Rogério Luiz da Rocha Videira

Post spinal meningitis and asepsis

Background:  Post spinal meningitis (PSM) is a complication still currently being reported. After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department.

Preoxygenation in children: for how long?

Although preoxygenation has been extensively studied, to our knowledge this is the first study addressing its optimal length in children, who form a high risk group for developing hypoxaemia during induction of anaesthesia. Recommended preoxygenation times in children range between 1 and 4 min, but whether one of these times maintains arterial oxygen saturation (Sao2) at an adequate level for a longer time period is unknown. This study was performed on 11 healthy children, randomly distributed into either Group 1 (1 min of preoxygenation, n = 6) or Group 2 (3 min of preoxygenation, n = 5). Sao2 was measured by pulse oximetry. While the patients were breathing room air, Sao2 was similar in both groups (97%) and rose to 100% after preoxygenation in all patients. After intravenous induction of anaesthesia and muscle relaxation, all patients became apnoeic. The time taken for the Sao2 to decrease to 90% was measured. In Group 1 this occurred in 91 s, whereas Group 2 required 144 s. Thus, a 3‐min rather than a 1‐min period of preoxygenation would appear to maintain Sao2 at a safe level for a longer time in children.

Remifentanil na prática clínica

BACKGROUND AND OBJECTIVES Remifentanil is the newest opioid for anesthetic procedures. This study aimed at reviewing the literature, with emphasis on information of clinical interest published from January 2000 to December 2002. CONTENTS Major remifentanil studies are described and grouped by areas of interest for clinical anesthesia. Issues such as recommended dose, equipment and their correct use, transitional analgesia, as well as controversial indications, such as sedation, pediatric or obstetric surgery and intensive care, are discussed. CONCLUSIONS Remifentanil is currently the best opioid for continuous intravenous infusion and may improve anesthesiologists efficiency provided usage recommendations are followed.JUSTIFICATIVA E OBJETIVOS: O remifentanil e o opioide mais recentemente introduzido na pratica anestesica. O objetivo desse estudo foi rever a literatura, com enfase na informacao de interesse clinico publicada no periodo de janeiro de 2000 a dezembro de 2002. CONTEUDO: Os principais estudos sobre remifentanil sao descritos e agrupados por areas de interesse para a anestesia clinica. Aspectos como dose recomendada, equipamento e forma de uso, analgesia de transicao e areas em que o uso ainda e controverso, como para sedacao, cirurgia pediatrica, obstetrica e terapia intensiva, sao discutidos. CONCLUSOES: O remifentanil e atualmente o opioide mais adequado para administracao por infusao venosa continua e pode tornar mais eficiente a pratica clinica do anestesiologista ao serem seguidas as recomendacoes para o seu uso.

Description of Nosocomial Infection Prevention Practices by Anesthesiologists in a University Hospital

BACKGROUND AND OBJECTIVES Anesthesiologists play an important role in the prevention of nosocomial infections. In anesthetic practice, physiologic barriers are routinely breached, allowing patient contamination with microorganisms and the consequent development of infection. The lack of adhesion to recommended practices can facilitate transmission of microorganisms. It is important to describe prophylactic practices of anesthesia-related nosocomial infections performed by anesthesiologists. METHODS Structured questionnaires were distributed to be answered voluntarily and anonymously by anesthesiologists. RESULTS Among 112 anesthesiologists, 75% answered the questionnaire. Surgical mask is used by 95.2% of anesthesiologists, 96.3% wear gloves frequently, 98.9% wear sterile gloves for neuraxial block, 91.3% use sterile technique for central venous puncture, 95.1% wash their hands between cases, 91.6% try to maintain the endotracheal tube sterile, 96.3% discard the prefilled propofol syringe at the end of each anesthesia, 30% clean the vials before using it in the neuraxial blocks, and 19.8% clean the vials before intravenous use. CONCLUSIONS Respondents showed good adhesion to practices of nosocomial infection prophylaxis and to improve them educational multidisciplinary campaigns are necessary.

