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Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:52Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:45:13Z : No. of bitstreams: 1 2-s2.0-0034122459.pdf: 68267 bytes, checksum: cf86dc1b8d5b2f238d0bbedfdad79725 (MD5) Made available in DSpace on 2014-05-27T11:19:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-01-01 Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level, onset time, quality of analgesia, labor analgesia duration, time for labor resolution, and Apgar scores at minute 1. Ast to motor block, GIII > GII and GI was intermediary. In relation to pain intensity, there was a trend for GI > GIII. For Apgar scores in minute 5, GII > (GI = GIII), and in minute 10 (GI = GII) < GIII. NACS at 2 h showed, GII > GI > GIII, and at 24 h, GII > GIII > GI. Conclusions - Ropivacaine has relieved maternal pain with less motor block. Newborns of GII mothers (ropivacaine) showed the best Apgar and NACS scores. Depto. de Anestesiologia FMB - UNESP, 18618-970 Botucatu, SP Depto. de Anestesiologia FMB - UNESP, 18618-970 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:52Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:29:16Z : No. of bitstreams: 1 2-s2.0-0034023808.pdf: 175258 bytes, checksum: ff183cbd792e43386349bb1f4df89cce (MD5) Made available in DSpace on 2014-05-27T11:19:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-01-01 Background and Objectives - Successful cadaver kidney transplantation relies on a fast procedure. Patients with chronic renal failure may present with a delayed gastric emptying making it critical a fast tracheal intubation and airway maintenance. Rocuronium a recently introduced nondepolarizing neuromuscular blocker with a fast onset. The aim of this study was to evaluate onset time and duration of rocuronium effects in patients undergoing renal transplantation. Methods - Sixty patients were allocated into two groups of 30: Group R (GR) = patients undergoing renal transplantation and Group N (GN) = patients with normal renal function. All patients were premedicated with oral midazolam (15 mg) and anesthesia was induced with 30 μg.kg-1 alfentanil, 0.3 mg.kg-1 etomidate and 0.6 mg.kg-1 rocuronium injected through a central venous catheter. neuromuscular block was monitored by acceleromyography in the ulnar nerve pathway. The following parameters were evaluated: time between administration of rocuronium and first twitch reduction to 5% after supra-maximal stimulation (T1) (onset time = OT); time for first twitch to return to 25% (clinical duration = R25); time elapsed between 25% and 75% recovery of first twitch (relaxation recovery time = R25-75). Heart rate (HR) and mean blood pressure (MBP) were recorded in 6 moments. Results - Median OT was 31 sec. in GR and 47 sec. in GN. Median R25 was 51.5 min in GR and 33.5 min in GN. Median R25-75 was 28 min in GR and 20 min in GN. MBP and HR were higher in GR. Tracheal intubation conditions were excellent for most patients in both groups. Conclusions - These results open the possibility of 0.6 mg.kg-1 rocuronium being injected through a central venous catheter when a faster onset is needed. Due to wide differences in individual responses, monitoring of neuromuscular block is recommended. Departamento de Anestesiologia FMB-UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP Departamento de Anestesiologia FMB-UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:52Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:34:19Z : No. of bitstreams: 1 2-s2.0-0034083388.pdf: 74258 bytes, checksum: 2541cb3f48796192ede743c14d98173b (MD5) Made available in DSpace on 2014-05-27T11:19:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-01-01 Background and Objectives - Allopurinol is a drug which inhibits the formation of noxious renal free radicals. The aim of this study was to evaluate the protecting renal effects of allopurinol in ischemic kidneys of dogs. Methods - Sixteen dogs were anesthetized with sodium pentobarbital and submitted to extracellular volume expansion (1.4 ml.kg-1.min-1), to mechanic ventilation with air, to right nephrectomy and to left renal artery clamping. Changes which might occur in renal morphology and function after 30 min of total ischemia and posterior reperfusion were studied in Group 1 (G1), in addition to the action of allopurinol (50 mg.kg-1) on those kidneys, when administered 24 h before the experiment and 1 h before the ischemic procedure in Group 2 (G2). The following parameters: heart rate, inferior vena cava pressure, mean blood pressure, PAH clearance (PAH(c)), renal blood flow (RBF), renal vascular resistance (RVR), creatinine clearance (Cr(c)), filtration fraction, urine output, plasma and urine osmolality, osmolar clearance, free water, sodium and potassium clearance, urine and fractional sodium and potassium excretion, hematocrit, rectal temperature, and left kidney histology were evaluated in four moments: M1 control, and M2, M3, M4 obtained immediately, 15 and 30 min after unclamping of the left renal artery. In G2, M1, M2, M3 and M4 were obtained 45, 90, 105, and 120 min after the second allopurinol dose. Results - Both groups showed the highest values for PAH(c), RBF, and Cr(c), and the lowest values for RVR in M1. Animals were tachycardiac since the beginning of the experiment both in G1 and in G2. The other parameters were not changed. Left kidney histological evaluation showed alterations compatible with acute tubular necrosis in both experimental groups. Conclusions - Alterations found in renal hemodynamics were compatible with the release of vasoconstrictor substances due to renal ischemia. Allopurinol was not effective in preventing renal alterations caused by ischemia and reperfusion. Dept. de Anestesiologia da FMB UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP Dept. de Anestesiologia da FMB UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:52Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:39:32Z : No. of bitstreams: 1 2-s2.0-0033769337.pdf: 32482 bytes, checksum: b3e0d4677a9fa6e881f984b57b0eefa0 (MD5) Made available in DSpace on 2014-05-27T11:19:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-01-01 Dept. de Anestesiol. da FMB - UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu - SP Dept. de Anestesiol. da FMB - UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu - SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:52Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:45:13Z : No. of bitstreams: 1 2-s2.0-0034085892.pdf: 114238 bytes, checksum: c02cb431f7e3bf3142f86d6d872a1e2d (MD5) Made available in DSpace on 2014-05-27T11:19:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-01-01 Background and Objectives - Sevoflurane is an inhalational anesthetic drug with low blood/gas solubility providing fast anesthesia induction and emergence. Its ability to maintain cardiovascular stability makes it ideal for pediatric anesthesia. The aim of this study was to evaluate hemodynamic stability, consumption of inhalational anesthetics and emergence time in children with and without premedication (midazolam or clonidine) anesthetized with sevoflurane titrated according to BIS monitoring. Methods - Participated in this study 30 patients aged 2 to 12 years, physical status ASA I, undergoing elective surgeries who were divided into 3 groups: G1 - without premedication, G2 - 0.5 mg.kg-1 oral midazolam, G3 - 4 μg.kg-1 oral clonidine 60 minutes before surgery. All patients received 30 μg.kg-1 alfentanil, 3 mg.kg-1 propofol, 0.5 mg.kg-1 atracurium, sevoflurane in different concentrations monitored by BIS (values close to 60) and N2O in a non rebreathing system. Systolic and diastolic blood pressure, heart rate, expired sevoflurane concentration (EC), sevoflurane consumption (ml.min-1) and emergence time were evaluated. Emergence time was defined as time elapsed between the end of anesthesia and patients' spontaneous movements trying to extubate themselves, crying and opening eyes and mouth. Results - There were no differences among groups as to systolic and diastolic blood pressure, EC, sevoflurane consumption and emergence time. Heart rate was lower in G3 group. Conclusions - Sevoflurane has provided hemodynamic stability. Premedication with clonidine and midazolam did not influence emergence time, inhaled anesthetic consumption or maintenance of anesthesia with sevoflurane. Anesthesia duration has also not influenced emergence time. Hypnosis monitoring was important for balancing anesthetic levels and this might have been responsible for the similarity of emergence times for all studied groups. Depto. de Anestesiologia da FMB UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP Depto. de Anestesiologia da FMB UNESP, Distrito de Rubiao Junior, 18618-970 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:43Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:29:12Z : No. of bitstreams: 1 2-s2.0-0032991112.pdf: 64976 bytes, checksum: 002ec902b133a10226dab80c3e5a13bb (MD5) Made available in DSpace on 2014-05-27T11:19:43Z (GMT). No. of bitstreams: 0 Previous issue date: 1999-03-19 Backgrounds and Objectives: Both continuous venous anesthesia with propofol and inhalational anesthesia with sevoflurane propitiate fast arousal with few side effects. The aim of this study was to compare the arousal and post anesthestic recovery times in patients submitted to these two agents. Methods: Forty three patient aged 18 to 50 years, physical status I or II, submitted to gynecological laparoscopy were distributed in two groups: G1 - propofol in continuous infusion of 115 μg.kg -1.min -1 and G2 sevoflurane. All the patients were pre-medicated with 7.5 mg midazolam, sufentanil 0.5 μg.kg -1, propofol 2 mg.kg -1, atracurium 0.5 mg.kg -1, N 2O in 50% of oxygen in a no-rebreathing system. The depth of the anesthesia and arousal time were assessed by the Bispectral index (BIS). The time between end of anesthesia and eye opening, time for command response and time for orientation were also evaluated. Results: The times recorded in minutes were: G1 - eye opening 8.2 ± 2.9, command response 8.6 ± 3.1, orientation 9.8 ± 3.4, recovery 31.6 ± 3.8; G2 - eye opening 4.5 ± 3, command response 4.9 ± 3.4, orientation 6.2 ± 3.4, recovery 66 ± 8. Except the recovery time, all the values were larger in G1. Conclusions: Both intravenous propofol or inhalational sevoflurane were considered excellent anesthetic techniques as to recovery time and recovery room discharge. Sevoflurane provided an earlier arousal with a longer recovery room stay as compared to propofol. Dept. de Anestesiologia FMB - UNESP Distrito de Rubiao Junior, 18618-000 Botucatu, SP Dept. de Anestesiologia FMB - UNESP Distrito de Rubiao Junior, 18618-000 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:42Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:44:34Z : No. of bitstreams: 1 2-s2.0-0032892828.pdf: 46691 bytes, checksum: a53cdc2b60cfe48b103e86ad6998978c (MD5) Made available in DSpace on 2014-05-27T11:19:42Z (GMT). No. of bitstreams: 0 Previous issue date: 1999-01-27 Background and Objectives. The analgesic actions of nonsteroidal anti-inflammatory drugs (NSAID) result from the inhibition of the peripheral synthesis of prostaglandins. In spite of the emphasis on the peripheral action, several studies have shown the potential central action of such drugs. In rats, NSAID doses insufficient to block pain when systemically