Congresso MedUBI 2009

www.doneuronioapessoa.blogspot.com

Ketamine: Reevaluation of an Old Drug

Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug

http://www.ncbi.nlm.nih.gov/pubmed/19546251?dopt=Abstract

Sugammadex Mechanism of Action Video

Sugammadex Mechanism of Action Video

Colloid preload increases cardiac output after spinal anesthesia for cesareans

Colloid preload increases cardiac output after spinal anesthesia for cesareans

Administering crystalloid IV fluids before the induction of spinal anesthesia for cesarean delivery increases maternal cardiac output during the first 5 minutes after spinal anesthesia, say researchers.
However, they note that the effect of this colloid preload on maternal and neonatal outcomes does not differ significantly from that of a “coload,” administered at the time that the local anesthetic block starts to take effect.
The efficacy of fluid preloading for increasing cardiac output is thought to be limited due to rapid redistribution, Wendy Teoh and Alex Sia, from KK Women’s and Children’s Hospital in Singapore, explain. The coload approach is thought to “maximize intravascular volume expansion during vasodilation from the sympathetic blockade and limit fluid redistribution and excretion.”
The researchers compared the two methods in 40 women scheduled for elective cesarean delivery who were of American Society of Anesthesiologists Physical Status I and II.
The women were randomly assigned to receive a preload of 15 ml/kg of hydroxyethyl starch (HES) immediately before induction of spinal anesthesia or a coload of the same fluid load but at the time of cerebrospinal fluid identification. Arterial blood pressure was maintained at 90% to 100% of baseline values using IV pheylephrine boluses.
Heart rate, arterial blood pressure, stroke volume, and cardiac output were recorded at baseline and every minute for the first 10 minutes and then every 2.5 minutes for the next 10 minutes.
Within the first 5 minutes after induction of spinal anesthesia, CO was significantly higher in patients receiving preload HES than in those receiving coload, at 8.20 to 8.60 L/min versus 6.00 6.90 L/min. However, this significant difference was not sustained at 10 minutes.
The two groups had similar incidences of hypotension and there was no significant difference in absolute arterial blood pressure values, predelivery median phenylephrine requirements, or neonatal outcome, as measured by Apgar scores and umbilical arterial and venous blood gas values.
Nausea occurred in one patient receiving preload and two receiving coload HES, with all incidences associated with hypotension predelivery and treated with vasopressor.
Teoh and Sia say that some may argue that, “since a preload takes more time, and there was no difference in outcome between the two groups, then a coload should be used.”
They conclude: “The use of a modest colloid preload or coload (eg, 500 mL), plus support of blood pressure close to baseline with phenylephrine, results in minimal maternal nausea/vomiting and no obvious difference in neonatal outcomes.
“This may be a reasonable option for hemodynamic management of women presenting for cesarean delivery under spinal anesthesia.”

Sugammadex and rocuronium accelerates reversal of neuromuscular blockade versus succinylcholine

Sugammadex and rocuronium accelerates reversal of neuromuscular blockade versus succinylcholine

Reversal of rocuronium-induced neuromuscular blockade with sugammadex is much faster than spontaneous recovery from succinylcholine, say researchers.
“Succinylcholine has the shortest duration of action of all currently available neuromuscular blocking agents (NMBAs),” note Chingmuh Lee (University of California Los Angeles, USA) and colleagues. And efforts to develop a shorter-acting NMBA than succinylcholine have failed, they add.
But in their study the administration of sugammadex 3 minutes after rocuronium-induced neuromuscular blockade reduced recovery of the first train-of-four twitch (T1) to 10% by 2.7 minutes compared with spontaneous recovery from succinylcholine-induced block. The time for T1 to reach 90% was reduced by 4.6 minutes.
The team randomly assigned 115 American Society of Anesthesiologists Class I-II surgical patients to have neuromuscular transmission blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine.
In patients receiving rocuronium, sugammadex (16 mg/kg) was administered 3 minutes after rocuronium administration.
The average times to recovery of T1 to 10% and 90% were 4.4 minutes and 6.2 minutes, respectively, for patients receiving rocuronium and sugammadex compared with 7.1 minutes and 10.9 minutes, respectively, for those given succinylcholine.
The researchers report that, after sugammadex administration, 87% of patients showed recovery of the train-of-four-ratio to 0.9 by 3 minutes, 52% between 1 to 2 minutes, and 13% within 1 minute.
Clinical signs of recovery were comparable between the two treatment groups, with approximately half of patients in each group awake and oriented before transfer to the recovery room, increasing to 90% at discharge from the recovery room.
Both treatments were well tolerated and the occurrence of adverse events was similar. The most common events were procedural pain and nausea.
“Rocuronium is currently indicated in approximately 25% of rapid-sequence induction cases in the emergency department. Our results suggest that sugammadex may have considerable use in such a setting,” Lee et al write in the journal Anesthesiology.

