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Quintão VC, Carvalho VH, Costa LGVD, Germano-Filho PA, Nascimento JCR, Lima RME, Nunes RR, Brandão AC, Schmidt AP. Videolaryngoscopy in anesthesia and perioperative medicine: innovations, challenges, and best practices. Braz J Anesthesiol 2023; 73:525-528. [PMID: 37734833 PMCID: PMC10533969 DOI: 10.1016/j.bjane.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Vinícius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Instituto da Criança e do Adolescente, São Paulo, SP, Brazil.
| | | | | | - Paulo Alipio Germano-Filho
- Universidade Federal Fluminense, Departamento de Cirurgia Geral e Especializada, Anestesiologia, Niterói, RJ, Brazil
| | - José Carlos R Nascimento
- Hospital Geral de Fortaleza, Departamento de Anestesia e Transplante de Fígado, Fortaleza, CE, Brazil
| | - Rodrigo Moreira E Lima
- University of Manitoba, Department of Anesthesiology, Perioperative, and Pain Medicine, Winnipeg, Manitoba, Canada
| | - Rogean Rodrigues Nunes
- Hospital Geral de Fortaleza, Departamento de Anestesia e Transplante de Fígado, Fortaleza, CE, Brazil
| | - Antônio Carlos Brandão
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil
| | - André P Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre e Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil
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Coccolini F, Corradi F, Sartelli M, Coimbra R, Kryvoruchko IA, Leppaniemi A, Doklestic K, Bignami E, Biancofiore G, Bala M, Marco C, Damaskos D, Biffl WL, Fugazzola P, Santonastaso D, Agnoletti V, Sbarbaro C, Nacoti M, Hardcastle TC, Mariani D, De Simone B, Tolonen M, Ball C, Podda M, Di Carlo I, Di Saverio S, Navsaria P, Bonavina L, Abu-Zidan F, Soreide K, Fraga GP, Carvalho VH, Batista SF, Hecker A, Cucchetti A, Ercolani G, Tartaglia D, Galante JM, Wani I, Kurihara H, Tan E, Litvin A, Melotti RM, Sganga G, Zoro T, Isirdi A, De'Angelis N, Weber DG, Hodonou AM, tenBroek R, Parini D, Khan J, Sbrana G, Coniglio C, Giarratano A, Gratarola A, Zaghi C, Romeo O, Kelly M, Forfori F, Chiarugi M, Moore EE, Catena F, Malbrain MLNG. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines. World J Emerg Surg 2022; 17:50. [PMID: 36131311 PMCID: PMC9494880 DOI: 10.1186/s13017-022-00455-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. MATERIAL AND METHODS An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. CONCLUSION Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
| | | | | | - Raul Coimbra
- Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA
| | - Igor A Kryvoruchko
- Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | | | - Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Ceresoli Marco
- General Surgery Department, Monza University Hospital, Monza, Italy
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Walt L Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Paola Fugazzola
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | | | | | | | - Mirco Nacoti
- ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Timothy C Hardcastle
- Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Milano, Italy
| | - Belinda De Simone
- Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Matti Tolonen
- Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Salomone Di Saverio
- General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Pradeep Navsaria
- Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Luigi Bonavina
- General Surgery Department, San Donato Hospital, Milan, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Andreas Hecker
- General Surgery, Giessen University Hospital, Giessen, Germany
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Joseph M Galante
- General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA, USA
| | - Imtiaz Wani
- General Surgery Department, Government Gousiua Hospital, Srinagar, India
| | - Hayato Kurihara
- Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy
| | - Edward Tan
- Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Zoro
- ICU Department, Pisa University Hospital, Pisa, Italy
| | | | - Nicola De'Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Adrien M Hodonou
- Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin
| | - Richard tenBroek
- General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK
| | | | | | | | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Oreste Romeo
- Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Manu L N G Malbrain
- First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium
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Castedo JS, Carvalho VH. The anesthesiologist thoughts on medical residency in anesthesiology in Brazil. Braz J Anesthesiol 2022; 73:115-116. [PMID: 35917845 PMCID: PMC9366517 DOI: 10.1016/j.bjane.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Affiliation(s)
- João S. Castedo
- Unidade Local de Saúde de Matosinhos (ULSM), Departamento de Anestesia, Matosinhos, Portugal,Corresponding author.
