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BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov).

Resumo Justificativa A cirurgia cardiaca pode produzir deficit persistente na razao entre oferta de oxigenio (DO2) e consumo de oxigenio (VO2). A Saturacao venosa central de Oxigenio (SvcO2) e uma medida acessivel e indireta da razao DO2/VO2. Objetivo Monitorar a SvcO2 perioperatoria e avaliar sua correlacao com a mortalidade em cirurgia cardiaca. Metodo Este estudo observacional prospectivo avaliou 273 pacientes submetidos a cirurgia cardiaca. Coletamos amostras de sangue para medir a SvcO2 em tres momentos: T0 (apos inducao anestesica), T1 (final da cirurgia) e T2 (24 horas apos a cirurgia). Os pacientes foram divididos em dois grupos (sobreviventes e nao sobreviventes). Os seguintes desfechos foram analisados: mortalidade intra‐hospitalar, tempo de permanencia na Unidade de Terapia Intensiva (UTI) e de internacao hospitalar, e variacao na SvcO2. Resultados Dos 273 pacientes, 251 (92%) sobreviveram e 22 (8%) nao. Houve queda significante da SvcO2 perioperatoria nos sobreviventes (T0 = 78% ± 8,1%, T1 = 75,4% ± 7,5% e T2 = 68,5% ± 9%; p Conclusoes Valores precoces de SvcO2 intraoperatoria

Inorganic salts based ceramic composites have extended thermal energy storage applications particularly when the salts are used as phase change materials. The wetting behavior of interacting materi...

Background and objectives: Perioperative management of femoral fractures in elderly patients has been studied to determine modifiable causes of complications and death. The aim of this study was to evaluate the mortality rate and its causes in the elderly population with FF. We also evaluated perioperative complications and their association with postoperative mortality. Method: In this prospective and observational study, we evaluated 182 patients, by questionnaire and electronic medical record, from the moment of hospitalization to one year after surgery. Statistical analyzes using the multivariate Cox proportional hazards model and Kaplan-Meier curves were performed to detect independent mortality factors. Results: Fifty-six patients (30.8%) died within one year after surgery, and the main cause of death was infection followed by septic shock. The main complication, both preoperatively and postoperatively, was hydroelectrolytic disorder. For every one-unit (one-year) increase in age, the odds ratio for death increased by 4%. With each new preoperative complication, the odds ratio for death increased by 28%. Patients ASA III or IV had a 95% higher odds ratio for death than patients ASA I or II. Conclusions: Increasing age and number of preoperative complications, in addition to ASA classification III or IV, were independent factors of increased risk of death in the population studied. The mortality rate was 30.8%, and infection followed by septic shock was the leading cause of death. Resumo: Justificativa e objetivos: O manejo perioperatório das fraturas de fêmur em pacientes idosos tem sido estudado com o intuito de determinar causas modificáveis de complicações e óbito. Este estudo tem por objetivo avaliar taxa de mortalidade e suas causas na população idosa com fraturas de fêmur. Avaliamos também complicações perioperatórias e sua associação com mortalidade pós-operatória. Método: Neste estudo prospectivo e observacional, avaliamos 182 pacientes, por questionário e prontuário eletrônico, desde o momento da internação até um ano após a cirurgia. Análises estatísticas pelo modelo multivariado de riscos proporcionais de Cox e curvas de Kaplan-Meier foram feitas para detectar fatores independentes de mortalidade. Resultados: Cinquenta e seis pacientes (30,8%) obituaram em até um ano de pós-operatório, sendo que a principal causa determinada de óbito foi infecção seguida de choque séptico. A principal complicação, tanto pré quanto pós-operatória, foi distúrbio hidroeletrolítico. Para cada aumento de uma unidade (em ano) na idade, a razão de chance de vir a óbito aumentou em 4%. A cada nova complicação pré-operatória apresentada, a razão de chance de óbito aumentou em 28%. Os pacientes ASA III ou IV apresentaram razão de chance de óbito, em um ano, 95% maior do que aqueles ASA I ou II. Conclusões: O aumento da idade e do número de complicações pré-operatórias, além da classificação de ASA III ou IV foram fatores independentes de risco aumentado de óbito na população estudada. A taxa de mortalidade foi de 30,8%, sendo que infecção seguida de choque séptico foi a principal causa determinada de óbito. Keywords: Femoral fractures, Postoperative complications, Risk factors, Mortality, Palavras-chave: Fraturas do fêmur, Complicações pós-operatórias, Fatores de risco, Mortalidade

