueron tratados con reserpina (10 mg.kg-1, por la via intraperitoneal) para evaluar la reactividad de los conductos deferentes a la tiramina o noradrenalina, en la ausencia o presencia de la ropivacaina. RESULTADOS: La ropivacaina en las concentraciones de 5 o 10 µg.mL-1 potencio el efecto maximo (Emax) de la noradrenalina en un 47% y 35%, respectivamente, mientras que en las concentraciones de 50 o 100 µg.mL-1 inhibio el efecto maximo producido por este agonista. En conductos deferentes separados de ratones reserpinizados, la ropivacaina (10 o 20 µg.mL-1) potencio (150% y 25%, respectivamente) las contracciones inducidas por la noradrenalina, mientras que las concentraciones de 50 o 100 µg.mL-1 no alteraron las respuestas a la noradrenalina. CONCLUSIONES: Los resultados logrados permiten concluir que la ropivacaina bloquea la recaptacion neuronal de noradrenalina por los terminales nerviosos simpaticos.BACKGROUND AND OBJECTIVES In addition to local anesthetic action, ropivacaine has clinically significant vasoconstrictor effects, which may be observed at infiltrative anesthesia, making it an important anesthetic for field blockade. This study aimed at characterizing the constrictor mechanism of ropivacaine on smooth muscles. METHODS Norepinephrine concentration-effect curves in the absence or presence of ropivacaine were plotted on isolated preparations of vas deferens of rats. In another series of experiments rats were treated with reserpine (10 mg.kg-1, i.p.) to evaluate vas deferens reactivity to tyramine or norepinephrine, in the absence or presence of ropivacaine. RESULTS Ropivacaine 5 or 10 microg.mL-1 potentiated maximum norepinephrine effect (Emax) in 47% and 35%, respectively, while higher concentrations (50 or 100 microg.mL-1) inhibited its maximum effect. In isolated vas deferens of rats treated with reserpine, ropivacaine (10 or 20 microg.mL-1) potentiated (150% and 25%, respectively) norepinephrine-induced contractions, while higher concentrations (50 or 100 microg.mL-1) have not changed responses to norepinephrine. CONCLUSIONS Ropivacaine blocks neuronal norepinephrine reuptake by sympathetic nerve terminals.

Efecto de la ropivacaína en la recaptación neuronal de noradrenalina en un músculo liso

JUSTIFICATIVA Y OBJETIVOS: Ademas de la accion anestesica local, la ropivacaina presenta un efecto vasoconstrictor, clinicamente significativo y puede ser observado cuando de la anestesia infiltrativa, con esto lo hace un anestesico importante en el bloqueo del campo. Este trabajo tuvo por objetivo caracterizar el mecanismo de accion constrictor de la ropivacaina en musculo liso. METODO: En preparaciones separadas del conducto deferente de ratones fueron construidas curvas concentracion-efecto de noradrenalina en la ausencia o en la presencia de la ropivacaina. En otra serie de experimentos los ratones fueron tratados con reserpina (10 mg.kg-1, por la via intraperitoneal) para evaluar la reactividad de los conductos deferentes a la tiramina o noradrenalina, en la ausencia o presencia de la ropivacaina. RESULTADOS: La ropivacaina en las concentraciones de 5 o 10 µg.mL-1 potencio el efecto maximo (Emax) de la noradrenalina en un 47% y 35%, respectivamente, mientras que en las concentraciones de 50 o 100 µg.mL-1 inhibio el efecto maximo producido por este agonista. En conductos deferentes separados de ratones reserpinizados, la ropivacaina (10 o 20 µg.mL-1) potencio (150% y 25%, respectivamente) las contracciones inducidas por la noradrenalina, mientras que las concentraciones de 50 o 100 µg.mL-1 no alteraron las respuestas a la noradrenalina. CONCLUSIONES: Los resultados logrados permiten concluir que la ropivacaina bloquea la recaptacion neuronal de noradrenalina por los terminales nerviosos simpaticos.BACKGROUND AND OBJECTIVES In addition to local anesthetic action, ropivacaine has clinically significant vasoconstrictor effects, which may be observed at infiltrative anesthesia, making it an important anesthetic for field blockade. This study aimed at characterizing the constrictor mechanism of ropivacaine on smooth muscles. METHODS Norepinephrine concentration-effect curves in the absence or presence of ropivacaine were plotted on isolated preparations of vas deferens of rats. In another series of experiments rats were treated with reserpine (10 mg.kg-1, i.p.) to evaluate vas deferens reactivity to tyramine or norepinephrine, in the absence or presence of ropivacaine. RESULTS Ropivacaine 5 or 10 microg.mL-1 potentiated maximum norepinephrine effect (Emax) in 47% and 35%, respectively, while higher concentrations (50 or 100 microg.mL-1) inhibited its maximum effect. In isolated vas deferens of rats treated with reserpine, ropivacaine (10 or 20 microg.mL-1) potentiated (150% and 25%, respectively) norepinephrine-induced contractions, while higher concentrations (50 or 100 microg.mL-1) have not changed responses to norepinephrine. CONCLUSIONS Ropivacaine blocks neuronal norepinephrine reuptake by sympathetic nerve terminals.