| | - Vanessa Henriques Carvalho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Departamento de Anestesiologia, Campinas, SP, Brazil
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Ribeiro Junior IDV, Carvalho VH, Brito LGO. Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis. Braz J Anesthesiol 2021; 72:506-515. [PMID: 34673125 PMCID: PMC9373474 DOI: 10.1016/j.bjane.2021.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a regional block that may be used for several surgeries. However, the evidence regarding obstetrical procedures is not pooled in the literature. OBJECTIVES To assess whether ESPB improves the postoperative pain after cesarean section by a systematic review and meta-analysis. METHODS The protocol of this review was registered on PROSPERO (CRD42020192760). We included randomized controlled trials from databases until August 2020. The primary outcome was pain measured on a visual analogic scale; secondary outcomes were analgesic duration, postoperative opioid dose within the 24 hours, nausea/vomiting. The risk of bias and the GRADE criteria to assess quality of evidence were analyzed. RESULTS From 436 retrieved studies, three were selected. There was no difference in the pain scores between ESPB and controls at rest after surgery at 4 h (mean difference [MD] = 0.00; 95% CI: -0.72 to 0.72; I² = 0%; very low certainty), 12 h (MD = -1.00; 95% CI: -2.00 to -0.00; I² = 0%, low certainty) and 24 h (MD = -0.68; 95% CI: -1.56 to 0.20; I² = 50%; very low certainty). There was a smaller consumption of tramadol with ESPB compared with controls (MD = -47.66; 95% CI: -77.24 to -18.08; I² = 59%; very low certainty). The analgesic duration of ESPB was longer than the controls (MD = 6.97; 95% CI: 6.30 to 7.65; I² = 58%; very low certainty). CONCLUSION ESPB did not decrease the postoperative pain scores when compared to other comparators. However, ESPB showed a lower consumption of tramadol and a longer blockade duration, although the quality of evidence of these outcomes were very low.
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Affiliation(s)
| | | | - Luiz Gustavo Oliveira Brito
- Universidade Estadual de Campinas (UNICAMP), Departamento de Obstetrícia e Ginecologia, Campinas, SP, Brazil.
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Ferrarezi WPP, Braga ADFDA, Ferreira VB, Mendes SQ, Brandão MJN, Braga FSDS, Carvalho VH. Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial. Braz J Anesthesiol 2021; 71:642-648. [PMID: 34411627 PMCID: PMC9373100 DOI: 10.1016/j.bjane.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Assess patients submitted to elective cesarean section under spinal anesthesia, and the efficacy of different doses of fentanyl associated with bupivacaine. Methods The study included 124 pregnant women randomly distributed into 4 groups (n = 31) according to different doses of fentanyl (15 μg, 10 μg, 7.5 μg), Groups I, II, and III, respectively, and control group IV, associated with 0.5% hyperbaric bupivacaine (10 mg). An epidural catheter was inserted in case epidural top-up was required. We assessed the anesthetic blockage characteristics, negative maternal and neonatal outcomes, and maternal side effects. Statistical analysis was performed using Kruskal-Wallis, Fisher’s exact and chi-square tests. The level of significance was 5% (p < 0.05). Results The quality of analgesia, time for the first complaint of pain and motor block recovery time were significantly better for groups that received fentanyl in comparison to controls (p < 0.001). None of the groups had negative maternal-fetal outcomes. Nausea was significantly more frequent in patients in Groups II (10 µg) and III (7.5 µg) when compared to Groups I (15 µg) and IV (no fentanyl). Vomiting was more frequent in Group III than in Group I (p = 0.006). The incidence of pruritus was significantly higher in the groups receiving fentanyl (p = 0.012). Conclusions Among the solutions studied, the spinal anesthesia technique using 15 µg of fentanyl associated with 10 mg of hyperbaric bupivacaine provided satisfactory analgesia and very low incidence of adverse effects for patients submitted to cesarean section. Trial Registration Number UTN U1111-1199-0285. REBEC RBR-5XWT6T.
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Affiliation(s)
- Wesla Packer Pfeifer Ferrarezi
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Farmacologia, Campinas, SP, Brazil
| | | | - Valdir Batista Ferreira
- Universidade Estadual de Campinas (UNICAMP), Centro de Atenção Integrada à Saúde Mental (CAISM), Campinas, SP, Brazil
| | - Sara Quinta Mendes
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil
| | - Maria José Nascimento Brandão
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil
| | - Franklin Sarmento da Silva Braga
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil
| | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil.
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Ribeiro-Junior IDV, Brito LGO, Rossmann-Machado M, do Amaral RLG, Braga AFA, Carvalho VH. Ultrasound-guided quadratus lumborum block for surgical treatment of endometriosis: case report. Braz J Anesthesiol 2021; 71:285-287. [PMID: 33934880 PMCID: PMC9373635 DOI: 10.1016/j.bjane.2021.02.014] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022] Open
Abstract
Quadratus lumborum block (QLB) is a technique that is not widely applied for gynecological surgery. Endometriosis affects 10% of the female population and chronic pelvic pain is one of the most prevalent symptoms. Laparoscopic surgery for removal of endometriosis may present a long intra-operative duration and this technique might improve postoperative pain control. We described a case report of a patient submitted to general anesthesia associated to bilateral QLB for pelvic endometriosis. QLB was an adjuvant anesthetic technique for endometriosis, providing somatic and visceral analgesia. However, prospective studies are needed to identify the standard dosage and total duration of analgesia.
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Affiliation(s)
| | - Luiz Gustavo Oliveira Brito
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Obstetrícia e Ginecologia, Campinas, SP, Brazil
| | - Maíra Rossmann-Machado
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Obstetrícia e Ginecologia, Campinas, SP, Brazil
| | - Rose Luce Gomes do Amaral
- Centro de Atenção Integral à Saúde da Mulher (CAISM), Hospital da Mulher Prof. Dr. J. A. Pinotti, Campinas, SP, Brazil
| | - Angélica F A Braga
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil
| | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brazil.
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Alexandrino H, Baptista S, Vale L, Júnior JHZ, Espada PC, Junior DS, Vane LA, Carvalho VH, Marcelo L, Madeira F, Duarte R, Ferreira L, Pereira J, Pinheiro LF, Fraga GP, Mesquita C. Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses. World J Surg 2021; 44:1856-1862. [PMID: 32072223 DOI: 10.1007/s00268-020-05421-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
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Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal. .,Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Sérgio Baptista
- Centro Hospitalar Médio Tejo, EPE, Av. Maria de Lurdes Melo e Castro, Ap. 118, 2304-909, Tomar, Portugal
| | - Luís Vale
- Hospital Nélio Mendonça and Regional Emergency Service (SRPC/IPRAM) - Serviço de Saúde da RAM, E.P.E, Avenida Luís de Camões, no 57, 9004-514, Funchal, Portugal
| | - José Hélio Zen Júnior
- Hospital e Maternidade Galileo, Valinhos, São Paulo, Brazil.,Faculdade de Ciências Médicas, Pós Graduação em Ciências Médicas, Universidade Estadual de Campinas/UNICAMP, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil
| | - Paulo César Espada
- Departamento de Cirurgia Geral, Faculdade Medicina de São José do Rio Preto-FAMERP, São José de Rio Preto, Brazil
| | | | - Luiz Antonio Vane
- Faculdade de Ciências Médicas, Avenida Brigadeiro Faria Lima, 811, Putim, São José dos Campos, São Paulo, Brazil