Resumo Justificativa e objetivos O manejo perioperatorio das fraturas de femur em pacientes idosos tem sido estudado com o intuito de determinar causas modificaveis de complicacoes e obito. Este estudo tem por objetivo avaliar taxa de mortalidade e suas causas na populacao idosa com fraturas de femur. Avaliamos tambem complicacoes perioperatorias e sua associacao com mortalidade pos‐operatoria. Metodo Neste estudo prospectivo e observacional, avaliamos 182 pacientes, por questionario e prontuario eletronico, desde o momento da internacao ate um ano apos a cirurgia. Analises estatisticas pelo modelo multivariado de riscos proporcionais de Cox e curvas de Kaplan‐Meier foram feitas para detectar fatores independentes de mortalidade. Resultados Cinquenta e seis pacientes (30,8%) obituaram em ate um ano de pos‐operatorio, sendo que a principal causa determinada de obito foi infeccao seguida de choque septico. A principal complicacao, tanto pre quanto pos‐operatoria, foi disturbio hidroeletrolitico. Para cada aumento de uma unidade (em ano) na idade, a razao de chance de vir a obito aumentou em 4%. A cada nova complicacao pre‐operatoria apresentada, a razao de chance de obito aumentou em 28%. Os pacientes ASA III ou IV apresentaram razao de chance de obito, em um ano, 95% maior do que aqueles ASA I ou II. Conclusoes O aumento da idade e do numero de complicacoes pre‐operatorias, alem da classificacao de ASA III ou IV, foram fatores independentes de risco aumentado de obito na populacao estudada. A taxa de mortalidade foi de 30,8%, sendo que a infeccao seguida de choque septico foi a principal causa determinada de obito.

Although pharmacotherapy is considered the first-line treatment for bipolar disorders (BD), adjunctive psychoeducation has proven its effectiveness in improving self-management of the disease and reducing relapse rates. Few studies have evaluated the effect of brief group psychoeducation on pragmatic variables, such as the number of hospitalizations. The aim of the present study was to assess the mid-term effect of a four-session group psychoeducation on course-related variables in BD. Thirty-two individuals with BD were included in the study. Sixteen were exposed to psychoeducation and were matched to sixteen nonexposed individuals who received their usual treatment. Both groups were compared on insight, treatment adherence, change in the number of hospitalizations and visits to the emergency services, occurrence rate after intervention, and time to the first psychiatric hospitalization and the first urgent attendance. There was a significant reduction in the mean number of hospitalizations and urgent attendances in the exposed group in comparison to the nonexposed group. The first urgent attendance was significantly sooner in the nonexposed cohort. There were no differences between groups in any of the other variables. This intervention has shown benefits for pragmatic variables of the disease course and may be a feasible and cost-effective intervention to routinely implement in the management of BD.

The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.RéSUMé: L’épidémie liée au coronavirus 2019 (COVID-19) a été qualifiée d’urgence de santé publique de portée internationale. La préparation face à une pandémie nécessite de la part d’un hôpital l’élaboration de stratégies pour gérer ses infrastructures, ses processus, son personnel et ses patients; il doit notamment instaurer des mesures de prévention des infections pour réduire la transmission intrahospitalière. Pour un bloc opératoire, ces préparations impliquent la participation de nombreux acteurs et peuvent constituer un véritable défi. Nous décrivons les mesures prises en réponse à l’épidémie par le département d’anesthésie qui sert le plus grand hôpital universitaire de soins aigus (1700 lits) de Singapour (Singapore General Hospital) et un plus petit hôpital régional (Sengkang General Hospital). Cela a été obtenu grâce à des expertises d’ingénierie, telles que l’identification et la préparation d’une salle d’opération en isolation, des mesures administratives telles que la modification du déroulement des activités et des processus, l’introduction d’équipements de protection individuels pour le personnel et — enfin — la formulation de lignes directrices cliniques pour la gestion anesthésique. La simulation a été importante pour évaluer la faisabilité de toutes nouvelles modifications des salles d’opération ou d’un nouveau flux de travail. Dans le contexte des différentes phases d’une pandémie, nous discutons de l’application d’une hiérarchie de contrôles comme cadre des modifications à chaque niveau de contrôle et nous passons aussi en revue les données probantes soutenant les mesures prises. Ces mesures de confinement sont nécessaires pour optimiser la qualité des soins procurés aux patients atteints de COVID-19 et pour réduire le risque de transmission du virus à d’autres patients ou employés du domaine de la santé.