Remifentanil in the clinical practice.

BACKGROUND AND OBJECTIVES Remifentanil is the newest opioid for anesthetic procedures. This study aimed at reviewing the literature, with emphasis on information of clinical interest published from January 2000 to December 2002. CONTENTS Major remifentanil studies are described and grouped by areas of interest for clinical anesthesia. Issues such as recommended dose, equipment and their correct use, transitional analgesia, as well as controversial indications, such as sedation, pediatric or obstetric surgery and intensive care, are discussed. CONCLUSIONS Remifentanil is currently the best opioid for continuous intravenous infusion and may improve anesthesiologists efficiency provided usage recommendations are followed.JUSTIFICATIVA E OBJETIVOS: O remifentanil e o opioide mais recentemente introduzido na pratica anestesica. O objetivo desse estudo foi rever a literatura, com enfase na informacao de interesse clinico publicada no periodo de janeiro de 2000 a dezembro de 2002. CONTEUDO: Os principais estudos sobre remifentanil sao descritos e agrupados por areas de interesse para a anestesia clinica. Aspectos como dose recomendada, equipamento e forma de uso, analgesia de transicao e areas em que o uso ainda e controverso, como para sedacao, cirurgia pediatrica, obstetrica e terapia intensiva, sao discutidos. CONCLUSOES: O remifentanil e atualmente o opioide mais adequado para administracao por infusao venosa continua e pode tornar mais eficiente a pratica clinica do anestesiologista ao serem seguidas as recomendacoes para o seu uso.

Descrição das práticas de prevenção da infecção Hospitalar por anestesiologistas em um Hospital Universitário

JUSTIFICATIVA E OBJETIVOS: Os anestesiologistas desempenham importante papel na prevencao de infeccoes hospitalares. Na pratica anestesica, rotineiramente sao ultrapassadas as barreiras fisiologicas, possibilitando a contaminacao do paciente por micro-organismos e o desenvolvimento de infeccao. A nao adesao as praticas recomendadas pode facilitar a transmissao de micro-organismos. E importante descrever as praticas de profilaxia da infeccao hospitalar relacionadas ao ato anestesico executadas por medicos anestesiologistas. METODO: Foram distribuidos questionarios estruturados, preenchidos pelo proprio anestesiologista de forma voluntaria e anonima. RESULTADOS: Dentre os 112 anestesiologistas, 75% responderam ao questionario. A mascara cirurgica e usada por 95,2%, 96,3% usam luvas frequentemente, 98,8% usam luva esteril para bloqueio do neuroeixo, 91,3% adotam a tecnica esteril para puncao venosa central, 95,1% lavam as maos entre os casos, 91,6% procuram manter esteril a cânula de intubacao orotraqueal, 96,3% descartam o propofol em seringa ao final de cada anestesia, 30% limpam os frascos para uso no neuroeixo e 19,8% para uso endovenoso. CONCLUSOES: As praticas de profilaxia de infeccao hospitalar apresentaram boa adesao e, para melhora-las, e necessario realizar campanhas educacionais multidisciplinares.

