Incidence of urinary retention in a tertiary post operative hospital

Patients in the immediate post-operative period have several clinical features and when they are admitted in the post-anesthetic recovery room the signs and symptoms that affect the patient physically and psychologically resulting of surgical procedures begin to emerge. Urinary retention occurs frequently in these patients, as some anesthetics contribute to the development of this clinical condition. This research aims to analyze the incidence of urinary retention after surgery of patients of various specialties, correlating the type of anesthesia and the need for urinary catheterization. This study is characterized as exploratory, descriptive, with quantitative approach and was performed in a hospital of high complexity in Juazeiro do Norte. The sample was composed of the patients admitted to the post-anesthetic recovery room and during that time they presented urinary retention. Data analysis was demonstrated by the tables relating to the literature. The study contributed to the growth of scientific knowledge for hospital staff under study, as there were a large number of species records about urinary retention of patients undergoing surgical procedures that were admitted to the patient unit, especially in surgical units. That worried the nursing staff on the efficiency of systematization so there was an improvement in the quality of care, as many times, such deductions were accompanied by distension and suprapubic pain. Through these results, we could identify some interventions that have contributed to solve this nursing diagnosis, involving the whole multidisciplinary team and ensure the patient unit staff understood holistically the issues involved in this clinical condition and to be more involved in this process

Video laryngoscopy as a device for removal of foreign body in the laryngopharynx

Background: Foreign bodies in the hypo pharynx unusually present needle stick nature, and not tend to perforate the mucosa. The most common in this region are described EC spines of fish, but a wide variety of objects have been found. In this case were rice husk (oryza sativa). The following  case report describe the foreign body removing with devices usually used for intubation.Case report: a female patient, 28 years old, admitted to the emergency HRC with complaints of pain and irritation in the throat (herringbone). Was referred for endoscopy diagnosis of foreign body in the oesophagus and submitted to EDA under general anesthesia without visualizing abnormalities.  Conclusions: video laryngoscopy devices  can be used to remove most foreign body in the hypo pharynx after several attempts by other techniques

ESTRESSE E USO DE ÁLCOOL EM ENFERMEIROS QUE TRABALHAM EM URGÊNCIA E EMERGÊNCIA

A Qualidade de vida no trabalho parece estar cada vez mais prejudicada, em função de mudanças por que tem passado o mundo nos tempos atuais. Nesse sentido, nosso trabalho procurou identificar parâmetros da Qualidade de Vida dos Profissionais de Enfermagem do Município de Cajazeiras-PB. Diversos são os fatores e as responsabilidades que recaem sobre o profissional da saúde, principalmente os que trabalham em urgência e emergência, muitos dos quais fogem ao seu controle. A metodologia utilizada foi a quantitativa, correlacional, do tipo ex post facto. Os sintomas psicológicos mais apontados foram problemas com a memória, insônia e pensamento recorrente. Além disso, 21,9% faz uso de risco quanto ao álcool e 15,6% dos sujeitos apresentaram nível de estresse na fase II – Exaustão. Portanto, a preocupação com a qualidade de vida dos profissionais da enfermagem, se apresenta como de extrema relevância, pois são nas mãos desses profissionais que nos deparamos com o limite entre a sobrevivência ou não, nas mais críticas situações humanas.(http://dx.doi.org/10.14295/cad.cult.cienc.v13i2.845

General anesthetics in children: neurotoxic or neuroprotective?

Introduction: general anesthetics are involved in neuroprotection in adults after ischemic events and cognitive impairment, thus, they also may be associated with learning disorders in children exposed to them before three years of age. Objective: Describe about the neurotoxic effects of general anesthetics in experimental animals and children. Method: This is a systematic review, performed from search in databases and on PubMed using the keywords "neurotoxicity" and "general anesthetics," and "general anesthetics," "neurotoxicity", "children", "young child "and" pediatric ". Results: The search resulted in 185 articles. Out of these, 78 met our inclusion criteria. We found that there was a significant evidence of neurotoxicity induced by general anesthetics in experimental animals that were just born, resulting in late and permanent cognitive deficits. This effect was associated with multiple exposures, exposure length of time and combination of drugs. However, some studies found cognitive impairment after a single exposure to anesthetic. Conclusion: There is insufficient evidence to state that general anesthetics are neurotoxic and have the potential to trigger learning and behavior disabilities in children. However, we suggest caution in indicating surgery in children under three years old, analyzing risk-benefit and inserting the family in the decision process.   Keywords: Neurotoxicity; Neuroprotection; Cognitive Impairment; Children; General Anesthesics     &nbsp

