Revista brasileira de anestesiologia
-
Rev Bras Anestesiol · Mar 2008
Total intravenous anesthesia as a target-controlled infusion. An evolutive analysis.
Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. ⋯ The advent of new infusion pumps with pharmacokinetic models of remifentanil, sufentanil and propofol opens a new chapter in TIVA and aligns Brazil with the world tendency in TCI. Those systems will allow TCI of hypnotics and opioids concomitantly. However, the most important conclusion refers to the economy, since drugs used in those pumps will not be restricted to only one drug company, similar to what happened with propofol. Nowadays, TCI devices for the use of propofol and opioids, which accept any pharmaceutical presentation, with the advantage of changing the concentration of the drug in the syringe according to the dilution desired are available.
-
Rev Bras Anestesiol · Jan 2008
Comparative Study Controlled Clinical TrialProphylactic antiemetic therapy for acute abdominal surgery. A comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone.
It is calculated that the incidence of postoperative nausea and vomiting (PONV) is approximately 30%. The prophylaxis of PONV has been the subject of several studies, both to decrease this problem and to compare the cost-benefit ration of the treatment used. The objective of this study was to compare the efficacy of 5 antiemetic drugs with a control group in emergency appendectomy. ⋯ Low doses of droperidol were more effective in the prophylaxis of PONV in emergency appendectomy than the other drugs.
-
The incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. This complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. The objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. ⋯ Understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.
-
Rev Bras Anestesiol · Jan 2008
Case ReportsUltrasound-guided ileoinguinal and ileohypogastric nerve block associated with general anesthesia. Case report.
Outpatient surgeries are becoming more frequent. Ilioinguinal and iliohypogastric nerve block has been used in postoperative analgesia of patients undergoing outpatient inguinal herniorrhaphy. Ultrasound-guided regional anesthesia increases the accuracy of deposition of the local anesthetic around the nerves. The objective of this report was to present a case of ultrasound-guided ilioinguinal and iliohypogastric nerve block for outpatient inguinal herniorrhaphy. ⋯ Ultrasound-guided iliohypogastric and ilioinguinal nerve block in patients undergoing outpatient inguinal herniorrhaphy can be done as an aid to postoperative analgesia.
-
The axillary artery is the anatomical reference, in the surface, for axillary brachial plexus block. Anatomic studies suggest variability in the location of the structures in the brachial plexus in relation to the axillary artery. These variations can hinder blocks by neurostimulation. The ultrasound allows the identification of the structures within the brachial plexus(1). The objective of this report was to describe the position of the nerves in the brachial plexus in relation to the axillary artery. ⋯ Real-time ultrasound inspection of the neurovascular structures of the brachial plexus in the axilla demonstrated that the median, ulnar and radial nerves have different relations with the axillary artery.