This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

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In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital.In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/condition-related. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs).A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0–19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7–16.9) followed by surgery-related (2.2, 95% CI: 1.0–3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III–V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001).There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings.

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Hyoscine may represent an alternative to atropine for treating bradycardia.

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RESUMOA expressão de receptores de estrógeno (ER) e progesterona (PR) por meio da técnica de q-PCR foi avaliada em 26 cadelas portadoras de neoplasias mamárias e cinco cadelas sem afecções mamárias (grupo controle). Os resultados mostraram que os três grupos de animais estudados -com tumor maligno ou benigno e controle  expressaram receptores de estrógeno alfa, beta e progesterona. A quantificação relativa mostrou tendência para uma expressão maior de receptores no grupo controle e menor no grupo de animais com neoplasias malignas. Além disso, observou-se expressão maior de ERα em relação ao ERβ, e as neoplasias malignas de origem mista apresentaram maiores concentrações dos receptores PR, ERα e ERβ que as neoplasias de origem epitelial.Palavras-chave: cadela, neoplasia mamária, estrógeno, progesterona, receptores Os tumores da glândula mamária de cães têm interesse especial para os pesquisadores que trabalham com neoplasias em razão de algumas similaridades com o câncer de mama humano. Inclusive tem sido proposto, em muitos trabalhos, o estudo dessas lesões na espécie canina como modelo comparativo para a espécie humana (Schneider, 1970;Peleteiro, 1994). As hipóteses etiológicas da neoplasia mamária envolvem a origem viral, influência da dieta e obesidade, componentes genéticos, estresse Recebido em 8 de maio de 2011 Aceito em 20 de julho de 2012 E-mail: renataramos_vet@yahoo.com.br oxidativo e, principalmente, influência hormonal (Peleteiro, 1994; Fonseca e Daleck, 2000;Zuccari et al., 2001;Silva et al., 2004). Nas cadelas, a ovariossalpingohisterectomia realizada antes do primeiro estro reduz o risco de desenvolvimento da neoplasia mamária para 0,5%; esse risco aumenta significativamente nas fêmeas esterilizadas após o primeiro ciclo estral (8,0%) e o segundo (26%). A proteção conferida pela castração desaparece após os dois anos e meio de idade, quando nenhum efeito é obtido (Schneider et al ABSTRACT The estrogen and progesterone receptor (ER and PR) expression with the q-PCR technique was evaluated in 26 female dog carrying of mammary tumors and five female dogs without mammary disease (control group

Catecholamines and arginine vasopressin (AVP) release can affect arterial blood pressure (ABP) and hemodynamic stability in standing, sedated horses. Six mature horses were included in this prospective, randomized, crossover, blinded, experimental study. All the horses were sedated with detomidine (DET) alone (0.01 mg/kg, IV) or combined with methadone (MET) (0.01 mg/kg DET and 0.2 mg/kg MET, IV). Cardiopulmonary data and blood samples were collected 30 minutes before (prebaseline and baseline) and for 120 minutes postinjection. The combination DET/MET produced a significant increase (31%) in mean ABP (MAP) 5 minutes after drug administration which lasted for 120 minutes. Detomidine alone induced only a short-term increase in MAP (15%) at 5 minutes compared with baseline. There were significant differences between groups at 5, 15, and from 60 to 120 minutes. Plasma AVP concentrations were higher in horses receiving the treatment DET from 60 to 120 minutes than those in the combination group, for the same period. There were no significant differences in norepinephrine and epinephrine serum concentrations respect to baseline and between treatments. Detomidine induces a short-term MAP increase, and this effect was prolonged and potentiated by MET association. There is no evidence of AVP, norepinephrine, and epinephrine involvement in this effect.