| | - Vanessa Henriques Carvalho
- School of Medical Science - Unicamp - Campinas-Brazil School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Lara Marcelo
- Centro Hospitalar Universitário do Porto, EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Madeira
- Department of Anesthesiology, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | | | - Luís Ferreira
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Viseu, Portugal
| | | | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Carlos Mesquita
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
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Trizotti JPSDS, Braga ADFDA, Carvalho VH, Braga FSDS. [Influence of different local anesthetics on atracurium neuromuscular blockade on rats]. Rev Bras Anestesiol 2020; 70:220-224. [PMID: 32522376 DOI: 10.1016/j.bjan.2020.01.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The association between Local Anesthetics (LAs) and Neuromuscular Blocking (NMB) drugs in clinical practice, and the possibility of interaction between these drugs has been investigated. LAs act on neuromuscular transmission in a dose-dependent manner and may potentiate the effects of NMB drugs. OBJECTIVE The aim of this study was to evaluate, in an experimental model, the effect of lidocaine and racemic bupivacaine on neuromuscular transmission and the influence on neuromuscular blockade produced by atracurium. METHODS Male Wistar rats, weighing from 250 g to 300g were used. The preparation was set up based on a technique proposed by Bülbring. Groups were formed (n = 5) according to the drug studied: lidocaine 20 μg.mL-1 (Group I); racemic bupivacaine 5 μg.mL-1 (Group II); atracurium 20 μg.mL-1 (Group III); atracurium 20 μg.mL-1 in a preparation previously exposed to lidocaine 20 μg.mL-1 and racemic bupivacaine 5 μg.mL-1, Groups IV and V, respectively. The following parameters were assessed: 1) Amplitude of hemi diaphragmatic response to indirect stimulation before and 60 minutes after addition of the drugs; 2) Membrane Potentials (MP) and Miniature Endplate Potentials (MEPPs). RESULTS Lidocaine and racemic bupivacaine alone did not alter the amplitude of muscle response. With previous use of lidocaine and racemic bupivacaine, the neuromuscular blockade (%) induced by atracurium was 86.66 ± 12.48 and 100, respectively, with a significant difference (p = 0.003), in comparison to the blockade produced by atracurium alone (55.7 ± 11.22). These drugs did not alter membrane potential. Lidocaine initially increased the frequency of MEPPs, followed by blockade. With the use of bupivacaine, the blockade was progressive. CONCLUSIONS Lidocaine and racemic bupivacaine had a presynaptic effect expressed by alterations in MEPPs, which may explain the interaction and potentiation of NMB produced by atracurium.
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Affiliation(s)
| | | | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil.
| | - Franklin Sarmento da Silva Braga
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
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Braga ADFDA, Teixeira CEFDA, Carvalho VH. [Reply to the letter to the editor - anesthesia for cesarean delivery in a patient with Klippel-Trenaunay syndrome]. Rev Bras Anestesiol 2019; 70:73-74. [PMID: 31607376 DOI: 10.1016/j.bjan.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/09/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
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Braga ADFDA, Carvalho VH, Braga FSDS, Pereira RIC. Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 30219195 PMCID: PMC9391717 DOI: 10.1016/j.bjane.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.
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Affiliation(s)
| | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil.