Bloqueo peridural sacral: evaluación de la duración de la analgesia con el uso asociado de lidocaína, fentanil y clonidina

BACKGROUND AND OBJECTIVES The association of different substances to local anesthetics aims to improve the blockade quality and prolonging analgesia. The aims of this study were to compare the effectiveness of the association of clonidine, clonidine and fentanyl, and fentanyl, to lidocaine for postoperative analgesia. METHODS Participated in this study 64 patients aged 23 years or above, physical status ASA I or II, undergoing to orificial proctologic surgery under epidural caudal anesthesia. Patients were distributed in 4 groups of 16: group I (lidocaine alone); group II (lidocaine and fentanyl); group III (lidocaine, fentanyl and clonidine); and group IV (lidocaine and clonidine). The quality of sensory and motor blockade were compared. RESULTS There has been no difference in onset and maximum block level among groups. Absence of motor block was the most frequent result, found in about 64% of patients. Analgesia length was different among groups, being more significant in group III. CONCLUSIONS Clonidine, associated or not to fentanyl, has prolonged postoperative analgesia after epidural caudal blockade with lidocaine.JUSTIFICATIVA Y OBJETIVOS: La asociacion de diferentes substancias a los anestesicos locales es hecha con el objetivo de mejorar la cualidad del bloqueo y prolongar la duracion de la analgesia. El objetivo de este trabajo fue comparar la eficacia de la asociacion de clonidina, clonidina y fentanil y de fentanil a la lidocaina, en el tiempo de analgesia pos-operatoria. METODO: El estudio envolvio 64 pacientes con edad igual o superior a 23 anos, estado fisico I o II (ASA), escalados para cirugia proctologica orificial, sometidos a anestesia peridural sacral. Los pacientes fueron distribuidos en 4 grupos de 16: grupo I (lidocaina aislada), grupo II (lidocaina y fentanil), grupo III (lidocaina, fentanil y clonidina) y grupo IV (lidocaina y clonidina). Se compararon las caracteristicas de los bloqueos sensitivo y motor. RESULTADOS: No hubo diferencia entre la latencia, bien como en el nivel maximo de bloqueo entre los grupos. La ausencia de bloqueo motor fue el resultado mas frecuente, encontrado en cerca de 64% de los pacientes. El intervalo de analgesia fue diferente entre los grupos, siendo mas significativo en el grupo III. CONCLUSIONES: El uso de la clonidina, asociada o no al fentanil, prolongo el tiempo de analgesia pos-operatoria en la anestesia peridural sacral con lidocaina.

Anesthesiologists blood pressure during surgical anesthetic procedures in the morning

