Sonia Maria Faresin

Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia

The production process comprises A) forming an acidic aqueous solution comprising alkali metal cations, bromide anions, and sulfamate anions; B) feeding into said aqueous solution a source of alkali metal cations and chlorine-containing bromide oxidant proportioned to keep the resultant aqueous medium acidic and to form an acidic product solution containing at least about 5 wt % of active bromine, and C) raising the pH of the aqueous product solution with water-soluble base to at least about 10.

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery.

OBJECTIVE To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN Prospective clinical trial. SETTING A tertiary university hospital. PATIENTS 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patients pulmonary status.

Efeitos do local de inserção do dreno pleural na função pulmonar no pós-operatório de cirurgia de revascularização do miocárdio

OBJECTIVE: To analyze the pulmonary function changes and pain in patients undergoing off-pump coronary artery bypass grafting utilizing a left internal thoracic artery graft, comparing the pleural drain insertion through the intercostal space and subxyphoid approach. METHODS: Twenty eight patients (mean age 57.4 ± 8.4 years) were divided into two groups, according to the pleural drain site. Group IL (n=15) had the pleural drain inserted through the sixth left intercostal space at the mid-axillary line and in the IM group (n=13) the drain was placed through the subxyphoid region. All the patients underwent pre- and post-operative evaluation of pulmonary function tests as well as arterial blood gas analysis. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were recorded in the preoperative period, and in the first, third and fifth postoperative days. The pain sensation was evaluated using a standard score from 0 to 10. RESULTS: In both groups falls in FVC and FEV1 were noted, up to the fifth postoperative day (P<0.001). However, the decrease was higher in the IL group, when compared to the IM group (p<0.05). Also arterial blood gas analysis showed a decline of the partial oxygen pressure in both groups on the fist postoperative day, but more significantly in the IL group (p=0.021). The pain sensation was higher in the IL group (p=0.002). CONCLUSION: Off-pump coronary artery bypass grafting with using of left internal thoracic artery, disregarding the pleural drain site, leads to a significant decrease of postoperative pulmonary function. However, the subxyphoid technique of drain insertion has shown a better preservation of the lung function when compared to the intercostal drain site.

Pressões respiratórias máximas e capacidade vital: comparação entre avaliações através de bocal e de máscara facial

INTRODUCAO: A medida das pressoes respiratorias maximas e a capacidade vital sao importantes na avaliacao da funcao pulmonar, no entanto, variacoes metodologicas podem interferir na interpretacao dos resultados obtidos. OBJETIVO: Comparar os valores das pressoes respiratorias maximas e da capacidade vital, obtidos atraves de bocal e de mascara facial. METODO: Foram estudados 30 pacientes (16 homens), com idade de 55,9 ± 15,7 anos, em periodo pre-operatorio de cirurgia abdominal. As variaveis pressao inspiratoria maxima, pressao expiratoria maxima e capacidade vital foram avaliadas atraves de um bocal rigido achatado e de uma mascara facial, em ordem randomizada. RESULTADOS: A avaliacao com mascara facial nao alterou de forma significativa os valores de capacidade vital e pressao inspiratoria maxima, porem a pressao expiratoria maxima foi significantemente menor do que quando avaliado com bocal rigido. A presenca de escape aereo ao redor da mascara durante a medida da pressao expiratoria maxima foi observada em 60% das avaliacoes. Quando consideradas apenas as medidas de pressao expiratoria maxima avaliadas sem a presenca de escape de ar, os valores com o uso da mascara foram maiores do que os com o bocal. CONCLUSAO: A avaliacao da pressao inspiratoria maxima e capacidade vital pode ser realizada com uso de mascara facial, sem interferencia nos resultados obtidos. A avaliacao da pressao expiratoria maxima atraves de mascara facial mostrou-se adequado quando foi possivel evitar o escape de ar ao redor da mascara, porem a grande prevalencia de vazamentos e a consequente reducao dos valores obtidos na avaliacao tornam seu uso limitado.

