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ABSTRACT BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

Resumo Justificativa Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC ® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo‐MM e Grupo‐MV utilizaram laringoscópios Macintosh e o Grupo‐VV e Grupo‐VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo‐MM e Grupo‐VM e videolaringoscópios pelo Grupo VV e Grupo‐MV. Resultados As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV ( p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo‐VM ( p = 0,008). Conclusões A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal. Background Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC ® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group‐MM and Group‐MV used Macintosh laryngoscopes; Group‐VV and Group‐VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group‐MM and Group‐VM and videolaryngoscopes used in Group‐VV and Group‐MV. Results Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV ( p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group‐VM ( p = 0.008). Conclusions The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs. [ABSTRACT FROM AUTHOR]

Resumo Justificativa Apesar dos novos avanços em reanimação cardiopulmonar (RCP), o dano cerebral muitas vezes ocorre após a reanimação. Objetivo Avaliar o valor prognóstico de medir a saturação de oxigênio cerebral (rSO 2 ) para estimar o prognóstico em pacientes após a reanimação cardiopulmonar. Projeto Análise retrospectiva. Medidas e resultados Foram avaliados após RCP 25 pacientes (12 do sexo feminino e 13 do masculino). Todos os pacientes foram submetidos à hipotermia (temperatura alvo de 33‐34 °C). As mensurações da Escala de Coma de Glascow (GCS), dos reflexos corneanos (RC), dos reflexos pupilares (RP) e do excesso de base (EB) e rSO 2 foram feitas na admissão. Na hipertermia, as mensurações de GCS, RC, RP, EB e rSO 2 foram feitas depois que a temperatura atingiu 36 °C. Resultados Em sobreviventes, o valor basal de rSO 2 foi de 67,5 (46‐70) e a diferença percentual entre o valor basal e a hipertermia de rSO 2 foi de 0,03 (0,014‐0,435). Em não sobreviventes, o valor basal de rSO 2 foi de 30 (25‐65) e a diferença percentual entre o valor basal de hipotermia de rSO 2 foi de 0,031 (‐0,08‐20). Não houve diferença estatística nas variações percentuais entre os valores da rSO 2 na fase basal e de reaquecimento. Uma diferença estatisticamente significativa foi observada entre os valores da GCS na fase basal e de reaquecimento dos grupos ( p = 0,004). Não houve diferença estatisticamente significativa entre GCS, RC, RP, EB e rSO 2 para determinar o prognóstico. Conclusão Embora os valores da rSO 2 tenham sido mais elevados em sobreviventes do que em não sobreviventes, não observamos uma diferença estatisticamente significativa dos valores da rSO 2 entre os grupos na fase basal e de reaquecimento. Como a mensuração é simples, e não afetada por hipotensão e hipotermia, a rSO 2 pode ser um indicador útil para determinar o prognóstico após a RCP. Background Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective To assess the prognostic value of cerebral oxygen saturation measurement (rSO 2 ) for assessing prognosis on patients after cardiopulmonary resuscitation. Design Retrospective analysis. Measurements and results We analyzed 25 post‐CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33–34 °C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO 2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO 2 measurements were made after the patient's temperature reached 36 °C. Results In survivors, the baseline rSO 2 value was 67.5 (46–70) and the percent difference between baseline and rewarming rSO 2 value was 0.03 (0.014–0.435). In non‐survivors, the baseline rSO 2 value was 30 (25–65) and the percent difference between baseline and rewarming rSO 2 value was 0.031 (−0.08 to −20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO 2. Statistically significant difference was detected between baseline and rewarming GCS groups ( p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO 2 to determine the prognosis. Conclusion Despite higher values of rSO 2 on survivors than non‐survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO 2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO 2 may be a useful predictor for determining the prognosis after CPR. [ABSTRACT FROM AUTHOR]

Resumo Justificativa Nos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incidência de parada cardíaca (PC). Postula‐se que a incidência de parada cardíaca intraoperatória (PCI) tem diminuído ao longo dos anos, especialmente em países desenvolvidos. A nossa hipótese foi que, como no resto do mundo, a incidência de PCI está diminuindo no Brasil, um país em desenvolvimento. Objetivos O objetivo deste estudo foi pesquisar e avaliar na literatura as publicações que relacionam a incidência de PCI no Brasil e analisar a tendência na incidência de PCI. Conteúdo Descobrimos quatro artigos que atenderam aos critérios de inclusão, que resultaram em 204.072 pacientes submetidos à anestesia regional ou geral em dois hospitais terciários e acadêmicos e 627 casos de PCI. A média de incidência de PCI para o período de 25 anos foi de 30,72:10.000 anestesias. Houve uma diminuição de 39:10.000 anestesias para 13:10.000 anestesias no período analisado, com letalidade relacionada de 48,3% para 30,8%. Além disso, as principais causas de mortalidade relacionadas à anestesia mudaram de mau funcionamento de máquinas e overdose de medicamentos para hipovolemia e causas respiratórias. Conclusões Houve uma clara redução na incidência de PCI nos últimos 25 anos no Brasil. Essa redução é observada em todo o mundo e pode ser o resultado de vários fatores, incluindo novas leis que regulam medicamentos no Brasil, incorporação de tecnologias, melhor nível de desenvolvimento humano do país e melhor assistência ao paciente. Background Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. Objectives The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. Contents There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia‐related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. Conclusions There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care. [ABSTRACT FROM AUTHOR]

Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation., Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO 2 ) for assessing prognosis on patients after cardiopulmonary resuscitation., Design: Retrospective analysis., Measurements and Results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34°C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO 2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO 2 measurements were made after the patient's temperature reached 36°C., Results: In survivors, the baseline rSO 2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO 2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO 2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO 2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO 2. Statistically significant difference was detected between baseline and rewarming GCS groups (p=0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO 2 to determine the prognosis., Conclusion: Despite higher values of rSO 2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO 2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO 2 may be a useful predictor for determining the prognosis after CPR., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country., Objectives: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest., Contents: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes., Conclusions: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)