Rosa Inês Costa Pereira

Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women

BackgroundTo evaluate the effectiveness and safety of water aerobics during pregnancy.MethodsA randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fishers or Students t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across time using MANOVA or Friedman multiple analysis.ResultsThere were no significant differences between the groups regarding maternal weight gain, BMI or percentage of body fat during pregnancy. Incidence of preterm births (RR = 0.84; 95%CI:0.28–2.53), vaginal births (RR = 1.24; 95%CI:0.73–2.09), low birthweight (RR = 1.30; 95%CI:0.61–2.79) and adequate weight for gestational age (RR = 1.50; 95%CI:0.65–3.48) were also not significantly different between groups. There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session.ConclusionWater aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition, type of delivery, preterm birth rate, neonatal well-being or weight.

Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes

BackgroundTo evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes.MethodsA randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Students t or Mann-Whitney tests. Wilks Lambda or Friedmans analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature.ResultsVO2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23–0.77). Neonatal results were similar in both groups.ConclusionThe regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. There was no influence on maternal cardiovascular capacity, duration of labor or type of delivery; however, there were fewer requests for analgesia during labor in the water aerobics group.

Spinal anesthesia for elective ceasarean section: use of different doses of hyperbaric bupivacaine associated with morphine and clonidine

PURPOSE To comparatively study the efficacy and maternal and fetal side-effects of two doses of bupivacaine associated with morphine and clonidine, administered by the subarachnoid route for cesarean section. METHODS The study included 66 pregnant women at term, distributed into two groups. GI: bupivacaine 8.0 mg (1.6 mL) + clonidine 75 µg (0.5 mL) + morphine 100 µg (1.0 mL) and GII: bupivacaine 10 mg (2.0 mL) + clonidine 75 µg (0.5 mL) + morphine 100 µg (1.0 mL). The following parameters were assessed: onset and maximum level of sensory block; quality of intraoperative and postoperative analgesia; degree and duration of motor block; maternal repercussions and Apgar score. RESULTS The onset of sensory block, quality of intraoperative analgesia and total duration of analgesia were similar in both groups; maximum extent of sensory block predominated in T4; maximum degree of motor block (Bromage 3); time motor block regression was significantly longer in GII; Hemodynamic, respiratory repercussions, adverse maternal effects and Apgar scores were similar between groups. In both groups, there was a predominance of drowsy or sleeping patients. CONCLUSION The addition of morphine and clonidine to low doses of hyperbaric bupivacaine produced adequate anesthesia for cesarean section and good postoperative analgesia, without any maternal and fetal repercussions.

Fetal cardiotocography before and after water aerobics during pregnancy

ObjectiveTo evaluate the effect of moderate aerobic physical activity in water on fetal cardiotocography patterns in sedentary pregnant women.MethodIn a non-randomized controlled trial, 133 previously sedentary pregnant women participated in multiple regular sessions of water aerobics in a heated swimming pool. Cardiotocography was performed for 20 minutes before and just after the oriented exercise. Cardiotocography patterns were analyzed pre- and post-exercise according to gestational age groups (24-27, 28-31, 32-35 and 36-40 weeks). Students t and Wilcoxon, and McNemar tests were used, respectively, to analyze numerical and categorical variables.ResultsNo significant variations were found between pre- and post-exercise values of fetal heart rate (FHR), number of fetal body movements (FM) or accelerations (A), FM/A ratio or the presence of decelerations. Variability in FHR was significantly higher following exercise only in pregnancies of 24-27 weeks.ConclusionsModerate physical activity in water was not associated with any significant alterations in fetal cardiotocography patterns, which suggests no adverse effect on the fetus.

