TRANSTORNO DE ANSIEDADE GENERALIZADA: DO DIAGNÓSTICO AO TRATAMENTO

An integrative literature review is presented on generalized anxiety disorder, its clinical and epidemiological aspects, as well as the impact of this condition on the individual's life. Generalized Anxiety Disorder (GAD) is a neurological condition that can affect various activities or events in an individual's life, since the symptoms are usually excessive anxiety and worry that are disproportionate to the actual likelihood or impact of the anticipated event. These symptoms are difficult to control and cause suffering or impairment in social, professional or other areas of functioning. Diagnostic criteria are used to define the condition, which can coexist with other comorbidities. There is a need for a multidisciplinary team to intervene to improve patients' quality of life, as well as treatment aimed at the various aspects of this disorder.Apresenta-se uma revisão integrativa de literatura acerca do transtorno de ansiedade generalizada, seus aspectos clínicos, epidemiológicos, bem como o impacto dessa condição na vida do indivíduo. O Transtorno de Ansiedade Generalizada (TAG) é uma condição neurológica que pode atingir diversas atividades ou eventos da vida do indivíduo, uma vez que os sintomas costumam ser ansiedade e preocupação excessivas que são desproporcionais à probabilidade real ou ao impacto do evento antecipado. São sintomas difíceis de controlar e causam sofrimento ou prejuízo no funcionamento social, profissional ou em outras áreas. Utilizam-se critérios diagnósticos para definir o quadro, que pode coexistir com outras comorbidades. Há necessidade de uma equipe multidisciplinar para intervir na melhoria e na qualidade de vida dos pacientes, assim como um tratamento voltado para os vários aspectos que esse transtorno apresent

Níveis disfuncionais de ansiedade relacionada ao Coronavírus em estudantes de medicina: Dysfunctional levels of Coronavirus-related anxiety in medical students

As preocupações com a saúde mental das pessoas afetadas pela pandemia de coronavírus não foram abordadas adequadamente. Isso é surpreendente, uma vez que tragédias em massa, particularmente aquelas que envolvem doenças infecciosas, muitas vezes desencadeiam ondas de medo e ansiedade elevados que são conhecidos por causar perturbações maciças no comportamento e no bem-estar psicológico de muitos na população. Assim, o objetivo desse trabalho é demonstrar os níveis disfuncionais de ansiedade relacionada ao coronavírus em estudantes de medicina. Para isso, foi realizado uma revisão sistemática sobre a temática

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications