Artigos - Anestesiologia - FMB

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  • ItemArtigo
    Comparison between oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in autism spectrum disorder: double-blind randomized clinical trial
    (2023-05-01) Penna, Heber de Moraes [UNESP]; Paiva, Andreia Portela Martins; Romano, Antônio José Marques; Alves, Rodrigo Leal [UNESP]; Nascimento Junior, Paulo do [UNESP]; Módolo, Norma Sueli Pinheiro [UNESP]; Universidade Estadual Paulista (UNESP); Hospital Santa Terezinha; Odontologia Hospitalar; Odontopediatria e Pacientes Especiais
    Background: Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. Methods: The sample included 64 persons with ASD, aged 2˗59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5−1, maximum 15 mg) or oral midazolam (0.5−1) associated with oral S(+)-ketamine (3−1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. Results: According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. Conclusion: The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism.
  • ItemArtigo
    Sevoflurane and isoflurane anesthesia induce redox imbalance, but only sevoflurane impairs vascular contraction
    (2023-01-01) Rocha, Thalita L. A. [UNESP]; Borges, Teubislete F. [UNESP]; Rodrigues, Serginara D. [UNESP]; Martins, Laisla Z. [UNESP]; da Silva, Maria L. S. [UNESP]; Bonacio, Gisele F.; Rizzi, Elen; Dias-Junior, Carlos A. [UNESP]; Universidade Estadual Paulista (UNESP); UNAERP
    Volatile anesthetics may cause vascular dysfunction; however, underlying effects are unclear. The aim of the present study was to investigate whether sevoflurane and isoflurane affect vascular function, nitric oxide (NO) bioavailability, and biomarkers of oxidative stress and inflammation. Wistar rats were divided into three experimental groups: Not anesthetized (control group) or submitted to anesthesia with isoflurane (Iso group) or sevoflurane (Sevo group). Hemodynamic parameters were monitored during anesthesia, and blood gas values and biochemical determinants were analyzed. Isometric contractions were recorded in aortic rings. Vasoconstriction induced by potassium chloride (KCl) and phenylephrine (Phe) were measured. No differences in hemodynamic parameters and blood gasses variables were observed. Impaired KCl and Phe-induced contractions were observed in endothelium-intact aorta of Sevo compared to Iso and Control groups. Redox imbalance was found in Sevo and Iso groups. Reduced NO bioavailability and increased activity of matrix metalloproteinase 2 (MMP-2) were observed in Sevo, but not in the Iso group. While reduced IL-10 and IL-1β were observed in Sevo, increases in IL-1β in the Iso group were found. Sevoflurane, but not isoflurane, anesthesia impairs vasocontraction, and reduced NO and cytokines and increased MMP-2 activity may be involved in vascular dysfunction after sevoflurane anesthesia.
  • ItemArtigo
    Incidence of bradycardia during noradrenaline or phenylephrine bolus treatment of postspinal hypotension in cesarean delivery: A randomized double-blinded controlled trial
    (2023-01-01) de Queiroz, Daniel Vieira; Velarde, Luis Guillermo Coca; Alves, Rodrigo Leal [UNESP]; Verçosa, Nubia; Cavalcanti, Ismar Lima; Servidores do Estado Federal Hospital (Hospital Federal dos Servidores do Estado); Universidade Federal Fluminense (UFF); Universidade Estadual Paulista (UNESP); Universidade Federal do Rio de Janeiro (UFRJ)
    The treatment of choice for spinal anesthesia-induced hypotension during cesarean section is phenylephrine. As this vasopressor can cause reflex bradycardia, noradrenaline is a suggested alternative. This randomized double-blinded controlled trial included 76 parturients undergoing elective cesarean delivery under spinal anesthesia. Women received noradrenaline in bolus doses of 5 mcg or phenylephrine in bolus doses of 100 mcg. These drugs were used intermittently and therapeutically to maintain systolic blood pressure ≥ 90% of its baseline value. The primary study outcome was bradycardia incidence (<60 bpm) with intermittent bolus administration of these drugs. Secondary outcomes included extreme bradycardia (<40 bpm), number of bradycardia episodes, hypertension (systolic blood pressure > 120% of baseline value), and hypotension (systolic blood pressure < 90% of baseline value and requiring vasopressor use). Neonatal outcomes per the Apgar scale and umbilical cord blood gas analysis were also compared. The incidence of bradycardia in both groups (51.4% and 70.3%, respectively; p = 0.16) were not significantly different. No neonates had umbilical vein or artery pH values below 7.20. The noradrenaline group required more boluses than phenylephrine group (8 vs. 5; p = 0.01). There was no significant intergroup difference in any of the other secondary outcomes. When administered in intermittent bolus doses for the treatment of postspinal hypotension in elective cesarean delivery, noradrenaline, and phenylephrine have a similar incidence of bradycardia. When treating hypotension related to spinal anesthesia in obstetric cases, strong vasopressors are commonly administered, thought these can also have side effects. This trial assessed bradycardia after bolus administration of noradrenaline or phenylephrine, and found no difference in risk for clinically meaningful bradycardia.
  • ItemCarta
    Type of delivery and pain response in full-term newborns after vitamin K administration: assessment using the COMFORT Behavior and Neonatal Facial Coding System scales
    (2023-03-01) Ferreira, Esther Angelica Luiz; Valete, Cristina Ortiz Sobrinho; Nassif, Damaris Souza [UNESP]; de Barros, Guilherme Antonio Moreira [UNESP]; Universidade Federal de São Carlos (UFSCar); Universidade Estadual Paulista (UNESP)
  • ItemArtigo
    Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy
    (2023-02-01) Tomacheuski, Rubia M. [UNESP]; Oliveira, Alice R. [UNESP]; Trindade, Pedro H. E. [UNESP]; Oliveira, Flávia A.; Candido, César P. [UNESP]; Teixeira Neto, Francisco J. [UNESP]; Steagall, Paulo V. [UNESP]; Luna, Stelio P. L. [UNESP]; Universidade Estadual Paulista (UNESP); Federal University of Northern Tocantins; City University of Hong Kong; Université de Montréal
    Pain assessment guides decision-making in pain management and improves animal welfare. We aimed to investigate the reliability and validity of the UNESP-Botucatu cattle pain scale (UCAPS) and the cow pain scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) bulls after castration. Methods: Ten Nelore and nine Angus bulls were anaesthetised with xylazine–ketamine–diazepam–isoflurane–flunixin meglumine. Three-minute videos were recorded at -48 h, preoperative, after surgery, after rescue analgesia and at 24 h. Two evaluators assessed 95 randomised videos twice one month apart. Results: There were no significant differences in the pain scores between breeds. Intra and inter-rater reliability varied from good (>0.70) to very good (>0.81) for all scales. The criterion validity showed a strong correlation (0.76–0.78) between the numerical rating scale and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The UCAPS and CPS were responsive; all items and total scores increased after surgery. Both scales were specific (81–85%) and sensitive (82–87%). The cut-off point for rescue analgesia was >4 for UCAPS and >3 for CPS. Conclusions. The UCAPS and CPS are valid and reliable to assess postoperative pain in Bos taurus and Bos indicus bulls.
  • ItemArtigo
    Effects of Human Observer Presence on Pain Assessment Using Facial Expressions in Rabbits
    (2023-01-01) Pinho, Renata H.; Justo, André A; Cima, Daniela S. [UNESP]; Fonseca, Mariana W. [UNESP]; Minto, Bruno W. [UNESP]; Rocha, Fabiana D L [UNESP]; Leach, Matthew C.; Luna, Stelio P L [UNESP]; Universidade Estadual Paulista (UNESP); Universidade de São Paulo (USP); Newcastle University
    The goal of this study was to evaluate the effect of a human observer on Rabbit Grimace Scale (RbtGS) scores. The study scored video footage taken of 28 rabbits before and after orthopedic surgery, as follows: 24 h before surgery ( baseline), 1 h after surgery ( pain), 3 h after analgesia administration ( analgesia), and 24 h after surgery ( 24h) in the presence and absence of an observer. Videos were assessed twice in random order by 3 evaluators who were blind to the collection time and the presence or absence of an observer. Responses to pain and analgesia were evaluated by comparing the 4 time points using the Friedman test, followed by the Dunn test. The influence of the presence or absence of the observer at each time point was evaluated using the Wilcoxon test. Intra- and interrater reliabilities were estimated using the intraclass correlation coefficient. The scale was responsive to pain, as the scores increased after surgery and had decreased by 24 h after surgery. The presence of the observer reduced significantly the RbtGS scores (median and range) at pain (present, 0.75, 0 to 1.75; absent, 1, 0 to 2) and increased the scores at baseline (present, 0.2, 0 to 2; absent, 0, 0 to 2) and 24h after surgery (present, 0.33, 0 to 1.75; absent, 0.2, 0 to 1.5). The intrarater reliability was good (0.69) to very good (0.82) and interrater reliability was moderate (0.49) to good (0.67). Thus, the RbtGS appeared to detect pain when scored from video footage of rabbits before and after orthopedic surgery. In the presence of the observer, the pain scores were underestimated at the time considered to be associated with the greatest pain and overestimated at the times of little or no pain.
