Pedro Thadeu Galvão Vianna | Universidade Estadual Paulista "Júlio de Mesquita Filho" (original) (raw)
Papers by Pedro Thadeu Galvão Vianna
Acta Cirurgica Brasileira, 2013
To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (R... more To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (RL) in a rodent model of non-septic renal ischemia.
Revista Brasileira de Anestesiologia, 2005
![Research paper thumbnail of [Hemodynamic and renal effects of high epidural clonidine doses in dogs]](https://attachments.academia-assets.com/41157702/thumbnails/1.jpg)
](Revista brasileira de anestesiologia, 2005
There are no studies reporting renal effects promoted by high epidural clonidine doses. This stud... more There are no studies reporting renal effects promoted by high epidural clonidine doses. This study aimed at evaluating hemodynamic and renal effects of high epidural clonidine doses in dogs. This double-blind randomized study involved 20 animals anesthetized with sodium thiopental and fentanyl, which were distributed in two groups: Group 1 or placebo (n = 10), receiving 0.2 mL.kg-1 saline, and Group 2 or clonidine (n = 10), receiving 0.2 mL.kg-1 of a solution with 50 microg.mL-1 clonidine in the epidural space. The following hemodynamic parameters were evaluated: heart rate (HR): beat.min-1; mean blood pressure (MBP): mmHg; pulmonary capillary wedge pressure (PCWP): mmHg; cardiac output (CO): L.min-1; and systolic volume (SV): mL. The following renal function parameters were also evaluated: renal blood flow (RBF) mL.min-1; renal vascular resistance (RVR): mmHg.mL-1; urinary minute volume (UMV): mL.min-1; creatinine clearance (C Cr): mL.min-1; para-aminohippurate clearance (C PAH): m...
Revista Brasileira de Anestesiologia, 2005
Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Avaliação da Função Renal do Idoso em Duas Hor... more Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Avaliação da Função Renal do Idoso em Duas Horas JUSTIFICATIVA E OBJETIVOS: Os idosos têm diminuição progressiva da função renal e os hipertensos, maior risco de lesão renal adicional no intra-operatório. Avalia-se a função renal pela depuração da creatinina, com débito urinário de 24 horas, para diluir o erro de possível volume vesical residual (VVR). O objetivo deste trabalho foi avaliar a função renal pré-operatória de idosos hipertensos e não-hipertensos, com débito urinário de duas horas, utilizando aparelho de ultra-som portátil para determinação do volume vesical residual. MÉTODO: Foram analisados 30 pacientes, distribuídos em dois grupos, Gn (15), idosos não-hipertensos, e Gh (15), idosos hipertensos, coletando-se urina durante 2 horas. Mediu-se o VVR com aparelho de ultra-som portátil. Analisaram-se os seguintes parâmetros: idade, sexo, estado físico, altura, peso, índice de massa corpórea, creatinina plasmática e urinária, sódio e potássio plasmáticos e urinários, osmolalidade plasmática e urinária, débito urinário, depuração da creatinina, osmolar e de água livre, excreção urinária e fracionária de sódio e potássio. Comparou-se a depuração estimada de creatinina com a depuração da creatinina. RESULTADOS: Os pacientes de Gn e Gh não apresentaram diferenças significativas quanto à maioria dos parâmetros estudados. Os idosos hipertensos apresentaram tendência a maior excreção fracionária de sódio e o potássio plasmático mostrou-se mais baixo nos hipertensos, porém com valores normais. A depuração estimada de creatinina correlacionou-se positivamente com a de creatinina apenas em Gn. CONCLUSÕES: Os pacientes hipertensos apresentaram potássio plasmático mais baixo e excretaram mais sódio, tendo ocorrido correspondência entre a depuração estimada de creatinina e a depuração da creatinina apenas para os pacientes do grupo dos não-hipertensos. Unitermos: ANESTESIA, Geriátrica; DOENÇAS: hipertensão arterial; SISTEMA RENAL: função SUMMARY Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Two-Hour Evaluation of Renal Function in the Elderly BACKGROUND AND OBJECTIVES: Elderly have progressive renal function deterioration and hypertensive patients are at higher risk of additional intraoperative kidney injury. Renal function is evaluated by creatinine clearance, with 24-hour urinary output to dilute the error of possible residual vesical volume (RVV). This study aimed at evaluating preoperative renal function of hypertensive and normotensive elderly patients, with 2-hour urinary output, using portable ultrasound to determine residual vesical volume. METHODS: Participated in this study 30 patients distributed in 2 groups: Gn (15) normotensive elderly, and Gh (15) hypertensive elderly. Urine was collected for 2 hours. RVV was measured with portable ultrasound. The following parameters were evaluated: age, gender, physical status, height, weight, body mass index, plasma and urinary creatinine, plasma and urinary sodium and potassium, plasma and urinary osmolality, urinary output, creatinine, osmolar and free water clearance, sodium and potassium urinary and fractional excretion. Estimated creatinine clearance was compared to actual creatinine clearance. RESULTS: Gn and Gh patients were not significantly different in most evaluated parameters. Hypertensive elderly had a trend to higher sodium fractional excretion and plasma potassium was lower in hypertensive patients, however within normal ranges. Estimated creatinine clearance was positively correlated to actual creatinine clearance in Gn only. CONCLUSIONS: Hypertensive patients had lower plasma potassium and excreted more sodium, with correspondence between estimated and actual creatinine clearance in normotensive patients only.