| | - Franklin Sarmento da Silva Braga
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
| | - Rosa Inês Costa Pereira
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
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Teixeira CEFDA, Braga ADFDA, Braga FSDS, Carvalho VH, Costa RMD, Brighenti GIT. [Anesthesia for cesarean delivery in a patient with Klippel-Trenaunay syndrome]. Rev Bras Anestesiol 2018; 68:641-644. [PMID: 29506860 DOI: 10.1016/j.bjan.2018.01.015] [Citation(s) in RCA: 5] [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: 04/03/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Klippel-Trenaunay syndrome is a rare congenital vascular disease characterized by cutaneous hemangiomas, varicosities, and limb asymmetry, which may evolve with coagulation disorders and hemorrhage as those more frequent complications in pregnant patients. Pregnancy is not advised in women with this syndrome due to increased obstetrical risk. CASE REPORT Female patient, 29 years old, 99kg, 167cm, BMI 35.4kg.m-2, physical status ASA III, with 27 weeks of gestational age and diagnosis of Klippel-Trenaunay syndrome. She was admitted to attempt inhibition of preterm labor. As manifestations of Klippel-Trenaunay syndrome, the patient presented with cerebral and cutaneous hemangioma mainly in the trunk and lumbar region, paresis in the left upper and lower limbs, and limb asymmetry requiring the use of a walking stick. Physical examination revealed absence of airway vascular malformations and Mallampati class 3. Laboratory tests were normal and abdominal angiotomography showed irregular uterus, with multiple varices and vessels of arterial origin and bilateral periadnexal varices. She evolved with failure in preterm labor inhibition, and cesarean section under total intravenous anesthesia was indicated. Monitoring, central and peripheral venous access, radial artery catheterization, and diuresis were secured. Cesarean section was performed with median incision and longitudinal uterine body section for fetal extraction. Two episodes of arterial hypotension were seen intraoperatively. The postoperative evolution was uneventful. The choice of anesthesia was dependent on the clinical manifestations and the lack of imaging tests proving the absence of neuraxial hemangiomas.
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Affiliation(s)
| | | | - Franklin Sarmento da Silva Braga
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
| | - Vanessa Henriques Carvalho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
| | - Rafael Miranda da Costa
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil
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Santos FNC, Braga ADFDA, Ribeiro CJBDL, Braga FSDS, Carvalho VH, Junqueira FEF. Aplicação de protocolo e avaliação da incidência de curarização residual pós‐operatória na ausência de aceleromiografia intraoperatória – Ensaio clínico randomizado. Braz J Anesthesiol 2017; 67:592-599. [DOI: 10.1016/j.bjan.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/09/2017] [Indexed: 12/20/2022] Open
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Santos FNC, Braga ADFDA, Junqueira FEF, Bezerra RM, de Almeida FF, Braga FSDS, Carvalho VH. Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade: A retrospective study. Medicine (Baltimore) 2017; 96:e7322. [PMID: 28658142 PMCID: PMC5500064 DOI: 10.1097/md.0000000000007322] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This research aimed to assess the use of neuromuscular blockers (NMB) and its reversal, associated or not with neuraxial blockade, after general anesthesia.This retrospective study analyzed 1295 patients that underwent surgery with general anesthesia at Prof. Dr. José Aristodemo Pinotti Hospital in 2013. The study included patients aged >1 year, with complete, readable medical charts and anesthetic records.Rocuronium (ROC) was the most used NMB (96.7%), with an initial dose of 0.60 (0.52-0.74) mg/kg and total dose of 0.38 (0.27-0.53) mg/kg/h. In 24.3% of the cases, neuraxial blockade was associated with a significantly longer anesthesia (P < .001) than in cases without neuraxial block, regardless of technique (total intravenous (TIV) vs intravenous and inhalational (IV+IN)). In 71.9% of the cases, a single dose of NMB was used. Patients under TIV general anesthesia associated with neuraxial blockade had a lower total dose of ROC (mg/kg/h) in comparison with TIV GA alone (0.30 (0.23-0.39) and 0.42 (0.30-0.56) mg/kg/h, respectively, P < .001). The same was observed for patients under IV+IN GA (0.32 (0.23-0.41) and 0.43 (0.31-0.56) mg/kg/h, respectively, P < .001). The duration of anesthesia was longer according to increasing number of additional NMB doses (P < .001). Dose of neostigmine was 2.00 (2.00-2.00) mg or 29.41 (25.31-33.89) μg/kg. The interval between neostigmine and extubation was >30 minutes in 10.9% of cases.The most widely used NMB was ROC. Neuroaxial blockade (spinal or epidural) was significantly associated with reduced total dose of ROC (mg/kg/h) during general anesthesia, even in the absence of neuromuscular monitoring and regardless of general anesthetic technique chosen. In most cases, neostigmine was used to reverse neuromuscular block. The prolonged interval between neostigmine and extubation (>30 minutes) was neither associated with total doses of ROC or neostigmine, nor with the time of NMB administration. This study corroborates the important role of quantitative neuromuscular monitors and demonstrates that neuraxial blockade is associated with reduced total ROC dose. Further studies are needed to evaluate the possible role of neuraxial blockade in reducing the incidence of postoperative residual curarization.
