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Sampaio JBP, Quintão VC, Teixeira FP, de Souza GD, Simões CM, Carmona MJC. Recycling and sustainability in anaesthesia: a Brazilian national survey. Br J Anaesth 2024:S0007-0912(24)00094-1. [PMID: 38519367 DOI: 10.1016/j.bja.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/09/2024] [Accepted: 02/06/2024] [Indexed: 03/24/2024] Open
Affiliation(s)
- Josyanne B P Sampaio
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto Central ICHC, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vinícius C Quintão
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto da Criança e do Adolescente ICr, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Fernanda P Teixeira
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme D de Souza
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Claudia M Simões
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo ICESP, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Serviços Médicos de Anestesia SMA, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Maria J C Carmona
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto Central ICHC, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Araújo Filho EAF, Carmona MJC, Otsuki DA, Maia DRR, Lima LGCA, Vane MF. Effect of AT1 receptor blockade on cardiovascular outcome after cardiac arrest: an experimental study in rats. Sci Rep 2023; 13:18269. [PMID: 37880377 PMCID: PMC10600238 DOI: 10.1038/s41598-023-45568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
Angiotensin II receptor 1(AT1) antagonists are beneficial in focal ischemia/reperfusion (I/R). However, in cases of global I/R, such as cardiac arrest (CA), AT1 blocker's potential benefits are still unknown. Wistar male rats were allocated into four groups: Control group (CG)-animals submitted to CA by ventricular fibrillation induced by direct electrical stimulation for 3 min, and anoxia for 5 min; Group AT1 (GAT1)-animals subjected to CA and treated with 0.2 mg/kg of candesartan diluted in dimethylsulfoxide (DMSO) (0.1%); Vehicle Group (VG): animals subjected to CA and treated with 0.2 ml/kg of DMSO and Sham group (SG)-animals submitted to surgical interventions, without CA. Cardiopulmonary resuscitation consisted of group medications, chest compressions, ventilation, epinephrine (20 mcg/kg) and defibrillation. The animals were observed up to 4 h after spontaneous circulation (ROSC) return, and survival rates, hemodynamic variables, histopathology, and markers of tissue injury were analyzed. GAT1 group had a higher rate of ROSC (62.5% vs. 42.1%, p < 0.0001), survival (100% vs. 62.5%, p = 0.027), lower incidence of arrhythmia after 10 min of ROSC (10% vs. 62.5%, p = 0.000), and lower neuronal and cardiac injury scores on histology evaluation (p = 0.025 and p = 0.0052, respectively) than GC group. The groups did not differ regarding CA duration, number of adrenaline doses, or number of defibrillations. AT1 receptor blockade with candesartan yielded higher rates of ROSC and survival, in addition to neuronal and myocardial protection.
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Affiliation(s)
- E A F Araújo Filho
- Departamento de Cirurgia (LIM 08), Faculdade de Medicina da USP (FMUSP), EAF: Av. Dr. Arnaldo, 455, sala 2120 (LIM-08), São Paulo, SP, 01246-903, Brazil.
| | - M J C Carmona
- Departamento de Cirurgia, Disciplina de Anestesiologia, Universidade de São Paulo, São Paulo, Brazil
| | - D A Otsuki
- Departamento de Cirurgia (LIM 08), Faculdade de Medicina da USP (FMUSP), EAF: Av. Dr. Arnaldo, 455, sala 2120 (LIM-08), São Paulo, SP, 01246-903, Brazil
| | - D R R Maia
- Departamento de Cirurgia (LIM 08), Faculdade de Medicina da USP (FMUSP), EAF: Av. Dr. Arnaldo, 455, sala 2120 (LIM-08), São Paulo, SP, 01246-903, Brazil
| | - L G C A Lima
- Departamento de Patologia, Faculdade de Medicina da USP (FMUSP), São Paulo, Brazil
| | - M F Vane
- Departamento de Cirurgia (LIM 08), Faculdade de Medicina da USP (FMUSP), EAF: Av. Dr. Arnaldo, 455, sala 2120 (LIM-08), São Paulo, SP, 01246-903, Brazil
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Salles IC, Gouvea GB, Calderaro M, Monteiro VS, Correa RF, Silva SNMF, Shinohara HNI, Umeda IIK, Aikawa P, Carvalho HB, Mansur AP, Carmona MJC, Semeraro F, Bottiger BW, Nakagawa NK. Lack of knowledge on acute stroke in children, adolescents and adults from public schools. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases. This community-based study investigated students' stroke knowledge, emergency medical services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels.