  • ItemArtigo
    Measurement properties of pain scoring instruments in farm animals: A systematic review using the COSMIN checklist
    (2023-01-01) Tomacheuski, Rubia Mitalli [UNESP]; Monteiro, Beatriz Paglerani; Evangelista, Marina Cayetano; Luna, Stelio Pacca Loureiro [UNESP]; Steagall, Paulo Vinícius [UNESP]; Universidade Estadual Paulista (UNESP); Université de Montréal; City University of Hong Kong
    This systematic review aimed to investigate the measurement properties of pain scoring instruments in farm animals. According to the PRISMA guidelines, a registered report protocol was previously published in this journal. Studies reporting the development and validation of acute and chronic pain scoring instruments based on behavioral and/or facial expressions of farm animals were searched. Data extraction and assessment were performed individually by two investigators using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Nine categories were assessed: two for scale development (general design requirements and development, and content validity and comprehensibility) and seven for measurement properties (internal consistency, reliability, measurement error, criterion and construct validity, responsiveness and cross-cultural validity). The overall strength of evidence (high, moderate, low, or very low) of each instrument was scored based on methodological quality, number of studies and studies’ findings. Twenty instruments for three species (bovine, ovine and swine) were included. There was considerable variability concerning their development and measurement properties. Three behavior-based instruments scored high for strength of evidence: UCAPS (Unesp-Botucatu Unidimensional Composite Pain Scale for assessing postoperative pain in cattle), USAPS (Unesp-Botucatu Sheep Acute Composite Pain Scale) and UPAPS (Unesp-Botucatu Pig Composite Acute Pain Scale). Four instruments scored moderate for strength of evidence: MPSS (Multidimensional Pain Scoring System for bovine), SPFES (Sheep Pain Facial Expression Scale), LGS (Lamb Grimace Scale) and PGS-B (Piglet Grimace Scale-B). Most instruments (n = 13) scored low or very low for final overall evidence. Construct validity was the most reported measurement property followed by criterion validity and reliability. Instruments with reported validation are urgently required for pain assessment of buffalos, goats, camelids and avian species.
  • ItemArtigo
    Effects of Preoperative Acupuncture on Prevention of Nausea and Vomiting and Plasma Serotonin Values in the Hysterectomy Postoperative Period: a Randomized Clinical Trial
    (2022-01-01) Pires, Michelle Catarina [UNESP]; de Barros, Guilherme Antonio Moreira [UNESP]; Fonseca, Lucas Guimarães Ferreira [UNESP]; Thom, Murilo Moreira [UNESP]; do Nascimento, Paulo [UNESP]; Módolo, Norma Sueli Pinheiro [UNESP]; Universidade Estadual Paulista (UNESP)
    Background: Nausea and vomiting are frequent complications of anesthesia in the postoperative period. Acupuncture at the pericardium point 6 (PC6) is known to be effective in preventing postoperative nausea and vomiting (PONV). Objectives: The objective of the present study is to investigate the effects of acupuncture performed at the PC6 point in the prevention of PONV in women undergoing elective open hysterectomy under general inhalational anesthesia and to assess its association with plasma serotonin levels. Methods: 97 patients undergoing elective open hysterectomy were randomly divided into two groups: acupuncture group (bilateral acupuncture at PC6, n = 49), and a control group (no acupuncture, n = 48). All patients prophylactically received ondansetron and dexamethasone and, as rescue medication, metoclopramide in case of occurrence of PONV. The primary outcome evaluated was occurrence of nausea and vomiting within 24 hours after surgery. Serotonin plasma levels were measured before and after acupuncture prior to anesthesia induction. For the control group, the repeat measurement was performed 30 minutes after admission to the preoperative unit. Results: Acupuncture at PC6 significantly reduced the incidence of nausea (29.2% vs. 6.1%; p < 0.003), and the need of rescue medication (metoclopramide) (33.3% vs. 10.2%; p < 0.006), but not vomiting (4.2 vs. 4.1; p < 0.98). The plasma serotonin levels between control and acupuncture groups did not differ. Conclusion: This study shows that acupuncture at PC6 resulted in a lower incidence of postoperative nausea in patients undergoing hysterectomy.