administered were effective when intrathecally injected. This effect could be mediated by interaction with descending serotoninergic ways together with neurotransmission modulation of glycine or N-methyl-D-aspartate receptors. Our goal was to study the effect of different tenoxican doses in the histology of dogs spinal cord and meninges. Methods. Thirty two dogs (7 to 17 kg) were randomly distributed in four groups: G1 - Control with distilled water (DW); G2 - 2 mg tenoxican diluted in DW; G3 - 4 mg tenoxican diluted in DW; G4 - 10 mg tenoxican diluted in DW in a constant volume of 1 ml. Anesthesia was induced with etomidate and fentanyl and dural puncture was performed with a 25G spinal needle in interspace L6-7. Animals were observed for 72 hours and subsequently euthanized by electrocution. Lumbar and sacral spinal cord segments were removed for further histologic examination. Results. All animals were clinically normal during the observation period and there has been no histologic alteration of the nervous system and meninges. Conclusions. In our experimental model intrathecal tenoxican doses up to 10 mg have not triggered nervous tissue or meningeal injuries in dogs. Departamento de Anestesiologia FMB-UNESP, Caixa Postal 530, 18618-000 Botucatu, SP Departamento de Anestesiologia FMB-UNESP, Caixa Postal 530, 18618-000 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:35Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:28:47Z : No. of bitstreams: 1 2-s2.0-0031804685.pdf: 49947 bytes, checksum: 089a84de15a37a2cbcb0c0cd582f5e8f (MD5) Made available in DSpace on 2014-05-27T11:19:35Z (GMT). No. of bitstreams: 0 Previous issue date: 1998-06-16 Background and Objectives - Inhalational anesthetics have a mild analgesic effect. The reduction of alveolar concentration (MAC) of potent volatile anesthesics by increasing plasma concentrations of opioids is desired in inhalational anesthesia. The purpose of this study was to determine the role of sufentanil in reducing sevoflurane and isoflurane MAC. Methods - Thirty eight adult patients of both genders, physical status ASA I or II, submitted to major abdominal procedures were randomly allocated into two groups. Group I (n = 24) received inahalational anesthesia with sevoflurane and Group II (n = 14) received inhalational anesthesia with isoflurane, both diluted in a mixture of N2O (1 liter) and O2 (0.5 liter). A semi-closed system with CO2 absorber and partial reinhalation was used. Ventilation was mechanically controlled. Sufentanil infusion was administered aiming at obtaining 0.5 ng.ml-1 of plasma concentration. Sufentanil plasma concentration was previously calculated by a computer software. End-tidal concentrations were obtained through a gas analyzer and measured at 15 minutes (M1), 30 minutes (M2), 60 minutes (M3), 90 minutes (M4) and 120 minutes (M5). Systolic and diastolic blood pressure (SBP and DBP) and heart rate (RR) were measured during the same periods with the addition of M0 (pre-anesthetic period). Hourly consumption of the inhalational anesthetic agent (IAC), extubation time (ET = time between admission to the recovery room and extubation) and stay in the post anesthesia recovery room (PA-RR) were also measured. Results - Type and duration of surgeries were similar for both groups. There were no statistically significant differences in MAC, SBP, DBP, RR, IAC, TE and PA-RR between groups. Systolic blood pressure in group I (sevoflurane) showed differences among periods F = 3.82 p < O.05; (M2 = M3)(M4 = M5) and M1 had a intermediate value. MAC in group I showed differences among periods F = 9.0 p < 0.05; M1 < M3. MAC in group II also showed differences among periods F = 13.03 p < O.05; M1 < (M2,M3,M4,M5). Conclusions - Both groups had similar behavior when associated to sufentanil in major abdominal surgeries. Group II showed a higher cardiac and circulatory stability. Dept Anestesiologia da FMB - UNESP, 18618-000 Botucatu, SP Dept Anestesiologia da FMB - UNESP, 18618-000 Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:19:32Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:44:37Z : No. of bitstreams: 1 2-s2.0-0031870887.pdf: 57812 bytes, checksum: a5c46d857ff22eb5e9290cedcb5243f7 (MD5) Made available in DSpace on 2014-05-27T11:19:32Z (GMT). No. of bitstreams: 0 Previous issue date: 1998-01-01 Background and Objectives - There are many questions and opinions about the value of routine preoperative tests as an integral part of the preanesthetic evaluation. Current trends suggest that such tests should be based on detailed clinical and physical evaluation. Since such tests are still routinely performed and questions about their real value still persist, the aim of this study was to assess the value of routine hematocrit (Ht), hemoglobin concentration (Hb), blood urea nitrogen (BUN) and serum creatinine results in patients undergoing elective surgery, to establish when they are needed and aiming at answering such questions. Methods - 1065 patients aged 12 years and above, physical status ASA I, II and III, scheduled for elective surgery were studied. Patients were divided into 7 different age groups with randomized distribution of gender. Ht, Hb, BUN and serum creatinine results, routinely asked by our surgical departments, were observed and analyzed. Variance Analysis was used for each variable, and the Bonferroni Multiple Comparison Test was used to compare group to group. Differences were considered significant when p < 0.05 (5%). Results - For all patients, 4025 laboratory tests were obtained. The number of tests was the same for each group. There were no differences in Ht and Hb values which remained within normal ranges. Considering BUN and serum creatinine, there was a difference between younger and older patients, but the results were normal in all groups. Conclusions - We concluded that mean Ht, Hb, BUN and serum creatinine values in all age groups were all acceptable for surgical patients in general. However, they are barely useful if performed regardless of clinical evaluation. Thus, such preoperative routine tests should be abandoned and the good clinical practice with common sense should prevail in indicating them. Dept de Anestesiologia FMB, UNESP Distrito de Rubiao Junior, 18618-970 - Botucatu, SP Dept de Anestesiologia FMB, UNESP Distrito de Rubiao Junior, 18618-970 - Botucatu, SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:18:11Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:33:43Z : No. of bitstreams: 1 2-s2.0-0030833006.pdf: 85170 bytes, checksum: 93d896be3a08c4ed73abbd2407cf232c (MD5) Made available in DSpace on 2014-05-27T11:18:11Z (GMT). No. of bitstreams: 0 Previous issue date: 1997-01-01 Background and Objectives - Gynecological laparoscopy causes high postoperative morbidity, mainly due to occurrences such as nausea and vomiting. They result from a great multiplicity of etiologies and drugs used in anesthesia may function as contributing factors. Both the emetic properties of nitrous oxide and the efficacy of metoclopramide as antiemetic agent are controversial. This study was undertaken to determine the effects of both drugs, when used alone or in combination. Methods - Eighty three physical status ASA I and II women were studied. They were premedicated with midazolam before induction of anesthesia with alfentanil and propofol. Anesthesia was maintained with isoflurane with or without nitrous oxide in oxygen. Muscle relaxation was achieved with atracurium. There were 4 groups of patients: GI: midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GII: midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen; GIII: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GIV: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen. The incidence of nausea and vomiting was assessed both in the recovery room (RR) and in the ward. Results - There were no significant differences as regards age, weight and height of the patients and duration of anesthesia and surgery. Nausea and vomiting were more frequent in patients who received N2O (GII, 50%; GIV, 33%), as compared to those who didn't receive this agent (GI and GII, 9.5% and 14.35%, respectively). Metoclopramide decreased the incidence of nausea and vomiting in the recovery room, in patients who didn't receive N2O (GII). These patients remained in the recovery room for 90 minutes. Conclusions - N2O increases the incidence of nausea and vomiting and metoclopramide is effective in reducing these complications only in the recovery room. Departamento de Anestesiologia FMB-UNESP Distrito de Rubiao Junior, 18618-970-Botucatu-SP Departamento de Anestesiologia FMB-UNESP Distrito de Rubiao Junior, 18618-970-Botucatu-SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:18:03Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:44:05Z : No. of bitstreams: 1 2-s2.0-0029960922.pdf: 63831 bytes, checksum: ac46307cb7c8710c19599d89e6d7682b (MD5) Made available in DSpace on 2014-05-27T11:18:03Z (GMT). No. of bitstreams: 0 Previous issue date: 1996-01-01 Background and Objectives - A controversy exists in the literature regarding the effects of the acute administration of magnesium on the cardiovascular system of animals and humans. The purpose of this study was to evaluate the effects of hypermagnesemia on the cardiovascular hemodynamics of dogs. Methods - Sixteen mongrel dogs were anesthetized with pentobarbitone 30 mg.kg-1 and submitted to volume expansion with Ringer's solution (0.4 ml.kg-1.min-1 and mechanical ventilation with room air. In this model, the hemodynamic repercussions of the following drugs and doses were studied. pentobarbitone 5 mg.kg-1 Group 1, control - and the association of pentobarbitone and magnesium sulphate (MS), at the dose of 140 mg.kg-1 injected in 15 minutes, followed by an infusion of 80 mg.kg-1.h-1 - Group 2. The parameters studied were: heart rate, blood pressure, inferior vena cava pressure, cardiac index, systolic index and peripheral resistance index, evaluated at 5 different moments: 15(M1), 30(M2), 60(M3) and 75(M4) minutes after the first suppplementary dose of pentobarbitone and 15 minutes (M5) after the second supplementary dose. In Group 2, the moments M3, M4, M5 corresponded to 15, 30 and 60 minutes after the priming dose of magnesium sulphate. Results - Group 1 animals exhibited tachycardia since the beginning of the experiment. There was a decrease in the cardiac index, in the systolic index and an increase in the inferior vena cava pressure. Group 2 animals also exhibited tachycardia, but heart rate decreased after MS infusion. The blood pressure and the peripheral resistance index decreased. The systolic index increased and the cardiac index decreased only at the end of the experiment. Conclusions: The antiadrenergic effects of MS could have been responsible for the decrease in heart rate. The vasodilating effects of the magnesium induced the decrease in the peripheral resistance index. The systolic index increased, showing that myocardial depression did not occur. Dept de Anestesiologia de FMB-UNESP Distrito de Rubiao Junior, 18618-970 Botucatu - SP Dept de Anestesiologia de FMB-UNESP Distrito de Rubiao Junior, 18618-970 Botucatu - SP