Monitoring the Suspension of Surgical Procedures

Introduction: A surgical suspension generates a series of hassles and dissatisfaction of the patient and his family. Preparations for surgery involve an entire remodeling of the professional, social and family schedule, as well as other factors such as expectations regarding the results and the fear of the unknown. Objective: A quantification and identification of the reasons for surgical cancellations was realized for a better understanding and guidance to the leadership team's actions on this issue. Thus, their monitoring is important in the search for actions to make the surgery center´s processes more effective, favoring possibilities for improvement in the quality of hospital services. This way, the objective of this research was to identify the main causes for the cancellations of surgical procedures. Method: Study of documentary and retrospective type, quantitative, performed in the surgical center of a hospital in the city of Juazeiro do Norte, CE, Brazil. Data collection was performed through digital files of the 'syshosp' system used to record performed and suspended surgical procedures. Data were collected from January to December 2014 and analyzed using simplified statistics and presentation through a table. Results: The justifications for cancellation of procedures related to the organizational aspects of the institution were highlighted as main reasons for surgical suspension:  the priority for urgency, lack of material resources / equipment required for the surgical procedure and no hospitalization of surgical patients. There were also those related to the lack of staff, being most of them because of the surgeon's inability to attend and absence of anesthesiologist causing the impossibility of building the surgical team. Finally, the suspensions regarding priority for emergencies are highlighted. It was observed that the main determinants for surgical suspensions were those related to the organization of the hospital, with a total of 267 (51.1%), standing out among these: technical problems (16.1%), no admission (42, 3%), lack of material (13.5%) and the priority for urgency (21%). Discussion: The Brazilian Ministry of Health (Ministério da Saúde) defines the surgery suspension rate by the number of suspended surgeries divided by the total of scheduled surgeries in a given period and multiplied by 1003. During the studied period, there were 6591 scheduled surgeries 6069 surgeries were performed and there were 522 suspensions. Thus, the overall average rate of suspension obtained was 7.9%. Compared to other studies and the goals of the institution (5%), it is clear that this is a high rate, but manageable. Conclusion: It was observed that the suspensions of surgeries must be carefully monitored and analyzed by the entire team involved in order to disseminate this indicator and its possible consequences to all. The process of identification of consequences is still weak and needs to be strengthened to an effective action plan. It was revealed that the main cause of surgical cancellations during the surveyed year was related to the organization of the hospital, emphasizing the importance of updating the interaction of processes with the sectors that influence this indicator and preparation of strategic planning with everybody´s involvement so you can minimize the data, as it directly affect the patient, professionals and the hospital, resulting from the patient´s dissatisfaction to the longer permanency of the patient in hospital

Fractalidade e comportamento caótico da variabilidade da frequência cardíaca como preditores de hipotensão após raquianestesia: protocolo de ensaio clínico randomizado