  • ItemArtigo
    Computed tomography and anatomy of the abdominal structures in the giant anteater (Myrmecophaga tridactyla)
    (2023-05-01) de Oliveira, Fernanda Gabriela [UNESP]; Schimming, Bruno Cesar [UNESP]; da Costa, Isis Pinto [UNESP]; da Silva, Jeana Pereira [UNESP]; de Lima, Heloísa Coppini [UNESP]; Cardoso, Eduardo Burgarelli Mayrink [UNESP]; da Silva, Suelen Lorena [UNESP]; da Silva Alves, Lidiane [UNESP]; Mamprim, Maria Jaqueline [UNESP]; Universidade Estadual Paulista (UNESP)
    The giant anteater (Myrmecophaga tridactyla) is the largest of the Neotropical vermilinguans. This animal is the second mammal most frequently run over on the roads of Cerrado biome, Brazil. Therefore, it is pivotal to know the anatomy of this species to contribute to the clinical care of these animals. Thus, the aim of this study was to identify the anatomical structures in the abdominal region of the giant anteater using computed tomography (CT). For this, the tomographic analysis was performed in sequential order in the craniocaudal direction in five giant anteaters. Moreover, four giant anteater corpses were used for anatomical studies, where two corpses were sectioned in cross sections of approximately 3 cm each, and two animals were dissected to identify the abdominal organs. The association between CT and anatomical study allowed the visualization of anatomical structures found in the abdominal cavity, such as the topographic anatomy facilitates the identification of organs on CT images. The findings of this study demonstrated that CT is a good technique to provide detailed information about the anatomical structures in the abdominal cavity and that this study can be used as CT and anatomical reference for veterinarians who care for wild animals.
  • ItemArtigo
    Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke: PRISMA-7 - Disability or Death after Stroke
    (2022-12-01) Miranda, Luana Aparecida [UNESP]; Luvizutto, Gustavo José; Stephan, Blossom Christa Maree; Souza, Juli Thomaz de [UNESP]; Silva, Taís Regina da [UNESP]; Winckler, Fernanda Cristina [UNESP]; Ferreira, Natalia Cristina [UNESP]; Antunes, Leticia Claudia de Oliveira [UNESP]; Bessornia, Pedro Augusto Cândido [UNESP]; Bazan, Silméia Garcia Zanati [UNESP]; Fukushima, Fernanda Bono [UNESP]; Costa, Rafael Dalle Molle da [UNESP]; Modolo, Gabriel Pinheiro [UNESP]; Minicucci, Marcos Ferreira [UNESP]; Bazan, Rodrigo [UNESP]; Vidal, Edison Iglesias de Oliveira [UNESP]; Universidade Estadual Paulista (UNESP); Federal University of Triângulo Mineiro (UFTM); University of Nottingham Medical School
    Objectives: We aimed to evaluate the predictive performance of the PRISMA-7 frailty criteria regarding the composite outcome of disability or death in patients with an acute ischemic stroke, and to compare it with the Frailty Index and the National Institutes of Health Stroke Scale (NIHSS). Materials and methods: This prospective cohort study involved all patients aged ≥ 40 years admitted with an acute ischemic stroke between March 2019 and January 2020. We performed survival analyses, calculated risk ratios, sensitivity, specificity, and predictive values for the combined outcome of disability or death according to the presence of frailty as determined by the PRISMA-7 and the Frailty Index, and stroke severity based on the NIHSS. Results: In 174 patients with acute ischemic stroke, being frail in the week before the stroke according to the PRISMA-7 was associated with a Risk Ratio of 4·50 (95%CI 1·77-11·43, P <0·001) and a Positive Predictive Value of 89% (95%CI 77-99%) for being disabled or dead 90 days after the stroke, and a Hazard Ratio of 3·33 (95%CI 1·48-7·51, P = 0·004) for the survival outcome. The predictive performance of the PRISMA-7 was not significantly different from the Frailty Index or the NIHSS. Conclusions: We provide evidence that the PRISMA-7 frailty criteria may be a useful prognostication tool in acute ischemic stroke.