Oral comparable to intravenous ondansetron for PONV

Oral comparable to intravenous ondansetron for PONV

Orally disintegrating ondansetron is an effective alternative to intravenous ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy, say researchers.
Previous concerns regarding the oral route for ondansetron have included bioavailability and duration of efficacy, but the team found that oral ondansetron when administered pre-operatively prevented PONV for as long as 6 hours postoperatively.
“The patients usually tolerate oral intake by this time and can be administered another dose if the need arises postoperatively,” wrote Preethy Mathew and colleagues, from the Postgraduate Institute of Medical Education and Research in Chandigarh, India.
The researchers randomly assigned 109 patients scheduled for laparoscopic cholecystecotmy to receive oral ondansetron, intravenous oldansetron, or placebo to prevent PONV.
Surgery was converted to open cholecystectomy for six patients, leaving data on 103 for analysis.Duration of surgery, duration of anesthesia and time to recovery were comparable for the three groups.
The researchers report that patients taking placebo took a longer time to tolerate oral intake than those receiving oral or intravenous ondansetron, at an average of 366.1 minutes compared with 322.9 minutes and 322.4, respectively. They note that this was due to the higher incidence of nausea and vomiting in the placebo-treated group during the first 6 hours postoperatively compared with patients given oral or intravenous ondansetron, at 44.4% versus 17.7% and 18.2%, respectively.
Overall, 67.7% patients receiving oral ondansetron had no episodes of nausea or vomiting in the 24 hours after surgery. This was comparable to the 72.7% of patients receiving intravenous ondansetron and significantly different to the 47.2% of patients given placebo.
Patient satisfaction was also similar for oral and intravenous ondansetron, and significantly higher when compared with placebo.
“PONV are common and distressing complications and are the main concern of 40% to 70% of patients after laparoscopic surgery,” Mathew and co-workers highlight in the journal Anaesthesia.
“We conclude that orally disintegrating ondansetron is an effective alternative to intravenous ondansetron in preventing PONV in patients undergoing laparoscopic cholecystectomy.”

Virtual Transoesophageal Echocardiogram

Virtual Transoesophageal Echocardiogram

This website from Toronto General has an excellent 3D model of the heart and allows an interactive view to facilitate understanding of the sonoanatomy of the heart. It would be useful for anyone who is learning how to use transoesphageal echocardiography.

Sevoflurane in the Foeto-Placental Circulation

Role of potassium and calcium channels in sevoflurane-mediated vasodilation in the foeto-placental circulation

Jarman J, Maharaj CH, Higgins BD, Farragher RF, Laffey CD, Flynn NM, Laffey JG Anesthesiology 2009, 9:4 (10 June 2009)

[Abstract] [Provisional PDF]

O Enfermeiro na Prevenção e Controlo da Dor

O Enfermeiro na Prevenção e Controlo da Dor

Este grupo da OE foi dissolvido e de Dor...mais não se ouviu falar...

...mais um exemplo de muito bom trabalho!!!

Esta situação, serve para responder a muitos dos que me perguntaram, porque decidiste ir para Medicina?!

