Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Apr 2006
[Influence of lidocaine on the neuromuscular block produced by rocuronium: study in rat phrenic-diaphragmatic nerve preparation.].
The action mechanism of local anesthetics (LA) on neuromuscular junction motivated several studies. When administered at low doses, they do not interfere on neuromuscular transmission. But high doses may compromise neuromuscular transmission and increase the effects of neuromuscular blockers. The objective of this study was to evaluate lidocaine interaction with rocuronium on rat diaphragm through its influence on neuromuscular block degree. ⋯ Lidocaine increases the neuromuscular blocking produced by rocuronium. MEPP modifications identify a presynaptic action. The complete antagonism of 4-aminopyridine indicates a presynaptic component. This idea is supported by the partial antagonism through neostigmine.
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Outcome in intensive care can be categorized as mortality related or morbidity related. Mortality is an insufficient measure of ICU outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. The aim of the present study was to estimate the incidence and predictive factors for intrahospitalar outcome measured by mortality and LOS in patients admitted to a surgical ICU. ⋯ In conclusion, prolonged ICU stay is more frequent in more severely ill patients at admission and it is associated with higher hospital mortality. Hospital mortality is also more frequent in patients submitted to emergent and major surgery.
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Rev Bras Anestesiol · Feb 2006
[The lateral midfemoral approach to sciatic nerve block as an anesthetic option to trauma: case repor t.].
Both nervous plexus block and isolated peripheral nerve block are uncommon procedures for patients with lower limb trauma or full stomach, prevailing epidural and spinal blocks as the primary indication. This case report describes the choice of sciatic nerve block as the best indication for a patient with full stomach and severe foot trauma. ⋯ Lateral midfemoral sciatic nerve block as anesthetic option for foot trauma was based on pre-established criteria, such as the preference for regional anesthesia in patients with full stomach and candidates to urgency limb procedures, postural limitation of patients to perform some techniques, such as spinal procedures, anatomic understanding of somatic limb innervation and the mastering of alternative regional techniques.
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Management of hemostasis of cardiopulmonary bypass (CPB) patients is still a major challenge. New monitoring methods, new hemostatic drugs and new platelet function inhibitors are being added to the pre, intra and postoperative periods. The multifactorial nature of CBP-induced hemostasis disorders requires the understanding of their pathophysiology and the accurate hemostasis evaluation for effective coagulation during CPB, in addition to the maintenance of adequate postoperative hemostasis. Activated clotting time (ACT) and coagulogram are not enough for this management. A broader evaluation is needed with monitors able to measure platelet function and hemostatic process dynamics as a whole. ⋯ Thromboelastograph is an important hemostasis monitor for patients submitted to CPB. It has been incorporated to hemostatic disorders evaluation protocols and transfusion therapy, with good results.
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Residual neuromuscular block in the post-anesthetic recovery unit (PACU) may increase postoperative morbidity from 0% to 93%. This study aimed at evaluating the incidence of residual neuromuscular block in the PACU. ⋯ Both groups had high incidence of residual neuromuscular block in the PACU. Residual postoperative curarization is still a problem even with new intermediary action neuromuscular blockers. It is highly important to objectively monitor all patients submitted to general anesthesia with neuromuscular blockers.