  • ItemArtigo
    DNA rare copy number alterations in Reinke's Edema
    (2023-03-01) Móz, Luis Eduardo Silva; Martins, Regina Helena Garcia [UNESP]; Lapa, Rainer Marco Lopez; Villacis, Rolando André Rios; dos Reis, Patricia Pintor [UNESP]; Rogatto, Silvia Regina; Faculdade de Ciências Médicas da Santa Casa de São Paulo; São Camilo Oncologia; Universidade Estadual Paulista (UNESP); Laboratory of Molecular Physiology; Universidade de Brasília (UnB); University Hospital of Southern Denmark; Institute of Regional Health Research
    Introduction: Reinke's Edema (RE) is a laryngeal lesion related to excessive tobacco smoking, voice overuse, and laryngopharyngeal reflux. Although the risk of malignancy has been considered low in literature, RE is classified among precancerous lesions. Objectives: We investigated DNA Copy Number Alterations (CNAs) in specimens of RE and its potential association with malignant progression. Methods: We used array-based comparative genomic hybridization (aCGH, Agilent 4 × 180 K platform) to study eight RE cases. All patients were heavy tobacco users for at least 30 years, and none of them progressed to cancer in the follow-up (>8 years). Two RE presented mild dysplasia, one moderate dysplasia, and no histological alterations were found in the remaining five cases. CNAs were compared with the Database of Genomic Variants (DGV) and genes mapped on altered regions had their functions annotated. Results: Six of eight patients showed different rare copy number alterations on chromosomes 2q37.3, 4q13.1, 4q13.3, 7q11.22, 10p14, and 13q34. A gain of the whole chromosome 8 were detected in one case. Of interest, four of eight RE cases showed copy number imbalances involving genes previously described in several tumor types (RASA3, COL6A3, LINC00707, LINP1, SMR3A, and SMR3B). Conclusion: The genomic imbalances herein found in RE have the potential to contribute to the phenotype but with limited or no risk of cancer. A long-term follow-up in a large series of patients could clarify the mechanisms involved in the malignant progression of RE. Level of evidence: 4.