Clinics (São Paulo, Brazil), 2014
Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtra... more Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery. In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calcu...
Revista brasileira de anestesiologia, 2003
Spinal injection of large local anesthetic volumes after accidental dural puncture is an epidural... more Spinal injection of large local anesthetic volumes after accidental dural puncture is an epidural anesthesia complication. This study aimed at investigating potential clinical and histological changes triggered by large volumes of 2% lidocaine or 1% ropivacaine in a simulated accidental spinal injection in dogs. Twenty one dogs were randomly allocated into three experimental groups, which received spinal injections of: G1 - 0.9% sodium chloride, G2 - 2% lidocaine, G3 - 1% ropivacaine. Spinal puncture was performed in L6-L7 interspace. Anesthetic volume was 1 ml per 10 cm-distance between the occipital protuberance and the lumbosacral space (5 - 6.6 ml). After 72 hours of clinical observation animals were sacrificed and their spinal cords were removed for histological examination under light microscopy. No G1 animal presented clinical or histological changes in the spinal cord. There were two cases of nervous tissue necrosis in G2, however clinical changes were only observed in one o...
![Research paper thumbnail of [Simplified method to maintain propofol blood concentration in an approximately constant level associated to nitrous oxide in pediatric patients]](https://attachments.academia-assets.com/40645008/thumbnails/1.jpg)
](Revista brasileira de anestesiologia, 2002
Maintaining target-controlled propofol blood concentrations in approximately constant levels is a... more Maintaining target-controlled propofol blood concentrations in approximately constant levels is a technique that can be used in a simple way in the operating room. The aim of this study was to compare in clinical and laboratorial terms propofol infusion in children, using Shorts and Marshs pharmacokinetic parameters. Forty-one patients of both genders, aged 4 to 12 years, physical status ASAI or ASAII were distributed in two groups: Group S (n = 20) and Group M (n = 21). Shorts pharmacokinetic parameters were applied to group S, while Marshs pharmacokinetic parameters were applied to group M. Intravenous anesthesia was induced with 30 microg.kg-1 bolus alfentanil, 3 mg.kg-1 propofol and 0.08 mg.kg-1 pancuronium. Patients were intubated and anesthesia was maintained with N2O/O2 (60%) in controlled mechanical ventilation. Propofol infusion in group S was 254 microg.kg-1 (30 min) followed by 216 microg.kg-1.min-1 for additional 30 minutes. Propofol infusion in group M was 208 microg.kg...
Revista Brasileira de Anestesiologia, 2005
This study aimed at evaluating acute radiological contrast effects in fluid restriction situation... more This study aimed at evaluating acute radiological contrast effects in fluid restriction situations, observing renal and cardiovascular effects after intra-arterial injection of high osmolarity radiological contrast. Participated in this study 16 dogs anesthetized with sodium thiopental (15 mg.kg-1) and fentanyl (0.03 mL.kg-1), followed by continuous infusion of 40 microg.kg-1.min-1 (sodium thiopental) and 0.1 microg.kg-1.min-1 (fentanyl). Hydration was achieved with 5% glucose solution (0.03 mL.kg-1.min-1) and ventilation was mechanically controlled with compressed air. The following attributes were evaluated: heart rate (HR); mean blood pressure (MBP); inferior vena cava pressure (IVP); cardiac output (CO); hematocrit (Ht); effective renal plasma flow (ERPF); renal blood flow (RBF); glomerular filtration rate (GFR); filtration fraction; renal vascular resistance (RVR), urinary volume (UV); plasma and urinary osmolarity; osmolar clearance; free water clearance; sodium and potassium clearance; plasma sodium and potassium; sodium and potassium urinary fractional excretion and rectal temperature. These attributes were evaluated in four moments: 30 (M1), 60 (M2), 90 (M3) and 120 (M4) minutes after sodium para-aminohipurate and creatinine administration (beginning of experiment). In moment 2, G1 received intra-arterial 0.9% saline (1.24 mL.kg-1) and G2 received intra-arterial radiological contrast (1.4 mL.kg-1). Group G1 has presented increased HR, ERPF, RBF, plasma osmolarity, sodium clearance and sodium urinary excretion, in addition to decreased urinary osmolarity, plasma sodium, potassium clearance and rectal temperature. Group G2 has presented increased HR, RVR, UV, osmolar clearance, sodium clearance and sodium urinary and fractional excretion; there has also been decrease in hematocrit, glomerular filtration rate, filtration fraction, urinary osmolarity, free water clearance, urinary sodium and potassium, plasma potassium and rectal temperature. This study has concluded that intra-arterial radiological contrast has promoted a two-phase effect on renal function. Initially it has promoted increased diuresis and sodium excretion but then the hemodynamic conditions impaired, and consequently renal function impaired, with increased renal vascular resistance and decreased glomerular filtration rate.