Introduction: All drugs and techniques that induce the anesthetic state act in some way in the Autonomic Nervous System (ANS). The administration of local anesthetics in the subarachnoid space produces motor, sensitive and sympathetic block, with latencies and variable and independent block levels. The motor block is the first to install, followed by the sympathetic and the sensitive. Sympathetic blockage affects 2 to 6 dermatomes above the sensory block. The recovery of spinal anesthesia is assessed through a scale defined in 1979 by Bromage and is based exclusively on the return of motor function and does not take into account the recovery of ANS activity. The persistence of sympathetic block may imply a higher incidence of urinary retention, bradycardia and hypotension. Objective: To assess cardiac autonomic modulation during perioperative hypotension caused by subarachnoid anesthesia. Methods: A randomised, double-blind clinical trial will be performed in a large hospital located in the southern region of Ceará, Brazil and at the HUJB in Cajazeiras, Paraíba. Sixty patients from the anaesthesia outpatient clinic were enrolled. Patients were divided into two groups: one group received Bupivacaine with clonidine, and the other group received only bupivacaine at a dose of 15 mg. The sample consisted of 60 ASA patients I to III, submitted to orthopedic surgery of lower limbs and lower abdomen under spinal anesthesia. The Heart Rate Variability will be evaluated in three moments: rest, before anesthesia; 20 min after the blockade was installed, and at the time of motor function recovery according to the Bromage criteria and prognostic indices will be evaluated in the development of perioperative hypotension in two groups. Linear methods will be used in the frequency domain and nonlinear in chaos domain, Poincaré plot, approximate entropy, Detrended Fluctuation Analysis (DFA) and Correlation Dimension. The data will be collected through a Polar V800® heart rate meter and properly submitted for analysis and filtering by Kubios 3.0® software. Discussion: In the literature we find data evaluating the installation of sympathetic block through HRV using linear methods however, there is a lack of studies using methods based on the domain of chaos. Some studies address the value of HRV as a predictor of hypotension following subarachnoid anesthesia, mainly using linear methods in the frequency domain. It is understood to be important to analyze these factors using methods already validated in the domain of chaos, complexity and fractality, more compatible with the complexity of the behavior of biological systems, in the characterization of the autonomic function during the subarachnoid anesthesia. Registry: The clinical trial was registered in the Brazilian Registry of Clinical Trials (ReBEC) under the number RBR-4Q53D6.Introdução: Todas as drogas e técnicas que induzem o estado anestésico atuam de alguma forma no SNA. A administração de anestésicos locais no espaço subaracnóideo produz bloqueio motor, sensitivo e simpático, com latências e níveis de bloqueio variáveis e independentes. O bloqueio motor é o primeiro a ser instalado, seguido pelo simpático e sensitivo. O bloqueio simpático afeta de 2 a 6 dermátomos acima do bloqueio sensitivo. A recuperação da raquianestesia é avaliada através de uma escala definida em 1979 por Bromage e baseia-se exclusivamente no retorno da função motora e não leva em conta a recuperação da atividade da SNA. A persistência do bloqueio simpático pode implicar em maior incidência de retenção urinária, bradicardia e hipotensão. Objetivo: Caracterizar a variabilidade da frequência cardíaca durante anestesia subaracnóidea por meio de métodos lineares no domínio da frequência e métodos não lineares no domínio caos e definir a duração do bloqueio autonômico em raquianestesia através desses parâmetros, bem como identificar índices de variabilidade da frequência cardíaca (VFC) que podem ser usados como preditores de hipotensão perioperatória. Método: Um ensaio clínico randomizado, duplo-cego será realizado em um hospital de grande porte localizado na região sul do Ceará, no Brasil, e no HUJB em Cajazeiras, na Paraíba. Sessenta pacientes do ambulatório de anestesia serão incluídos. Os pacientes serão divididos em dois grupos: um grupo receberá Bupivacaína com clonidina e o outro grupo receberá apenas bupivacaína na dose de 15 mg. A amostra será composta por 60 pacientes ASA I a III, a serem submetidos a cirurgia ortopédica de membros inferiores e abdome inferior sob raquianestesia. A Variabilidade da Frequência Cardíaca será avaliada em três momentos: repouso, antes da anestesia; 20 min após a instalação do bloqueio, e no momento da recuperação da função motora, de acordo com os critérios de Bromage. Será avaliada a incidência de hipotensão perioperatória nos dois grupos. Métodos lineares serão utilizados no domínio da freqüência e não-lineares no domínio do caos: plot de Poincaré, entropia aproximada, Análise de Flutuação Destendenciada (DFA) e Dimensão de Correlação. Os dados serão recolhidos através de um cardiofrequencímetro Polar V800® e devidamente submetidos para análise e filtragem pelo software Kubios 3.0®.  Discussão: Na literatura encontramos dados avaliando a instalação do bloqueio simpático através da VFC utilizando métodos lineares, no entanto, faltam estudos utilizando métodos baseados no domínio do caos. Alguns estudos abordam o valor da VFC como um preditor de hipotensão após a anestesia subaracnóidea, principalmente usando métodos lineares no domínio da frequência. Entende-se ser importante analisar esses fatores utilizando métodos já validados no domínio do caos, complexidade e fractalidade, mais compatíveis com a complexidade do comportamento dos sistemas biológicos, na caracterização da função autonômica durante a anestesia subaracnóidea. Registro: O ensaio clínico foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC) sob o número RBR-4Q53D6

Acute abdomen in a patient with haemophilia A: A case study

Background: Haemophilia A is a hereditary haemorrhagic disorder that can cause bleeding in the intestinal loops and, on rare occasions, simulate an acute surgical abdomen. Careful assessment of coagulation must be performed in these patients, followed by an attempt to correct the dysfunctions. Often, the administration of the deficient factor is sufficient to resolve the problem, avoiding unnecessary surgeries. Case report: We present a male patient, 15-years-old, of indigenous descent, who was a diagnosed with haemophilia A. The young man was admitted with abdominal pain in the right iliac fossa; ultrasonography suggested acute appendicitis. He underwent an exploratory laparotomy that revealed a normal appendix and the presence of a caecal wall haematoma, without other abnormalities. Conclusion: This case describes an unusual instance of decompensation of a patient with haemophilia A that simulated an acute surgical abdomen. The case suggests the need for further evaluation of carriers of coagulopathies, whether acquired or congenital, when they suffer abdominal pain. Otherwise, clinically treatable dysfunctions are prone to surgical treatment, with a potential for increased morbidity and mortality.Â