  • ItemEditorial
    Perioperative fluid therapy: more questions than definitive answers
    (2022-11-01) Navarro e Lima, Lais Helena [UNESP]; Papa, Fábio de Vasconcelos; Amorim, Célio Gomes de; Guimarães, Gabriel Magalhães Nunes; Alves, Rodrigo Leal [UNESP]; Pain and Perioperative Medicine; Universidade Estadual Paulista (UNESP); St. Michael's Hospital; University of Toronto; Universidade Federal de Uberlândia (UFU); Universidade de Brasília (UnB); Hospital Sirio Libanês Brasília; Hospital São Rafael; Universidade Federal da Bahia (UFBA)
  • ItemArtigo
    (Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem, 2023-05-29) Santos, Letícia Nunes Coca Dos [UNESP]; Andrade, Juliane [UNESP]; Ignacio, Mariana Alice De Oliveira; Barros, Laviny Moraes [UNESP]; Nibi, Scarllet Zamuner; Alencar, Rúbia De Aguiar [UNESP]; Universidade Estadual Paulista (UNESP); Ministério da Saúde; Clínica Anestesiológica Botucatu LTDA
  • ItemArtigo
    Non-reactive mydriasis after rocuronium infusion in patients with COVID-19: a case series
    (2022-01-01) Fernandes, Flávia Assis; Pontes, João Paulo Jordão; Borges, Celso Eduardo Rezende; Honorato, Erika Lopes; Soares, Sanzio Dupim; Módolo, Norma Sueli Pinheiro [UNESP]; Lima, Laís Helena Navarro e [UNESP]; Hospital Mater Dei Santa Genoveva de Uberlândia; Uberlândia Medical Center; Uberlândia; Universidade Estadual Paulista (UNESP); Queens University
  • ItemEditorial
    Anesthesiology and pain medicine
    (2022-09-01) de Barros, Guilherme Antonio Moreira [UNESP]; Kraychete, Durval Campos; Lineburger, Eric Benedet; Módolo, Norma Sueli Pinheiro [UNESP]; Universidade Estadual Paulista (UNESP); Universidade Federal da Bahia (UFBA); Anestesiologia e Controle da Dor
  • ItemArtigo
    Safety and efficacy of target-controlled infusion versus intermittent bolus administration of propofol for sedation in colonoscopy: a randomized controlled trial
    (2022-01-01) Cuiabano, Igor Seror; de Miranda Garbin, Priscila; Módolo, Norma Sueli Pinheiro [UNESP]; do Nascimento, Paulo [UNESP]; Hospital de Câncer de Mato Grosso (Hcan-MT); Hospital Nossa Senhora do Perpétuo Socorro; Universidade Estadual Paulista (UNESP)
    Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.m−2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL−1 plus 0.5 μg.mL−1 until unconsciousness and as necessary for agitation) or intermittent bolus (1−1 plus 0.5−1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0‒0) vs. 0 (0‒0) (p = 0.239) and 1 (0‒1) vs. 3 (1‒4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group ‒ 2 (0‒2) vs. 1 (0‒1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 µ−1.min−1 vs. 195 ± 44 µ−1.min−1 (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.
  • ItemCarta
    Comment on: Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression
    (2022-07-01) Braz, Leandro G. [UNESP]; Tiradentes, Teófilo Augusto A. [UNESP]; Braz, Jose R.C. [UNESP]; Universidade Estadual Paulista (UNESP)
  • ItemArtigo
    Validation of the rabbit pain behaviour scale (RPBS) to assess acute postoperative pain in rabbits (Oryctolagus cuniculus)
    (2022-05-01) Pinho, Renata Haddad [UNESP]; Luna, Stelio Pacca Loureiro [UNESP]; Trindade, Pedro Henrique Esteves [UNESP]; Justo, André Augusto; Cima, Daniela Santilli [UNESP]; Fonseca, Mariana Werneck [UNESP]; Minto, Bruno Watanabe [UNESP]; Rocha, Fabiana Del Lama [UNESP]; Miller, Amy; Flecknell, Paul; Leach, Matthew C.; Universidade Estadual Paulista (UNESP); Universidade de São Paulo (USP); Teesside University; Newcastle University
    Considering the widespread use of rabbits in research that potentially causes pain and discomfort and the limited number of pain assessment validated tools in this species, we aimed to develop and validate a scale of acute postoperative pain in rabbits (RPBS). Footage of 58 rabbits from previous studies were used, recorded at ‘baseline’ (before orthopaedic and soft tissue surgeries), ‘pain’ (after surgery), ‘analgesia’ (after analgesic), and ‘24h post’ (24 hours after surgery). The videos were randomised and assessed twice by four evaluators, within one-month interval between evaluations. After content validation, RBPS was further refined using the criteria from the validation. According to the principal component analysis, RPBS was considered unidimensional. The intra- and inter-observer reliability was excellent (ICC>0.80) for all evaluators. There was a high Spearman’s correlation of the RPBS with unidimensional scales (>0.80) and a moderate correlation with the Rabbit Grimace Scale (0.68), confirming criterion validity. According to the mixed linear model, the scale was responsive, shown by the increase in pain scores after surgery. Construct validity was confirmed by known-group approach and internal relationships among items. Adequate item-total correlation (>0.3) was observed for all items, except for the attention to the affected area (0.04). The internal consistency was very good (Cronbach’s α coefficient = 0.78; Mcdonald’s ω coefficient = 0.83). The cut-off score for rescue analgesia was ≥3, with an area under the curve >0.95, demonstrating a high discriminatory capacity of the instrument. Scores 3 and 4 were within the uncertainty diagnostic zone. Specificity was 87% and sensitivity was 90%. It was concluded that the RPBS presented content, criterion, and construct validities, responsiveness, and reliability to assess acute pain in rabbits submitted to orthopaedic and soft tissue surgeries. The cut-off for rescue analgesia serves as a basis for the administration of analgesics to rabbits submitted to painful procedures.
