16 research outputs found
Genetic polymorphism associated with the occurrence of postoperative nausea and vomiting (PONV) in patients undergoing oncological surgeries
No full textIntrodução: A decisão clínica sobre qual população cirúrgica deve receber medicação antiemética profilática é baseada preferencialmente em sistemas de pontuação com base no risco clínico. No entanto, os fatores herdados podem desempenhar um papel significativo na sensibilidade basal para NVPO em populações específicas. Métodos: Um estudo de casocontrole foi conduzido para identificar possíveis diferenças clínicas, étnicas e genéticas interindividuais que podem ser responsáveis por prever NVPO em uma população submetida a cirurgia oncológica. Foram seguidos consecutivamente 310 pacientes cirúrgicos durante as primeiras 24 horas de pós-operatório. Um buffy coat foi obtido a partir de 10 mL de amostra de sangue e processado para genotipagem de 32 diferentes polimorfismos de nucleotídeo único (SNPs), a partir de 23 genes candidatos, usando PCR em tempo real. Resultados: Sexo feminino, idade, história de NVPO/enjoo, uso de opioide pós-operatório, escore APFEL e vômito induzido por quimioterapia foram encontrados como fatores de risco para NVPO na análise univariada (p <0,05). História de NVPO ou cinetose permaneceu como o único fator preditor independente para NVPO na análise multivariada (OR ajustado = 3,15; IC 95%: 1,34-7,37, p = 0,008). Destaca-se associação significativa de rs208294 (gene P2RX7) e NVPO nos modelos de genótipo, dominante e alelo (p <0,05). Os modelos de regressão multivariada (ajustados para história de NVPO ou cinetose) mostraram o alelo C polimórfico de rs208294 como protetor contra NVPO. Além disso, foram encontradas associações significativas do polimorfismo rs17641121 (gene KCNJ3) e NVPO (p <0,05) em uma amostra estratificada classificada como escore de alto risco de acordo com o escore APFEL. As raças autodeclaradas e a ancestralidade molecular apresentaram maiores percentuais de componentes europeus, africanos ou asiáticos em pessoas autodeclaradas como brancas, negras ou amarelas, respectivamente. No entanto, não houve diferença na incidência de NVPO relacionada à raça. Conclusão: Antecedente de NVPO/cinetose, polimorfismo rs208294 do gene P2RX7 e polimorfismo rs17641121 do gene KCNJ3 são os preditores mais importantes para NVPO no presente estudoClinical decision on which surgical population should receive prophylactic anti-emetic medication is based preferentially on clinical risk-based score systems. However, inherited factors may play a significant role in background sensitivity for PONV in specific populations. Methods: A case-control study was conducted to identify possible clinical, ethnic and genetic inter-individual differences that may account for PONV prediction in a population undergoing cancer surgery. We consecutively followed 310 surgical patients during the first 24 postoperative hours. A buffy coat was obtained from a 10 mL blood sample and processed for genotyping of 32 different single nucleotide polymorphisms (SNPs), from 23 candidate genes, using Real-time PCR. Results: Female gender, age, history of PONV/motion sickness, postoperative opioid use, APFEL score and chemotherapy-induced vomiting were found as risk factors for PONV in univariate analysis (p<0.05). History of PONV or motion sickness remained as the only independent predictor factor for PONV in the multivariate analysis (adjusted OR=3.15; 95% CI: 1.34-7.37, p=0.008). We detected significant association of rs208294 (P2RX7 gene) and PONV in Genotype, Dominant and Allele Models (p<0.05). The multivariate regression models (adjusted for history of PONV or motion sickness) showed the polymorphic C allele of rs208294 as protector against PONV. Furthermore, we found significant associations of rs17641121 polymorphism (KCNJ3 gene) and PONV (p<0.05) in a stratified sample classified as high-risk score according to APFEL Score. Self-declared races and molecular ancestry showed higher percentages of European, African or Asian components in people self-reported as White, Black or Yellow, respectively. However, there was no difference in the incidence of PONV related to race. Conclusion: Previous PONV/motion sickness, rs208294 polymorphism from P2RX7 gene and rs17641121 polymorphism from KCNJ3 gene are the most important predictors for PONV in the present stud
Analgesia, sedação e bloqueio neuromuscular em UTI
No full textA dor é um sintoma freqüentemente associado ao paciente crítico, O tratamento adequado desta condição está relacionado não apenas aos processos de humanização na UTI como também a modificar o prognóstico e reduzir os custos hospitalares. São apresentados métodos de avaliação da intensidade da dor e técnicas de tratamento, desenvolvidos pela equipe atuante na UTI. Exposição a um ambiente com grande sobrecarga de estímulos sensitivos, dolorosos, ruído, aspiração traqueal e a privação de sono pode requerer o uso de drogas para controlar a ansiedade e a inquietude. Além disso, algumas situações clínicas, tais como a ventilação mecânica, podem não dispensar a sedação para lograrem sucesso. A importância e as indicações clínicas do uso de relaxantes musculares são revistas.Pain is a major symptom which is often found in critically iii patients. Adequate management of this condition is implicated not only with humanization process in the ICU but may also to improve outcome and reduce hospital costs. Importance of measuring daily pain scores by the ICU team, as well as the available techniques of providing a good pain relief are pointed out. Exposition to a noxious environment which includes pain, noise, tracheal suctioning, sensory overload or sleep deprivation may require the use of drugs to promote sedation in order to control anger and mental stress. Furthermore, some clinical conditions, such as mechanical ventilation, may require sedation for its success. Some clinical aspects of neuromuscular blocking agents and their uses in the ICU are also reviewed
