This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain in patients who underwent cardiac surgery. In addition, we sought to determine whether TENS would be related to improved pulmonary function and muscle electrical activity in this patient population. Forty-five patients, 32 males and 13 females, aged 41-74 years were randomly allocated to receive TENS (n=23) or sham treatment (n=22) during 4 h on the third postoperative day. A 0-10 visual analogic scale was used to assess pain; lung function was evaluated by spirometry and surface electromyography (n=10 in each group) was used to quantify electrically-induced muscle activity (trapezius and pectoralis major). TENS was associated with significant reductions on spontaneous and cough-induced postoperative pain as compared to sham (P<0.05). There was also improvement in chest wall-pulmonary mechanics after TENS with proportional increases in tidal volume and vital capacity (P<0.05). In addition, electrical activity of both muscle groups was enhanced after TENS, but not post sham (P<0.05). TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles.

Background: Respiratory muscle strength has been related to the postoperative outcome of cardiac surgeries. The main documented therapeutic purpose of transcutaneous electrical nerve stimulation (TENS) is the reduction of pain, which could bring secondary benefits to the respiratory muscles and, consequently, to lung capacities and volumes.Objectives: The objective of the present study was to evaluate the effectiveness of short-duration transcutaneous electrical nerve stimulation (TENS) in the reduction of pain and its possible influence on respiratory muscle strength and lung capacity and volumes of patients in the postoperative period of cardiac surgery.Methods: Twenty five patients with mean age of 59.9 ± 10.3 years, of whom 72% were men, and homogeneous as regards weight and height, were randomly assigned to two groups. One group received therapeutic TENS (n = 13) and the other, placebo TENS (n = 12), for four hours on the third postoperative day of cardiac surgery. Pain was analyzed by means of a visual analogue scale, and of respiratory muscle strength as measured by maximum respiratory pressures and lung capacity and volumes before and after application of TENS. Results

Marfan syndrome (MS) is a dominant autosomal disease caused by mutations in chromosome 15, the locus controlling fibrillin 1 synthesis, and may exhibit skeletal, ocular, cardiovascular, and other manifestations. Pulse wave velocity (PWV) is used to measure arterial elasticity and stiffness and is related to the elastic properties of the vascular wall. Since the practice of exercise is limited in MS patients, it was of interest to analyze the acute effect of submaximal exercise on aortic distensibility using PWV and other hemodynamic variables in patients with MS with either mild or no aortic dilatation. PWV and physiological variables were evaluated before and after submaximal exercise in 33 patients with MS and 18 controls. PWV was 8.51 + or - 0.58 at rest and 9.10 + or - 0.63 m/s at the end of exercise (P = 0.002) in the group with MS and 8.07 + or - 0.35 and 8.98 + or - 0.56 m/s in the control group, respectively (P = 0.004). Comparative group analysis regarding PWV at rest and at the end of exercise revealed no statistically significant differences. The same was true for the group that used beta-blockers and the one that did not. The final heart rate was 10% higher in the control group than in the MS group (P = 0.01). Final systolic arterial pressure was higher in the control group (P = 0.02). PWV in MS patients with mild or no aortic dilatation did not differ from the control group after submaximal effort.

SummaryBackground: The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation.

OBJETIVOS: Observar respostas cardiovasculares ante a mobilização precoce no pós-operatório de revascularização do miocárdio. MÉTODO: Intervenção com 5 pacientes submetidos à revascularização do miocárdio, com idade entre 45 e 65 anos. Mobilização realizada no segundo dia pós-operatório, consistindo na mobilização passiva ou ativa de membros inferiores por 6 minutos, um minuto para cada membro, com 30 segundos para descanso. Analisadas a frequência cardíaca (FC, bpm), frequência respiratória (f, rpm), pressão arterial sistólica (PAs, mmHg) e diastólica (PAd, mmHg), duplo produto (DP) e variabilidade da frequência cardíaca (VFC). RESULTADOS: Houve aumento da FC na mobilização precoce (p=0,004) e exercício ativo (p<0,01) com diminuição após a atividade (p<0,05); FC foi maior na mobilização ativa em relação a passiva (p<0,05). O DP aumentou com a mobilização ativa. Não houve alterações nas demais variáveis. CONCLUSÕES: As respostas cardiovasculares ocorreram, como esperado, com elevação da FC e retirada vagal, sem ativação simpática e elevação da PA no exercício ativo.

Clinical and electrocardiographic behavior suggests that the 6MWT is safe, but may be considered of high intensity for some patients with severe heart failure. Variables related to the performance on the 6MWT may be associated to worsening clinical status in this population.

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