Influência da técnica anestésica nas alterações hemodinâmicas no transplante renal: estudo retrospectivo

JUSTIFICATIVA Y OBJETIVOS: El exito en el transplante renal (Tx) depende del tipo de donador, de la duracion de la isquemia fria y de los parametros hemodinamicos en la reperfusion. El objetivo de esta investigacion fue analizar la tecnica anestesica, la incidencia de alteraciones cardiovasculares y el aparecimiento de diuresis en el periodo perioperatorio de los Tx realizados en la UNICAMP. METODO: Se evaluo retrospectivamente Tx de adultos realizados entre enero de 2005 y abril de 2006. Se tuvieron en cuenta los datos demograficos, los examenes laboratoriales preoperatorios, tecnicas y agentes anestesicos, hidratacion, parametros hemodinamicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con analisis comparativo entre los subgrupos formados conforme a la tecnica anestesica empleada. Se usaron en el analisis estadistico el test t de Student (parametricos), Mann-Whitney (no parametricos), test del Cui-cuadrado y Exacto de Fisher para la comparacion de proporciones y analisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG) y 33 anestesia general asociada a la epidural (AG + Peri), 42 recibieron rinones de donantes vivos y 50 de fallecidos. No hubo diferencia (p < 0,05) en la mayoria de los parametros preoperatorios estudiados, con excepcion del origen del injerto (82% AG + Peri recibieron rinones de donante fallecido). La alteracion cardiovascular mas frecuente fue la hipotension arterial (30% AG y 48% AG + Peri, p < 0,05). El regimen de hidratacion no fue diferente entre los grupos (86,7 ± 30,2 mL.kg-1 AG y 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). El injerto del donante fallecido se correlaciono con una mayor inestabilidad hemodinamica y con un peor pronostico para la funcion inmediata del injerto, p < 0,01 y 0,01 respectivamente. Un volumen de hidratacion de 80 mL.kg-1 se asocio a la diuresis (OR = 2,94, IC95% 1,00-8,32). CONCLUSIONES: La tecnica anestesica empleada fue anestesia general, asociada o no a la epidural. La alteracion hemodinamica mas comun fue la hipotension arterial. Se mostraron beneficos con relacion a la diuresis por ser de un receptor de donante vivo y recibir una hidratacion de 80 mL.kg-1 de solucion fisiologica a 0,9%.BACKGROUND AND OBJECTIVES The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7+/- 30.2 mL.kg(-1) GA and 94.8 +/- 21.8 mL.kg(-1) GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg(-1) was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg(-1) of NS favored diuresis.

Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study

JUSTIFICATIVA Y OBJETIVOS: El exito en el transplante renal (Tx) depende del tipo de donador, de la duracion de la isquemia fria y de los parametros hemodinamicos en la reperfusion. El objetivo de esta investigacion fue analizar la tecnica anestesica, la incidencia de alteraciones cardiovasculares y el aparecimiento de diuresis en el periodo perioperatorio de los Tx realizados en la UNICAMP. METODO: Se evaluo retrospectivamente Tx de adultos realizados entre enero de 2005 y abril de 2006. Se tuvieron en cuenta los datos demograficos, los examenes laboratoriales preoperatorios, tecnicas y agentes anestesicos, hidratacion, parametros hemodinamicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con analisis comparativo entre los subgrupos formados conforme a la tecnica anestesica empleada. Se usaron en el analisis estadistico el test t de Student (parametricos), Mann-Whitney (no parametricos), test del Cui-cuadrado y Exacto de Fisher para la comparacion de proporciones y analisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG) y 33 anestesia general asociada a la epidural (AG + Peri), 42 recibieron rinones de donantes vivos y 50 de fallecidos. No hubo diferencia (p < 0,05) en la mayoria de los parametros preoperatorios estudiados, con excepcion del origen del injerto (82% AG + Peri recibieron rinones de donante fallecido). La alteracion cardiovascular mas frecuente fue la hipotension arterial (30% AG y 48% AG + Peri, p < 0,05). El regimen de hidratacion no fue diferente entre los grupos (86,7 ± 30,2 mL.kg-1 AG y 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). El injerto del donante fallecido se correlaciono con una mayor inestabilidad hemodinamica y con un peor pronostico para la funcion inmediata del injerto, p < 0,01 y 0,01 respectivamente. Un volumen de hidratacion de 80 mL.kg-1 se asocio a la diuresis (OR = 2,94, IC95% 1,00-8,32). CONCLUSIONES: La tecnica anestesica empleada fue anestesia general, asociada o no a la epidural. La alteracion hemodinamica mas comun fue la hipotension arterial. Se mostraron beneficos con relacion a la diuresis por ser de un receptor de donante vivo y recibir una hidratacion de 80 mL.kg-1 de solucion fisiologica a 0,9%.BACKGROUND AND OBJECTIVES The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7+/- 30.2 mL.kg(-1) GA and 94.8 +/- 21.8 mL.kg(-1) GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg(-1) was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg(-1) of NS favored diuresis.

Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study

PURPOSE To evaluate the efficacy and side-effects of fentanyl and sufentanil combined with hyperbaric spinal bupivacaine in elective cesarean section. METHODS A prospective, randomized, double-blind study with 64 term parturients, distributed into 2 groups according to the opioid combined with hyperbaric bupivacaine 0.5% (10mg): GF - fentanyl (25 µg) and GS - sufentanil (5.0 µg). The latency and maximum sensory block level; degree and duration of motor block; duration and quality of analgesia; maternal-fetal repercussions were evaluated. This was an intention-to-treat analysis with a 5% significance level. RESULTS The latency period, maximum sensory block level, motor block degree and perioperative analgesia were similar in both groups. Motor block and analgesia had a longer duration in the sufentanil group. Maternal adverse effects and neonatal repercussions were similar. The incidence of hypotension was higher in the fentanyl group. In both groups, there was a predominance of patients who were awake and either calm or sleepy. CONCLUSIONS The addition of fentanyl and sufentanil to hyperbaric subarachnoid bupivacaine was shown to be effective for the performance of cesarean section, and safe for the mother and fetus. Analgesia was more prolonged with sufentanil.

Epidural block for cesarean section: a comparative study between 0.5% racemic Bupivacaine (S50-R50) and 0.5% enantiomeric excess Bupivacaine (S75-R25) associated with Sufentanil

BACKGROUND AND OBJECTIVES Epidural 0.5% racemic bupivacaine associated with opioids is a technique used in cesarean sections; however, its toxicity has been questioned. 50% Enantiomeric excess bupivacaine has lower cardio- and neurotoxicity. The efficacy of epidural 0.5% racemic bupivacaine and 0.5% enantiomeric excess bupivacaine associated with sufentanil in parturients undergoing cesarean sections was evaluated. METHODS Fifty gravida at term, undergoing elective cesarean section under epidural block, were divided in two groups according to the local anesthetic used: Group I - 0.5% racemic bupivacaine with vasoconstrictor; and Group II - 0.5% enantiomeric excess bupivacaine (S75-R25) with vasoconstrictor. In both groups, the local anesthetic (100 mg) was associated with sufentanil (20 microg), and a total of 24 mL of the solution was used. The following parameters were evaluated: latency of the sensitive blockade; maximal level of the sensitive blockade; degree for motor blockade; time of motor blockade regression; duration of analgesia; maternal side effects; and neonatal repercussions. RESULTS Latency, maximal level of sensitive blockade, degree of motor blockade, and duration of analgesia were similar in both groups; the mean time for regression of the motor blockade was significantly smaller in Group II. The incidence of side effects was similar in both groups. Maternal cardiocirculatory changes and neonatal repercussions were not observed. CONCLUSIONS Epidural racemic bupivacaine and 50% enantiomeric excess bupivacaine provided adequate anesthesia for cesarean sections. 50% Enantiomeric excess bupivacaine is a promising alternative for this procedure, since it has faster regression of the motor blockade, which is desirable in obstetric patients.

Analgesia peridural para o trabalho de parto e para o parto: efeitos da adição de um opióide

O objetivo deste estudo foi avaliar a eficacia e seguranca da associacao bupivacaina com sufentanil para a analgesia no trabalho de parto e do parto por meio de um bloqueio peridural continuo. Realizou-se um ensaio clinico duplo-cego, prospectivo e aleatorio, incluindo sessenta mulheres nuliparas da Maternidade do CAISM/UNICAMP. No momento da analgesia, as mulheres foram aleatoriamente alocadas em dois grupos: BS, recebendo 12,5 mg de bupivacaina com adrenalina mais 30 µg de sufentanil e BP, recebendo 12,5 mg de bupivacaina com adrenalina mais placebo. Foram avaliados os parâmetros relativos a qualidade e duracao da analgesia, duracao do trabalho de parto e tambem possiveis efeitos sobre o recem-nascido. Os resultados mostraram a superioridade da adicao do sufentanil sobre o grau de analgesia durante o tempo de acao da primeira dose de anestesico local. Nao houve aumento na duracao do trabalho de parto depois do inicio da analgesia quando se compararam ambos os grupos, nem qualquer diferenca quanto a via de parto. Nao houve tambem diferencas entre os grupos com relacao a avaliacao dos recem-nascidos. Conclui-se que a associacao de 30 µg de sufentanil a primeira dose de bupivacaina e segura e eficaz, melhorando a qualidade da analgesia, sua duracao e nao afetando a progressao do trabalho de parto e o resultado neonatal.

Influencia de la técnica anestésica en las alteraciones hemodinámicas en el transplante renal: estudio retrospectivo

JUSTIFICATIVA Y OBJETIVOS: El exito en el transplante renal (Tx) depende del tipo de donador, de la duracion de la isquemia fria y de los parametros hemodinamicos en la reperfusion. El objetivo de esta investigacion fue analizar la tecnica anestesica, la incidencia de alteraciones cardiovasculares y el aparecimiento de diuresis en el periodo perioperatorio de los Tx realizados en la UNICAMP. METODO: Se evaluo retrospectivamente Tx de adultos realizados entre enero de 2005 y abril de 2006. Se tuvieron en cuenta los datos demograficos, los examenes laboratoriales preoperatorios, tecnicas y agentes anestesicos, hidratacion, parametros hemodinamicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con analisis comparativo entre los subgrupos formados conforme a la tecnica anestesica empleada. Se usaron en el analisis estadistico el test t de Student (parametricos), Mann-Whitney (no parametricos), test del Cui-cuadrado y Exacto de Fisher para la comparacion de proporciones y analisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG) y 33 anestesia general asociada a la epidural (AG + Peri), 42 recibieron rinones de donantes vivos y 50 de fallecidos. No hubo diferencia (p < 0,05) en la mayoria de los parametros preoperatorios estudiados, con excepcion del origen del injerto (82% AG + Peri recibieron rinones de donante fallecido). La alteracion cardiovascular mas frecuente fue la hipotension arterial (30% AG y 48% AG + Peri, p < 0,05). El regimen de hidratacion no fue diferente entre los grupos (86,7 ± 30,2 mL.kg-1 AG y 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). El injerto del donante fallecido se correlaciono con una mayor inestabilidad hemodinamica y con un peor pronostico para la funcion inmediata del injerto, p < 0,01 y 0,01 respectivamente. Un volumen de hidratacion de 80 mL.kg-1 se asocio a la diuresis (OR = 2,94, IC95% 1,00-8,32). CONCLUSIONES: La tecnica anestesica empleada fue anestesia general, asociada o no a la epidural. La alteracion hemodinamica mas comun fue la hipotension arterial. Se mostraron beneficos con relacion a la diuresis por ser de un receptor de donante vivo y recibir una hidratacion de 80 mL.kg-1 de solucion fisiologica a 0,9%.BACKGROUND AND OBJECTIVES The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7+/- 30.2 mL.kg(-1) GA and 94.8 +/- 21.8 mL.kg(-1) GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg(-1) was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg(-1) of NS favored diuresis.