Anesthesiologists role in trauma management
No full textO papel do anestesiologista, dentro da equipe de atendimento multiprofissional no trauma, tem aumentado progressivamente nos últimos anos. Esta revisão aborda o papel do especialista tanto em relação ao atendimento pré quanto intra-hospitalar até a fase de reabilitação do trauma. Métodos de controle da via aérea, reposição volêmica, monitorização e uso de drogas anestésicas no traumatizado são discutidos. A analgesia pós-operatória é apresentada como método de redução da morbimortalidade pós-operatória com diminuição dos custos de internação hospitalar .The role for the anesthetist in multiprofessional trauma team has increased in the last few years. This paper reviews the role of the specialist concerning the pre-hospital and hospital management extended to the rehabilitation period. Methods of airway management, fluid therapy, monitoring and anesthetic drugs use are discussed. Postoperative analgesia as a way to reduce postoperative morbidity and mortality and reduce hospital stays costs is shown
Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models
No full textLocal anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group) were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg) was perineurally injected in two different animal pain models. In the flinching behavior test, the number of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg) increased both paw withdrawal latency in response to radiant heat (8.3 +/- 1.1, 12.7 +/- 1.8, 8.4 +/- 0.8, and 11.1 +/- 3.3 s) and mechanical threshold in response to von Frey filaments (459 +/- 82.8, 447.5 +/- 91.7, 320.1 +/- 120, 126.43 +/- 92.8 mN) at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg) blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics
Effect of intraoperative intravenous lidocaine on pain and plasma interleukin-6 in patients undergoing hysterectomy
No full textAbstractBackground and objectivesInterleukin-6 is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma interleukin-6 after hysterectomy.MethodA prospective, randomized, comparative, double-blind study with 40 patients, aged 18–60 years. G1 received lidocaine (2mgkg−1h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24h), first analgesic request, and dose of morphine in 24h were evaluated. Interleukin-6 was measured before starting surgery (T0), 5h after the start (T5), and 24h after the end of surgery (T24).ResultsThere was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5±364.1ngmL−1 in T5 and 30.1±14.2ngmL−1 in T24.ConclusionIntravenous lidocaine (2mgkg−1h−1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy
Efecto de la lidocaína venosa intraoperatoria sobre el dolor e interleucina-6 plasmática en pacientes sometidas a histerectomía
No full textResumenJustificación y objetivosLa interleucina-6 (IL-6) es predictora de intensidad en el trauma. El objetivo de este estudio fue evaluar el efecto de la lidocaína por vía venosa sobre la intensidad del dolor e IL-6 después de la histerectomía.MétodoEl estudio fue prospectivo, aleatorizado, comparativo y doble ciego en 40 pacientes, entre 18 y 60 años. Fue administrada lidocaína (2mg/kg–1.h–1) en el G1 o solución salina al 0,9% en el G2 durante la operación. La anestesia fue con O2/isoflurano. Se calculó la intensidad del dolor (T0: despertar y 6, 12, 18 y 24h), la primera solicitud de analgésico, y la dosis de morfina en las primeras 24h. La IL-6 se midió antes del inicio de la operación (T0), después de 5h del inicio (T5) y 24h después de finalizada (T24).ResultadosNo hubo diferencia en la intensidad del dolor entre los grupos. Hubo disminución de la intensidad del dolor entre T0 y los otros momentos evaluados en el G1. El tiempo para la primera complementación fue mayor en el G2 (76±104,4min) que en el G1 (26,7±23,3min). No hubo diferencia en las dosis de morfina complementaria entre G1 (23,5±12,6mg) y G2 (18,7±11,3mg). Hubo aumento en las concentraciones de IL-6 en los 2 grupos de T0 para T5 y T24. No hubo diferencia en la dosificación de IL-6 entre los grupos. La concentración de lidocaína fue 856,5±364,1ng/ml–1 en T5 y 30,1±14,2ng/ml–1 en T24.ConclusiónLa lidocaína (2mg/kg–1 /h–1) por vía venosa no generó reducción de la intensidad del dolor y de los niveles plasmáticos de IL-6 en pacientes sometidas a histerectomía abdominal.AbstractBackground and objectivesInterleukin-6 (IL-6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy.MethodA prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2mg.kg−1.h−1) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24hours), first analgesic request, and dose of morphine in 24hours were evaluated. IL-6 was measured before starting surgery (T0), 5hours after the start (T5), and 24hours after the end of surgery (T24).ResultsThere was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5±364.1ng.ml−1 in T5 and 30.1±14.2ng.ml−1 in T24.ConclusionIntravenous lidocaine (2mg.kg−1.h−1) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy
