Cerebral and cardiovascular effects of analgesic doses of ketamine during a target controlled general anesthesia: a prospective randomized study

Introduction: Ketamine is increasingly being used in various pain settings. The purpose of this study was to assess the effect of an analgesic dose of ketamine in the bispectral index (BIS), spectral edge frequency (SEF-95), density spectral array (DSA), cerebral oximetry (rSO2) and mean arterial pressure (MAP) during general anaesthesia with a target controlled infusion. Methods: A prospective, single-blinded and randomized study on adult patients scheduled for elective spine surgery was carried out. After anaesthesia induction with propofol, remifentanil and rocuronium, when a stable BIS value (45-55) was achieved, an automatic recording of BIS, SEF-95, rSO2 and MAP values during 9 min was performed to establish patients baseline values. Subsequently, patients were randomly assigned to receive a ketamine bolus dose of 0.2 mg/kg, 0.5 mg/kg or 1 mg/kg; all variables were recorded for additional 9 min after the ketamine bolus, in the absence of any surgical stimulus. A p-value <0.05 was considered significant in the statistical analysis. Results and discussion: Thirty-nine patients were enrolled in the study. Our results show a dose-related increase of SEF-95 and BIS values. DSA demonstrate a shift in the frequency range and power distribution towards higher frequencies. Our results do not show significant differences in MAP and rSO2 values. Conclusion: When ketamine is used intraoperatively in analgesic doses, the anaesthetist should anticipate an increase in SEF-95 and BIS values which will not be associated with the level of anaesthesia.info:eu-repo/semantics/publishedVersio

Mode of delivery and labour analgesia: a study of preference in portuguese pregnant women

Background: Portugal has had one of the highest cesarean rates in Europe, possibly influenced by patient preferences. A reduction in the prevalence of these rates due to safety, quality, and concern with costs is one of the current goals of obstetric care. Fear of pain, often associated with vaginal delivery, is one of the reasons why pregnant women might prefer a cesarean section. Objective: The aim of this study was to identify the type of delivery and anaesthesia/analgesia preferred, as well as the reasons and factors associated with this preference, in a representative sample in order to identify possible modifiable factors possibly involved in increased rates. Methods: A descriptive cross-sectional study was carried out by an anonymous questionnaire to 245 pregnant women from February to April 2018. Respondents were also asked about their preference for peripartum anaesthesia/analgesia and on the sources of information that helped decide their preferences. Results: 22% of respondents would prefer an elective cesarean section. This preference was higher in women with a previous cesarean section. The preference for vaginal delivery was higher in women with more advanced pregnancies. The main reasons that led participants to prefer a vaginal delivery were the quicker postpartum recovery and not wanting to miss the first hours of their child's life. Regarding the preference for an elective cesarean section, the main reasons were fear and convenience. Most pregnant women preferred epidural analgesia. Respondents who selected their doctor (most common source) were more likely to prefer vaginal delivery. Conclusion: A minority of women showed a preference for cesarean delivery. A majority would prefer to have epidural anaesthesia. Despite the high cesarean rates, maternal desire for cesarean section is low, suggesting that this number is due to factors other than the preference of pregnant women.info:eu-repo/semantics/publishedVersio

Laryngeal mask airway in prone position in ambulatory surgery: a prospective observational study