Revista Brasileira de Anestesiologia, 2005
Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Estudo Comparativo dos Efeitos Hemodinâmicos e V... more Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Estudo Comparativo dos Efeitos Hemodinâmicos e Ventilatórios da Ventilação Controlada a Volume ou a Pressão, em Cães Submetidos ao Pneumoperitônio JUSTIFICATIVA E OBJETIVOS: A ventilação com pressão controlada (PCV) está disponível em aparelhos de anestesia, mas não existem estudos sobre o seu uso, durante o pneumoperitônio com o CO 2 (PPC). O objetivo deste estudo foi avaliar a ventilação controlada a pressão bem como as alterações hemodinâmicas e ventilatórias durante o PPC, comparando-a com a ventilação controlada a volume (VCV) convencionalmente utilizada. MÉTODO: Dezesseis cães anestesiados com tiopental sódico, citrato de fentanil e brometo de pancurônio, foram divididos aleatoriamente em dois grupos: VC -ventilação controlada a volume (n = 8) e PC -ventilação controlada a pressão (n = 8) Os parâmetros hemodinâmicos e ventilatórios foram monitorizados e registrados em 4 momentos: M1 (antes do PPC), M2 (30 minutos após PPC = 10 mmHg), M3 (30 minutos após PPC = 15 mmHg) e M4 (30 minutos após a deflação do PPC). RESULTADOS: Com a aplicação do PPC ocorreu um aumento do volume corrente no grupo PC, aumento das pressões inspiratórias (máxima e de platô), diminuição da complacência proporcional ao aumento do PPC, aumento da freqüência cardíaca, manutenção da pressão arterial média com valores maiores no grupo VC em todos os momentos, aumento da pressão de átrio direito com diminuição significativa após a deflação, diminuição do pH sangüíneo durante o PPC com menor variação no grupo PC, maior estabilidade da pressão parcial do CO 2 no sangue arterial no grupo PC, sem alterações da pressão parcial do O 2 no sangue arterial. CONCLUSÕES: Apesar das diferenças de alguns parâmetros hemodinâmicos e ventilatórios, entre os dois modos de controle da ventilação, nas condições estudadas foi possível a u ti l i za ç ã o d a v e n ti l a ç ã o c o n tr o l a d a a p r e s s ã o pa r a procedimentos com a aplicação do PPC. É fundamental observar o controle rigoroso da ventilação alveolar, ajustando a pressão inspiratória para manter eliminação adequada do CO 2 e garantir oxigenação. U n i t e r m o s : A N I M A L , C ã o ; C I R U R G I A , A b d o m i n a l : videolaparoscópica; VENTILAÇÃO: controlada mecânica SUMMARY Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Hemodynamic and Ventilatory Effects of Volume or Pressure Controlled Ventilation in Dogs Submitted to Pneumoperitoneum. Comparative Study
Revista Brasileira de Anestesiologia, 2002
Justificativa e Objetivos -A laparoscopia ginecológica é procedimento que determina alta incidênc... more Justificativa e Objetivos -A laparoscopia ginecológica é procedimento que determina alta incidência de náusea e vômito no pós-operatório. Este estudo teve por finalidade comparar a eficácia do propofol isoladamente ou em associação com a dexametasona na prevenção de náusea e vômito em pacientes submetidas à laparoscopia ginecológica. Método -Participaram do estudo 40 pacientes, estado físico ASA I e II, com idades entre 18 e 46 anos, sem queixas gástricas prévias, submetidas à laparoscopia para diagnóstico ou cirurgia. As pacientes foram divididas em 2 grupos: o grupo 1 recebeu (solução fisiológica 2 ml) e o grupo 2 dexametasona (8 mg), por via venosa antes da indução da anestesia. Todas as pacientes receberam midazolam (7,5 mg) por via oral como medicação pré-anestésica, sufentanil (0,5 µg.kg -1 ), propofol em infusão contínua para indução e manutenção da anestesia (BIS -60) e N 2 O/O 2 em fração inspirada de O 2 a 40% e atracúrio (0,5 mg.kg -1 ) como bloqueador neuromuscular. A analgesia pós-operatória foi realizada com cetoprofeno (100 mg) e buscopam composto â .As pacientes fora avaliadas na sala de recuperação pós-anestésica (SRPA) e na enfermaria 1, 2, 3 e 12 horas após a alta da SRPA. Resultados -Ambos os grupos foram idênticos quanto aos dados antropométricos e à duração da cirurgia e da anestesia. No grupo 1 (n = 20) uma paciente apresentou náusea na SRPA e na enfermaria e três pacientes vomitaram na enfermaria. No grupo 2 (n = 20) nenhuma paciente apresentou náusea ou vômito durante o período de observação clínica, resultados estatisticamente não significativos. Conclusões -O propofol isoladamente ou associado à dexametasona foi eficaz na prevenção de náusea e vômito no pós-operatório de pacientes submetidas à laparoscopia ginecológica UNITERMOS: CIRURGIA: Ginecológica: laparoscopia; COMPLICAÇÕES: náusea, vômito; DROGAS: dexametasona; HIPNÓTICOS: propofol SUMMARY Ganem EM, Fukushima FB, Silva DSM, Nakamura G, Castiglia YMM, Vianna PTG -Efficacy of Propofol and Propofol plus Dexamethasone in Controlling Postoperative Nausea and Vomiting of Gynecologic Laparoscopy
Revista Brasileira de Anestesiologia, 2002
Resumo: Background and Objectives-A simplifield method is proposed to calculate intravenous sufen... more Resumo: Background and Objectives-A simplifield method is proposed to calculate intravenous sufentanil infusion rate based on the finite-differnces method, also know as Euler method. Methods-Softwares were elaborated for sufentanil, using the Bovill ...