1.Objetivos Determinar el perfil de la población usuaria de un CSMIJ respecto al uso de juegos de ordenador, móvil, tablet y consola, aplicando los criterios propuestos para el trastorno por uso de juegos online. 2.Material y métodos Estudio observacional de casos consecutivos, se recogieron datos sociodemográficos, clínicos y administrativos. Edades 6-18 años. Análisis estadístico de los datos mediante paquete SPSS. 3.Resultados De los 33 casos valorados, un 22% eran mujeres. -Motivos de consulta más prevalentes: problemas de atención (35,5%), alteraciones de la conducta (23%). -Diagnósticos más frecuentes: trastornos de ansiedad y trastorno por déficit de atención (21’4% ambos) -78% de los casos con antecedentes psiquiátricos familiares. El 33% mostraba graves dificultades para dejar de jugar. El 20% se mostraba muy nervioso si no podía jugar. El 37% había perdido interés en otras actividades lúdicas. El 59% deseaba jugar más tiempo. El 38% utilizaba los videojuegos para escapar del malestar emocional. El 14% engañaba sobre las horas dedicadas. El 13% mostraba gran tensión mientras jugaba. El 23% dormía menos horas para de poder jugar. El 37% discutía con frecuencia por el uso de los dispositivos. El 23% no respetaba horarios de otras actividades. El 27% seguía jugando a pesar de los problemas que le suponía. El 13% había intentado reducir las horas de juego sin éxito. El 54,5% mostraba un intenso interés por los juegos. 4.Conclusiones: -El uso de ordenador, móvil, tablet y consola constituye un interés primordial entre los niños y adolescentes. -La elevada prevalencia de antecedentes psiquiátricos familiares puede facilitar un mayor uso de estos dispositivos (dificultades de supervisión y manejo en los adultos).

Molten salts have been used extensively as energy storing materials, however, their thermophysical properties, such as specific heat capacity and thermal conductivity have limited their applications. In this study, potassium nitrate and sodium–potassium nitrate (NaNO3:KNO3 with 60:40 molar ratio) are used as the base salts and different types of nanoparticles, which are iron oxide (Fe2O3), titanium dioxide (TiO2) and copper oxide (CuO), are dispered to form various nanosalts. Laser flash analysis is used to measure thermal diffusivity and dynamic scanning calorimeter for specific heat, latent heat and melting temperature of the molten salts and nanosalts over a wide range of temperature up to 773 K. The addition of Fe2O3 into sodium–potassium nitrate salt increases the effective thermal diffusivity up to 50%. The highest increase in the latent heat reaches 14.45% for 1 wt % CuO-binary nitrate salt. The total thermal energy storage of nanosalt increases up to 6% including both sensible and latent heat, which is due to the formation of the interface layer between nanoparticles and salts. The morphology of nanosalt measured by scanning electron microscopy shows a heterogeneous dispersion of nanoparticles, including agglomerated areas that could be responsible for the degradation of the performance.

Solar Salt-based nanofluids have attracted significant scientific interest in recent years due to their improved thermal properties, making them strong candidates as thermal energy storage materials and/or heat transfer fluids in CSP plants. There have been reports on increased specific heat due to the addition of nanoparticles, however, there is a lack of comprehensive information on other essential properties affecting the heat transfer, such as the viscosity. This article concerns the rheological behaviour of nanofluids made of Solar Salt (mass percentage at 60% NaNO3 – 40% KNO3) as the base fluid and silica or alumina nanoparticles as additives. The evolution of these nanofluids viscosity as a function of the shear rate (1–1000 s−1) at a temperature range of 250–400 °C was measured and analysed. The impact of the salt purity (refined or industrial grade), the nanoparticle concentration (0.5–1.5 wt%) and the rheometer measuring configuration (coaxial cylinder or parallel plate) are examined. The results showed in general a Newtonian behaviour of the nanofluids with independency of the rheometer configuration. The relationship between the viscosity and the temperature follows an Arrhenius model. The influence of the nanoparticle concentration on the viscosity of the refined grade Solar Salt is analysed according to the Maron-Pierce and Kriegher-Dougherty models for the nanofluids containing alumina and silica nanoparticles respectively, due to their different shape.