Introduction: The laryngeal mask airway (LMA) is a common airway device used for anesthesia in ambulatory surgery, with a recently new described utilization in prone position. The aim of this study was to evaluate the safety and the effectiveness of the LMA, in prone position for anesthesia in ambulatory surgery, based on our new anesthesia department protocol. Methods: Patients from February 2013 to July 2014 were included in this prospective study. After the patient selfpositioning in prone position, general anesthesia was induced and the LMA was placed. Second generation LMA types were used (Supreme™, iGel™ and Proseal™) and all patients were mechanically ventilated. At the end of surgery, LMA was removed in prone or supine position. Number of attempts of LMA insertion, volume leak, airway peak pressure and complications were registered until 2 hours after the procedure. Results: The LMA placement was 85.1% effective in the first attempt and 100% in the second attempt. The need for a second attempt LMA placement was due to non-progression of the aspiration probe, a high leak and impossible ventilation. Mechanical ventilation was considered effective and safe with maximum peak airway pressure of 17.9 ± 5.5 cm H2O and maximum leak of 47.7 ± 31.2 ml. Complications were present in 6 patients (9%) with hypoventilation, bronchospasm and laryngospasm. Other “minor” events registered included the presence of blood in the LMA at the end of procedure and gum lesion with the rigid piece of the Supreme™ LMA. Discussion and conclusion: Complications found in our study are similar to those described in literature in supine position and are related to the anesthetist previous experience. Anesthetic depth adjustment improved all complications found. Effectiveness and overall safety of LMA use in prone position was observed, allowing further utilizations in selected patients according to the anesthesia department protocol.info:eu-repo/semantics/publishedVersio

Increased lung inflammation with oxygen supplementation in tracheotomized spontaneously breathing rabbits: an experimental prospective randomized study

Background Mechanical ventilation is a well–known trigger for lung inflammation. Research focuses on tidal volume reduction to prevent ventilator-induced lung injury. Mechanical ventilation is usually applied with higher than physiological oxygen fractions. The purpose of this study was to investigate the after effect of oxygen supplementation during a spontaneous ventilation set up, in order to avoid the inflammatory response linked to mechanical ventilation. Methods A prospective randomised study using New Zealand rabbits in a university research laboratory was carried out. Rabbits (n = 20) were randomly assigned to 4 groups (n = 5 each group). Groups 1 and 2 were submitted to 0.5 L/min oxygen supplementation, for 20 or 75 minutes, respectively; groups 3 and 4 were left at room air for 20 or 75 minutes. Ketamine/xylazine was administered for induction and maintenance of anaesthesia. Lungs were obtained for histological examination in light microscopy. Results All animals survived the complete experiment. Procedure duration did not influence the degree of inflammatory response. The hyperoxic environment was confirmed by blood gas analyses in animals that were subjected to oxygen supplementation, and was accompanied with lower mean respiratory rates. The non-oxygen supplemented group had lower mean oxygen arterial partial pressures and higher mean respiratory rates during the procedure. All animals showed some inflammatory lung response. However, rabbits submitted to oxygen supplementation showed significant more lung inflammation (Odds ratio = 16), characterized by more infiltrates and with higher cell counts; the acute inflammatory response cells was mainly constituted by eosinophils and neutrophils, with a relative proportion of 80 to 20% respectively. This cellular observation in lung tissue did not correlate with a similar increase in peripheral blood analysis. Conclusions Oxygen supplementation in spontaneous breathing is associated with an increased inflammatory response when compared to breathing normal room air. This inflammatory response was mainly constituted with polymorphonuclear cells (eosinophils and neutrophils). As confirmed in all animals by peripheral blood analyses, the eosinophilic inflammatory response was a local organ event

Oxygen Increases Lung Inflammatory Response in Spontaneous One-Lung Ventilation in Rabbits: A Prospective Randomized Experimental Study

Study objective: The purpose of this study was to investigate if oxygen supplementation would increase lung inflammatory response in a spontaneous one-lung ventilation animal model, when compared to room-air oxygen fraction. Design: In vivo prospective randomized animal study Setting: University research laboratory Subjects: New Zealand rabbits Interventions: Rabbits (n=20) were randomly assigned to 2 groups (n=10 each group). Groups (OS – Oxygen Supplemented, and NOS – Non-Oxygen Supplemented) were submitted to spontaneous One-Lung Ventilation (OLV) during 60 minutes; OS group had a 2-liter/minute oxygen supplement, and NOS group was kept on roomair. Ketamine/xylazine was administered for induction and maintenance of anesthesia. One-lung ventilation was achieved by administration of air into interpleural space, and left lung collapse was visually confirmed through the center of diaphragm. Clinical monitoring and arterial blood gas analyses were performed in all rabbits. Measurements: Lung histology plates were observed under light microscopy for quantification of inflammatory response (light, moderate and severe). Main results: All subjects had at least light inflammatory response. However, rabbits submitted to oxygen supplementation had a statistically significant value for the occurrence of moderate inflammation (p<0.001). The inflammatory cells found were mainly eosinophils and neutrophils in an average proportion of 80/20. Oxygen partial pressure increased in both groups with a higher proportion in OS group (p<0.001). Conclusion: In this spontaneous OLV model, the use of oxygen supplementation was associated with a greater inflammatory response.info:eu-repo/semantics/publishedVersio