Brazilian Journal of Anesthesiology, 2011
Pereira IDF, Grando MM, Braz JRC, Castiglia YMM, Vane LA, Módolo NSP, Nascimento Jr P, Amorim RB,... more Pereira IDF, Grando MM, Braz JRC, Castiglia YMM, Vane LA, Módolo NSP, Nascimento Jr P, Amorim RB, Rodrigues Jr GR, Braz LG, Ganem EM -Retrospective Analysis of Risk Factors and Predictors of Intraoperative Complications in Neuraxial Blocks at Faculdade de Medicina de Botucatu-UNESP.
Renal Failure, 2011
Objective: The aim of this study was to verify whether preoperative diabetes, hypertension, and r... more Objective: The aim of this study was to verify whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function in patients submitted to anesthesia for arterial surgery. Methods: Prospective observational study. One hundred and forty-four patients submitted to anesthesia for arterial surgery enrolled consecutively and divided into four groups: G1 -diabetes and hypertension; G2 -diabetes; G3 -hypertension; and G4 -without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr), alkaline phosphatase (AP), g-glutamyltransferase (gGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2). Results: Values of gGT, gGT/Ucr, and AP × gGT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m 2 ) presented increased gGT/Ucr and AP × gGT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m 2 ) presented increased gGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltagGT, deltagGT/Ucr, deltaAP/Ucr, and deltaAP × gGT/Ucr. Conclusions: Diabetes, hypertension, and preoperative renal function seem to interfere in tubular enzymuria immediately after surgery in arteriopathic patients. However, when these markers do not increase in postoperative period, renal dysfunction cannot be discarded.
Renal Failure, 2007
Hypovolemia from hemorrhage evokes protective compensatory reactions, such as the renin-angiotens... more Hypovolemia from hemorrhage evokes protective compensatory reactions, such as the renin-angiotensin system, which interferes in the clearance function and can lead to ischemia. This study was designed to evaluate the effects of glibenclamide, a K(+)(ATP) channel blocker, on renal function and histology in rats in a state of hemorrhagic shock under sevoflurane anesthesia. Twenty Wistar rats were randomized into two groups of 10 animals each (G1 and G2), only one of which (G2) received intravenous glibenclamide (1 microg.g(-1)), 60 min before bleeding was begun. Both groups were anesthetized with sevoflurane and kept on spontaneous respiration with oxygen-air, while being bled of 30% of volemia in three stages with 10 min intervals. There was an evaluation of renal function - sodium para-aminohippurate and iothalamate clearances, filtration fraction, renal blood flow, renal vascular resistance - and renal histology. Renal function attributes were evaluated at three moments: M1 and M2, coinciding with the first and third stages of bleeding; and M3, 30 min after M2, when the animals were subjected to bilateral nephrectomy before being sacrificed. Significant differences were found in para-aminohippurate clearance, G1 < G2, and higher renal vascular resistance values were observed in G1. Histological examination showed the greater vulnerability of kidneys exposed to sevoflurane alone (G1) with higher scores of vascular and tubular dilatation. There were vascular congestion and tubular vacuolization only in G1. Necrosis and signs of tubular regeneration did not differ in both groups. Treatment with glibenclamide attenuated acutely the renal histological changes after hemorrhage in rats under sevoflurane anesthesia.
Regional Anesthesia and Pain Medicine, 2015
Although there is no documented evidence that tattoo pigments can cause neurological complication... more Although there is no documented evidence that tattoo pigments can cause neurological complications, the implications of performing neuraxial anesthesia through tattooed skin are unknown. In this study, we aimed to assess whether spinal puncture performed through tattooed skin of rabbits determines changes over the spinal cord and meninges. In addition, we sought to evaluate the presence of ink fragments entrapped in spinal needles. Thirty-six young male adult rabbits, each weighing between 3400 and 3900 g and having a spine length between 38.5 and 39 cm, were divided by lot into 3 groups as follows: GI, spinal puncture through tattooed skin; GII, spinal puncture through tattooed skin and saline injection; and GIII, spinal puncture through skin free of tattoo and saline injection. After intravenous anesthesia with ketamine and xylazine, the subarachnoid space was punctured at S1-S2 under ultrasound guidance with a 22-gauge 2½ Quincke needle. Animals in GII and GIII received 5 μL/cm of spinal length (0.2 mL) of saline intrathecally. In GI, the needle tip was placed into the yellow ligament, and no solution was injected into the intrathecal space; after tattooed skin puncture, 1 mL of saline was injected through the needle over a histological slide to prepare a smear that was dyed by the Giemsa method to enable tissue identification if present. All animals remained in captivity for 21 days under medical observation and were killed by decapitation. The lumbosacral spinal cord portion was removed for histological analysis using hematoxylin-eosin stain. None of the animals had impaired motor function or decreased nociception during the period of clinical observation. None of the animals from the control group (GIII) showed signs of injuries to meninges. In GII, however, 4 animals presented with signs of meningeal injury. The main histological changes observed were focal areas of perivascular lymphoplasmacyte infiltration in the pia mater and arachnoid. There was no signal of injury in neural tissue in any animal of both groups. Tissue coring containing ink pigments was noted in all GI smears from the spinal needles used to puncture the tattooed skin. On the basis of the present results, intrathecal injection of saline through a needle inserted through tattooed skin is capable of producing histological changes over the meninges of rabbits. Ink fragments were entrapped inside the spinal needles, despite the presence of a stylet.