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:17:55Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:28:16Z : No. of bitstreams: 1 2-s2.0-0028355925.pdf: 55525 bytes, checksum: 606be18cdf3cfe82315ba7e40cf9e1eb (MD5) Made available in DSpace on 2014-05-27T11:17:55Z (GMT). No. of bitstreams: 0 Previous issue date: 1994-01-01 Little research has been done with propofol in relation to renal function. The aim of this study was to evaluate the effects of the continuous infusion of propofol on renal function in dogs. Sixteen dogs, previously anesthetized with pentobarbital sodium (30 mg.kg-1) for surgical preparation, catheterism and monitoring, were studied. The dogs were mechanically ventilated with air and received alcuronium (0.2 mg.kg-1 in bolus and 0.06 mg.kg-1 - maintenance). The following parameters were studied: heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), aortic blood flow (A(o)BF - by electromagnetic flowmeter installed in the ascending aortic), aortic vascular resistance index (A(o)VRI), renal plasma flow (ERPF - by para-aminohipurate clearance), glomerular filtration rate (GFR - by creatinine clearance), effective renal blood flow (ERBF = ERPF/1 - hematocrit), urinary volume (UV), renal vascular resistance (RVR = MAP.80/ERBF.10-3), urinary sodium excretion (UE(Na)), fractionated sodium excretion (FE(Na)), osmolar clearance (C(osm)) and free water clearance (C(H2O)). These parameters were studied at 15 (M1), 30 (M2), 45 (M3) and 60 (M4) min after beginning pentobarbital sodium infusion (5 mg.kg-1.h-1). The dogs were allocated into two groups of eight animals each: G1 (control-pentobarbital sodium) and G2 (propofol). In G1, pentobarbital was given at the four times studied. G2 dogs received the same treatment as G1 dogs at M1 and M2; infusion of pentobarbital was substituted by propofol (3 mg.kg-1 bolus, followed by 12 mg.kg-1.h-1 continuous infusion) at M3 and M4. Profile Analysis was used to analyze the results statistically. In G1 (pentobarbital), there was a significant increase in RVR (M1 < M4) and a decrease in ERPF and ERBF (M1 > M4). In G2 (propofol) there was only a significant increase in A(o)BF (M1 < M2 = M3). In comparison among groups, these was a significant alteration of FE(Na) at M3 (pentobarbital > propofol). It was observed that the continuous infusion of propofol in dogs, at the given doses, did not alter the basic variables of renal function and hemodynamics studied. We concluded that propofol can be one of the drugs of choice to provide base anesthesia in studies of renal function in dogs. Departamento de Anestesiologia Faculdado de Medicina UNESP, 18618-000 Rubiao Junior, Botucatu Departamento de Anestesiologia Faculdado de Medicina UNESP, 18618-000 Rubiao Junior, Botucatu

Submitted by ALEXANDRE FABRICIO MARTUCCI null (afmartucci@gmail.com) on 2016-10-11T17:02:55Z No. of bitstreams: 1 Alexandre Fabricio Martucci (doutorado - pós-defesa)1.pdf: 1424088 bytes, checksum: 37085065265b125c45e34a67ec21913d (MD5) Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-10-18T16:18:29Z (GMT) No. of bitstreams: 1 martucci_af_dr_bot.pdf: 1424088 bytes, checksum: 37085065265b125c45e34a67ec21913d (MD5) Made available in DSpace on 2016-10-18T16:18:29Z (GMT). No. of bitstreams: 1 martucci_af_dr_bot.pdf: 1424088 bytes, checksum: 37085065265b125c45e34a67ec21913d (MD5) Previous issue date: 2016-08-26 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) National Institutes of Health (NIH) As reações adversas relacionadas à transfusão sanguínea chegam a 0,138%. Lesão Pulmonar Aguda Relacionada à Transfusão (TRALI), imunossupressão, febre, transmissão de patógenos e reação hemolítica aguda são as complicações mais comuns. Na tentativa de mitigar essas reações, pesquisadores tentam criar carreadores de oxigênio eficazes e não tóxicos. As soluções até agora apresentadas não foram melhores do que uma transfusão sanguínea. O óxido nítrico (NO) tem influência nas alterações vasculares e pode ter influência na toxicidade. Assim como o NO, a curva de saturação da hemoglobina (Hb) pelo oxigênio e a meia-vida são características que não foram completamente investigadas quanto à toxicidade e às alterações sistêmicas e micro-hemodinâmicas. Objetivo. Determinar se as diferentes propriedades quanto à meia-vida, à dissociação de oxigênio e à cinética de NO de soluções de carreadores de oxigênio baseados em Hb (HBOC) afetam a microvasculatura e a função renal, diferentemente. Material e Métodos. Estudo prospectivo realizado no Laboratório de Bioengenharia da Universidade da Califórnia, San Diego, EUA, usando hamsters Sírios Dourados machos. Foi injetado um HBOC em animal previamente anestesiado e operado para instalação de uma janela de visualização da microvasculatura e, também, para implante de cateteres centrais. Cinco tipos de solução que variavam entre elas quanto à meia-vida, à curva de dissociação do oxigênio e ao consumo de NO foram empregadas. Foram avaliados a pressão arterial média (PAM), a frequência cardíaca, o conteúdo plasmático de Hb livre. Arteríolas de 50 a 100mcm foram avaliadas ao longo do experimento quanto a alterações de diâmetro, fluxo e velocidade do fluxo através da janela de visualização. Foi também avaliado o ritmo de filtração glomerular (RFG) com sinistrina associada à fluoresceína-isotiocianato em três tempos diferentes após a infusão das soluções. A estrutura renal foi analisada com cortes histológicos após o sacrifício. Somente após o experimento terminado é que as características das soluções foram reveladas. Principais resultados. As cinco soluções estudadas causaram aumento da PAM e diminuição da frequência cardíaca sustentados até 30 minutos após a infusão das soluções. As medidas de diâmetro arteriolar e do fluxo e velocidade do fluxo nesses vasos não foram diferentes até 60 minutos após a infusão. Não foi detectada alteração significativa do RFG, no entanto a análise histológica revelou dano tubular associado à infusão das soluções. Conclusão. As soluções estudadas causaram lesão renal sem alterações do RFG. O aumento da PAM sem alterações uniformes da microcirculação pode sugerir que esse aumento seja decorrente de alterações em vasos de maior calibre. There is a 0,138% incidence of adverse reactions related to blood transfusion. Synthetic oxygen carriers have been developed as an attempt to mitigate these reactions. So far, no solution is better than a regular blood transfusion. Nitric oxide (NO) has been implied to cause hypertension and may have influence on toxicity. As much as NO, hemoglobin (Hb) dissociation slope of oxygen and half-life have not been completely investigated regarding toxicity, microhemodynamics and systemic parameters. Objective. To determine if different oxygen and NO kinetics how toploads of Hb-based oxygen carriers (HBOC) with different half-life, oxygen and NO kinetics of Hb-based oxygen carriers (HBOC) affect microvascular hemodynamics and kidney function differently. Design. Prospective study done at Bioengineering Laboratory of University of California, San Diego, USA, using mal e Golden Syrian hamsters. Interventions: Hamsters implemented with a dorsal window chamber were given HBOC infusions characterized by five different Hb, oxygen, and NO kinetics and heme dissociation rates. Measurements: Systemic variables included mean arterial pressure, heart rate and free plasma Hb content. Microvascular hemodynamic measurements included arteriolar diameter and red blood cell flow velocity in vessels ranging from 50 to 100mcm. Glomerular filtration rate (GFR) was estimated with fluorescein-isothiocyanate sinistrin clearance. Renal structure was investigated with histological analysis. Main results. All five HBOC solutions caused hypertension and bradycardia that were sustained up to 30 minutes after infusion. Microvascular diameter and blood flow velocity were not different from baseline up to 60 minutes after infusion. Acute changes in GFR were not detected however histological analysis performed 72 hours later revealed tubular damage. The characteristics of solution were only revealed after all the experiment was completed. Conclusion. All the rHb solutions resulted in kidney structural damage without change in GFR. There was no statistical uniform variation regarding arteriolar diameter, velocity or flow. The mean arterial pressure increased without microhemdynamics uniform variations suggest a role to bigger vessels. CAPES: 99999.005137/2014-04

Submitted by VERUSCA MICHELE OLIVA null (veruscami@yahoo.com.br) on 2016-05-27T00:43:01Z No. of bitstreams: 1 Verusca Michele Oliva (Doutorado).pdf: 871575 bytes, checksum: cab8b37728988e1fd844ab6c3cc5575d (MD5) Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-05-31T12:50:23Z (GMT) No. of bitstreams: 1 oliva_vm_dr_bot.pdf: 879577 bytes, checksum: 4ac3579ab3e68ccaf626cc77cfc9b077 (MD5) Made available in DSpace on 2016-05-31T12:50:23Z (GMT). No. of bitstreams: 1 oliva_vm_dr_bot.pdf: 879577 bytes, checksum: 4ac3579ab3e68ccaf626cc77cfc9b077 (MD5) Previous issue date: 2016-05-05 Objetivo: estudar fatores que influenciaram o sucesso do transplante renal de doador vivo. Métodos: estudo de coorte retrospectiva analítica - prontuários de Hospital Universitário de 160 receptores de rins e seus doadores. No doador e receptor, estudaram-se dados de avaliação pré-anestésica, anestesia e anestésicos empregados e, no receptor, tempos de isquemia quente e fria, complicações no pós-operatório, evolução do TX quanto à creatinina sérica (Cr) - redução de 50% em 24h e normalização em até 119h - e relação desses comportamentos com alta hospitalar. Análise estatística: regressão de Poisson com técnica de passos para trás. Resultados: nos receptores, com intervalo de confiança 95%: fatores protetores para redução inicial da Cr, hipertensão arterial, razão de prevalência (RP) 0,49 (0,26-0,92), p=0,020, anestesia inalatória, RP 0,36 (0,18-0,69), p 20 anos [entre 30-39 anos, RP 8,84 (2,05-38,11), p=0,003], tempo de isquemia fria > 120min, RP 1,87 (1,06-3,29), p=0,020. Sem redução inicial esperada da Cr, ocorreu alta hospitalar tardia. Conclusão: no receptor, foram fatores protetores para iniciar redução da Cr, hipertensão prévia e anestesia inalatória e, para sua normalização, idade < 20 anos e tempo adequado de isquemia fria. Com redução inicial da Cr a alta pode ocorrer em menor tempo. Aim: to study the factors that influenced the success of living donor kidney transplant. Methods: analytical retrospective cohort study analyzing School Hospital records of 160 renal recipients and their donors. Pre-anesthetic evaluation data, anesthesia and anesthetics used were studied for donor and recipient. Exclusively for the recipient, time of warm and cold ischemia, postoperative complications and transplant evolution regarding creatinine (Cr), 50% decrease within 24h and normalization up to 119h, as well as the relation of such evolution with discharge were also studied. Statistical analysis: Poisson regression with step wise with backward elimination. Results: for the recipients, with 95% confidence interval: protective factors for Cr initial decrease, arterial hypertension, prevalence ratio (PR) 0,49 (0,26-0,92), p=0,020, inhalational anesthesia, PR 0,36 (0,18-0,69), p 20 years old [between 30-39 years old, PR 8,84 (2,05-38,11), p=0,003], cold ischemia time > 120min, PR 1,87 (1,06-3,29), p=0,020. Without proper Cr initial decrease there was > hospitalization period. Conclusion: for the recipient, protective factors to Cr initial decrease were previous hypertension and inhalational anesthesia, and to Cr normalization, age < 20 years old and adequate cold ischemia time. With proper Cr initial decrease, the patient can be discharged in a shorter time.