Methods
We conducted the survey with a structured questionnaire between March 2019 and December 2020.
Results
Students from the elementary school (n=1,187, ∼13 y.o., 14% with prior experience, 51% women), high school (n=806, ∼17 y.o., 13% with prior experience, 47% women) and University (n=1,961, ∼22 y.o., 9% with prior experience, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42–66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62–65% of students recognised arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS phone number; 81% were willing to have stroke education included at school, and 75.2% found it essential and mandatory. Female, higher education and prior experience were associated with higher scores of stroke risk factors (OR: 1.28, 95% CI: 1.10–1.48; OR: 2.12, 95% CI:1.87–2.40; and OR: 1.46, 95% CI: 1.16–1.83; respectively), and signs and symptoms (OR: 2.22, 95% CI: 1.89–2.60; OR: 3.30, 95% CI: 2.81–3.87; and OR: 2.04, 95% CI: 1.58–2.63; respectively).
Conclusion
Being female, having prior experience, and a higher educational level increase the identification of associated risk factors and warning signs and symptoms. Stroke awareness should be emphasized among schoolchildren and adolescents.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I C Salles
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | - G B Gouvea
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | - M Calderaro
- Sao Paulo University Medical School, Neurology Department, Sao Paulo, Brazil
| | - V S Monteiro
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | - R F Correa
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | - S N M F Silva
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | | | - I I K Umeda
- Sao Paulo University Medical School, Sao Paulo, Brazil
| | - P Aikawa
- Federal University of Rio Grande (FURG), Physiology Department, Rio Grande, Brazil
| | - H B Carvalho
- Sao Paulo University Medical School, Preventive Medicine Department, Sao Paulo, Brazil
| | - A P Mansur
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M J C Carmona
- Sao Paulo University Medical School, Anaesthesiology Division, Sao Paulo, Brazil
| | - F Semeraro
- Maggiore Hospital, Anaesthesia and Intensive Care Department, Bologna, Italy
| | - B W Bottiger
- University of Cologne, Anaesthesiology and Intensive Care Medicine Department, Cologne, Germany
| | - N K Nakagawa
- Sao Paulo University Medical School, Physiotherapy, Communication Science and Speech Therapy and Occupational Therapy Department, Sao Paulo, Brazil
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Rangel FP, Auler JOC, Carmona MJC, Cordeiro MD, Nahas WC, Coelho RF, Simões CM. Opioids and premature biochemical recurrence of prostate cancer: a randomised prospective clinical trial. Br J Anaesth 2021; 126:931-939. [PMID: 33712224 DOI: 10.1016/j.bja.2021.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prostate cancer is one of the most prevalent neoplasms in male patients, and surgery is the main treatment. Opioids can have immune modulating effects, but their relation to cancer recurrence is unclear. We evaluated whether opioids used during prostatectomy can affect biochemical recurrence-free survival. METHODS We randomised 146 patients with prostate cancer scheduled for prostatectomy into opioid-free anaesthesia or opioid-based anaesthesia groups. Baseline characteristics, perioperative data, and level of prostate-specific antigen every 6 months for 2 yr after surgery were recorded. Prostate-specific antigen >0.2 ng ml-1 was considered biochemical recurrence. A survival analysis compared time with biochemical recurrence between the groups, and a Cox regression was modelled to evaluate which variables affect biochemical recurrence-free survival. RESULTS We observed 31 biochemical recurrence events: 17 in the opioid-free anaesthesia group and 14 in the opioid-based anaesthesia group. Biochemical recurrence-free survival was not statistically different between groups (P=0.54). Cox regression revealed that biochemical recurrence-free survival was shorter in cases of obesity (hazard ratio [HR] 1.63, confidence interval [CI] 0.16-3.10; p=0.03), high D'Amico risk (HR 1.58, CI 0.35-2.81; P=0.012), laparoscopic surgery (HR 1.6, CI 0.38-2.84; P=0.01), stage 3 tumour pathology (HR 1.60, CI 0.20-299) and N1 status (HR 1.34, CI 0.28-2.41), and positive surgical margins (HR 1.37, CI 0.50-2.24; P=0.002). The anaesthesia technique did not affect time to biochemical recurrence (HR -1.03, CI -2.65-0.49; P=0.18). CONCLUSIONS Intraoperative opioid use did not modify biochemical recurrence rates and biochemical recurrence-free survival in patients with intermediate and high D'Amico risk prostate cancer undergoing radical prostatectomy. CLINICAL TRIAL REGISTRATION NCT03212456.