Acta Cirurgica Brasileira, 2013
To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (R... more To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (RL) in a rodent model of non-septic renal ischemia.
Revista Brasileira de Anestesiologia, 2005
Revista brasileira de anestesiologia, 2005
There are no studies reporting renal effects promoted by high epidural clonidine doses. This stud... more There are no studies reporting renal effects promoted by high epidural clonidine doses. This study aimed at evaluating hemodynamic and renal effects of high epidural clonidine doses in dogs. This double-blind randomized study involved 20 animals anesthetized with sodium thiopental and fentanyl, which were distributed in two groups: Group 1 or placebo (n = 10), receiving 0.2 mL.kg-1 saline, and Group 2 or clonidine (n = 10), receiving 0.2 mL.kg-1 of a solution with 50 microg.mL-1 clonidine in the epidural space. The following hemodynamic parameters were evaluated: heart rate (HR): beat.min-1; mean blood pressure (MBP): mmHg; pulmonary capillary wedge pressure (PCWP): mmHg; cardiac output (CO): L.min-1; and systolic volume (SV): mL. The following renal function parameters were also evaluated: renal blood flow (RBF) mL.min-1; renal vascular resistance (RVR): mmHg.mL-1; urinary minute volume (UMV): mL.min-1; creatinine clearance (C Cr): mL.min-1; para-aminohippurate clearance (C PAH): m...
Revista Brasileira de Anestesiologia, 2005
Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Avaliação da Função Renal do Idoso em Duas Hor... more Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Avaliação da Função Renal do Idoso em Duas Horas JUSTIFICATIVA E OBJETIVOS: Os idosos têm diminuição progressiva da função renal e os hipertensos, maior risco de lesão renal adicional no intra-operatório. Avalia-se a função renal pela depuração da creatinina, com débito urinário de 24 horas, para diluir o erro de possível volume vesical residual (VVR). O objetivo deste trabalho foi avaliar a função renal pré-operatória de idosos hipertensos e não-hipertensos, com débito urinário de duas horas, utilizando aparelho de ultra-som portátil para determinação do volume vesical residual. MÉTODO: Foram analisados 30 pacientes, distribuídos em dois grupos, Gn (15), idosos não-hipertensos, e Gh (15), idosos hipertensos, coletando-se urina durante 2 horas. Mediu-se o VVR com aparelho de ultra-som portátil. Analisaram-se os seguintes parâmetros: idade, sexo, estado físico, altura, peso, índice de massa corpórea, creatinina plasmática e urinária, sódio e potássio plasmáticos e urinários, osmolalidade plasmática e urinária, débito urinário, depuração da creatinina, osmolar e de água livre, excreção urinária e fracionária de sódio e potássio. Comparou-se a depuração estimada de creatinina com a depuração da creatinina. RESULTADOS: Os pacientes de Gn e Gh não apresentaram diferenças significativas quanto à maioria dos parâmetros estudados. Os idosos hipertensos apresentaram tendência a maior excreção fracionária de sódio e o potássio plasmático mostrou-se mais baixo nos hipertensos, porém com valores normais. A depuração estimada de creatinina correlacionou-se positivamente com a de creatinina apenas em Gn. CONCLUSÕES: Os pacientes hipertensos apresentaram potássio plasmático mais baixo e excretaram mais sódio, tendo ocorrido correspondência entre a depuração estimada de creatinina e a depuração da creatinina apenas para os pacientes do grupo dos não-hipertensos. Unitermos: ANESTESIA, Geriátrica; DOENÇAS: hipertensão arterial; SISTEMA RENAL: função SUMMARY Benarab MCBS, Castiglia YMM, Vianna PTG, Braz JRC -Two-Hour Evaluation of Renal Function in the Elderly BACKGROUND AND OBJECTIVES: Elderly have progressive renal function deterioration and hypertensive patients are at higher risk of additional intraoperative kidney injury. Renal function is evaluated by creatinine clearance, with 24-hour urinary output to dilute the error of possible residual vesical volume (RVV). This study aimed at evaluating preoperative renal function of hypertensive and normotensive elderly patients, with 2-hour urinary output, using portable ultrasound to determine residual vesical volume. METHODS: Participated in this study 30 patients distributed in 2 groups: Gn (15) normotensive elderly, and Gh (15) hypertensive elderly. Urine was collected for 2 hours. RVV was measured with portable ultrasound. The following parameters were evaluated: age, gender, physical status, height, weight, body mass index, plasma and urinary creatinine, plasma and urinary sodium and potassium, plasma and urinary osmolality, urinary output, creatinine, osmolar and free water clearance, sodium and potassium urinary and fractional excretion. Estimated creatinine clearance was compared to actual creatinine clearance. RESULTS: Gn and Gh patients were not significantly different in most evaluated parameters. Hypertensive elderly had a trend to higher sodium fractional excretion and plasma potassium was lower in hypertensive patients, however within normal ranges. Estimated creatinine clearance was positively correlated to actual creatinine clearance in Gn only. CONCLUSIONS: Hypertensive patients had lower plasma potassium and excreted more sodium, with correspondence between estimated and actual creatinine clearance in normotensive patients only.