  • ItemArtigo
    Association between pre-operative complications, comorbidities, and in-hospital mortality in a hip fracture cohort: a register study in a tertiary hospital in Brazil
    (2022-08-01) Souza, Andre Moreira Fogaça de [UNESP]; Macola, Abner [UNESP]; Gumieiro, David Nicoletti [UNESP]; Nicolodi, Gustavo Augusto [UNESP]; Lima, Rodrigo Moreira e; Minicucci, Marcos Ferreira [UNESP]; Azevedo, Paula Schmidt [UNESP]; Sahota, Opinder; Lima, Lais Helena Navarro e [UNESP]; Universidade Estadual Paulista (UNESP); Queen’s University; University of Nottingham
    Purpose: The incidence of hip fractures is increasing exponentially due to an aging Brazilian population. Older people had significant comorbidities which increases the risk of post-operative mortality. Our purpose was to examine the association between pre-operative infections and comorbidities on the risk of post-operative in-hospital mortality after proximal femur fracture surgery’s, beyond that, to evaluate the association between comorbidities and time to surgery. Methods: This is a population-based cohort retrospective study, using medical records of all six year consecutive surgical procedures for correction of hip fracture in a tertiary teaching Hospital in Brazil. The exclusion criteria aimed to exclusively allocate patients who had their first hip fracture secondary to low-energy trauma. Multivariate logistical regression was performed and receiver operating characteristic (ROC) curve with area under curve (AUC) to evaluate the sensitivity and specificity of the model. p-value < 0.05 was considered significant. Results: Final sample was composed by 856 consecutive patients with 81 years of median and 164 patients were excluded. The median length of hospital say was five days with − l mortality at 3.6%. Significant variables for increased mortality included the presence of pre-operative infection (odds ratio (OR): 3.9(1.12–8.54), chronic obstructive pulmonary disease (COPD) (OR: 3.83(1.36–10.82)), and systemic arterial hypertension (SAH) (OR: 4.1(1.18–14.25)). Development of pre-operative infection was associated with a delay to surgery (OR: 1.1 (1.08–1.13)). Conclusions: In older people with proximal femur fracture, the presence of pre-operative infection, COPD and SAH were the strongest risk factor for post-operative in-hospital mortality. Pre-operative infection was associated with statistically significant delay to surgery.
  • ItemArtigo
    Morphine-induced pruritus after epidural administration followed by treatment with naloxone in a cat
    (2016-01-01) Evangelista, Marina C. [UNESP]; Steagall, Paulo; Garofalo, Natache A. [UNESP]; Rodrigues, Jessica C. [UNESP]; Teixeira-Neto, Francisco [UNESP]; Universidade Estadual Paulista (UNESP); University of Montreal
    Case summary A young male domestic shorthair cat weighing 1.6 kg was admitted to a veterinary teaching hospital for elective orchiectomy. A lumbosacral epidural injection of preservative-free morphine (0.1 mg/kg) and lidocaine (0.25 ml/kg) was performed under general anesthesia. One hour after extubation, the cat became agitated. Severe licking and biting of the hindlimbs, tail and lumbar area were observed. Pruritus was suspected and likely to be caused by epidural morphine. Acepromazine (0.02 mg/kg IM) was administered but clinical signs did not cease. Naloxone (2 µg/kg IV) was administered and clinical signs resolved within 20 mins. Relevance and novel information Different therapeutic approaches are available for the treatment of morphine-induced pruritus. This case describes an additional treatment option using opioid antagonism with naloxone.