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BECCARI, Marcos. Articulações Simbólicas: uma nova filosofia do design. Teresópolis, RJ: 2 AB Editora, 2016.

Background and Objectives: Sugammadex is an alternative pharmacological drug capable of reversing neuromuscular blockades without the limitations that are presented by anticholinesterase drugs. Coagulation disorders that are related to treatment with sugammadex were reported. The exact mechanism of the effects on coagulation are not fully understood. The objective of this research is to evaluate the effects of rocuronium, sugammadex and the rocuronium-sugammadex complex on coagulation in an experimental model in rats., Methods: This is an experimental randomized animal study. Wistar rats were randomly assigned into the following groups: the Control Group; the Ssal Group - 0.5 mL of intravenous saline; the Sugammadex Group - intravenous sugammadex (100 mg.kg -1 ); and the Rocuronium-Sugammadex Group - intravenous solution with rocuronium (3.75 mg.kg -1 ) and sugammadex (100 mg.kg -1 ). Anesthesia was performed by using isoflurane with controlled ventilation. Coagulation factors were measured 10 minutes after the end of the preoperative preparation and 30 minutes after the administration of the drugs in accordance with the chosen groups., Results: Platelet counts, prothrombin times and activated partial thromboplastin times were similar between the groups and between the moments within each group. There were reductions in the plasma fibrinogen levels between sample times 1 and 2 in the Rocuronium-Sugammadex group (p=0.035)., Conclusions: The rocuronium-sugammadex complex promoted reductions in plasma fibrinogen counts, although the levels were still within normal limits., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Pain is one of the most common reason for seeking medical care. This study aimed to analyze patients with chronic pain in Maricá, Rio de Janeiro State, Brazil., Methods: A transversal retrospective study with 200 patients, who were treated in ambulatory care in a public hospital from June 2014 to December 2015. The variables analyzed were: pain intensity, type of pain, anatomical location, diagnosis and treatment. The data were submitted to statistical analysis, the Fisher's exact test was applied, and the probability p was significant when ≤0.05., Results: We analyzed 200 patients with chronic pain, most of them female (83%). Mean age was 58.6±13.01 years old. The patients were classified in groups by age, six groups with ten years of difference between them. Main age range was the 50-59 years old group, with 49 females (32%) and 5 males (15%). About 65.5% of the total of patients (131) had severe pain (Numeric Rating Sacale was 9.01). Mixed pain was predominant, affecting 108 patients (92 females and 16 males, what represents 55% and 47% of the total of females and males, respectively, that participate in the study). The most prevalent anatomical pain (159 patients, 131 females and 28 males) was in the lower limbs. Lower back pain was present in 113 of the 200 patients (94 females and 19 males). In the 30-39, 50-59, 60-69 years old group, the results for pain locations were significant: p=0.01, p=0.0069, p=0.0003, respectively., Conclusion: The prevalence of chronic pain was associated with females in 50-59 years old and severe mixed pain. It was located mainly in lower limbs and lumbar region. The most frequent diagnosis was low back pain followed by fibromyalgia. The patients were informed about their disease and treatment., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Preoperative instruction is known to significantly reduce patient anxiety before surgery. The present study aimed to investigate the effects of preoperative education on the level of anxiety of cancer patients undergoing surgery using the self-reported Beck anxiety inventory., Methods: This study is a short-term observational study, including 72 female patients with a diagnosis of endometrial cancer who were scheduled to undergo surgical treatment under general anesthesia. During the pre-anesthetic consultation 15 days before surgery, one group of patients (Group A, n=36) was given comprehensive information about their scheduled anesthetic and surgical procedures, while the other group of patients (Group B, n=36) did not receive any information pertaining to these variables. The Beck anxiety inventory, blood pressure and heart rate were evaluated before and after the preoperative education in Group A. In Group B, these parameters were evaluated at the beginning and at the end of the consultation., Results: The hemodynamic values were lower in the group that received preoperative education, in comparison with the group that did not receive preoperative education. Educating the patients about the procedure resulted in a reduction in the levels of anxiety from mild to minimum, whereas there was no change in the group that did not receive the preoperative education. This latter group kept the same level of anxiety up to the end of pre-anesthetic consultation., Conclusions: Patient orientation in the preoperative setting should be the standard of care to minimize patient anxiety prior to surgery, especially for patients with cancer., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: To compare deep sedation with general anesthesia for curative ablation of atrial fibrillation., Methods: We conducted a prospective, randomized study with 32 patients, aged between 18 and 65 years, ASA 2 and 3, BMI d" 30 kg/m2, divided into two groups: deep sedation (G1) and general anesthesia (G2). All patients received intravenous midazolam (0.5 mg / kg). G1 received propofol (1mg/kg) and O2 by facemask, followed by continuous infusion of propofol (25-50mg/kg/min) and remifentanil (0.01-0.05 mg / kg / min). G2 received propofol (2mg/kg) and laryngeal mask with built-in drain tube, followed by continuous infusion of propofol (60-100mg/kg/min) and remifentanil (0.06 to 0.1g/kg/min). We compared heart rate, invasive blood pressure, arterial blood gases, complications and recurrence (outcome) in three months., Results: G1 patients had arterial blood gas with higher PaCO2 levels and lower pH (p = 0.001) and higher incidence of cough. There was a decrease in Mean Arterial Pressure (MAP) and Heart Rate (HR) in G2. Except cough, complications and recurrence were similar in both groups., Conclusion: Both techniques can be used for the curative ablation of atrial fibrillation. General anesthesia provided smaller respiratory changes and greater immobility of the patient.

Background and Objectives: We compared hemodynamic profiles of healthy and mildly preeclamptic pregnant women at term, as well as those of non-pregnant controls, using a new non-invasive cardiac output monitor (NICOM) based on bio-reactance., Methods: We studied healthy term pregnant women at term (Preg, n = 10), mildly preeclamptic pregnant women at term (PregPE, n = 10), and healthy non-pregnant female volunteers (NonPreg, n = 10). With the subjects in the semi left lateral position, 4 electrodes of the NICOM device were applied to their chest wall, followed by a 15-minute rest period. Hemodynamic variables, including the systolic (SBP), diastolic (DPB) and mean arterial (MAP) pressures, as well as the heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), cardiac output (CO), cardiac power output (CPO), and ventricular ejection time (VET) were then monitored for 15 minutes., Results: The Preg and NonPreg groups showed similar hemodynamic profiles, except for a shorter VET in the Preg group (213.3 ± 19.3 ms versus 265.0 ± 28.8 ms, p < 0.001). The PregPE group showed higher SBP, DBP and MAP, as well as CPO (145.5 ± 12.6 mmHg; 94.5 ± 9.1 mmHg; 111.5 ± 9.8 mmHg; 1.6 ± 0.3 watts), compared to both the Preg (114 ± 12.1 mmHg; 71.7 ± 8.4 mmHg; 85.9 ± 9.3 mmHg; 1.1 ± 0.3 watts) and NonPreg (101.2 ± 11.9 mmHg; 66.7 ± 10.4 mmHg; 78.1 ± 10.6 mmHg; 1.0 ± 0.2 watts) groups. The PregPE group showed higher HR, CO, and TPR, and shorter VET (85.4 ± 8.4 beats.min⁻¹; 6.6 ± 0.7 L.min⁻¹; 1,369.9 ± 173.5 dyne.sec.cm⁻⁵, 221.6 ± 22.4 ms) compared to the NonPreg group (67.9 ± 9.5 beats.min⁻¹; 5.6 ± 0.7 L.min⁻¹; 1,136.9 ± 149.8 dyne.sec.cm⁻⁵, 265.0 ± 28.8 ms)., Conclusions: The NICOM device is simple to use, operator independent, and provides clear and consistent monitoring signals. The output identified distinct hemodymamic profiles that are consistent with the findings of more invasive existing methods., (© 2010 Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Tricyclic antidepressants (TCAs) are widely used as analgesics in chronic lumbar pain and neuropathic pain. The objective of this study was to evaluate the electrocardiographic changes in patients with chronic pain treated with amitriptyline or imipramine., Methods: Forty patients, ages 26 to 81 years (57.27 +/- 13.65 years) of both genders (female 19, male 21), with neuropathic syndromes (lumbosciatalgia, postlaminectomy syndromes, and postherpetic neuritis, among others) participated in this study; 60% had cardiovascular diseases; 30% had changes in the ECG (RBBB, LBBB, first-degree AVB, LAHB, or PVCs). Three ECGs were done in each patient: one ECG was done before beginning treatment, and 30 and 60 days after beginning treatment evaluating PR, QRS, QT QTc, DQT DQTc, and HR. Thirty-two patients were on amitriptyline and eight on imipramine. The mean dose at the end of the study was 54.29 mg of amitriptyline and 46.87 mg of imipramine., Results: Analysis of electrocardiographic parameters after the use of TCAs showed that amitriptyline caused a transitory increase in heart rate in females (p = 0.049), and the duration of the QRS in patients 60 years or older and patients with cardiopathies (p = 0.01). In patients who received 75 mg of amitriptyline, the QTc interval was greater when compared to that of patients who received 25 mg of the drug (p = 0.0044). The increase in those parameters demonstrated the effects of amitriptyline on cardiac conduction; however, clinical compromise was not seen, since they remained within normal limits (QRS < 110 msec and QTc < 470 msec)., Conclusions: The chronic use of TACs proved to be safe and effective, and it did not show changes in cardiac conduction with clinical repercussion.

Background and Objectives: Neuromuscular blockers (NMB) are used to induce relaxation of skeletal muscles and facilitate tracheal intubation (TI). According to the literature, two effective doses (ED95) of NMB are ideal for TI. Rocuronium is a steroid-type, synthetic, non-depolarizing neuromuscular blocker of medium duration. The objective of this study was to evaluate and compare the conditions of tracheal intubation with one and two effective doses (ED95) of rocuronium, following the criteria of the Copenhagen Consensus Conference., Methods: Sixty patients of both genders, ages 20 to 60 years, physical status ASA I and II, Mallampati 1 and 2, body mass index (BMI) < 35, who underwent general anesthesia, randomly divided in two groups of 30 patients, were evaluated. Group 1 (G1) received 0.3 mg kg(-1) of rocuronium (1 ED95, and Group 2 (G2) received 0.6 mg kg(-1) (2 DE95). Parameters used to evaluate TI were based on the criteria of the Copenhagen Consensus Conference (Good Clinical Research Practice): laryngoscopy, vocal cords (position and movements), reaction to the insertion of the tube and/or filling of the cuff (movements of limbs and cough)., Results: All intubations were considered excellent or good (acceptable); therefore, there were no cases of failure or any intubation considered bad (unacceptable). The results of the statistical analysis were not significant. Consequently, we did not observe any clinically significant differences in the parameters evaluated, Conclusions: Both doses of rocuronium, 0.3 mg kg(-1) and 0.6 mg kg(-1) ED95, provided clinically satisfactory parameters of TI in elective procedures.

Background and Objectives: Total knee arthroplasty (TKA) causes severe tissue trauma, leading to severe postoperative pain. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block., Methods: Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluated., Results: The median of the duration of analgesia (M1) in Group A was 110 min, while in Group B it was 1285 min (p = 0.0001). There were no complications related to the technique used., Conclusions: Sciatic nerve block, when associated with femoral nerve block, under the conditions of the present study, improved significantly the quality of postoperative analgesia in TKA.

Background and Methods: The main goal of palliative care is the control of pain and other symptoms in patients with chronic diseases without possibility of cure, especially advanced cancer. About 75% of patients with advanced cancer experience severe pain, which interferes with quality of life and, according to the WHO, it is considered a worldwide medical emergency. This study evaluated the profile of oncology patients enrolled in the Chronic Pain Treatment and Palliative Care Program of the HUCFF/FM/UFRJ, focusing on the role of the anesthesiologist, medications used, humanization of the treatment, and improvement in patient's quality of life., Methods: The 2003-oncology patients' charts were analyzed retrospectively. Several parameters were compared: age, race, gender, preexisting conditions organ the cancer originated from, type of pain and other symptoms, medications, hospital routine, and end of treatment., Results: The types of pain included nociceptive, neuropathic, and incidental, which were evaluated using the unidimensional faces pain rating scale. In the first week, patients were treated with home-based patient controlled analgesia (PCA) with oral methadone. After this period, the patient returned to the clinic to calculate the regular dose of methadone. Other opioids used included codeine, tramadol, morphine, and oxycodone. Besides pain, patients experienced: constipation, vomiting, delirium, sleep disturbances, and dyspnea. Neuroleptics, corticosteroids, and laxatives were also used as adjuvant therapy., Conclusions: Patient controlled analgesia with methadone is safe and effective, since there were no significant side effects. The clinical and pharmacological knowledge of the anesthesiologist in the multidisciplinary team provided for better patient care, relief of symptoms, and humanization of the final stages of life.

Background and Objectives: This report includes seven patients with chronic non-oncologic neuropathic pain who have not responded to classic approaches with tricyclic antidepressant and anticonvulsant drugs. Oral methadone, a synthetic opioid similar to morphine, is referred as alternative to treat neuropathic pain due to its non-competitive antagonist action on NMDA receptors. This study aimed at evaluating methadone to treat chronic non-oncologic neuropathic pain patients who have not responded to classic approaches., Case Reports: Seven cases in which methadone dose was titrated in subsequent visits are presented. Pain severity according to facial scale, side effects and improved functional capacity were evaluated 1, 7, 14, 30 and 180 days after treatment beginning. There has been decrease in pain severity and in the incidence of side effects, such as constipation, sedation, nausea, headache and insomnia. There has been no euphoria, sweating, myoclonia, urinary retention, decreased libido and respiratory depression., Conclusions: Patients responded satisfactorily to low dose medication, side effects were controlled with simple measures and there has been significant functional capacity improvement. In the conditions of this study, methadone was an effective, safe and low-cost option to treat non-oncologic neuropathic pain.