Clinics (São Paulo, Brazil), 2014
Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtra... more Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery. In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calcu...
Revista brasileira de anestesiologia, 2003
Spinal injection of large local anesthetic volumes after accidental dural puncture is an epidural... more Spinal injection of large local anesthetic volumes after accidental dural puncture is an epidural anesthesia complication. This study aimed at investigating potential clinical and histological changes triggered by large volumes of 2% lidocaine or 1% ropivacaine in a simulated accidental spinal injection in dogs. Twenty one dogs were randomly allocated into three experimental groups, which received spinal injections of: G1 - 0.9% sodium chloride, G2 - 2% lidocaine, G3 - 1% ropivacaine. Spinal puncture was performed in L6-L7 interspace. Anesthetic volume was 1 ml per 10 cm-distance between the occipital protuberance and the lumbosacral space (5 - 6.6 ml). After 72 hours of clinical observation animals were sacrificed and their spinal cords were removed for histological examination under light microscopy. No G1 animal presented clinical or histological changes in the spinal cord. There were two cases of nervous tissue necrosis in G2, however clinical changes were only observed in one o...
Revista brasileira de anestesiologia, 2002
Maintaining target-controlled propofol blood concentrations in approximately constant levels is a... more Maintaining target-controlled propofol blood concentrations in approximately constant levels is a technique that can be used in a simple way in the operating room. The aim of this study was to compare in clinical and laboratorial terms propofol infusion in children, using Shorts and Marshs pharmacokinetic parameters. Forty-one patients of both genders, aged 4 to 12 years, physical status ASAI or ASAII were distributed in two groups: Group S (n = 20) and Group M (n = 21). Shorts pharmacokinetic parameters were applied to group S, while Marshs pharmacokinetic parameters were applied to group M. Intravenous anesthesia was induced with 30 microg.kg-1 bolus alfentanil, 3 mg.kg-1 propofol and 0.08 mg.kg-1 pancuronium. Patients were intubated and anesthesia was maintained with N2O/O2 (60%) in controlled mechanical ventilation. Propofol infusion in group S was 254 microg.kg-1 (30 min) followed by 216 microg.kg-1.min-1 for additional 30 minutes. Propofol infusion in group M was 208 microg.kg...
Revista Brasileira de Anestesiologia, 2005
This study aimed at evaluating acute radiological contrast effects in fluid restriction situation... more This study aimed at evaluating acute radiological contrast effects in fluid restriction situations, observing renal and cardiovascular effects after intra-arterial injection of high osmolarity radiological contrast. Participated in this study 16 dogs anesthetized with sodium thiopental (15 mg.kg-1) and fentanyl (0.03 mL.kg-1), followed by continuous infusion of 40 microg.kg-1.min-1 (sodium thiopental) and 0.1 microg.kg-1.min-1 (fentanyl). Hydration was achieved with 5% glucose solution (0.03 mL.kg-1.min-1) and ventilation was mechanically controlled with compressed air. The following attributes were evaluated: heart rate (HR); mean blood pressure (MBP); inferior vena cava pressure (IVP); cardiac output (CO); hematocrit (Ht); effective renal plasma flow (ERPF); renal blood flow (RBF); glomerular filtration rate (GFR); filtration fraction; renal vascular resistance (RVR), urinary volume (UV); plasma and urinary osmolarity; osmolar clearance; free water clearance; sodium and potassium clearance; plasma sodium and potassium; sodium and potassium urinary fractional excretion and rectal temperature. These attributes were evaluated in four moments: 30 (M1), 60 (M2), 90 (M3) and 120 (M4) minutes after sodium para-aminohipurate and creatinine administration (beginning of experiment). In moment 2, G1 received intra-arterial 0.9% saline (1.24 mL.kg-1) and G2 received intra-arterial radiological contrast (1.4 mL.kg-1). Group G1 has presented increased HR, ERPF, RBF, plasma osmolarity, sodium clearance and sodium urinary excretion, in addition to decreased urinary osmolarity, plasma sodium, potassium clearance and rectal temperature. Group G2 has presented increased HR, RVR, UV, osmolar clearance, sodium clearance and sodium urinary and fractional excretion; there has also been decrease in hematocrit, glomerular filtration rate, filtration fraction, urinary osmolarity, free water clearance, urinary sodium and potassium, plasma potassium and rectal temperature. This study has concluded that intra-arterial radiological contrast has promoted a two-phase effect on renal function. Initially it has promoted increased diuresis and sodium excretion but then the hemodynamic conditions impaired, and consequently renal function impaired, with increased renal vascular resistance and decreased glomerular filtration rate.