Autonomic Nervous System and Allergic Diseases: Integrative Literature Review

Introduction: Allergic diseases have their incidence constantly increased especially asthma, allergic rhinitis and eczema or atopic dermatitis. The causes related with the appearance of these diseases such as the environment, hereditary and others are unable to explain certain behaviors. Changes in the autonomic nervous system (ANS) are cited as one of the factors that may contribute to the onset of exacerbations. Objective: Identify the autonomic nervous system´s behavior in allergic diseases. Methods: Integrative literature review conducted from the following databases: Scielo, Lilacs and PubMed. The keywords used were autonomic nervous system, asthma, allergic rhinitis and eczema in Portuguese, English and Spanish languages. Four articles were selected for this review. Results: The selected articles point to an increased activity of the parasympathetic nervous system or decreased activity of the sympathetic system in cases of allergic rhinitis. With asthma, it is believed that the changes in the ANS are secondary to diseases. Articles about atopic eczema were not found using the selected words to search. Conclusion: There is evidence of changes in the ANS in allergic diseases, however, there is so far no study that states which system excels, only that the parasympathetic is more active or that the sympathetic is in underactivity

Learning disorders related to exposure to general anesthetic in children

Background: There are many animal studies demonstrating increased neuroapoptose in the first periods of development, especially in stronger neural development regions. In young cobais neuroapoptose also noted, however, more localized area as the dentate nucleus and the olfactory bulb of the brain regions that show sinaptogênse even in adulthood and is responsible for learning. Objective: To describe the current studies about learning disabilities and cognitive impairment related to exposure to general anesthetics in children.  Method: This is a systematic review, performed from the search in the PubMed database using the keywords "general anesthetics," "neurotoxicity", "children", "young child" and "pediatric" with the criterion inclusion, published in the last five years, in English and related exposure to anesthetics in human children . Were excluded from the articles concerning the studies in experimental animals or that they focus on side effects of other substances on the central nervous system, such as alcohol.    Results: So were found 108 articles. All were analyzed by two researchers individually. Only 27 met the inclusion criteria. Discussion: In recent years, several studies have been conducted addressing neurotoxicity triggered by general anesthetics. The vast majority using experimental animals or stem cells. Suggest that both inhaled anesthetics such as venous are able to trigger the activation neuroapoptose with release of caspase 3:09, especially in phases of high growth and neural development. There is a strong association between duration of anesthesia and multiple exposures with learning disabilities and behavior. Conclusion: Currently, you can not say that the damage caused by agents in animals can be replicated humans. However, the severity of outcomes, the FDA recommends avoiding anesthesia and surgery in children under three years, at least those that do not have an emergency basis

Are General anesthetics neurotoxic? Review

Introduction: General anaesthesia has been used worldwide since its first public demonstration with ether in 1846. Until a little more than a decade ago, it was believed that the anaesthetic state was limited to the period of exposure. Studies in rats, pigs, and rhesus monkeys have shown that almost all general anaesthetics accelerate the apoptotic process in neurones, oligodendrocytes, and glial cells. Objective: Our aim was to analyse the relationship between general anaesthetics and their role in triggering neuroapoptosis in laboratory animals. Method: A search was carried out in PubMed and Google Scholar with the keywords "neurotoxicity" and "general anesthetics" for selecting articles published in the last five years. After having evaluated the abstracts, 77 articles were selected and read by 2 independent investigators. All authors met and discussed the most relevant aspects. Results: All general anaesthetics, when inhaled or administered intravenously, enhance neuroapoptosis, mainly during the gestational and neonatal stages in rats, pigs, and non-human primates. Neurones and oligodendrocytes that are capable of neurogenesis and synaptogenesis are the most affected. General anaesthetics commonly lead to learning and behavioural disorders, in addition to permanent memory deficit. Conclusion: The neurotoxicity of general anaesthetics affects different mammalian species and accelerates the neuroapoptotic process. This deleterious effect involves specific brain areas and occurs in developing neurones. The exceptions are the dentate gyrus and the olfactory bulb, which undergo apoptosis even in adulthood, albeit to a lesser extent