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Made available in DSpace on 2016-07-01T13:10:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-13. Added 1 bitstream(s) on 2016-07-01T13:13:42Z : No. of bitstreams: 1 000866212.pdf: 679544 bytes, checksum: a308632dc61295ffb969a148d43b84fc (MD5)

Made available in DSpace on 2018-07-27T18:26:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-10-22. Added 1 bitstream(s) on 2018-07-27T18:30:44Z : No. of bitstreams: 1 000877132.pdf: 338509 bytes, checksum: 70985e98e4ff1c130a8628a0750eb782 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) A pré-eclâmpsia é uma doença multissistêmica que afeta, entre outros órgãos, placenta e rim. Objetivo: Utilizando vários biomarcadores, avaliar a função renal e a integridade tubular após cesariana em gestantes pré-eclâmpticas leves submetidas à anestesia subaracnoidea. Métodos: Este estudo coorte prospectivo analisou a função renal e a integridade tubular de 72 gestantes com hipertensão gestacional ou crônica, com e sem pré-eclâmpsia leve, após cesariana sob anestesia subaracnoidea, tendo como marcadores do ritmo de filtração glomerular (RFG) a cistatina C e a creatinina plasmáticas, e da integridade tubular a fosfatase alcalina (FA), γ-glutamiltransferase (γ-GT) e lipocalina associada à gelatinase neutrofílica (NGAL) urinárias, antes da cesariana (T1) e 48h após (T2), distribuídas nos grupos: pré-eclâmpsia leve (P), n= 27; hipertensão arterial crônica e pré-eclâmpsia leve sobreposta (PH), n=16; hipertensão arterial (H, grupo controle), n=29. Resultados: O RFG pela cistatina C aumentou entre T1 e T2 de todos os grupos. O RFG pela creatinina diminuíu significativamente em todos os grupos. Os valores de NGAL aumentaram de T1 para T2 em todos os grupos, e os das enzimas FA e γ-GT diminuíram significativamente em T2 dos grupos P e H. Conclusões: Para o período pós-operatório de cesariana de gestante com pré-eclâmpsia leve, a cistatina C e o NGAL não se mostraram biomarcadores livres de viés para o estudo da função renal. O RFG medido pela creatinina mostrou leve diminuição, compatível com o estresse do período perioperatório. Houve diminuição das enzimas da borda em escova nas gestantes hipertensas e naquelas com pré-eclâmpsia Preeclampsia is a multisystemic disease that affects, among other organs, placenta and kidney. Objective: Using multiple biomarkers, assess renal function and tubular integrity after cesarean section in mild preeclamptic patients undergoing subarachnoid anesthesia. Methods: This prospective cohort study examined renal function and tubular integrity of 72 pregnant patients with gestational or chronic hypertension, with and without mild preeclampsia, after cesarean section under subarachnoid anesthesia, having as markers of glomerular filtration rate (GFR) cystatin C and creatinine plasmatic, and of tubular integrity, alkaline phosphatase (AP), γ-glutamyl transpeptidase (γ-GT) and neutrophil gelatinase associated lipocalin (NGAL) urinary, before cesarean section (T1) and 48 h after (T2), distributed among groups: mild preeclampsia (P, case group), n = 27; chronic hypertension and mild preeclampsia superimposed (PH, case group), n = 16; hypertension (H, control group), n = 29. Results: The GFR by cystatin C increased between T1 and T2 for all groups while the GFR by creatinine was significantly decreased in all groups. The values of NGAL increased from T1 to T2 in all groups, and the FA and γ-GT enzymes decreased significantly in T2 of the groups P and H. Conclusions: For the postoperative period of cesarean section of pregnant patients with mild preeclampsia, cystatin C and NGAL were biomarkers not free of bias for the study of renal function. The GFR measured by creatinine showed a slight decrease, consistent with the stress of the perioperative period. There was a reduction of brush border enzymes in hypertensive pregnant patients and in those with pre-eclampsia FAPESP: 2010/06986-7

Made available in DSpace on 2015-05-14T16:53:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-28Bitstream added on 2015-05-14T16:58:38Z : No. of bitstreams: 1 000816092.pdf: 555534 bytes, checksum: 60cc661122084b4ae08b5daaf4c5481a (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introdução: O parecoxibe tem comprovada eficácia analgésica no tratamento da dor, entretanto seus efeitos adversos renais não estão esclarecidos. Se por um lado os inibidores da ciclooxigenase-2 geram danos ao rim por alterar a dinâmica vascular renal, por outro lado bloqueiam a inflamação, e admite-se que a inflamação esteja relacionada com prejuízos ao rim. Em casos de hipoperfusão renal, como em situação de hemorragia e hipovolemia, há diminuição direta do aporte de nutrientes e a isquemia estimula a produção de mediadores inflamatórios. O objetivo desta pesquisa foi avaliar se a dose única de parecoxibe influi na ocorrência de apoptose ou necrose em rins de ratos submetidos à hemorragia. Métodos: Vinte e quatro ratos Wistars adultos anestesiados com sevoflurano foram distribuídos aleatoriamente em quatro grupos (n=6): grupo placebo/ sem hemorragia (plac/ sh); grupo parecoxibe/ sem hemorragia (PCX/ sh); grupo placebo/ hemorragia (plac/ H) e grupo parecoxibe/ hemorragia (PCX/ H). Receberam bolus endovenoso em dose única de parecoxibe, 20mg/kg, ou placebo de acordo com a distribuição por grupos. Os animais dos grupos com hemorragia sofreram sangria correspondente a 30% da volemia durante 20 min. Após 80 min da administração do bolus de parecoxibe ou placebo e 30 min do fim da hemorragia, foi realizada nefrectomia bilateral para avaliação de necrose ou apoptose pela citometria de fluxo. Resultados: Os grupos que receberam parecoxibe (PCX/ sh e PCX/ H) apresentaram maior quantidade de necrose, menor quantidade de apoptose e maior quantidade de células viáveis renais pela citometria de fluxo. Conclusão: A dose única de parecoxibe gerou necrose renal, mas associou-se à proteção do órgão contra apoptose e à maior quantidade de células viáveis precocemente após hemorragia Introduction. Parecoxib has proven analgesic efficacy in the treatment of pain, however its adverse renal effects are unclear. The cyclooxygenase-2 inhibitors generate damage to the kidney through renal vascular dynamic changes, on the other hand they block the inflammation, and it is believed that inflammation is related to kidney damage. In cases of renal hypoperfusion, as in situation of hemorrhage and hypovolemia, there is direct reduction of nutrient input and ischemia stimulates the production of inflammatory mediators. The aim of this study was to evaluate whether a single dose of parecoxib influences the occurrence of apoptosis or necrosis in kidneys of rats submitted to hemorrhage. Methods. Twenty-four adult Wistar rats anesthetized with sevoflurane were randomly distributed into four groups (n=6): placebo/ no hemorrhage (plac/ nh), parecoxib/ no hemorrhage (PCX/ nh); placebo/ hemorrhage (plac/ H) and parecoxib/ hemorrhage (PCX/ H). The animals received single intravenous bolus of parecoxib, 20mg/kg, or placebo according to the group distribution. The animals in groups with hemorrhage suffered bleeding corresponding to 30 % of volemia during 20 min. Eighty min after the administration of parecoxib or placebo and 30 minutes after the end of the hemorrhage period, bilateral nephrectomy was performed to assess necrosis or apoptosis by flow cytometry. Results. The groups which received parecoxib (PCX/ nh and PCX/ H) showed a higher amount of renal necrosis, minor amounts of apoptosis, and higher amount of viable cells by flow cytometry. Conclusion. A single dose of parecoxib generated renal necrosis, but was associated with kidney protection against apoptosis and with increased number of viable cells early after hemorrhage FAPESP: 10/18469-7

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-13Bitstream added on 2014-06-13T20:27:01Z : No. of bitstreams: 1 zamorano_mcr_dr_botfm.pdf: 958615 bytes, checksum: 37778d2e30a8f008f73ee49acb47dfb9 (MD5) Em ratos anestesiados com sevoflurano, após hemorragia aguda, investigar a influência da ressuscitação fluídica com solução de Ringer ou hidroxietilamido 130/0,4 (HEA) pelas alterações da pressão arterial média (PAM), histologia e expressão de citocinas renais. Foram anestesiados 44 ratos com sevoflurano, alocados em 4 grupos (n=12): GSevo - ratos submetidos à hemorragia, sem ressuscitação fluídica, GRinger- hemorragia e ressuscitação com solução de Ringer (proporção de 3:1 de sangue retirado), GHEA – hemorragia e ressuscitação com HEA (proporção de 1:1) e GSham - sem hemorragia. A hemorragia foi de 30% da volemia: três etapas de 10% a cada 10 minutos. Realizada hidratação basal com solução de Ringer, 7 mL/kg/h, em todos os animais. Após o fim da ressuscitação fluídica, realizada nefrectomia bilateral nos 4 grupos para análise histológica e das citocinas fator-α de necrose tumoral (TNF-α) e interleucina-1 (IL-1) renais. No final do experimento todos os grupos apresentaram hipotensão arterial, exceto GHEA. A degeneração tubular foi a lesão mais encontrada, estando presente em todos os grupos, mais intensa em GSham. Apenas em GSham, GRinger e GHEA foi observada necrose tubular - um rim de cada grupo. Houve expressão de IL-1 em todos os rins, porém com significância estatística apenas em GHEA. A expressão de TNF-α ocorreu em todos os grupos, mas sem diferença entre eles. A resposta da pressão arterial média foi melhor após ressuscitação com HEA. O sevoflurano e/ou o estresse cirúrgico foram responsáveis pela degeneração tubular e expressão renal de IL-1 e TNF-α e a administração basal de Ringer melhorou a resposta histológica, enquanto que o HEA acentuou a expressão de IL-1 To investigate the influence of fluid resuscitation with Ringer solution versus hydroxyethyl starch 130/0.4 (HES) on mean arterial pressure (MAP), and renal histology and cytokine expression in rats submitted to acute hemorrhage under sevoflurane anesthesia. Forty-four rats anesthetized with sevoflurane were allocated into 4 groups (n=12): GSevo- hemorrhage with no fluid resuscitation, GRinger- hemorrhage and resuscitation with Ringer solution (3:1 of blood loss), GHES – hemorrhage and resuscitation with HES (1:1), and GSham - without hemorrhage. Hemorrhage was induced by withdrawing 30% blood volume loss over 30 minutes (10% every 10 min). All animals received 7 mL/kg/h of Ringer solution for basal hydration. Bilateral nephrectomy was conducted in all animal groups for the analysis of renal histology and expression of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1)