This study investigated the transient natural convection phenomenon in an underground water pit thermal storage with heat losses through the surrounding walls. An experimental test rig was built up, and a numerical model was developed to obtain the characteristics of the thermal stratification in the water pit thermal storage. Fluid properties are assumed to be constant, except for the density changes with temperature which is treated using the Boussinesq approximation. The simulations of temperature profiles are reasonably proved by experiments with the maximum relative errors of ±9.77%. The results show that water temperature decreases close to the walls due to the heat losses, which leads to a downward flow along the inclined sidewalls. A slight upward flow occurs at the center of the water pit thermal storage, which lifts the warmer water to a higher level. As a result, the buoyancy-driven flow gradually builds up the thermal stratification in the water pit thermal storage. The modelling results also show that the values of the average Nusselt numbers on the inner surface of the inclined sidewalls and the bottom of the tank are much higher than that of the top thermal insulation layer. The thermal energy storage efficiency decreases rapidly in the first five minutes from 100% to 83.19% due to the intense heat transfer, and then tends to level off at the end of 40 min. The maximum velocity of the natural convection appears close to the upper part of the inclined sidewalls, and it decreases with the cooling process evolved. The present work has a valuable attempt to fill the gap in the existing studies and is useful for guiding the water pit thermal storage design.

Air conditioning system in transport applications is a great challenge due to the frequently fluctuated load which causes comfort degradation and even healthy concern. In our previous study, a compact energy storage device filled with PCM was designed and experimentally tested which showed great potential for thermal comfort improvement and efficiency improvement. In this study, charging properties of the energy storage device for train air conditioning systems are experimentally investigated. Time evolutions of PCM temperature during the charging process are presented. The charging performances including charging time, transient charging rate, thermal efficiency and exergy efficiency are revealed. The results show that the designed device has excellent heat transfer behaviors with exergy efficiency up to 78%. The designed device is feasible to be used in transport air conditioning systems due to the quick charging.

Photovoltaic modules during sunny days can reach temperatures 35 °C above the ambient temperature, which strongly influences their performance and electrical efficiency as power losses can be up to −0.65%/°C. To minimize and control the PV panel temperature, the scientific community has proposed different strategies and innovative approaches, one of them through passive cooling with phase change materials (PCM). However, further investigation, including the effects of geometric shape, insulation, phase change temperature, ambient temperature, and solar radiation on the PV module power output and efficiency, needs further optimization and research. Therefore, the current work aims to investigate several system configurations and different PCMs (RT42, RT31, and RT25) and compare the system with and without insulation through computational fluid dynamic (CFD) tools. The final goal is to optimise and control the temperature of PV modules and evaluate their system efficiency and energy generation. The results showed that compared with a rectangular shape of the PCM container, the trapezoid-one exhibits a considerably better cooling performance with a negligible variation of the PV temperature, even when the melting temperature of the PCM was lower than the average ambient temperature. Moreover, the study showed that having insulation in the PCM container increases the amount of PCM needed, compared with no insulation case, and the increased amount depends on the PCM type. The newly proposed PV/PCM system configuration shows an efficiency and power generation enhancement of 17% and 14.6%, respectively, at peak times.

Dialectical behaviour therapy skills training (DBT-ST) has proven effective to treat individuals with borderline personality disorder (BPD). However, therapy still faces the problem of early dropout. The aim of the present study is to examine which factors are associated with early dropout from DBT-ST in a sample of subjects with BPD.118 subjects with BPD diagnosis were included in the study. Apart from socio-demographic and clinical variables, childhood trauma history, personality dimensions, and comorbidities with other psychiatric disorders were collected. Differences in regards to the aforementioned variables were compared between individuals who dropped out prematurely from therapy and those who finalized it.Significant differences between groups regarding socio-demographic and clinical variables, including childhood trauma history and comorbid personality disorders, were not found. Both groups differed significantly in regards to trait impulsiveness and in comorbidity with Eating Disorders (ED) and Cocaine Use Disorder (CUD). The regression analyses showed that ED and CUD significantly predicted drop-out (p=0.011 and p=0.031 respectively), while scores in trait impulsivity showed a tendency towards signification (p=0.063).Comorbidities between BPD and axis I disorders (i.e., ED and CUD) should be taken into account when referring patients to DBT-ST.