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Affiliation(s)
- Filipe Nadir Caparica Santos
- Department of Anesthesiology
- Department of Pharmacology, State University of Campinas, Rua Tessália Vieira de Camargo, 126 – Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil - CEP 13083-887
| | - Angélica de Fátima de Assunção Braga
- Department of Anesthesiology
- Department of Pharmacology, State University of Campinas, Rua Tessália Vieira de Camargo, 126 – Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil - CEP 13083-887
| | - Fernando Eduardo Feres Junqueira
- Department of Pharmacology, State University of Campinas, Rua Tessália Vieira de Camargo, 126 – Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil - CEP 13083-887
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Carvalho VH, Braga ADFDA, Braga FSDS, Potério GMB, Santos FNC, Junqueira FEF. Association between levobupivacaine and pancuronium. Interference in neuromuscular transmission and blockade in rats. Acta Cir Bras 2017; 31:486-9. [PMID: 27487284 DOI: 10.1590/s0102-865020160070000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. METHODS Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - levobupivacaine (5 µg.mL-1); Group II - pancuronium (2 µg.mL-1); Group III - pancuronium (2 µg.mL-1) + levobupivacaine (5µg.mL-1). The following parameters were evaluated: 1) amplitude of diaphragmatic response to indirect stimulation, before and 60 minutes after the addition of levobupivacaine and pancuronium alone, and after the addition of levobupivacaine combined with pancuronium; 2) membrane potentials (MP) and miniature endplate potentials (MEPP). RESULTS Levobupivacaine alone did not alter the amplitude of muscle response and MP. In preparations previoulsy exposed to levobupivacaine, the block with pancuronium was significantly denser (90.2 ± 15.2%), showing a significant difference (p=0.031) in comparison to the block produced by pancuronium alone (48.9% ± 9.8%). There was a decrease in the frequency and amplitude of MEPPs. CONCLUSION Levobupivacaine potentiated the neuromuscular blockade produced by pancuronium, confirming a presynaptic action by a decrease in miniature endplate potentials.
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Affiliation(s)
- Vanessa Henriques Carvalho
- PhD, Department of Anesthesiology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Brazil. Intellectual, scientific and design of the study; acquisition and interpretation of data; technical procedures; manuscript preparation and writing, critical revision, supervised all phases of the study
| | - Angélica de Fátima de Assunção Braga
- Associate Professor, Department of Anesthesiology, Faculty of Medical Sciences, UNICAMP, Campinas-SP, Brazil. Intellectual, scientific and design of the study; interpretation of data; technical procedures; manuscript preparation and writing, critical revision, supervised all phases of the study
| | | | - Gloria Maria Braga Potério
- Associate Professor, Department of Anesthesiology, Faculty of Medical Sciences, UNICAMP, Campinas-SP, Brazil. Critical revision
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de Assunção Braga ADF, Carvalho VH, da Silva Braga FS, Potério GMB, Santos FNC, Junqueira FEF. Effect of 50% enantiomeric excess bupivacaine mixture combined with pancuronium on neuromuscular transmission in rat phrenic nerve-diaphragm preparation; a pilot study. Indian J Anaesth 2015; 59:701-5. [PMID: 26755834 PMCID: PMC4697241 DOI: 10.4103/0019-5049.170019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Local anaesthetics are drugs that are widely used in clinical practice. However, the effects of these drugs on the neuromuscular junction and their influence on the blockade produced by non-depolarising neuromuscular blocking drugs are still under investigation. The aim of this study was to evaluate, in vitro, the influence of a 50% enantiomeric excess bupivacaine mixture on neuromuscular transmission and neuromuscular block produced by pancuronium. METHODS Rats were distributed into three groups (n = 5) according to the drug studied namely, 50% enantiomeric excess bupivacaine mixture (5 μg/mL); pancuronium (2 μg/mL); 50% enantiomeric excess bupivacaine mixture + pancuronium. The following parameters were evaluated: (1) Effects of a 50% enantiomeric excess bupivacaine mixture on membrane potential (MP) and miniature endplate potentials (MEPPs); (2) amplitude of diaphragmatic response before and 60 min after the addition of a 50% enantiomeric excess bupivacaine mixture; the degree of neuromuscular block with pancuronium and pancuronium combined with a 50% enantiomeric excess bupivacaine mixture. RESULTS A 50% enantiomeric excess bupivacaine mixture did not alter the amplitude of muscle response (MP) but decreased the frequency and amplitude of MEPP. The block produced by pancuronium was potentiated by a 50% enantiomeric excess bupivacaine mixture. CONCLUSION A 50% enantiomeric excess bupivacaine mixture used alone did not affect neuromuscular transmission, but potentiated the neuromuscular block produced by pancuronium. No action was shown on the muscle fibre, and alterations on MEPPs demonstrated a presynaptic action.
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Braga ADFDA, Carvalho VH, Braga FSDS, Potério GMB, Santos FNC. Evidence of presynaptic and postsynaptic action of local anesthetics in rats. Acta Cir Bras 2013; 28:774-7. [DOI: 10.1590/s0102-86502013001100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/22/2013] [Indexed: 11/22/2022] Open
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Braga ADFDA, Carvalho VH, Braga FSDS, Rodrigues-Simioni L, Loyola YCS, Potério GB. Influência de anestésicos locais sobre o bloqueio neuromuscular produzido pelo rocurônio: ação da lidocaína e da mistura enantiomérica em excesso de 50% de bupivacaína na junção neuromuscular. Braz J Anesthesiol 2009. [DOI: 10.1590/s0034-70942009000600008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Carvalho VH, Braga ADFDA, Braga FSDS, Loyola YCS, Araújo DRD, Mantovani M. The influence of lidocaine and racemic bupivacaine on neuromuscular blockade produced by rocuronium: a study in rat phrenic nerve-diaphragm preparation. Acta Cir Bras 2009; 24:211-5. [DOI: 10.1590/s0102-86502009000300009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 03/24/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate in vitro lidocaine and racemic bupivacaine effects in neuromuscular transmission and in neuromuscular blockade produced by rocuronium. METHODS: Rats were distributed in 5 groups (n = 5) in agreement with the studied drugs: lidocaine, racemic bupivacaine, rocuronium, separately (Groups I, II, III); rocuronium in preparations exposed to local anesthetics (Groups IV, V). The concentrations used were: 20 µg/mL, 5 µg/mL and 4 µg/mL, for lidocaine, bupivacaine and rocuronium, respectively. It was evaluated: 1) amplitude of diaphragm muscle response to indirect stimulation, before and 60 minutes after separately addition of lidocaine, racemic bupivacaine and rocuronium and the association of local anesthetics - rocuronium; 2) membrane potentials (MP) and miniature end-plate potentials (MEPP). RESULTS: Lidocaine and bupivacaine separately didn't alter the amplitude of muscle response and MP. In preparations previously exposed to lidocaine and racemic bupivacaine, the rocuronium blockade was significantly larger (90.10 ± 9.15% and 100%, respectively), in relation to the produced by rocuronium separately (73.12 ± 9.89%). Lidocaine caused an increase in the frequency of MEPP, being followed by blockade; racemic bupivacaine produced decrease being followed by blockade. CONCLUSIONS: Local anesthetics potentiated the blockade caused by rocuronium. The alterations of MEPP identify presynaptic action.
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