Made available in DSpace on 2014-06-11T19:28:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-25Bitstream added on 2014-06-13T19:16:41Z : No. of bitstreams: 1 martucci_af_me_botfm.pdf: 228219 bytes, checksum: ce34b2e82a7242601a90e1e535b1b1ed (MD5) O aumento sérico da creatinina em 0,3mg/dL define o termo lesão renal aguda (LRA) e associa-se a maior incidência de mortalidade pós-operatória em pacientes submetidos a revascularização do miocárdio. Os estudos clínicos quanto à influência da dexmedetomidina (DEX) sobre a função renal ainda são escassos. Avaliou-se a LRA no pós operatório de revascularização do miocárdio com e sem circulação extracorpórea (CEC) quando se anestesiou com DEX. Neste estudo, retrospectivo, fez-se análise seriada da creatinina sérica (CrS) até 48h de pós-operatório de 286 pacientes submetidos a revascularização do miocárdio para avaliar a incidência de LRA. Testou-se a homogeneidade entre os grupos, avaliando-se os pacientes separadamente quanto ao uso de CEC e de DEX. Cada paciente foi avaliado em relação à sua concentração sanguínea de creatinina nos períodos pré-operatório, pós-operatório imediato, de 24h e de 48h. Em cada período foi efetuada a comparação da concentração de creatinina com a concentração no pré-operatório. Se em pelo menos um dos períodos esta comparação indicou aumento de creatinina≥0,3 mg/dL, o paciente foi classificado como tendo LRA. Foi também avaliado o risco de LRA em pacientes com creatinina sanguínea pré-operatória alterada (valores entre 1,1 a 2,0mg/dL para mulheres ou 1,3 a 2,0mg/dL para homens) em comparação com os pacientes com creatinina normal.Os resultados foram homogêneos quanto a peso, idade e creatinina alterada no pré-operatório e os pacientes que fizeram uso de DEX e foram submetidos a CEC apresentaram maior incidência de LRA, com p=0,043. Dentre aqueles que não foram submetidos a CEC, houve maior incidência de LRA após DEX, porém com p=0,066.O uso da DEX no intraoperatório aumentou a incidência de LRA no pós-operatório de revascularização do miocárdio de pacientes submetidos a CEC The increase of 0.3mg/dL in serum creatinine defines the term acute kidney injury (AKI) and is associated with higher incidence of postoperative mortality in patients undergoing coronary artery bypass grafting surgery (CABG). Clinical studies regarding the influence of dexmedetomidine (DEX) on renal function are scarce. We evaluated the LRA in postoperative of patients submitted to CABG with and without cardiopulmonary bypass (CPB) under anesthesia with DEX. In this retrospective study it was made serial analysis of serum creatinine (SCr) until 48h after the surgery of 286 patients undergoing CABG under DEX to evaluate the incidence of AKI. We tested the homogeneity among groups, evaluating patients separately for the use of CPB and DEX. Each patient was evaluated with respect to their blood concentration of creatinine in the preoperative and postoperative: early, 24h and 48h. In each period, it was compared the creatinine concentration with creatinine concentration preoperatively. If at least in one of the periods this comparison showed increased creatinine ≥ 0.3mg/dL, the patient was classified as having AKI. It has also assessed the risk of AKI in patients with preoperative blood creatinine changed: values between 1.1 to 2.0mg/dL for females or 1.3 to 2.0mg/dL for men compared with patients with normal creatinine concentration. The results were homogeneous for weight, age and creatinine concentration altered to 2.0mg/dL preoperatively. Patients who used DEX and underwent CPB had a higher incidence of AKI, with p = 0.043. Among those who were not undergoing CPB, there was a higher incidence of AKI after DEX, but with p = 0.066. Conclusion. The use of intraoperative DEX increased the incidence of AKI in the postoperative myocardial revascularization in patients undergoing CPB

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-05Bitstream added on 2014-06-13T18:46:38Z : No. of bitstreams: 1 000741147.pdf: 1573813 bytes, checksum: 31603e04a097faa0cf498f6c658cd778 (MD5) O parecoxibe, único anti-inflamatório inibidor seletivo da COX-2 disponível para uso parenteral, tem comprovada eficácia analgésica no tratamento de dor pós-operatória. No entanto, seus efeitos adversos renais não estão esclarecidos, principalmente em situações de hipoperfusão renal, como hemorragia e hipovolemia. A isquemia renal estimula a produção de mediadores inflamatórios como citocinas, responsáveis pelo início e progressão da inflamação e lesão renal. O objetivo desta pesquisa foi avaliar se o pré-tratamento com dose única de parecoxibe tem influência na função, na lesão celular e na resposta inflamatória do rim de ratos submetidos à hemorragia aguda intra-operatória. Quarenta e quatro ratos Wistars adultos anestesiados com sevoflurano foram divididos, de forma aleatória, em quatro grupos (n=11 animais por grupo): grupo placebo/ sem hemorragia (Plac/SH); grupo parecoxibe/ sem hemorragia (Pcx/SH); grupo placebo/ hemorragia (Plac/H) e grupo parecoxibe/ hemorragia (Pcx/H). Receberam bolus endovenoso em dose única de parecoxibe (20mg/kg em 2 mL/kg) ou placebo (solução salina isotônica 2mL/kg) de acordo com a distribuição por grupos, e solução de para-aminohipurato de sódio (PAH) - 1 mg seguido de 1 mg/h - e de iotalamato de sódio (IOT) - 0,5 mg seguido de 0,25 mg/h, até o final do experimento. Os animais dos grupos com hemorragia sofreram sangria correspondente a 30% da volemia (em três etapas de retirada de 10% com intervalos de 10 minutos). Amostras de sangue foram colhidas para determinação do hematócrito e das concentrações de PAH, IOT e das citocinas séricas (IL-1α, IL-1β, IL-6, IL-10 e TNF-α) após trinta minutos da administração do bolus de parecoxibe ou placebo (momento Mi) e trinta minutos após o terceiro tempo de sangria (momento Mf). Foi realizada nefrectomia bilateral, seguida do sacrifício dos ratos. Os rins coletados foram divididos... Parecoxib, the only selective COX-2 inhibitor available for parenteral use, has proven analgesic efficacy in the treatment of postoperative pain. However, adverse renal effects are not clear, especially in situations of renal hypoperfusion, such as hemorrhage and hypovolemia. Renal ischemia stimulates the production of inflammatory mediators, such as cytokines, responsible for the onset and progression of inflammation and renal injury. The aim of this study was to evaluate whether pretreatment with a single dose of parecoxib affects the function, cell injury and inflammatory response of the kidney of rats subjected to acute intraoperative hemorrhage. Forty-four adult Wistar rats anesthetized with sevoflurane were randomized into four groups (n = 11 animals per group): placebo/ without hemorrhage (Plac/NH); parecoxib/ without hemorrhage (Pcx/NH); placebo/ hemorrhage (Plac/H), and parecoxib/ hemorrhage (Pcx/H). They all received a single dose of intravenous parecoxib (20mg.kg-1 at 2 mL.kg-1) or placebo (isotonic saline 2mL.kg-1) according to group distribution. They also received solution of sodium para-aminohippurate (PAH) - 1 mg followed by 1 mg.h-1, and iothalamate sodium (IOT) - 0.5 mg followed by 0.25 mg.h-1, until the end of the experiment. Animals in groups with hemorrhage suffered bleeding corresponding to 30% of volemia (three-stage withdrawal of 10% with a 10 minute interval). Blood samples were collected to measure hematocrit and concentrations of PAH, IOT and serum cytokines (IL-1α, IL-1β, IL-6, IL-10 and TNF-α) thirty minutes after administration of bolus of parecoxib or placebo (Mi) and thirty minutes after the third time of bleeding (Mf). Bilateral nephrectomy was then performed, followed by sacrifice of the rats. Kidneys were longitudinally divided into two halves - one for histological analysis and the other to obtain the renal supernatant of proteins for determination of tissue cytokines (IL-1α, IL-1β, IL-6, IL-10 ...