Energy storage plays a critical role in facilitating penetration of renewable energy and reducing carbon emission of conventional energy system. Among various energy storage technologies, thermal storage allows energy to be stored in form of heat or cold so that it can be used, later on, for heating and cooling purposes as well as for power generation. Development of highly efficient and cost-effective thermal storage materials as well as the corresponding devices has attracted much attention. Composite materials based on latent heat storage (LHS) have shown great potential for many thermal storage applications. This paper firstly elaborates the recent progress in the study of micro-structured LHS composite materials in light of three different types of material synthesis methods including incorporation, impregnation and microencapsulation. Detailed discussions about morphology, performance enhancement of thermal storage and heat transfer, and various applications are carried out for current micro-structured LHS composite materials. The latest study progress in macro-structured LHS devices are then summarized, which includes the structural design of devices, optimization of heat transfer and device efficiency, as well as the performance of the devices with different storage media. Lastly, opportunities for future work are identified.

Made available in DSpace on 2019-10-03T17:31:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01. Added 1 bitstream(s) on 2019-10-04T16:20:58Z : No. of bitstreams: 1 S0034-70942019000200184.pdf: 672709 bytes, checksum: 1a2fb84de72fb51deccebd12d16a765c (MD5) ResumoIntrodução: A importância e os benefícios do aleitamento materno para os bebês e para as mães estão bem estabelecidos e documentados na literatura. No entanto, é frequente que mães lactantes precisem se submeter à anestesia geral ou raquianestesia e, devido à falta de informações, muitas delas interrompem a amamentação após a anestesia. Existem poucos dados disponíveis sobre a transferência de anestésicos para o leite materno. O objetivo desta revisão foi desenvolver algumas considerações e recomendações com base na literatura disponível.Métodos: Uma busca sistemática da literatura realizada usando com os seguintes bancos de dados em ciências da saúde: Embase, Lilacs, Pubmed, Scopus e Web of Science. A pesquisa bibliográfica mais recente foi realizada em 6 de abril de 2018. Uma pesquisa bibliográfica adicional foi realizada através do site da Organização Mundial da Saúde. Usamos os seguintes termos para a estratégia de busca: Anestesia e Aleitamento materno e seus derivados.Resultados: Nesta pesquisa, 599 registros foram encontrados e 549 foram excluídos por diferentes razões. Foram incluídos 50 manuscritos, com diferentes modelos de estudo: estudos prospectivos, estudos observacionais retrospectivos, revisões, relatos de casos, ensaios clínicos randômicos, caso-controle e acesso a sites. Pequenas concentrações da maioria dos agentes anestésicos são transferidas para o leite materno; entretanto, sua administração parece ser segura para mães lactantes quando administrados em dose única durante a anestesia e isso não deve contraindicar o aleitamento materno. Por outro lado, altas doses, administração contínua ou repetida dos fármacos aumentam o risco de efeitos adversos em neonatos e devem ser evitados. Poucas drogas, como diazepam e meperidina, produzem efeitos adversos em bebês amamentados, mesmo quando administradas em doses únicas. Dexmedetomidina parece ser segura se a amamentação começar 24 horas após a interrupção do medicamento.Conclusões: A maioria dos anestésicos é segura para mães que amamentam e oferecem baixo risco para os recém-nascidos amamentados quando a administração é em dose única. No entanto, altas doses e repetidas administrações de drogas aumentam significativamente o risco de efeitos adversos em recém-nascidos. Além disso, diazepam e meperidina devem ser evitados em mulheres que amamentam. Finalmente, anestesiologistas e pediatras devem considerar o risco-benefício individual, com atenção especial para os recém-nascidos prematuros ou bebês com doenças concomitantes, pois são mais suscetíveis a efeitos adversos. AbstractIntroduction: The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anesthesia and, due to the lack of information, many of them interrupt breastfeeding after anesthesia. There are limited data available regarding anesthetics transfer to breast milk. This review aims to develop some considerations and recommendations based on available literature.Methods: A systematic search of the literature was conducted by using the following health science databases: Embase, Lilacs, Pubmed, Scopus, and Web of Science. The latest literature search was performed on April 6th, 2018. Additional literature search was made via the World Health Organization's website. We used the following terms for the search strategy: Anesthesia and Breastfeeding, and their derivatives.Results: In this research, 599 registers were found, and 549 had been excluded by different reasons. Fifty manuscripts have been included, with different designs of studies: prospective trials, retrospective observational studies, reviews, case reports, randomized clinical trials, case–control, and website access. Small concentrations of the most anesthetic agents, are transferred to the breast milk; however, their administration seem to be safe for lactating mothers when administered as a single dose during anesthesia and this should not contraindicate the breastfeeding. On the other hand, high-doses, continuous or repeated administration of drugs increase the risk of adverse effects on neonates, and should be avoided. Few drugs, such as diazepam and meperidine, produce adverse effects on breastfed babies even in single doses. Dexmedetomidine seems to be safe if breastfeeding starts 24 h after discontinuation of the drug.Conclusions: Most of the anesthetic drugs are safe for nursing mothers and offer low risk to the breastfed neonates when administered in single-dose. However, high-dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. Moreover, diazepam and meperidine should be avoided in nursing women. Finally, anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Anestesiologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Anestesiologia