Revista Brasileira de Anestesiologia, 2005
Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Estudo Comparativo dos Efeitos Hemodinâmicos e V... more Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Estudo Comparativo dos Efeitos Hemodinâmicos e Ventilatórios da Ventilação Controlada a Volume ou a Pressão, em Cães Submetidos ao Pneumoperitônio JUSTIFICATIVA E OBJETIVOS: A ventilação com pressão controlada (PCV) está disponível em aparelhos de anestesia, mas não existem estudos sobre o seu uso, durante o pneumoperitônio com o CO 2 (PPC). O objetivo deste estudo foi avaliar a ventilação controlada a pressão bem como as alterações hemodinâmicas e ventilatórias durante o PPC, comparando-a com a ventilação controlada a volume (VCV) convencionalmente utilizada. MÉTODO: Dezesseis cães anestesiados com tiopental sódico, citrato de fentanil e brometo de pancurônio, foram divididos aleatoriamente em dois grupos: VC -ventilação controlada a volume (n = 8) e PC -ventilação controlada a pressão (n = 8) Os parâmetros hemodinâmicos e ventilatórios foram monitorizados e registrados em 4 momentos: M1 (antes do PPC), M2 (30 minutos após PPC = 10 mmHg), M3 (30 minutos após PPC = 15 mmHg) e M4 (30 minutos após a deflação do PPC). RESULTADOS: Com a aplicação do PPC ocorreu um aumento do volume corrente no grupo PC, aumento das pressões inspiratórias (máxima e de platô), diminuição da complacência proporcional ao aumento do PPC, aumento da freqüência cardíaca, manutenção da pressão arterial média com valores maiores no grupo VC em todos os momentos, aumento da pressão de átrio direito com diminuição significativa após a deflação, diminuição do pH sangüíneo durante o PPC com menor variação no grupo PC, maior estabilidade da pressão parcial do CO 2 no sangue arterial no grupo PC, sem alterações da pressão parcial do O 2 no sangue arterial. CONCLUSÕES: Apesar das diferenças de alguns parâmetros hemodinâmicos e ventilatórios, entre os dois modos de controle da ventilação, nas condições estudadas foi possível a u ti l i za ç ã o d a v e n ti l a ç ã o c o n tr o l a d a a p r e s s ã o pa r a procedimentos com a aplicação do PPC. É fundamental observar o controle rigoroso da ventilação alveolar, ajustando a pressão inspiratória para manter eliminação adequada do CO 2 e garantir oxigenação. U n i t e r m o s : A N I M A L , C ã o ; C I R U R G I A , A b d o m i n a l : videolaparoscópica; VENTILAÇÃO: controlada mecânica SUMMARY Carraretto AR, Vianna PTG, Almeida AV, Ganem EM -Hemodynamic and Ventilatory Effects of Volume or Pressure Controlled Ventilation in Dogs Submitted to Pneumoperitoneum. Comparative Study
Revista Brasileira de Anestesiologia, 2002
Justificativa e Objetivos -A laparoscopia ginecológica é procedimento que determina alta incidênc... more Justificativa e Objetivos -A laparoscopia ginecológica é procedimento que determina alta incidência de náusea e vômito no pós-operatório. Este estudo teve por finalidade comparar a eficácia do propofol isoladamente ou em associação com a dexametasona na prevenção de náusea e vômito em pacientes submetidas à laparoscopia ginecológica. Método -Participaram do estudo 40 pacientes, estado físico ASA I e II, com idades entre 18 e 46 anos, sem queixas gástricas prévias, submetidas à laparoscopia para diagnóstico ou cirurgia. As pacientes foram divididas em 2 grupos: o grupo 1 recebeu (solução fisiológica 2 ml) e o grupo 2 dexametasona (8 mg), por via venosa antes da indução da anestesia. Todas as pacientes receberam midazolam (7,5 mg) por via oral como medicação pré-anestésica, sufentanil (0,5 µg.kg -1 ), propofol em infusão contínua para indução e manutenção da anestesia (BIS -60) e N 2 O/O 2 em fração inspirada de O 2 a 40% e atracúrio (0,5 mg.kg -1 ) como bloqueador neuromuscular. A analgesia pós-operatória foi realizada com cetoprofeno (100 mg) e buscopam composto â .As pacientes fora avaliadas na sala de recuperação pós-anestésica (SRPA) e na enfermaria 1, 2, 3 e 12 horas após a alta da SRPA. Resultados -Ambos os grupos foram idênticos quanto aos dados antropométricos e à duração da cirurgia e da anestesia. No grupo 1 (n = 20) uma paciente apresentou náusea na SRPA e na enfermaria e três pacientes vomitaram na enfermaria. No grupo 2 (n = 20) nenhuma paciente apresentou náusea ou vômito durante o período de observação clínica, resultados estatisticamente não significativos. Conclusões -O propofol isoladamente ou associado à dexametasona foi eficaz na prevenção de náusea e vômito no pós-operatório de pacientes submetidas à laparoscopia ginecológica UNITERMOS: CIRURGIA: Ginecológica: laparoscopia; COMPLICAÇÕES: náusea, vômito; DROGAS: dexametasona; HIPNÓTICOS: propofol SUMMARY Ganem EM, Fukushima FB, Silva DSM, Nakamura G, Castiglia YMM, Vianna PTG -Efficacy of Propofol and Propofol plus Dexamethasone in Controlling Postoperative Nausea and Vomiting of Gynecologic Laparoscopy
Revista Brasileira de Anestesiologia, 2002
Resumo: Background and Objectives-A simplifield method is proposed to calculate intravenous sufen... more Resumo: Background and Objectives-A simplifield method is proposed to calculate intravenous sufentanil infusion rate based on the finite-differnces method, also know as Euler method. Methods-Softwares were elaborated for sufentanil, using the Bovill ...
