No abstract

Topical analgesics are promising as a strategy for pain treatment, as they are associated with lower incidence of side effects. The benefit of local anesthetics, NSAID's and capsaicin is well established. However, the efficacy of clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids is still questionable. Studies have shown that the multimodal approach is an alternative, but studies are needed to confirm this hypothesis.

Fertility is preserved, especially in those patients with type I of the disease, and pregnancy can be carried to term. Delivery is usually surgical due to pelvic deformities in the gravida, cephalopelvic disproportion, and increased incidence of abnormal fetal presentation. The importance of the anesthesiologist in the surgical team relies on the perioperative management and the choice of the most appropriate anesthetic technique for each patient.

objective: To evaluate the effects of clonidine on heart rate (HR), and blood pressure (BP) as well as its sedative effect on patients submitted to a cineangiocardiography. Methods:A randomized, controlled, double blind, prospective clinical trial was conducted on 62 patients submitted to an elective cineangiocardiography. The patients were divided in two groups: the clonidine group, that were administered a 0.8 µg/kg dose of this drug and the control group, that were administered a 0.9% saline solution. Sedation was evaluated based on the Ramsay Scale and the administration of a 0.04 mg/kg dose of meperidine that was given to the patients who were agitated or anxious during the procedure. The invasive BP, HR and sedation score based on the Ramsay Scale were analyzed every 5 minutes and four different intervals were considered for the assessment: I1-start of the test; I2-5 minutes after the start of the test; I3-median time of the test and I4-end of the test. Results:The clonidine group presented better BP and HR stability and sedation efficacy while the control group presented a higher intake of meperidine (p<0.05). In the statistical analysis, the inference of the continuous variables was calculated using the Student's t-test or Mann-Whitney test and the c 2 or Fisher Exact Probability test was used for the categorical variables. Conclusion:This study demonstrated that clonidine was an efficient means to control BP and HR and provided a conscious sedation for patients submitted to a cineangiocardiography.

Topical analgesics are promising as a strategy for pain treatment, as they are associated with lower incidence of side effects. The benefit of local anesthetics, NSAID's and capsaicin is well established. However, the efficacy of clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids is still questionable. Studies have shown that the multimodal approach is an alternative, but studies are needed to confirm this hypothesis.

SummaryBackground: Sedation during coronary angiography has been rarely studied, and it is important to know which drug is the best to sedate these patients.

A COVID-19 é uma doença infecciosa que afeta as pessoas de diferentes maneiras. A maioria dos infectados apresenta sintomas leves a moderados, de curta duração e não precisa ser hospitalizada. Entretanto, alguns indivíduos cursam com sintomas mais prolongados e desenvolvem a síndrome pós-COVID-19. Esta síndrome é representada por uma ampla gama de novas alterações de saúde, as quais são recorrentes ou contínuas em pessoas que foram infectadas com o vírus SARS-Cov-2. Há relatos de pessoas experimentando cansaço ou fadiga, desnutrição, dificuldade de concentração, anosmia ou ageusia, tontura, taquicardia, palpitação, dispneia, tosse, transtornos do humor, fibrose pulmonar, insuficiência renal crônica e dor. O objetivo deste artigo é fazer uma revisão sobre a dor no paciente portador de síndrome pós-COVID-19, discutindo acerca dos mecanismos envolvidos e do seu impacto na qualidade de vida do indivíduo. Pacientes com síndrome pós-COVID-19 podem apresentar dor, que parece ser mais prevalente naqueles indivíduos que estiveram internados em unidade de terapia intensiva (UTI). Os pacientes neste contexto são submetidos a inúmeros fatores de risco, como: dor aguda mal tratada, insultos neurológicos, múltiplas comorbidades e alterações relacionadas à necessidade de ventilação prolongada, imobilização, bloqueio neuromuscular, posição pronada e sepse. Isolamento, internamento em UTI e o medo de morrer têm sido uma realidade para muitos pacientes, os quais apresentam sequelas psicológicas graves e grande morbidade. A condução do paciente e da dor na síndrome pós-COVID-19 deve ser multiprofissional. Só através da atuação de uma equipe formada por médicos de diferentes especialidades, fisioterapeutas, nutricionistas, psicólogos e fonoaudiólogos é possível atender à necessidade desses pacientes. O acompanhamento dos indivíduos portadores de síndrome pós-COVID-19 é essencial, não apenas para monitorar e tratar esses pacientes, mas também para compreender totalmente o impacto a longo prazo da infecção por SARS-Cov-2.

Background and objectives: Osteogenesis Imperfecta is a rare condition, especially in obstetric patients. It has an estimated prevalence of 1/10,000 in the general population, and 1/25,000 to 30,000 in obstetric patients. The objective of this report was to present a rare case of a pregnant woman with Osteogenesis Imperfecta undergoing cesarean section. Case report: This is a 23 years old gravida on the 38 th week, admitted to the maternity ward with loss of amniotic fluid and contractions for four hours, associated with the absence of fetal movements for four days. The patient had a mild form of Osteogenesis Imperfecta without other comorbidities. She was not taking any medication, and she did not have prenatal follow-up. The patient underwent spinal anesthesia in the L 3-L 4 space, median approach, with a single puncture with a 27G Quincke needle and the administration of hyperbaric 0.5% bupivacaine (10 mg) and morphine (60 μg). She was discharged in the second postoperative day without complaints. Conclusions: Fertility is preserved, especially in those patients with type I of the disease, and pregnancy can be carried to term. Delivery is usually surgical due to pelvic deformities in the gravida, cephalopelvic disproportion, and increased incidence of abnormal fetal presentation. The importance of the anesthesiologist in the surgical team relies on the perioperative management and the choice of the most appropriate anesthetic technique for each patient.