Spontaneous one-lung ventilation increases the lung inflammatory response : an experimental pilot study

Study objective: The purpose of this study was to investigate if spontaneous one-lung ventilation would induce any type of inflammatory lung response when compared to spontaneous two-lung ventilation and its intensity, by quantification of inflammatory cells in lung histology at the end of the procedure. Design: In vivo prospective randomised animal study Setting: University research laboratory Subjects: New Zealand rabbits Interventions: Rabbits (n=20) were randomly assigned to 4 groups (n=5 each group). Groups 1 and 2 were submitted to one-lung ventilation, during 20 and 75 minutes respectively; groups 3 and 4 were submitted to two-lung ventilation during 20 and 75 minutes and considered controls. Ketamine/xylazine was administered for induction and maintenance of anesthesia. One-lung ventilation was achieved by administration of air into the interpleural space, and left lung collapse was visually confirmed through the centre of the diaphragm. Measurements: Lung histology preparations were observed under light microscopy for quantification of the inflammatory response (light, moderate and severe). Main results: All subjects had at least light inflammatory response. However, rabbits submitted to one-lung ventilation had a statistically significant value for the occurrence of moderate inflammation (p<0.05). The inflammatory response found included mainly eosinophils, with an average proportion of 75/25 to other polymorphonuclear cells. No differences between groups were found regarding gas exchange, heart rate and respiratory rate. Conclusions: In this spontaneous one-lung ventilation model, lung collapse was positively associated with a greater inflammatory response when compared to normal two-lung ventilation

Predictive factors for cesarean delivery : a retrospective study

Background: Cesarean section rates have risen markedly worldwide. Considering the potential harm caused by this mode of delivery, and the general concern in reducing its incidence, it would be useful to individualize the risk of non-planned cesareans, and if there is any possibility, reduce that risk, and anesthesiologists should take part of this risk evaluation. In recent studies, many factors have been related with a higher risk of cesarean, and controversy still surrounds labor analgesia impact on cesarean risk. The aim of this study was to search for predictive factors for nonplanned cesarean delivery. Methods: Retrospective analysis of all labors occurred in our Obstetric Department during 2014. Maternal related factors, previous obstetric history, birth weight and factors related to labor analgesia and labor progression were studied. Our primary outcome was cesarean delivery. Results: We identified two independent predictive factors for cesarean delivery: birth weight (p=0,007 OR= 1,001 CI 95% [1,0003; 1,002]) and labor length since beginning of analgesia (p<0,0001 OR= 1,00005 CI 95%[1,00003; 1,00007]). Searching correlation between registered variables, maternal body mass index was positively associated with newborn birth weight (p<0.0001, R=0.157). Conclusion: Our study showed that birth weight and labor length since beginning of epidural analgesia are independent predictor factors of non-planned cesarean delivery. Furthermore, birth weight was associated with maternal body mass index, providing health professionals a modifiable factor in which we can intervene to improve outcome. As labor progression to cesarean is of major obstetric and anesthetic concern, multidisciplinary initiatives are warranted to clearly identify important variables concurring to operative delivery.info:eu-repo/semantics/publishedVersio

Dba-free" Palladium Intermediates Of The Heck-matsuda Reaction."

The dba-free Heck-Matsuda reaction was investigated via direct ESI-MS(/MS) monitoring. Palladium species involved in the reduction of Pd(II) during a Wacker type reaction and several dba-free arylpalladium transient complexes were detected and characterized. Based on these findings, a more comprehensible catalytic cycle for this pivotal reaction is suggested.113277-8

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus : Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ’overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings