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Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain.GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis.Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD -2.14, 95% CI -2.65 to -1.63; p0.00001) and after 30 days after the end of treatment with ketamine (MD -1.68, 95% CI -2.25 to -1.12; p0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p0.00001).There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review.

A psoríase é uma doença sistêmica e inflamatória que apresenta evolução de intensidades variadas, relaciona-se a um grande impacto físico e psicológico. Nos casos moderados a graves da enfermidade, o uso de imunobiológicos é a terapêutica de escolha uma vez que o tratamento tradicional não apresente resultados satisfatórios. No entanto, como o emprego destes medicamentos é relativamente recente nesta doença, devido aos efeitos colaterais ainda não totalmente esclarecidos e custo elevado, seu uso é recomendado por especialistas com cautela. Com o objetivo de estudar os efeitos adversos dos imunobiológicos (Etanercepte, Adalimumabe, Infliximabe, Efalizumabe e Ustekinumabe) foi realizada uma revisão integrativa da literatura, na qual foram selecionados, após a adequação aos critérios de inclusão e exclusão, 5 dos 66 artigos obtidos. Após a análise dos dados, concluiu-se que, ela deve ser usada com cautela e seguindo os protocolos nacionais e internacionais, devido a grande variedade de efeitos adversos encontrados.

The literature is sparse about anesthetic management for thoracobiliary fistula (TBF) correction surgeries. A gunshot wound victim to the right thoracoabdominal region presented a green colored secretion draining from the right hemithorax during the postoperative period. Laboratory analysis of the secretion along with ultrasound and CT scan confirmed the clinical suspicion of pleurobiliary fistula (PBF). Laparotomy with diaphragm and liver repair plus thoracic drainage was performed. The patient was discharged home after an uneventful postoperative recovery and returned 15 days later for follow-up visit without complaints. PBF is a clinical condition prone to complications and its recognition along with the differential diagnosis from BBF is important to determine which anesthetic and surgical measures should be taken. Anesthesia for PBF correction should preconize appropriate analgesia and remain vigilant to the risk of cardiovascular instability during fistula correction.