BACKGROUND AND OBJECTIVES Systemic arterial hypertension affects approximately 20% of the world population, depending on the interaction between genetic predisposition and environmental factors. Stresses inherent to the anesthesiologists work might reflect in the cardiovascular system, influencing professionals blood pressure. This study aimed at verifying whether the practice of anesthesia is a triggering factor for anesthesiologists blood pressure changes during surgical anesthetic procedures. METHODS Participated in these study 10 anesthesiologists, each one inducing 10 spinal anesthesias for cesarean section. Blood pressure was measured in five different moments, in a total of 50 readings one each anesthesiologist. The first measure was recorded soon after the anesthesiologists arrival in the operating center and was called M1; the second, before lumbar puncture and was called M2; the third, immediately after needle removal from the puncture site and was called M3; the forth reading, M4, was obtained immediately after fetal extraction; and the last value, M5, at end of skin suture. RESULTS There has been anesthesiologists blood pressure increase in moments M3 and M4. CONCLUSIONS The anesthetic practice is responsible for significant changes in anesthesiologists blood pressure and is a direct function of moments of higher risk for the patient during surgical anesthetic procedures.JUSTIFICATIVA E OBJETIVOS: A hipertensao arterial sistemica incide em aproximadamente 20% da populacao mundial, dependendo da interacao entre a predisposicao genetica e fatores ambientais. As condicoes de estresse inerentes ao trabalho do anestesiologista podem se manifestar no aparelho cardiovascular, influenciando na pressao arterial do profissional que a pratica. O objetivo deste estudo foi verificar se a pratica da anestesia e fator desencadeante da variacao da pressao arterial no anestesiologista durante o ato anestesico cirurgico. METODO: Participaram do estudo dez anestesiologistas, cada um realizando dez anestesias raquidianas para parto cesariano. Foram registradas cinco medidas da pressao arterial em cinco momentos diferentes, no total de 50 afericoes por anestesiologista. A primeira, realizada apos descanso previo de cinco minutos da chegada do anestesiologista ao centro cirurgico, denominado M1. A segunda, antes da realizacao da puncao lombar, M2. A terceira, logo apos a retirada da agulha do local da puncao onde foi realizado o bloqueio, M3. A quarta, imediatamente apos a retirada do feto, M4. E a ultima afericao, ao termino da sutura da pele, M5. RESULTADOS: Ocorreu elevacao na pressao arterial do anestesiologista nos momentos M3 e M4. CONCLUSOES: A pratica anestesica realizada e responsavel por alteracao significativa da pressao arterial do anestesiologista e esta diretamente relacionada com os momentos de maior risco para o paciente durante o ato anestesico cirurgico.

Presión arterial del anestesista durante el acto anestésico-quirúrgico en el período matutino

BACKGROUND AND OBJECTIVES Systemic arterial hypertension affects approximately 20% of the world population, depending on the interaction between genetic predisposition and environmental factors. Stresses inherent to the anesthesiologists work might reflect in the cardiovascular system, influencing professionals blood pressure. This study aimed at verifying whether the practice of anesthesia is a triggering factor for anesthesiologists blood pressure changes during surgical anesthetic procedures. METHODS Participated in these study 10 anesthesiologists, each one inducing 10 spinal anesthesias for cesarean section. Blood pressure was measured in five different moments, in a total of 50 readings one each anesthesiologist. The first measure was recorded soon after the anesthesiologists arrival in the operating center and was called M1; the second, before lumbar puncture and was called M2; the third, immediately after needle removal from the puncture site and was called M3; the forth reading, M4, was obtained immediately after fetal extraction; and the last value, M5, at end of skin suture. RESULTS There has been anesthesiologists blood pressure increase in moments M3 and M4. CONCLUSIONS The anesthetic practice is responsible for significant changes in anesthesiologists blood pressure and is a direct function of moments of higher risk for the patient during surgical anesthetic procedures.JUSTIFICATIVA E OBJETIVOS: A hipertensao arterial sistemica incide em aproximadamente 20% da populacao mundial, dependendo da interacao entre a predisposicao genetica e fatores ambientais. As condicoes de estresse inerentes ao trabalho do anestesiologista podem se manifestar no aparelho cardiovascular, influenciando na pressao arterial do profissional que a pratica. O objetivo deste estudo foi verificar se a pratica da anestesia e fator desencadeante da variacao da pressao arterial no anestesiologista durante o ato anestesico cirurgico. METODO: Participaram do estudo dez anestesiologistas, cada um realizando dez anestesias raquidianas para parto cesariano. Foram registradas cinco medidas da pressao arterial em cinco momentos diferentes, no total de 50 afericoes por anestesiologista. A primeira, realizada apos descanso previo de cinco minutos da chegada do anestesiologista ao centro cirurgico, denominado M1. A segunda, antes da realizacao da puncao lombar, M2. A terceira, logo apos a retirada da agulha do local da puncao onde foi realizado o bloqueio, M3. A quarta, imediatamente apos a retirada do feto, M4. E a ultima afericao, ao termino da sutura da pele, M5. RESULTADOS: Ocorreu elevacao na pressao arterial do anestesiologista nos momentos M3 e M4. CONCLUSOES: A pratica anestesica realizada e responsavel por alteracao significativa da pressao arterial do anestesiologista e esta diretamente relacionada com os momentos de maior risco para o paciente durante o ato anestesico cirurgico.