Intrathecal local anesthetic maldistribution is a well-known cause of spinal anesthesia failure (SAF). This could potentially result in sensory blockade restricted to the sacral dermatomes. We sought to determine the overall incidence of SAF and the role of sacral dermatomes in differentiating between total and partial failures. Of the 3111 spinals prospectively examined, 194 (6.2%) were classified as failures. Of the 72 presumed total failures based on the initial assessment, evaluation of the sacral dermatomes revealed sensory blockade in 32 (44%; 95% confidence interval, 32.7%-56.6%). Sacral dermatome assessment after SAF may be important in safely guiding subsequent anesthetic management.

Made available in DSpace on 2014-10-01T13:08:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-07-01Bitstream added on 2014-10-01T14:02:59Z : No. of bitstreams: 1 S0102-86502014000700472.pdf: 676928 bytes, checksum: 976f17f8d4590206f1eea489b79a9a98 (MD5) PURPOSE: To evaluate the effect of ketamine S (+) 5% with no preservatives and administered as a subarachnoid single puncture on the spinal cord and meninges of rabbits.METHODS: Twenty young adult female rabbits, each weighing 3500-5000 g and having a spine length between 34 and 38 cm, were divided by lot into two groups (G): 0.9% saline in G1 and ketamine S (+) 5% in G2, by volume of 5 μg per cm column (0.18 mL). After intravenous anaesthesia with ketamine and xylazine, the subarachnoid space was punctured at S1-S2 under ultrasound guidance, and a random solution was injected. The animals remained in captivity for 21 days under medical observation and were sacrificed by decapitation. The lumbosacral spinal cord portion was removed for immunohistochemistry to assess the glial fibrillary acidic protein (GFAP), and histology was assessed using hematoxylin and eosin (HE) stain.RESULTS:No histological lesions were found in the nervous tissue (roots and cord) or meninges in either group.CONCLUSION: The ketamine S (+) 5% unpreserved triggered no neurological or histological lesions in the spinal cord or meninges of rabbits. Paulista State University Botucatu Medical School UNESP Botucatu Medical School UNESP Faculty of Veterinary Medicine and Animal Science Department of Animal Reproduction and Veterinary Radiology UNESP Botucatu Medical School Department of Pathology UNESP Botucatu Medical School Department of Dermatology UNESP Botucatu Medical School Department of Anesthesiology Paulista State University Botucatu Medical School UNESP Botucatu Medical School UNESP Faculty of Veterinary Medicine and Animal Science Department of Animal Reproduction and Veterinary Radiology UNESP Botucatu Medical School Department of Pathology UNESP Botucatu Medical School Department of Dermatology UNESP Botucatu Medical School Department of Anesthesiology