Evaluation of pulmonary function in patients following on and off-pump coronary artery bypass grafting

OBJECTIVE: To evaluate and compare the pulmonary function in patients following on- and off-pump coronary artery bypass grafting (CABG). METHOD: Thirty patients (mean age 56.76 ± 10.20 years) were allocated to two groups, according to the use or not of cardiopulmonary bypasses: group A (n=15) off-pump and group B (n=15) on-pump, with all patients undergoing pre- and post-operative evaluation of the pulmonary function as well as arterial blood gases analysis. Forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1) were recorded in the preoperative period, and on the first, third and fifth postoperative days. Blood gases were evaluated in the preoperative period and on the first postoperative day. RESULTS: In both groups, significant falls in the FVC and FEV1 were detected up to the fifth postoperative day (p<0.05). When both groups were compared, the decreases in FCV and VEF1 were higher in group B (p<0.05). PaO2 values and the PaO2/FiO2 ratio presented significant drops on the first postoperative day in both groups, however the fall was higher in group B (p<0.05). CONCLUSION: Patients who undergo CABG, regardless of the use of CPB, display a significant reduction in the postoperative pulmonary function. However, patients who undergo off-pump CABG have a better preservation of the lung function compared to on-pump CABG.

Validade de um índice prognóstico para ocorrência de complicações pulmonares no pós-operatório de cirurgia abdominal alta

OBJCTIVE: To validate a previous prognostic index (Pereira et al.) to postoperative pulmonary complication in elective upper abdominal surgery, and observe the risk factor for mortality in this population. METHODS: 283 patients were followed from pre to postoperative period. They were followed in a protocol including a clinical questionnaire, physical examination, thoracic radiogram and spirometry at pre operative period. The main variables measured were: clinical and functional subjects characteristics at pre operative, type of surgery, duration of surgery, time spent in intensive care unit and hospitalization and the occurrence of pulmonary complication. RESULTS: 69 patients had pulmonary complications (24.4%), in 87 events registered. These occurred because some patients had more than one complication. Pneumonia was the most frequent event 34% (30/87) followed by atelectasis 24% (21/87), bronchoconstriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). The multiple logistic regression (MLR) showed the association between age above 56 years old (p = 0.0039); DS > 210 (p = 0.0044) and previous chronic pneumopathy (p = 0.0257) and postoperative pulmonary complication. The frequency of postoperative pulmonary complication observed in each categorical classis based on previous index (Pereira equation) did not differ statistically from the prognostic rate calculated, showing the validity of the prognostic index. When FEV1/FVC was included in MLR, the patients with VEF1/FVC 210 minutes showed a statistically lower number of pulmonary postoperative compared with estimated by the previous Pereira index. The mortality analyses showed significant association with comorbidity, number of days in care unit and postoperative pulmonary complication, however in the MLR only postoperative pulmonary complication had a significant association with death (p = 0.003). CONCLUSIONS: The index based on Pereira equation is valid to estimate the prognosis of postoperative pulmonary complication after elective upper abdominal surgery. Age higher 56 years old, duration of surgery more than 210 minutes and pneumopathy are important markers of postoperative pulmonary complication. The only significant marker for mortality was the post operative pulmonary complication.

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

Custo-efetividade de programa de educação para adultos asmáticos atendidos em hospital-escola de instituição pública

The direct costs incurred in managing patients with poorly controlled asthma are high and educational programs could decrease these costs. Aim: The objectives of this study were to compare the direct cost of the implementation of an educational program for adult asthmatic patients with the cost of the usual care delivered to asthmatics by specialists. Methods: Five years ago, a six-month study demonstrated that an educational program improved clinical outcomes (22 in educational program-E and 20 patients in control group-C). Throughout the educational intervention period all cases of hospitalization, emergency and regular calls involving patients from both groups were recorded. The basis for the values utilized in the calculation of costs was the healthcare database of the Brazilian government (DATASUS). The overall medication cost/patient in both groups was based on the amount of medication taken during the month preceding the last call. The final values were converted into US dollars. Results: The mean direct cost/patient in the educational (E) and control (C) groups and the difference (D) between groups were: hospitalizations (C = US

Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

183, E = 0, D = US

Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients

183); emergency calls (C = US