Tracheobronchial consequences of the use of heat and moisture exchangers in dogsPurpose: To determine the effect of heat and moisture exchange (HME) on the tracheobronchial tree (TBT) using a unidirectional anesthesic circuit with or without CO 2 absorber and high or low fresh gas flow (FGF), in dogs. Methods: Thirty-two dogs were randomly allocated to four groups: G I (n=8) valvular circuit without CO 2 absorber and high FGF (5 L'min-~); G2 (n=8) as G I with HME; G3 (n=8) circuit with CO 2 absorber with a low FGF (I L.min-~); G4 (n=8) as G3 with HME. Anesthesia was induced and maintained with pentobarbital. Tympanic temperature CI-I-), inhaled gas temperature (IGT), relative (RH) and absolute humidity (AH) of inhaled gas were measured at 15 (control), 60, 120 and 180 rain of controlled ventilation. Dogs were euthanized and biopsies in the areas of TBT were performed by scanning electron microscopy. Results: The G2 and G4 groups showed the highest AH (> 20 mgH20' L -I) and G I the lowest (< 10 mgH20' L -j) and G3 was intermediate (< 20 mgH20-L-~ ) (P < 0.01). There was no difference of-l-i-and IGT among groups. Alterations of the mucociliary system were greatest in G I, least in G2 and G4, and intermediate in G3. Conclusion: In dogs, introduction of HME to a unidirectional anesthetic circuit with/without CO 2 absorber and high or low FGF preserved humidity of inspired gases. HME attenuated but did not prevent alterations of the mucociliary system of the TBT.

Rev Bras AnestesiolINFORMAÇÃO CLÍNICA 2008; 58: 2: 165-171 CLINICAL REPORT RESUMO Bisinotto FMB, Cardoso RP, Abud TMV -Edema Agudo Pulmonar Associado à Obstrução das Vias Aéreas. Relato de Caso. JUSTIFICATIVA E OBJETIVOS:O edema pulmonar por pressão negativa tem sido definido como edema não-cardiogênico, com transudação de líquido para o interstício pulmonar, por aumento na pressão negativa intratorácica, ocasionado pela obstrução das vias aéreas superiores. Descreveu-se o caso de paciente hígida, submetida à anestesia geral, que apresentou edema agudo pulmonar após a extubação traqueal. RELATO DO CASO:Paciente de 23 anos, sexo feminino, estado físico ASA II, submetida à anestesia geral para videolaparoscopia ginecológica. O procedimento durou 3 horas, sem intercorrências. Após a extubação, a paciente apresentou laringoespasmo e diminuição da saturação de oxigênio. Houve melhora após colocação de cânula oral e administração de oxigênio, sob pressão positiva, com máscara facial. Estabilizado o quadro, foi encaminhada à sala de recuperação pós-anestésica, onde, logo após a admissão, apresentou edema agudo de pulmão com eliminação de secreção serossanguinolenta. O tratamento constou de elevação do dorso, oxigênio sob máscara, furosemida e restrição hídrica. A radiografia torácica mostrou imagem compatível com edema agudo pulmonar e área cardíaca normal. O eletrocardiograma (ECG), ecocardiografia e enzimas cardíacas estavam normais. A paciente apresentou boa evolução, recebendo alta hospitalar no dia seguinte, assintomática.CONCLUSÕES: O edema agudo de pulmão associado à obstrução das vias aéreas superiores é condição clínica que pode agravar procedimentos cirúrgicos de baixa morbidade e que aparece sobretudo em pacientes jovens. O tratamento deve ser instituído precocemente, pois a resolução também é rápida e, na maioria das vezes, sem seqüelas.Unitermos: COMPLICAÇÕES: edema pulmonar; VIAS AÉREAS: pressão negativa; obstrução. SUMMARYBisinotto FMB, Cardoso RP, Abud TMV -Acute Pulmonary Edema Associated with Obstruction of the Airways. Case Report. BAKGROUND AND OBJECTIVES:Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT:A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatm...

Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding.

No abstract

Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

Although the majority of patients was not referred by the surgical specialties, the initial SAPAN data demonstrated the benefits of a preanesthetic evaluation service.

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypassEffect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass ABSTRACT Purpose: To investigate the effects of different conditions used during cardiopulmonary bypass (CPB) surgery on accompanying production of cytokine and nitric oxide (NO). Methods: Patients undergoing CPB for the first time were prospectively enrolled and divided into two groups according to CPB parameters performed: i) normothermia (36.5-37°C) with blood cardioplegia (NB group, n=10) and ii) hypothermia (29-31°C) with crystalloid cardioplegia (HC group, n=10). Plasma samples obtained following intubation (baseline), during (5 and 30 min) and after (4 and 24 h) CPB were assayed for cytokines (ELISA) and NO metabolites (Griess reaction). Results: Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups, but in the HC group those levels increased earlier and persisted for longer (24 h) compared to baseline (P < 0.05). IL-10 levels also increased at 4 h compared to baseline, but only significantly so in the HC group. NO metabolites were reduced in HC group at all time points compared to baseline (P < 0.05), while no significant differences were detected in the NB group. Conclusion: The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and/or perfusion temperature used during CPB may contribute to the extent of inflammatory response. Key words: Cardiopulmonary Bypass. Myocardium. Perfusion. Nitric Oxide. Cytokines. RESUMOObjetivo: Investigar a hipótese de que diferentes procedimentos durante o bypass cardiopulmonary (BCP) causa diferentes níveis de citocinas (IL) e óxido nítrico (NO). Métodos: Pacientes submetidas a BCP foram prospectivamente estudadas de acordo com bypass realizado sobre normotermia (36.5-37°C) com cardioplegia sanguínea (NB group, n=10) or hipotermia (29-31°C) com cardioplegia cristalóide (HC group, n=10). Amostras de Plasma foram obtidas após a intubação (linha de base), durante (5, 30 min) e após (4, 24 h) o BCP. Os ensaios foram realizados através de ELISA (IL) e metabólitos do NO (reação de Griess). Resultados: Os picos de concentrações de IL-6 and IL-8 estavam aumentados em 4 h pós BCP em ambos os grupos, mas no grupo HC estes níveis aumentaram precocemente e persistiram aumentadas por 24 h, comparado a linha de base (P<0.05). O nível de IL-10 também teve o pico em 4 h, mas estatisticamente significante somente no grupo HC, comparado a linha de base. Os metabólitos do NO estavam reduzidos no grupo HC, em todo o tempo, comparado a linha de base (P<0.05), enquanto nenhuma diferença estatisticamente significante foi detectada no grupo NB. Conclusão: A associação entre o aumento sistêmico dos níveis de citocina e a redução da produção de NO no grupo HC sugere que o tipo de proteção miocárdica e/ou ...

Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.