Continuous Bilateral Posterior Lumbar Plexus Block with a Disposable Infusion Pump. Case Report

SummaryBackground and objectivesThe number of bilateral total hip arthroplasties (THA) has been increasing every year. Postoperative analgesia by continuous perineural infusion of local anesthetic has been shown favorable results when compared to systemic analgesia. The use of elastomeric pumps has increased patient satisfaction when compared to electronic models. The objective of this report was to describe a case of continuous bilateral posterior lumbar plexus block with an elastomeric infusion pump in a patient submitted to bilateral hip arthroplasty.Case reportThis is a 46 year-old female patient weighing 65kg, 162cm, with rheumatoid arthritis and hypertension, physical status ASA II, scheduled for bilateral THA in a single stage. She had been on corticosteroids for 13 years. Hemoglobin=10.1g.dL-1, hematocrit=32.7%. Routine monitoring. Spinal anesthesia with 15mg of 0.5% isobaric bupivacaine. General anesthesia with propofol (PFS) and remifentanil, and intubation without neuromuscular blockers. Right THA and, at the end, lumbar plexus block with a stimulator and a set of 150mm needle and injection of 20mL of 0.2% bupivacaine and introduction of a catheter. Left THA and, at the end, the same procedure. Anesthetic dispersion and contrast were investigated. Elastomeric pump was installed with 0.1% bupivacaine (400mL) at a rate of 14mL.h-1. The patient was transferred to the Intensive Care Unit (ICU). After 24 hour, a new pump was installed with the same solution. She did not receive any boluses for 50 hours. After removal of the catheter, pain was controlled with oral ketoprofen and dypirone.ConclusionsContinuous peripheral blockade with infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults

Reevaluation of the Airways of Obese Patients Undergone Bariatric Surgery after Reduction in Body Mass Index

SummaryBackground and objectivesDifficulty intubating is a cause of mortality in anesthesiology and it can be related to obesity. The diagnosis of difficult intubation contributes for successful airways management. However, parameters that predict difficult airways are not well established. Mallampati classification, the interincisor gap, neck circumference, thyromental distance, and the presence of obstructive sleep apnea, are parameters that can indicate difficult intubation. Surgical treatment of obesity provides reduction in body mass index (BMI) with stabilization after about 2 years. The objective of the present study was to reevaluate the parameters described above and compare them with pre-surgical values.MethodsThe BMI, Mallampati classification, neck circumference, interincisor gap, thyromental distance, and the degree of obstructive sleep apnea in polysomnography were evaluated in 51 patients of both genders in the preoperative period. Two years after the surgery and reduction of the BMI to < 35 kg.m−2, predictor factors of difficult airways were reevaluated by another anesthesiologist who knew the patients’ BMI before surgery. Nine patients were excluded. The new reevaluation was performed, and for those who did not have another polysomnography the somnolence scale of Epiworth was applied.ResultsForty-two patients were reevaluated. They showed a reduction in BMI and neck circumference, and an increase in both interincisor gap and thyromental distance. Only one patient showed a reduction in Mallampati scale, and only 4 patients performed polysomnography.ConclusionsReduction of the BMI allows for an increased interincisor gap, thyromental distance, and reduction in neck circumference. Mallampati classification remains the same

Metodología activa en el proceso de aprendizaje: estudio realizado con estudiantes del segundo Ciclo, 4º. 5º. Y 6º grado del nivel primario de la Escuela Oficial Rural Mixta del Cantón Llano del Pinal, Quetzaltenango.

Estudio realizado con estudiantes del segundo ciclo del nivel de Educación Primaria, que comprende el cuarto, quinto y sexto grado de la Escuela Oficial Rural Mixta del Cantón Llano del Pinal, Quetzaltenango. El objetivo fue establecer la incidencia de la metodología activa en el proceso de aprendizaje. El enfoque que se utilizó fue cualitativo; mientras que las técnicas fueron la investigación documental e investigación de campo. Se aplicó el método aleatorio, la muestra fue de 102 estudiantes y 31 docentes. Se propone al personal docente un Manual de técnicas y estrategias de metodología activa, para que tengan una guía de aplicación que le permita apropiarse de esa herramienta en forma consciente, de tal forma que su desarrollo no sea producto de la imposición, sino que esté intrínsecamente ligado a la necesidad de participar en la consecución de un verdadero proceso de aprendizaje de los estudiantes

Retrospective Analysis of Risk Factors and Predictors of Intraoperative Complications in Neuraxial Blocks at Faculdade de Medicina de Botucatu-UNESP

SummaryBackground and objectivesCardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital – HCFMB-UNESP.MethodsA retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis.Results32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27).ConclusionsIntraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks