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Clinicaltrials.gov identifier: NCT01804205.

SummaryMagnesium potentiates neuromuscular blockade. Sugammadex reverses rocuronium-induced blockade. The aim of this study was to determine the effect of pre-treatment with magnesium sulphate on sugammadex reversal time for neuromuscular blockade. Seventy-three patients were randomly assigned to receive magnesium sulphate (40 mg.kg À1 ) or saline intravenously. After anaesthetic induction, continuous train-of-four monitoring was performed and rocuronium was administered (0.6 mg.kg À1 ). When a second twitch appeared, the patients received sugammadex (2 mg.kg À1 ).

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BackgroundHemipelvectomy is a major orthopedic surgical procedure indicated in specific situations. Although many studies discuss surgical techniques for hemipelvectomy, few studies have presented survival data, especially in underdeveloped countries. Additionally, there is limited information on anesthesia for orthopedic oncologic surgeries. The primary aim of this study was to determine the survival rate after hemipelvectomy, and the secondary aims were to evaluate anesthesia and perioperative care associated with hemipelvectomy and determine the influence of the surgical technique (external hemipelvectomy [amputation] or internal hemipelvectomy [limb sparing surgery]) on anesthesia and perioperative care in Brazil.MethodsThis retrospective case series collected data from 35 adult patients who underwent hemipelvectomy between 2000 and 2013. Survival rates after surgery were determined, and group comparisons were performed using the Kaplan–Meier method and the log-rank test. Mantel–Cox test and multiple linear regression analysis with stepwise forward selection were performed for univariate and multivariate analyses, respectively.ResultsMean survival time was 32.8 ± 4.6 months and 5-year survival rate was 27 %. Of the 35 patients, 23 patients (65.7 %) underwent external hemipelvectomy and 12 patients (34.3 %) underwent internal hemipelvectomy. The survival rate was significantly higher in patients with bone tumors than in those with soft tissue sarcomas (P = 0.024). The 5-year cumulative probability of survival was significantly lower in patients who underwent external hemipelvectomy than in those who underwent internal hemipelvectomy (P = 0.043). In the univariate and multivariate analyses, only advanced disease stage (3 and 4) was identified as a significant independent predictor of reduced survival (P = 0.0003). Balanced general anesthesia combined with epidural block was the most frequent anesthesia technique. Median intraoperative crystalloid volume and red blood cell transfusions were 3500 mL and 2 units, respectively.ConclusionsOverall mean survival time after hemipelvectomy was 32.8 months. Advanced disease stage might be independently associated with reduced survival. Smaller amounts of fluids and transfusions were administered and time to discharge was shorter. Acute and chronic pain as well as wound complications are still important challenges in hemipelvectomy.

IntroductionTransrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50–50% N2O-O2 gas mixture on pain intensity in these patients.Material and methodsRandomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50–50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events.ResultsEighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0–10) vs 5.95 (0–10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups.ConclusionThe 50–50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.

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Objectives: The use of magnesium sulfate in the perioperative period has several benefits, including analgesia, inhibition of the release of catecholamines and prevention of vasospasm. The aim of this survey was to provide an overview of the use of magnesium sulfate in anesthesia. Method: This was a prospective descriptive cross-sectional study. An online questionnaire was sent to 9,869 Brazilian anesthesiologists and trainees. The questionnaire comprised closed questions mainly regarding the frequency, clinical effects, adverse events, and doses of magnesium sulfate used in anesthesia. Results: Of the 954 doctors who responded to the survey, 337 (35.32%) reported using magnesium sulfate in anesthesia. The most commonly cited clinical effects for the use of magnesium sulfate in anesthesia were ( n /%): postoperative analgesia (245/72.70%), reduction of anesthetic consumption (240/71.21%) and prevention and treatment of preeclampsia and seizures in eclampsia (220/65.28%). The most frequently reported adverse events were hypotension (187/55.48%), residual neuromuscular blockade (133/39.46%), hypermagnesemia (30/8.90%), and intravenous injection pain (26/7.71%). The intravenous doses of magnesium sulfate used in most general anesthesia inductions were between 30 and 40 mg.kg −1 . Conclusions: Magnesium sulfate is an important adjuvant drug in the practice of anesthesia, with several clinical effects and a low incidence of adverse events when used at recommended doses.