Mas a pergunta correcta seria, porque abandonaste tu a Enfermagem...?!

Não há espaço para este tipo de inércia nas ditas profissões de topo na saúde....

Distantes são os tempos, em que as lutas na Enfermagem se faziam sentir e tremer quem detinha o poder...

Mas...eu ainda acredito....

Nurse Anesthetists and Anesthesiologists Provide Equally Safe Obstetrical Anesthesia

National Study Confirms Nurse Anesthetists and Anesthesiologists Provide Equally Safe Obstetrical Anesthesia

The study, titled “Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes,” examined anesthesia provider models and hospital resources to explain maternal outcome variations. The authors are Jack Needleman, PhD, MS, associate professor, Director PhD and MS Programs, UCLA School of Public Health, Department of Health Services, and Ann Minnick, PhD, RN, FAAN, Senior Associate Dean-Research, Chenault Professor of Nursing, Vanderbilt University, School of Nursing.

“Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery”

AANA Annual Meeting

AANA Annual Meeting

San Diego Convention Center

San Diego, Calif., August 8-12, 2009

The Annual Meeting of the American Association of Nurse Anesthetists is designed to update and expand the practitioner's knowledge in the medical, nursing, and sociopsychological sciences related to nurse anesthesia. This highlight of the year features cutting-edge speakers and events that are not duplicated elsewhere.

2009 Exhibitor Prospectus
2009 Partners in the Profession

Sponsorship opportunities are still available
2009 Preliminary Schedule

2009 Registration Form
Sponsor-A-Student Program

N. Tavares Lopes

Conferência Nacional-Simulação Biomédica

Primeira Conferência Nacional sobre Simulação Biomédica

Auditório do Hospital Pedro Hispano

26 a 27 de Junho de 2009

http://simulacaobiomedica.blogspot.com/

Programa

Cursos:

Curso Cirurgia no Trauma
Curso de Emergências Obstétricas
Curso de Via Aérea Difícil
Curso Team Work in Trauma

N. Tavares Lopes

III Encontro de Anestesia Pediátrica

III Encontro de Anestesia Pediátrica
Centro e Artes e Espectáculos da Figueira da Foz

22 e 23 de Maio de 2009

Programa do encontro em versão PDF
Regulamento do Encontro em versão .DOC

N. Tavares Lopes

3º Curso VAD

3.º curso Teórico-Prático de Manuseamento da Via Aérea para Enfermeiros

14 de Maio de 2009

http://cursovadsantarem.no.sapo.pt

OBJECTIVOS DO CURSO PARA ENFERMEIROS
- Fornecer conhecimentos básicos de anatomia e fisiologia da via aérea.
- Proporcionar a aquisição de competências
- Na identificação de um doente com problemas na via aérea;
- Na ventilação de um doente com manobras e aparelhos simples;
- Na ventilação de um doente com dispositivos extraglóticos;
- Na manutenção do material reutilizável e na organização de todo o material.
- Como elemento integrante da equipa na abordagem da via aérea difícil.

Nuno Tavares Lopes

ERC 2009

Routine Preoperative Coagulation Screening

Routine Preoperative Coagulation Screening Detects a Rare Bleeding Disorder

Anesthesia & Analgesia 2009

http://www.gnmhealthcare.com/pdf/12-2008/28/1694495_RoutinePreoperativeCoagul.pdf

N. Tavares Lopes

Conversion of epidural labour analgesia

Conversion of epidural labour analgesia to anaesthesia for Caesarean section: a prospective study of the incidence and determinants of failure

BJA: British Journal of Anaesthesia 2008

http://www.gnmhealthcare.com/pdf/12-2008/15/1688220_Conversionofepidurallabou.pdf

N. Tavares Lopes

II Curso Prático de Bloqueios Periféricos

II Curso Prático de Bloqueios Periféricos: Membro Superior, Membro Inferior

20 a 24 de Abril de 2009

Descarregue aqui a informação em versão PDF