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Affiliation(s)
- Felipe P Rangel
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Serviços Médicos de Anestesia (SMA), São Paulo, Brazil.
| | - José O C Auler
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Department of Anaesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Anaesthesia Department, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Maria J C Carmona
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Department of Anaesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Mauricio D Cordeiro
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - William C Nahas
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Rafael F Coelho
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Claudia M Simões
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Serviços Médicos de Anestesia (SMA), São Paulo, Brazil; Anaesthesia Department, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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Zbóril S, Schmidt AP, Oses JP, Wiener CD, Portela LV, Souza DO, Auler JOC, Carmona MJC, Fugita MS, Flor PB, Cortopassi SRG. S100B protein and neuron-specific enolase as predictors of postoperative cognitive dysfunction in aged dogs: a case-control study. Vet Anaesth Analg 2020; 47:740-747. [PMID: 32800537 DOI: 10.1016/j.vaa.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative cognitive dysfunction (POCD) may be related to brain injury. S100B protein and neuron-specific enolase (NSE) have been investigated as potential biochemical markers of neural cell injury in animals and humans. This study aimed to investigate the association between POCD, brain injury and serum concentrations of S100B and NSE after periodontal surgery in aged dogs. STUDY DESIGN Prospective observational animal study. ANIMALS A total of 24 male and female dogs undergoing periodontal surgery. METHODS Dogs were separated into two groups based on age: control group, 10 dogs ≤ 8 years and aged group, 14 dogs > 8 years. Cognitive function was measured preoperatively and on the seventh postoperative day using the Canine Cognitive Dysfunction Rating scale and the Age-Related Cognitive and Affective Disorders scale. S100B protein and NSE serum concentrations were measured before and immediately after the surgery. RESULTS POCD was not observed after surgery in the present study. Serum concentrations of S100B and NSE were increased postoperatively in the control group but not in the aged group (p = 0.04 and 0.03, respectively). Preoperative S100B serum concentrations were significantly higher in the aged group (p = 0.01). CONCLUSIONS There was no association between POCD and high concentrations of S100B and NSE in dogs. However, increased postoperative serum concentrations of S100B and NSE were found in the control group after surgery, an effect that may indicate neural damage. CLINICAL RELEVANCE The results suggest that anesthesia and oral surgery are associated with higher postoperative serum concentrations of S100B and NSE in dogs ≤ 8 years old, which may indicate neural damage. Serum concentrations of S100B were elevated in aged dogs before anesthesia, a finding that might be related to chronic preoperative brain damage.
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Affiliation(s)
- Sabrina Zbóril
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - André P Schmidt
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Department of Anesthesia and Perioperative Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil; Department of Anesthesia, Santa Casa de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil; Department of Anesthesia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | - Jean P Oses
- Postgraduate Program in Biochemistry and Molecular Biology, Setor de Bioquímica, Instituto de Biociências, Universidade Federal do Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Carolina D Wiener
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, RS, Brazil
| | - Luis V Portela
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Diogo O Souza
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - José O C Auler
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, SP, Brazil
| | - Maria J C Carmona
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, SP, Brazil
| | - Mariana S Fugita
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Patricia B Flor
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Silvia R G Cortopassi
- Department of Surgery, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Simões CM, Carmona MJC, Hajjar LA, Vincent JL, Landoni G, Belletti A, Vieira JE, de Almeida JP, de Almeida EP, Ribeiro U, Kauling AL, Tutyia C, Tamaoki L, Fukushima JT, Auler JOC. Predictors of major complications after elective abdominal surgery in cancer patients. BMC Anesthesiol 2018; 18:49. [PMID: 29743022 PMCID: PMC5944034 DOI: 10.1186/s12871-018-0516-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/27/2018] [Indexed: 12/23/2022] Open
Abstract
Background Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. Methods We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events. Results Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01–1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33–5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21–4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03–4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98–1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00–4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55–27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75–0.84, p < 0.001). Conclusions Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids. Electronic supplementary material The online version of this article (10.1186/s12871-018-0516-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia M Simões
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil
| | - Maria J C Carmona
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ludhmila A Hajjar
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil.
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joaquim E Vieira
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Juliano P de Almeida
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil
| | - Elisangela P de Almeida
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil
| | - Ulysses Ribeiro
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil
| | - Ana L Kauling
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Celso Tutyia
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lie Tamaoki
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Julia T Fukushima
- Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil
| | - José O C Auler
- Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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de Oliveira AMRR, Silva JM, Rocha H, Sá Malbouisson LM, Carmona MJC. SAPS 3 as a predictor admission of surgical patients in the ICU. Crit Care 2013. [PMCID: PMC3891490 DOI: 10.1186/cc12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Silva JM, Nogueira FAM, Vianna PMM, Filho MCP, Neucamp CS, Maia VPL, de Oliveira AMRR, Carmona MJC, Sá Malbouisson LM. Excessive fluid balance effect in mortality rate from surgical patients. Crit Care 2013. [PMCID: PMC3891167 DOI: 10.1186/cc12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bliacheriene F, Avila WS, Bortolotto MRFL, Okano FT, Fontes ES, Galas FRBG, Carmona MJC. Anesthesia for cardiac surgery under cardiopulmonary bypass in pregnant patients: experience with nine cases. Int J Obstet Anesth 2012; 21:388-9. [PMID: 22922088 DOI: 10.1016/j.ijoa.2012.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/13/2012] [Accepted: 06/17/2012] [Indexed: 11/26/2022]
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Auler JOC, Kim SM, Carmona MJC, Malbouisson LMS, de Oliveira SA. Continuous cardiac output monitoring during haemodynamic changes in off-pump coronary artery bypass grafting surgery. Eur J Anaesthesiol 2006; 23:890-2. [PMID: 16953945 DOI: 10.1017/s0265021506211372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2006] [Indexed: 11/07/2022]
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Carmona MJC, Malbouisson LMS, Pereira VA, Bertoline MA, Omosako CEK, Le Bihan KB, Auler JOC, Santos SRCJ. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery. Braz J Med Biol Res 2005; 38:713-21. [PMID: 15917952 DOI: 10.1590/s0100-879x2005000500008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 +/- 8 years, mean weight 75.4 +/- 11.9 kg and mean body surface area 1.83 +/- 0.19 m(2)), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min(-1) kg(-1) (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.
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Affiliation(s)
- M J C Carmona
- Disciplina de Anestesiologia, Serviço de Anestesiologia e Terapia Intensiva Cirúrgica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São PauloSão Paulo, SP, Brasil.
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Nascimento JWL, Carmona MJC, Strabelli TMV, Auler JOC, Santos SRCJ. Systemic availability of prophylactic cefuroxime in patients submitted to coronary artery bypass grafting with cardiopulmonary bypass. J Hosp Infect 2005; 59:299-303. [PMID: 15749317 DOI: 10.1016/j.jhin.2004.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Accepted: 09/09/2004] [Indexed: 11/20/2022]
Abstract
Cardiopulmonary bypass and hypothermia (HCPB) is a procedure commonly used during heart surgery, representing a risk factor for the patient by promoting extensive haemodilution and profound physiological changes. Cefuroxime is used for the prevention of infection following heart surgery, and several dose schemes have been suggested for prophylaxis with cefuroxime. The objective of the present study was to assess, in a comparative manner, the systemic availability of cefuroxime administered intravascularly as a bolus dose of 1.5 g to 17 patients having heart surgery with or without HCPB. Plasma cefuroxime concentrations were determined by high-pressure liquid chromatography-UV, and the following values, expressed as medians, were obtained for the study group compared with controls: 69.1 vs. 62.7 mg/L (1st h), 35.8 vs. 26.0mg/L (3rd h), 14.6 vs. 8.7 mg/L (6th h, P<0.05), 6.1 vs. 3.0mg/L (9th h, P<0.05) and 2.6 vs. 1.0mg/L (12th h, P<0.05). Despite the differences recorded during the study period as a consequence of HCPB, low antibiotic concentrations were found as early as 6h post dose for both groups investigated. Thus, the low systemic availability of cefuroxime after the administration of a 1.5-g dose may not protect against postoperative infections. The data obtained permit us to recommend a change in the dose scheme in order to maintain adequate plasma levels of cefuroxime.
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Affiliation(s)
- J W L Nascimento
- Pharmacology and Therapeutics Laboratory, Pharmacy Department, School of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580, 05508-000 São Paulo, Brazil
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Carmona MJC, Pereira VA, Auler JOC, Santos SRCJ. Propranolol kinetics in patients submitted to cardiac surgery with cardiopulmonary bypass. Crit Care 2001. [PMCID: PMC3300906 DOI: 10.1186/cc1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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