O efeito da "sedação multifásica" no exame de tomografia computadorizada e ressonância magnética em crianças, pais e anestesiologistas

JUSTIFICATIVA E OBJETIVOS: O nosso objetivo foi investigar o efeito da "sedação multifásica" em crianças submetidas à Tomografia Computadorizada (TC) ou Ressonância Magnética (RM), em seus pais e nos anestesiologistas responsáveis. "Sedação multifásica" foi definida como "o nível de sedação pretendido obtido com um ou mais agentes através da mesma via ou vias diferentes com mais de uma administração". MATERIAL E MÉTODOS: Cem crianças e seus respectivos pais foram randomicamente designados para um dos dois grupos de estudo. Na fase 1, os pacientes do Grupo I receberam midazolam (0,5 mg.kg-1) em 5 mL de suco de frutas e os pacientes do Grupo II (grupo controle) receberam apenas suco de frutas. Na fase 2, após a canulação intravenosa (iv), bolus de propofol foi administrado para alcançar a sedação adequada para realização do exame de imagem. Os escores de ansiedade das crianças e de seus pais foram registrados usando a escala de Oucher e o IDATE, respectivamente, e a satisfação dos pais foi avaliada pela escala analógica visual (EAV). O número de tentativas para canulação iv, tempo de preparação e quantidade de hipnóticos foram registrados. RESULTADOS: O estado de ansiedade das crianças foi semelhante entre os grupos antes da pré-medicação, porém mais tarde esse nível foi menor no Grupo I. Antes do procedimento, o escore dos pais no IDATE foi semelhante, mas depois foi menor no Grupo I. A satisfação dos pais no Grupo I foi maior que no Grupo II. O número de tentativas de canulação iv e a dose necessária de propofol foi menor no Grupo I. CONCLUSÃO: O procedimento de "sedação multifásica" diminui a dor e a ansiedade das crianças e a ansiedade dos pais, aumentando a sua satisfação. Ele fornece uma sedação confortável e segura, pois possui um processo de preparação curto e sem problemas também para o anestesiologista responsável

Monitorization of the effects of spinal anaesthesia on cerebral oxygen saturation in elder patients using near-infrared spectroscopy

OBJECTIVE: Central blockage provided by spinal anaesthesia enables realization of many surgical procedures, whereas hemodynamic and respiratory changes influence systemic oxygen delivery leading to the potential development of series of problems such as cerebral ischemia, myocardial infarction and acute renal failure. This study was intended to detect potentially adverse effects of hemodynamic and respiratory changes on systemic oxygen delivery using cerebral oxymetric methods in patients who underwent spinal anaesthesia. METHODS: Twenty-five ASA I-II Group patients aged 65-80 years scheduled for unilateral inguinal hernia repair under spinal anaesthesia were included in the study. Following standard monitorization baseline cerebral oxygen levels were measured using cerebral oximetric methods. Standardized Mini Mental Test (SMMT) was applied before and after the operation so as to determine the level of cognitive functioning of the cases. Using a standard technique and equal amounts of a local anaesthetic drug (15 mg bupivacaine 5%) intratechal blockade was performed. Mean blood pressure (MBP), maximum heart rate (MHR), peripheral oxygen saturation (SpO2) and cerebral oxygen levels (rSO2) were preoperatively monitored for 60 min. Pre- and postoperative haemoglobin levels were measured. The variations in data obtained and their correlations with the cerebral oxygen levels were investigated. RESULTS: Significant changes in pre- and postoperative measurements of haemoglobin levels and SMMT scores and intraoperative SpO2 levels were not observed. However, significant variations were observed in intraoperative MBP, MHR and rSO2 levels. Besides, a correlation between variations in rSO2, MBP and MHR was determined. CONCLUSION: Evaluation of the data obtained in the study demonstrated that post-spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, this downward change did not result in deterioration of cognitive functioning

Can we use magnesium for sedation in the intensive care unit for critically ill patients: Is it as effective as other sedatives?