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2012Bitstream added on 2014-06-13T20:00:44Z : No. of bitstreams: 1 leite_f_dr_botfm.pdf: 1486779 bytes, checksum: e64d28f90d859367d20b7c32dac2b0b3 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) O objetivo deste estudo foi analisar o efeito da anestesia no desfecho perinatal de mulheres hipertensas obesas submetidas à cesárea. Trata-se de estudo observacional prospectivo de 98 gestantes hipertensas e seus recém-nascidos, submetidas à cesárea sob anestesia subaracnoidea. As gestantes foram divididas em quatro grupos de acordo com seus índices de massa corporal (IMC): normal, sobrepeso, obesidade I e obesidade II. Dados demográficos e cirúrgicos maternos, bem como os valores de amostras de sangue venoso do cordão umbilical e características neonatais foram comparados entre os quatro grupos. Mediana e percentis foram utilizados (tendência de distribuição não-normal) e variáveis categóricas foram expressas em valores absolutos e percentuais. Quase 70% das mulheres eram brancas. A parada da dilatação como indicação para cesárea diferiu entre os grupos (p = 0,002): 33,33% do grupo obesidade II, 8,69% do grupo obesidade I, 6,66% do grupo normal e zero no grupo com sobrepeso. Pressão arterial sistólica máxima foi maior em mulheres com IMC normal (p = 0,002). Valores de peso ao nascimento, estatura, pH do sangue venoso do cordão umbilical, lactato, meta-hemoglobina, reticulócitos e eritroblastos foram semelhantes entre os grupos. Escores de New Ballard, Apgar e Silverman-Andersen não diferiram significativamente entre os grupos analisados. Somente cinco recém-nascidos foram internados na unidade neonatal, 25 foram levados para o berçário, onde permaneceram até alta para o alojamento conjunto e 68 permaneceram com suas mães após o nascimento. Não houve influência da anestesia subaracnoidea no desfecho perinatal de gestação de hipertensas obesas The aim of this study was to analyze the effect of anesthesia on perinatal outcome of hypertensive obese women undergoing cesarean delivery. This is a prospective observational study of 98 cesarean sections in hypertensive pregnant women, and their newborns, under spinal anesthesia. Women were divided into four groups according to their body mass indices: normal, overweight, obese I, and obese II. Demographic and surgical maternal data, values of cord blood samples and neonatal outcomes were compared between the four groups. Median and percentiles were used (tendency of non-normal distribution) and categorical variables were expressed as absolute values and percentage. Almost 70% of the women were white. The arrest of dilation, which was the indication for cesarean delivery, differed between the groups (p = 0.002): 33.33% in the obese II, 8.69% in the obese I, 6.66% in the normal body mass index, and zero in the overweight group. Maximum systolic blood pressure was higher in women with normal body mass index (p = 0.002). Birth weight, height, umbilical venous cord blood pH, lactate, methemoglobin, reticulocyte, and erythroblast counts were similar between groups. New Ballard, Apgar and Silverman-Andersen scores did not differ significantly between the groups analyzed. Only five newborns were admitted to the neonatal unit, 25 were taken to the nursery, where they stayed until discharge when they joined their mothers and 68 remained with their mothers. There was no adverse effect of spinal anesthesia on neonatal outcome of hypertensive obese pregnant women

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-26Bitstream added on 2014-06-13T20:38:46Z : No. of bitstreams: 1 martins_fsc_me_botfm.pdf: 203779 bytes, checksum: ffa2d7231e5b5a3d8f579954a343ca88 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Na prática clínica, muitas vezes observam-se situações de hemorragia aguda em pacientes submetidos a cirurgias que normalmente não apresentariam grandes perdas sangüíneas, fazendo com que a reposição dessa perda não seja imediata, tanto com solução cristalóide, como com colóide, ou mesmo com sangue. Quais as reais conseqüências para o rim trazidas por essa situação? O objetivo desta pesquisa foi avaliar a histologia do rim de rato normotérmico e anestesiado com sevoflurano, em situação de hemorragia aguda e reposição com solução de Ringer sem lactato e hidroxietilamido 130/0,4. Quatro grupos de ratos Wistar (n=10) anestesiados com sevoflurano, recebendo solução de Ringer sem lactato, 7 mL/kg/h, três dos quais foram submetidos à hemorragia de 30% da volemia (três etapas de retirada de 10% com 10 min de intervalo): G1 - ratos sem reposição do sangue retirado; G2 - reposição com solução de Ringer sem lactato, em proporção de reposição de 3:1 de sangue retirado; G3 - reposição com solução de hidroxietilamido (HEA) 130/0,4, em proporção de 1:1 de sangue retirado; G4 - (sham) - ratos que não foram submetidos à hemorragia. Estudaram-se a pressão arterial média, a temperatura retal e o hematócrito, nos seguintes momentos: M1 – momento que correspondeu ao tempo em que ocorreu a 1a sangria; M2 - 40 min após a 1a sangria e 20 min após a 3a sangria; M3 – 50 min após a 3a sangria, quando os ratos foram sacrificados e foi realizada nefrectomia bilateral para análise histológica dos rins. A temperatura manteve-se estável durante todo o experimento em todos os grupos. Quanto ao hematócrito, em M1 e M2 os grupos foram iguais e, em M3, (G1=G4)>G3>G2. Quanto à pressão arterial média, em M1os grupos foram iguais, em M2, G4 > (G1 = G2 = G3) e, em M3, (G3 = G4) > G2 > G1. Na análise histológica... In clinical practice, situations of acute hemorrhage are many times observed in patients submitted to surgeries that would normally not present great blood loss, and the replacement for such loss is not immediate, even when using crystalloid solutions, such as colloid, or blood. What are the real consequences to the kidney resulting from this situation? This study aimed at evaluating the histology of the kidney in normothermic rats anesthetized with sevoflurane, in a situation of acute hemorrhage and replacement with Ringer solution without lactate and hydroxyethylamide 130/0.4. Four groups of Wistar rats (n=10) anesthetized with sevoflurane and receiving Ringer solution without lactate, 7 mL/kg/h, were used. Three of these were submitted to hemorrhage of 30% of volemia (three phases for removal of 10% with a 10-min interval): G1 – rats without replacement of the removed blood; G2 – replacement with Ringer solution without lactate, following a replacement proportion of 3:1 of removed blood; G3 – replacement with hydroxyethylamide (HEA) 130/0.4, in a proportion of 1:1 of the removed blood; G4 - (sham) – rats that were not submitted to hemorrhage. Mean arterial pressure, rectal temperature and hematocrits were studied at the following moments: M1 - moment that corresponded to the time when the 1st bleeding occurred; M2 - 40 min after the 1st bleeding and 20 min after the 3rd bleeding; M3 - 50 min after the 3rd bleeding, when the rats were euthanized and bilateral nephrectomy was performed for histological analysis of the kidneys. Temperature was kept stable during the whole experiment in all groups. Concerning hematocrits, in M1 and M2, the groups were similar, and in M3, (G1 = G4) > G3 > G2. As regards mean arterial pressure... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-06-30Bitstream added on 2014-06-13T21:07:32Z : No. of bitstreams: 1 silva_lm_dr_botfm.pdf: 518955 bytes, checksum: e691275d6c953c74d7e4df49bba41750 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Estudar a função renal de pacientes arteriopatas submetidos a cirurgia vascular, avaliando a concordância entre as estimativas do ritmo de filtração glomerular (RFG) obtidos pela aferição da creatinina e cistatina C plasmática, verificando se diabetes, hipertensão e função renal pré-operatórias apresentam relação com função tubular no pós-operatório e investigando a possível influência da hemodiluição na avaliação da função renal por meio da cistatina C. Trata-se de estudo de coorte, prospectivo, incluindo 144 pacientes consecutivos submetidos à anestesia para cirurgia arterial e distribuídos em 4 grupos, sendo (GDH), diabéticos e hipertensos, (GD), diabéticos, (GH), hipertensos e (GN), sem hipertensão ou diabetes. Foram obtidos urina para dosagens laboratoriais de creatinina urinária (Ucr) (mmol⁄L), fosfatase alcalina (FA) (U⁄L), -glutamiltransferase ( GT) (U⁄L) e sangue para dosagem de albumina (g/dL), globulina (g/dL) uréia (mg/dL), creatinina (mg/dL), cistatina C (mg/L) e aferida a osmolaridade plasmática (mOsm/L) no pré-operatórios (M1) e após 24 horas do término da cirurgia (M2). As estimativas do RFG foram comparadas pelo método de Bland-Altman. Os limites de concordância entre as equações para estimativa do RFG pela creatinina e cistatina C estudadas foram amplos tanto no pré como no pós-operatório e a diferença entre as médias das equações analisadas aumentou no período pós-operatório. Em 76,39 % dos pacientes analisados houve diminuição dos valores de cistatina C no pós-operatório. Houve correlação moderada entre a variação de cistatina C e a variação da osmolaridade plasmática (r=0,41; p 90mL/min/1,73m2) presented increased GT/Ucr and AP x GT/Ucr values at M2 and those with slightly compromised renal function (60-90mL/min/1,73m2)... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-19Bitstream added on 2014-06-13T18:59:01Z : No. of bitstreams: 1 marques_co_me_botfm.pdf: 378901 bytes, checksum: 2a06b8e8fb2e48ad5f6c9ce7c12f4c38 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Choque hemorrágico reduz o fluxo sanguíneo e a oxigenação teciduais, bem como a remoção de produtos de degradação. A hipóxia tecidual provoca alteração na síntese e liberação de citocinas pró-inflamatórias. A glibenclamida, antagonista dos canais KATP, em rins de ratos anestesiados com sevoflurano e que sofreram hemorragia, preservou mais a histologia e a função renais. O objetivo deste estudo foi verificar se houve alterações da concentração sérica e da expressão renal das citocinas IL-1 e TNF- em ratos que receberam sevoflurano e glibenclamida e que sofreram hemorragia, sem reposição adequada da volemia. Dois grupos de ratos Wistar (n=10) anestesiados com sevoflurano: G1, controle, e G2, com glibenclamida, 1μg/g iv, submetidos à hemorragia de 30% da volemia (10% a cada 10 min), com reposição por Ringer lactato, 5mL/kg/h. Estudaram-se as concentrações séricas de IL-1 e TNF- : na primeira hemorragia (M1) e 50 min após (M2). Em M2, estudou-se a expressão renal dessas citocinas. Em G1, TNF- sérico (normal de 143pg/ml): M1=178,6pg/mL ± 33,5 e M2=509,2pg/mL ± 118,8 e IL-1 sérica (normal de 158pg/mL): M1=148,8pg/mL ± 31,3 e M2=322,6pg/mL ± 115,4. Em G2, TNF- sérico: M1=486,2pg/mL ± 83,6 e M2=261,8pg/mL ± 79,5 e IL-1 sérica: M1=347,0pg/mL ± 72,0 e M2=327,3pg/mL ± 90,9. Houve expressão de TNF- e IL-1 nas células tubulares e glomerulares renais, mais marcantes em G2. A hemorragia e glibenclamida aumentaram a concentração sérica e a imunomarcação renal das citocinas IL-1 e TNF- , mas G2 enfrentou a hipotensão conseqüente à hemorragia com vasodilatação (provável ação do TNF- ) e melhor perfusão, resultando em alguma proteção Hemorrhagic shock reduces blood flow and tissue oxygenation, as well as the removal of degradation products. Tissue hypoxia causes changes in the synthesis and release of proinflammatory cytokines. Treatment with the KATP channel antagonist glibenclamide in sevoflurane-anesthetized rats that suffered from hemorrhaging preserved more renal function and histology. The objective of this study was to verify if there were changes in the serum concentration and renal expression of the IL-1 and TNF- cytokines in rats that received sevoflurane and glibenclamide and had hemorrhaging with inadequate volemia replacement. Two groups of sevofluraneanesthetized Wistar rats (n=10): G1 (control) and G2 (with glibenclamide, 1 μg/g i.v.) were subjected to 30% blood volume hemorrhaging (10% every 10 min), with replacement using Ringer’s lactate, 5 ml/kg/h. The IL-1 and TNF- serum concentrations were studied in the first hemorrhage (M1) and then 50 min later (M2). At M2, the renal expression of these cytokines was also studied. In G1, serum TNF- (normal range around 143 pg/mL) was M1=178.6 ± 33.5 pg/mL and M2=509.2 ± 118.8 pg/mL, while serum IL-1 (normal range around 158 pg/mL) was M1=148.8 ± 31.3 pg/mL and M2=322.6 ±115.4 pg/mL. In G2, serum TNF- was M1=486.2 ± 83.6 pg/mL and M2=261.8 ± 79.5 pg/mL, and serum IL-1 was M1=347.0 ± 72.0 pg/mL and M2=327.3 ±90.9 pg/mL. The expression of TNF- and IL-1 in the renal glomerular and tubular cells was more abundant in the G2 group. Hemorrhage and glibenclamide increased the serum concentration and renal immunoreactions of the TNF- and IL-1 cytokines, but the G2 group experienced hypotension resulting from the hemorrhage with vasodilatation, probably due to TNF- , and better perfusion, resulting in some protection

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2010Bitstream added on 2014-06-13T19:17:46Z : No. of bitstreams: 1 guedesjunior_fs_me_botfm.pdf: 315144 bytes, checksum: 9b1e84f53794ab139d681538ec1c4bfa (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Este estudo investigou a influência do inibidor não-seletivo da ciclooxigenase, cetoprofeno (ceto) intravenoso, em alterações histológicas e dos níveis das citocinas renais - fator α de necrose tumoral (TNF-α) e interleucina 1 (IL-1) - após hemorragia de 30% da volemia (10%, três vezes, em intervalos de 10 min) em ratos. Sob anestesia com sevoflurano (sevo), os grupos sevo e sevo+ceto (10 ratos cada) foram preparados cirurgicamente para leitura de pressão arterial média (PAM) e administração de solução de Ringer (5 mL.kg-1.h) e de cetoprofeno (1,5 mg.kg-1), no início da anestesia, no grupo sevo+ceto. Mediu-se temperatura retal continuamente. Os valores de temperatura e PAM foram observados antes da primeira hemorragia (T1), após a terceira hemorragia (T2) e 30 min após T2 (T3). Realizada nefrectomia bilateral nos dois grupos para análise histológica e imuno-histoquímica. Nos dois grupos, temperatura e PAM diminuíram com relação aos valores normais do rato. Hipotermia foi mais acentuada no grupo sevo (p=0,0002). Necrose tubular foi mais frequente no grupo sevo (p=0,02). As citocinas estiveram igualmente presentes nos rins dos dois grupos. Cetoprofeno foi mais protetor no rim de rato durante anestesia com sevoflurano e hipovolemia, porém parece que TNF-α e IL-1 não estão envolvidas nessa proteção This study investigated the influence of intravenous nonselective cyclooxygenase inhibitor, ketoprofen (keto), on kidney histological changes and kidney cytokines, tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1), levels after hemorrhage of 30% of volemia (three times 10%, intervals of 10 min) in rats. Under sevoflurane (sevo) anesthesia, sevo and sevo+keto groups (10 rats each) were instrumented for Ringer solution (5mL.kg-1.h-1) administration and mean arterial pressure (MAP) evaluation, plus keto (1.5mg.kg-1) administration in sevo+keto group in the beginning of anesthesia. Rectal temperature was continuously measured. The baseline data of temperature and MAP were collected at the first hemorrhage (T1), the third hemorrhage (T2) and 30min after T2 (T3). Bilateral nephrectomy was achieved for histology and immunohistochemistry. In both groups, temperature and MAP diminished from normal values of these animals. Hypothermia was greater in sevo group (p=0.0002). Tubular necrosis was more frequent in sevo group (p=0.02). The studied cytokines were equally present in the kidneys of both groups. Ketoprofen was more protective to the rat kidney in condition of anesthesia with sevoflurane and hypovolemia, but it seems that TNF-α and IL-1 were not involved in that protection

Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-17Bitstream added on 2014-06-13T18:59:00Z : No. of bitstreams: 1 medeiros_tp_me_botfm.pdf: 782559 bytes, checksum: 0672d69927e7c7c176cc5db3fc8ac695 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) A cirurgia videolaparoscópica, minimamente invasiva, traz o benefício de menor trauma cirúrgico com conseqüente redução do tempo de internação, necessitando, entretanto, de analgesia pós-operatória (PO) eficaz e segura. A associação de analgésicos tem sido utilizada. O objetivo desta pesquisa clínica prospectiva foi estudar os efeitos, na função renal, da analgesia com tramadol, associado à dipirona ou ao cetorolaco de trometamina, em pacientes submetidos à anestesia inalatória balanceada para colecistectomia por laparoscopia. Realizou-se estudo em 126 pacientes submetidos à anestesia geral com sevoflurano, NzO e remifentanil, com boa hidratação (solução de Ringer lactato, 10 mL. kg-1. h-1), para colecistectomia por laparoscopia, divididos em dois grupos de 63 pacientes cada. O grupo 1 (G1) recebeu placebo por via venosa (iv) no momento da administração da medicação pré-anestésica (MPA), com midazolam, e tramadol 100mg e dipirona 2g, iv, antes do término da cirurgia; o grupo 2 (G2) recebeu tramado I 100mg e cetoro·laco 30mg, iv, antes do término da cirurgia, já tendo recebido 30mg de cetorolaco, iv, no momento da MPA. Foram coletadas amostras de sangue e urina pré- e pós-operatórias (PO) para determinação e comparação da estimativa do ritmo de filtração glomerular (RFG) entre os momentos e os grupos. Os RFGs foram obtidos por meio de três fórmulas, duas dependentes de valores da creatinina (Cr) e uma dependente de valores da cistatina C. Foram estudados, na urina, as enzimas tubulares fosfatase alcalina (FA) e y-glutamiltransferase (y-GT), e o seu produto, sempre indexados aos valores de Cr urinária. Na SRPA, os pacientes foram avaliados quanto à dor, ao nível de consciência, à depressão respiratória e à necessidade de analgesia de resgate com morfina. Houve hemodiluição no PO, o que dificultou a análise do perfil dos RFGs -... The minimally invasive videolaparoscopic surgery brings the benefit of producing minimum surgical trauma with consequent reduction of hospital stay, needing, however, effective and safe post-operative (PO) analgesia. The association with analgesic has been used. This prospective clinical research aimed at studying the effects of analgesia with tramadol in the renal function, associated with dipyrone or ketorolac tromethamine, in patients submitted to inhalant balanced anesthesia for cholecistectomy through laparoscopy. A study was conducted in 126 patients submitted to general anesthesia with sevoflurane, NzO and remifentanil, with good hydration (Lactated Ringer's solution, 10mL.kg-1.h-1), for videolaparoscopic cholecistectomy, divided into 2 groups of 63 patients each. Group 1 (G1) received intravenous (iv) placebo at the moment of preanesthetic medication (PAM), with midazolam, and tramadol 100mg and dipyrone 2g, iv, before the end of the surgery; group 2 (G2) received tramadol 100mg and ketorolac 30mg, iv, before the end of the surgery, having already received 30mg of ketorolac, iv, at the moment of PAM. Preand PO blood and urine samples were collected for determination and comparison of estimated glomerular filtration rate (GFR) between the moments and groups. The GFRs were obtained via three formulas, two dependants of creatinine (Cr) values and one dependant of the cystatin C values. It was studied, in the urine, the tubular enzymes alkaline phosphatase (AP) and y-glutamiltransferase (Y-GT), and its product, always indexed to the urinary Cr values. At the recovery room (RR), patients wereevaluated in the following - pain, consciousness levels, respiratory depression and necessity of rescue analgesia with morphine. There has been hemodilution in the PO, which made more difficult the analysis of the GFRs' profile - those dependant of Cr increased and ....(Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-08-19Bitstream added on 2014-06-13T19:05:32Z : No. of bitstreams: 1 curtis_fg_dr_botfm.pdf: 484211 bytes, checksum: 20e51a34eb392644a7f2bf2d4f278caa (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) O fenômeno conhecido por pré-condicionamento isquêmico, de proteção cardíaca, também foi observado no rim e assemelha-se àquele obtido com alguns fármacos, como anestésicos inalatórios e alguns venosos. Pesquisou-se o possível pré-condicionamento farmacológico do anestésico inalatório sevoflurano e do agonista 2-adrenérgico dexmedetomidina, avaliando função e histologia renais de ratos anestesiados com S(+)-cetamina e submetidos à nefrectomia direita (D) e ao clampeamento arterial do rim esquerdo (E) por 45 minutos, com reperfusão de 48 horas. Método – Quarenta ratos Wistar machos, anestesiados com S(+)cetamina intraperitoneal (ip) foram divididos em quatro grupos de 10 animais, mantidos em normotermia (36oC-38oC), com pressão arterial média e freqüência cardíaca monitoradas, tendo sido nefrectomizados à D. Dois grupos receberam, também, sevoflurano (Sevo) ou dexmedetomidina (Dex) intravenosa (iv) e a artéria renal E foi clampeada durante 45 min, após administração dos fármacos por período mínimo de 20 min. Um terceiro e quarto grupos foram anestesiados com doses intermitentes de S(+)-cetamina iv e submetidos à isquemia renal E por 45 min (Controle) ou permaneceram sem clampeamento arterial E (Sham). A creatinina plasmática foi obtida antes da isquemia renal (M1) e 48 h após a isquemia (M2), quando se realizou nefrectomia E sob anestesia com pentobarbital sódico que também serviu para o sacrifício dos animais. Todos os rins foram submetidos à análise histológica e as lesões encontradas foram classificadas em escores. Houve tratamento estatístico para os valores de creatinina plasmática e para a análise histológica. Obteve-se creatinina plasmática em M2 > M1, mas sem significância nos grupos Sham e Sevo. Entre os grupos, Controle > Dex > Sevo : > Sham, significativamente. Os rins D não diferiram entre eles para todas as alterações... The phenomenon known as ischemic preconditioning, of heart protection, was also observed in the kidney and it was similar to that one obtained with some drugs such as the volatile anesthetics and other intravenous agents. The possible pharmacological preconditioning of the volatile anesthetic sevoflurane as well as the 2-adrenergic agonist dexmedetomidine were investigated, evaluating both renal function and histology of rats anesthetized with S(+)-ketamine and submitted to right (R) nephrectomy and left (L) renal artery clamping for 45 minutes, with 48 hour reperfusion. Methods – Forty male Wistar rats anesthetized with intraperitoneal (ip) S(+)- ketamine were dividided into four groups of 10 animals, maintained in normotermia (36oC-38oC), with mean arterial blood pressure and heart rate monitored, having been R nephrectomy. Two groups also received sevoflurane (Sevo) or intravenous (iv) dexmedetomidine (Dex) and had L renal artery clamping for 45 min, after respective drug administration about 20 min period at least. The third and fourth groups were anesthetized with iv intermittent doses of S(+)-ketamine and submitted to L renal artery clamping for 45 min (Control) or remained without L arterial clamping (Sham). Blood creatinine was obtained before the renal ischemia (M1) and with 48h of reperfusion (M2), when L nephrectomy was performed under anesthesia with ip sodium pentobarbital of which the overdose was used to sacrifice the animals. All kidneys were submitted to the histological analysis and the found lesions were classified in scores. Statistical analysis was performed for blood creatinine and histological changes. Blood creatinine in M2 > M1, but with no significance in Sham and Sevo groups. Comparing groups, Control > Dex > Sevo > Sham, significantly. The R kidneys did not differ in all studied histological changes. Scores of vascular dilation were significantly higher in L kidneys of the Control group than in R kidneys.

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-15Bitstream added on 2014-06-13T20:06:46Z : No. of bitstreams: 1 diego_las_dr_botfm.pdf: 928445 bytes, checksum: b041c5d0355031145492120fceebec02 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) A glibenclamida, sulfoniluréia muito utilizada clinicamente no controle do diabetes mellitus, possui propriedade bloqueadora dos canais de potássio dependentes de adenosina trifosfatona (k+ ATP), opondo-se à possível propriedade pré-condicionante do sevoflurano. Hipovolemia conseqüente à hemorragia suscita reações compensadoras de proteção orgânica. Entretanto, mecanismos protetores como a ativação do sistema renina-angiotensina ensejam agressão renal por vasoconstrição com interferência na função depuradora. O objetivo do presente estudo foi avaliar os efeitos da glibenclamida na função e histologia renais de ratos sob anestesia com sevoflurano em cenário de choque hemorrágico. Neste intuito, estudou-se uma amostra de 20 ratos Wistar. O delineamento consistiu em estudar os animais quanto à pressão arterial, à temperatura retal e ao hematócrito e quantificar atributos da função renal, tais como: ritmo de filtração glomerular (RGF), estudar os animais quanto ao peso, pressão arterial média, temperatura retal e hematócrito e fluxo plasmático renal efetivo (FPR efetivo), fluxo sangüíneo renal e resistência vascular renal (RVR), além de se analisarem as alterações histológicas após a imposição da condição experimental. A amostra foi aleatoriamente dividida em 2 grupos de 10 animais cada (G1 e G2), entretanto apenas um destes (G2) foi submetido a tratamento com glibenclamida venosa (1 mcg.g-1), 60 min antes do início de sangria. Os animais de ambos os grupos foram anestesiados com sevoflurano a 4% sob campânula apropriada e mantidos em respiração espontânea com ar enriquecido com oxigênio, além de sofrerem sangria de 30% da volemia (esta calculada como 6% do peso corporal)... Glibenclamide, a sulfonylurea widely used clinically for controlling diabetes mellitus, blocks adenosine triphosphate-dependent potassium (K+ ATP) channels, thus opposing the possible preconditioning property of sevoflurane. Hypovolemia from hemorrhage evokes protective compensatory reactions. However, protective mechanisms such as activation of the renin-angiotensin system result in renal impairment by vasoconstriction interfering in the clearance function. This study was designed to evaluate the effects of glibenclamide on renal function and histology in rats in a state of hemorrhagic shock under sevoflurane anesthesia. A sample of 20 Wistar rats was studied for that purpose. The design consisted in studying mean arterial pressure, rectal temperature and hematocrit and quantifying glomerular filtration rate (GFR), effective renal plasma flow (ERPF), renal blood flow (RBF) and renal vascular resistance (RVR), and analyzing histological alterations after the experimental conditions were attained. The sample was randomized into 2 groups of 10 animals each (G1 and G2), only one of which (G2) was treated with intravenous glibenclamide (1 mcg.g-1), 60 min before bleeding was begun. Both groups were anesthetized with sevoflurane at 4% under an appropriate bell jar and kept on spontaneous respiration with oxygen-enriched air, while being bled of 30% of volemia (calculated as 6% of body weight) in 3 stages with 10-min intervals. Evaluation of renal function used estimated renal clearances of paraaminohippurate (ERPF) and sodium iothalamate (GFR), while renal histology was evaluated by investigating the degree of vascular and tubular dilatation, vascular congestion, tubular vacuolization, necrosis and signs of tubular regeneration... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T19:00:38Z : No. of bitstreams: 1 reis_mrc_dr_botfm.pdf: 2372864 bytes, checksum: 3670f19e59c1bd70593103929a9e7758 (MD5) Apesar das diversas evidências clínicas que garantem sua segurança, a questão dos potenciais efeitos adversos do sevoflurano sobre a função renal continua gerando controvérsias. Este estudo, prospectivo, foi realizado com 16 cães, submetidos à indução anestésica com fentanil (20 mg.kg-1) e propofol (6 mg.kg-1), à manutenção com sevoflurano a 3% e à ventilação artificial dos pulmões com fluxo de lL.min-1 e FIO2 = 0,3. Foram realizados cateterismos, instalação de aparelhos de registro, preparação cirúrgica com lombotomia direita para nefrectomia e lombotomia esquerda para ligadura da artéria renal esquerda, por período de 30 minutos, com reperfusão, e cateterização do ureter esquerdo para coleta de urina. Para estudo do fluxo plasmático renal e da filtração glomerular, foi infundida solução de para-aminohipurato de sódio (PAH) e de creatinina. Estudaram-se as alterações que poderiam ocorrer na função renal sob a ação do sevoflurano, após 30 minutos de isquemia renal e posterior reperfusão (GI), e sem isquemia (GC). Foram estudados a freqüência cardíaca, pressão arterial média, pressão de veia cava inferior, fluxo sangüíneo renal, clearance de PAH e de creatinina, resistência vascular renal, fração de filtração, volume urinário, hematócrito, sódio e potássio plasmáticos, osmolalidade plasmática e urinária, clearance osmolar, de água livre e de sódio, excreção urinária e fracionária de sódio, clearance, excreção urinária e fracionária de potássio, pHa, PaO2, SpO2, PaCO2, ETCO2, temperatura corporal, da cal sodada 1 e 2 e ambiente e b2-microglobulina. Foram colhidos fragmentos para estudo histológico... Despite mounting clinical evidence that supports its safety, the question of the potential adverse effects of sevoflurane on renal function continues to generate some controversy. In a prospective study, sixteen dogs were submitted to anesthesia induction with fentanyl (20 mg.kg-1) and propofol (6 mg.kg-1) and maintenance with 3% sevoflurane, and to the artificial ventilation with lL.min-1 flow and FIO2 = 0,3. There were catheterizations and the installation of registration apparatus, surgical preparation with right lumbotomy to nephrectomy and left lumbotomy to clamping of left renal artery during a period of 30 minutes with reperfusion, and catheterization of the left ureter to urine collection. In order to study effective renal plasma flow and glomerular filtration rate, a solution containing para-aminohippurate sodium (PAH) and creatinine was infused. The changes that could happen in the renal function under sevoflurane effect and after 30 min of renal ischemia and reperfusion (GI), and without ischemia (GC) were studied. The following attributes were studied: heart rate, mean arterial blood pressure, inferior vena cava pressure, renal blood flow, PAH and creatinine clearance, renal vascular resistance, filtration fraction, urinary flow, hematocrit, serum sodium and potassium, serum and urinary osmolalities, osmolar, free water and sodium clearance, urinary and fractionary sodium excretions, potassium clearance, urinary and fractionary potassium excretions, pHa, PaO2, SpO2, PaCO2, ETCO2, body, soda lime 1 and 2, and... (Complete abstract, click electronic address below)