Anestesia em criança com síndrome de Pallister-Killian: relato de caso

BACKGROUND AND OBJECTIVES Pallister-Killian Syndrome (PKS) is a rare genetic disease due to a mosaic anomaly of chromosome 12. There is little information about PKS in the anesthetic literature. This report aimed at discussing aspects of this syndrome that may be relevant to anesthesia. CASE REPORT A 5-year-old male patient with typical PKS characteristics (facial dimorphism, temporal alopecia, micrognathia, macroglossia, mental retardation, seizures and pigmentary skin lesions) was scheduled to magnetic resonance of the head under general anesthesia. He was induced and maintained with sevoflurane under facial mask and oropharyngeal canulla. Pulmonary ventilation was manually assisted during induction. There has been no complication and the procedure was performed in outpatient regimen. CONCLUSIONS The importance of a thorough preanesthetic evaluation is emphasized due to possible malformations associated to PKS, including cardiopathies. Attention to difficult intubation or maintenance of the airways is recommended.JUSTIFICATIVA E OBJETIVOS: A sindrome de Pallister-Killian (SPK) e uma doenca genetica rara causada por uma anomalia, em mosaico, no cromossomo 12. Ha pouca informacao sobre esta sindrome na literatura anestesica. O objetivo deste relato foi divulgar e discutir as caracteristicas que podem ser de interesse para a anestesia. RELATO DO CASO: Paciente do sexo masculino, 5 anos de idade, foi submetido a anestesia geral para a realizacao de ressonância magnetica do crânio. Apresentava as caracteristicas tipicas da SPK: dismorfismo facial, alopecia temporal, micrognatismo, macroglossia, retardo mental, convulsoes e alteracoes pigmentares cutâneas. A anestesia foi induzida e mantida com sevoflurano sob mascara facial e cânula orofaringea, com ventilacao assistida manual durante a inducao. Nao houve intercorrencias e o exame foi feito em regime ambulatorial. CONCLUSOES: A importância da avaliacao pre-anestesica e enfatizada, devido as malformacoes, inclusive cardiacas, associadas a esta sindrome. E recomendada a preparacao para possivel dificuldade de intubacao traqueal ou de manutencao das vias aereas.

Anesthesia in child with Pallister-Killian syndrome: case report

BACKGROUND AND OBJECTIVES Pallister-Killian Syndrome (PKS) is a rare genetic disease due to a mosaic anomaly of chromosome 12. There is little information about PKS in the anesthetic literature. This report aimed at discussing aspects of this syndrome that may be relevant to anesthesia. CASE REPORT A 5-year-old male patient with typical PKS characteristics (facial dimorphism, temporal alopecia, micrognathia, macroglossia, mental retardation, seizures and pigmentary skin lesions) was scheduled to magnetic resonance of the head under general anesthesia. He was induced and maintained with sevoflurane under facial mask and oropharyngeal canulla. Pulmonary ventilation was manually assisted during induction. There has been no complication and the procedure was performed in outpatient regimen. CONCLUSIONS The importance of a thorough preanesthetic evaluation is emphasized due to possible malformations associated to PKS, including cardiopathies. Attention to difficult intubation or maintenance of the airways is recommended.JUSTIFICATIVA E OBJETIVOS: A sindrome de Pallister-Killian (SPK) e uma doenca genetica rara causada por uma anomalia, em mosaico, no cromossomo 12. Ha pouca informacao sobre esta sindrome na literatura anestesica. O objetivo deste relato foi divulgar e discutir as caracteristicas que podem ser de interesse para a anestesia. RELATO DO CASO: Paciente do sexo masculino, 5 anos de idade, foi submetido a anestesia geral para a realizacao de ressonância magnetica do crânio. Apresentava as caracteristicas tipicas da SPK: dismorfismo facial, alopecia temporal, micrognatismo, macroglossia, retardo mental, convulsoes e alteracoes pigmentares cutâneas. A anestesia foi induzida e mantida com sevoflurano sob mascara facial e cânula orofaringea, com ventilacao assistida manual durante a inducao. Nao houve intercorrencias e o exame foi feito em regime ambulatorial. CONCLUSOES: A importância da avaliacao pre-anestesica e enfatizada, devido as malformacoes, inclusive cardiacas, associadas a esta sindrome. E recomendada a preparacao para possivel dificuldade de intubacao traqueal ou de manutencao das vias aereas.

Efeito do óxido nitroso sobre o consumo de fentanil em pacientes queimados submetidos à troca de curativo

BACKGROUND AND OBJECTIVES Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS The association of N2O was not effective in reducing opioid consumption during dressing changes.

Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change

BACKGROUND AND OBJECTIVES Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS The association of N2O was not effective in reducing opioid consumption during dressing changes.