Objectives: The aim of this prospective, randomized study was to investigate the effect of magnesium added to midazolam on the hemodynamics, transition time to a T-piece, mechanical ventilation duration, additional sedative-analgesic requirement using bispectral index (BIS) monitorization and sedation scales

Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation

Background: This study was conducted to compare the efficacy and effects of dexmedetomidine and midazolam in preoperative sedation. Materials and Methods: A total of 125 patients in American Society of Anaesthesiologists (ASA) I-II were divided into three groups: Group I (n = 40) for controls, Group II (n = 40) for Dexmedetomidine (1 μg/kg), and group III was the midazolam group (n = 45). Group III was further divided into three subgroups according to the doses of midazolam: Group IIIA (n = 15) received 0.02 mg/kg, group IIIB (n = 15) received 0.04 mg/kg, and group IIIC (n = 15) received 0.06 mg/kg of midazolam. Drugs were infused over a 10-minute period with appropriate monitoring. Ramsay and visual analog scores, for sedation and anxiety, respectively, and mean arterial pressure, heart rate, and SpO 2 measurement, including respiratory rates were recorded, every 5 minutes for 30 minutes following infusion. Results: There was marked sedation and a decrease in anxiety in groups II and IIIC (P < 0.01). Mean arterial pressure (MAP) and heart rate (HR) decreased significantly in group II (P < 0.01 and P < 0.05, respectively), but there was no associated hypotension (MAP <60 mm Hg) or bradycardia (HR <50 bpm) (P < 0.05). Respiratory rates and SpO 2 values decreased in groups II, IIIA, IIIB, and IIIC. The differences in respiratory rates were not significant (P > 0.05); however, decrease in SpO 2 was significant in group IIIC (P < 0.01). Conclusions: Dexmedetomidine was as effective as higher doses of midazolam in sedation. The hemodynamic and respiratory effects were minimal. Although dexmedetomidine caused significant decrease in the blood pressure and heart rate, it probably just normalized increased levels caused by preoperative stress

The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A Preliminary Study

Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG

USG guided hemodialysis catheter insertion in sitting position: a case report

The use of USG has recently become more popular in anesthesia practice. The use of USG increases the success of the practice and protects the patient from possible complications. In this case, the benefits of hemodialysis catheter placement, procedural difficulties, and the use of USG are shared in a USG-accompanied patient who is expected to be difficult to administer. The use of USG increases the success of the attempted procedure and seriously reduces the complication rate especially in complicated patients. As in this case, we believe that the use of USG in such procedures will benefit many patients and practitioners and it would be beneficial to implement it routinely

The Effect of Pomegranate Juice on Diabetes-Related Oxidative Stress in Rat Lung

Objective: It is known that diabetes leads to depletion of the cellular antioxidant defense system and this causes the organ injuries related to the diabetic complications. Antioxidants have been shown to reduce indices of oxidative stress measures in experimental disease models and in humans. The present study was designed to evaluate the oxidative stress in lungs as well as the therapeutic effect of pomegranate juice (PJ), as an antioxidant, in rats with streptozotocin-induced diabetes. Material and Methods: Twenty seven rats were enrolled in the study where diabetes was induced by streptozotocin injection. Rats were treated with either PJ or saline for 10 weeks, and their lungs were harvested for histologic and immunohistochemical evaluation at the end. Protein carbonyl content (PCC), sialic acid (SA), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured in the pulmonary tissue as well as the presence of endothelial nitric oxide synthase (eNOS), through immunohistochemistry. Results: The pulmonary tissue in diabetic rats showed oxidative alterations related to the streptozotocin treatment. There was increased eNOS expressions in diabetic lungs, but PJ treatment diminished both eNOS expressions and inflammatory changes in pulmonary tissue. PCC and SA levels were higher in diabetic lungs (p<0.01) whereas SOD was lower (p=0.021) and GSH did not change significantly in comparison to PJ-treated diabetic group (p=0.374). Conclusion: The PJ treatment effectively reduced the oxidative stress and contributed to tissue recovery in experimental diabetic lungs. These findings would be of clinical relevance

TUR-P syndrome under spinal anesthesia: a case report

TUR-P syndrome is a syndrome occurring during transurethral resection of prostate (TURP), and is characterised by a spectrum of symptoms which may range from asymptomatic hyponatremia to convulsions, coma and death. The consistence of syndrome depends on the amount of fluid that enters to the intravascular space through blood vessels in the resection zone. The first step in treatment is the control of bleeding and the termination of operation

Retrospective Investigation of the Efficacy of Blocks for Analgesia in Lower Extremity Surgery

Objective: The aim of this study was to examine the efficacy of the blocks in the orthopedic lower extremity surgery for analgesia