Sérgio de Souza Oliveira

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Background Prolonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap. Methods Patients (18–90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study. The actual and prescribed times for fasting were collected and correlated with sex, age, surgical disease (malignancies or benign disease), operation type, American Society of Anesthesiologists score, type of hospital (public or private), and nutritional status. Results A total of 3,715 patients (58.1% females) with a median age of 49 (18–94) years from 16 Brazilian hospitals entered the study. The median (range) preoperative fasting time was 12 (2–216) hours, and fasting time was longer (P<0.001) in hospitals using a traditional fasting protocol (13 [6–216] hours) than in others that had adopted new guidelines (8 [2–48] hours). Almost 80% (n=2,962) of the patients were operated on after 8 or more hours of fasting and 46.2% (n=1,718) after more than 12 hours. Prolonged fasting was not associated with physical score, age, sex, type of surgery, or type of hospital. Patients operated on due to a benign disease had an extended duration of preoperative fasting. Conclusion Actual preoperative fasting time is significantly longer than prescribed fasting time in Brazilian hospitals. Most of these hospitals still adopt traditional rather than modern fasting guidelines. All patients are at risk of long periods of fasting, especially those in hospitals that follow traditional practices.

Prevalência da hepatite B em área rural de município hiperendêmico na Amazônia Mato-grossense: situação epidemiológica

Summary An outbreak of hepatitis B was identified in 1995, involving farmers recently settled in Cotriguacu county, in northwestern Mato Grosso State, Brazil. A vaccination campaign was performed after the report. In the following years the vaccination strategy remained, specially focused on the new immigrants still arriving. To assess the current epidemiological situation and the impact of prior vaccination a new survey of hepatitis B virus (HBV) markers was carried out in 2001. Nova Uniao community was chosen because at present it has been the most attractive site to migrants. The study included 838 subjects. The overall seroprevalence of HBV markers was 40.0%; 2.1% were HBV carriers, and 40.8% were protected by vaccine. Among HBV carriers, 28% had serological marker for hepatitis B. The HBV markers-associated variables were: sexual activity; regular use of alcohol; hepatitis case communicant; and having lived in gold mining camps. The moderate prevalence of HBV markers observed in the current study is lower than the high HBV prevalence noted in 1995. HBV was associated with increasing age and initiation of sexual activity. Since immigration to this area remains intense, it is recommended that mass vaccination should be continued. The progressive entry of HDV in this region should keep public health authorities on alert.

A abreviação do jejum pré-operatório para duas horas com carboidratos aumenta o risco anestésico?

JUSTIFICATIVA Y OBJETIVOS: El objetivo del presente estudio, fue evaluar el surgimiento de posibles complicaciones anestesicas relacionadas con la reduccion del ayuno preoperatorio en dos horas con una solucion que contiene dextrinomaltosa a 12,5% dentro del proyecto ACERTO (Aceleracion de la Recuperacion Total Postoperatoria). METODO: Se evaluaron de forma prospectiva, todos los pacientes sometidos a diversas operaciones sobre el tracto digestivo y la pared abdominal, dentro de un nuevo protocolo de conductas perioperatorias establecidas por el proyecto ACERTO, entre agosto de 2005 y diciembre de 2007. Todos recibieron el suplemento nutricional (dextrinomaltosa a 12,5%) por via oral seis y dos horas antes del procedimiento quirurgico. La recoleccion de datos fue prospectiva sin que los profesionales del servicio lo supieran. Se observo el tiempo de ayuno preoperatorio y las complicaciones anestesicas relacionadas con el corto tiempo de ayuno (broncoaspiracion). RESULTADOS: Se evaluaron 375 pacientes, siendo de ellos 174 hombres (un 46,4%) y 201 mujeres (un 53,6%), entre 18 y 90 anos de edad. El tiempo promedio de ayuno preoperatorio fue de cuatro horas, variando de 2 a 20 horas. No se registro ningun caso de broncoaspiracion durante los procedimientos. El tiempo de ayuno fue mayor (p < 0,01) cuando se practico el procedimiento anestesico asociado (bloqueo + general). CONCLUSIONES: La adopcion de las medidas multidisciplinarias perioperatorias del proyecto ACERTO, no conllevo a ninguna complicacion relacionada con el ayuno preoperatorio. La dextrinomaltosa es el suplemento nutricional mas util y seguro para el paciente.

Does Abbreviation of Preoperative Fasting to Two Hours with Carbohydrates Increase the Anesthetic Risk

BACKGROUND AND OBJECTIVES The objective of the present study was to evaluate the incidence of possible anesthetic complications related with the abbreviation of preoperative fasting to two hours with a solution of 12.5% dextrinomaltose within the ACERTO (from the Portuguese for Acceleration of Total Postoperative Recovery) project. METHODS All patients undergoing different types of digestive tract and abdominal wall surgeries within a new protocol of perioperative conducts, established by the ACERTO project, between August 2005 and December 2007 were evaluated. All patients received oral nutritional supplementation (12.5% dextrinomaltose) six and two hours before the procedure. Data were collected prospectively without the knowledge of the professionals in the department. The length of preoperative fasting and anesthetic complications related with the short fasting time (pulmonary aspiration) were recorded. RESULTS Three hundred and seventy five patients, 174 male (46.4%) and 201 female (53.6%), ages 18 to 90 years, were evaluated. The mean preoperative fasting time was four hours, ranging from two to 20 hours. Pulmonary aspiration was not observed during the procedures. The length of fasting was longer (p < 0.01) when combined anesthesia (blockade + general) was used. CONCLUSIONS Adopting the multidisciplinary preoperative measures of the ACERTO project was not associated with any preoperative fasting-associated complications. Dextrinomaltose is a useful and safe nutritional supplement for the patient.

A Associação de Haloperidol, Dexametasona e Ondansetrona Reduz a Intensidade de Náusea, Dor e Consumo de Morfina após Gastrectomia Vertical Laparoscópica☆

BACKGROUND AND OBJECTIVE Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). METHOD A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index ≥ 35 kg.cm-2. Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2 mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. RESULTS Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). CONCLUSION The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

Combination of Haloperidol, Dexamethasone, and Ondansetron Reduces Nausea and Pain Intensity and Morphine Consumption after Laparoscopic Sleeve Gastrectomy

BACKGROUND AND OBJECTIVE Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). METHOD A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index ≥ 35 kg.cm(-2). Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. RESULTS Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). CONCLUSION The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

Situação atual da hepatite B e D na região de Cotriguaçu, Amazônia Mato-grossense, 2001

Em 1195 foi identificada epidemia comunitaria de hepatite b entre colonos entao recentmente assentados em Cotriguacu, no noroeste mato-grossense. Houve campanha de vacinacao nos municipios da regiao. Nos anos seguintes, manreve-se a estrategias de vacinar os migrantes que continuaram chegando. Para avaliar a atual situacao da infeccao pelo VHB na regiao rural de Cotriguacu, foi planejado inquerito sobre a prevalencia dos marcadores do virus da hepatite B (VHB) e do virus da Hepatite D (VHD) em 2001(AU)