Brazilian Journal of Anesthesiology, 2011
Pereira IDF, Grando MM, Braz JRC, Castiglia YMM, Vane LA, Módolo NSP, Nascimento Jr P, Amorim RB,... more Pereira IDF, Grando MM, Braz JRC, Castiglia YMM, Vane LA, Módolo NSP, Nascimento Jr P, Amorim RB, Rodrigues Jr GR, Braz LG, Ganem EM -Retrospective Analysis of Risk Factors and Predictors of Intraoperative Complications in Neuraxial Blocks at Faculdade de Medicina de Botucatu-UNESP.
Renal Failure, 2011
Objective: The aim of this study was to verify whether preoperative diabetes, hypertension, and r... more Objective: The aim of this study was to verify whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function in patients submitted to anesthesia for arterial surgery. Methods: Prospective observational study. One hundred and forty-four patients submitted to anesthesia for arterial surgery enrolled consecutively and divided into four groups: G1 -diabetes and hypertension; G2 -diabetes; G3 -hypertension; and G4 -without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr), alkaline phosphatase (AP), g-glutamyltransferase (gGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2). Results: Values of gGT, gGT/Ucr, and AP × gGT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m 2 ) presented increased gGT/Ucr and AP × gGT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m 2 ) presented increased gGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltagGT, deltagGT/Ucr, deltaAP/Ucr, and deltaAP × gGT/Ucr. Conclusions: Diabetes, hypertension, and preoperative renal function seem to interfere in tubular enzymuria immediately after surgery in arteriopathic patients. However, when these markers do not increase in postoperative period, renal dysfunction cannot be discarded.
Renal Failure, 2007
Hypovolemia from hemorrhage evokes protective compensatory reactions, such as the renin-angiotens... more Hypovolemia from hemorrhage evokes protective compensatory reactions, such as the renin-angiotensin system, which interferes in the clearance function and can lead to ischemia. This study was designed to evaluate the effects of glibenclamide, a K(+)(ATP) channel blocker, on renal function and histology in rats in a state of hemorrhagic shock under sevoflurane anesthesia. Twenty Wistar rats were randomized into two groups of 10 animals each (G1 and G2), only one of which (G2) received intravenous glibenclamide (1 microg.g(-1)), 60 min before bleeding was begun. Both groups were anesthetized with sevoflurane and kept on spontaneous respiration with oxygen-air, while being bled of 30% of volemia in three stages with 10 min intervals. There was an evaluation of renal function - sodium para-aminohippurate and iothalamate clearances, filtration fraction, renal blood flow, renal vascular resistance - and renal histology. Renal function attributes were evaluated at three moments: M1 and M2, coinciding with the first and third stages of bleeding; and M3, 30 min after M2, when the animals were subjected to bilateral nephrectomy before being sacrificed. Significant differences were found in para-aminohippurate clearance, G1 < G2, and higher renal vascular resistance values were observed in G1. Histological examination showed the greater vulnerability of kidneys exposed to sevoflurane alone (G1) with higher scores of vascular and tubular dilatation. There were vascular congestion and tubular vacuolization only in G1. Necrosis and signs of tubular regeneration did not differ in both groups. Treatment with glibenclamide attenuated acutely the renal histological changes after hemorrhage in rats under sevoflurane anesthesia.
Regional Anesthesia and Pain Medicine, 2015
Although there is no documented evidence that tattoo pigments can cause neurological complication... more Although there is no documented evidence that tattoo pigments can cause neurological complications, the implications of performing neuraxial anesthesia through tattooed skin are unknown. In this study, we aimed to assess whether spinal puncture performed through tattooed skin of rabbits determines changes over the spinal cord and meninges. In addition, we sought to evaluate the presence of ink fragments entrapped in spinal needles. Thirty-six young male adult rabbits, each weighing between 3400 and 3900 g and having a spine length between 38.5 and 39 cm, were divided by lot into 3 groups as follows: GI, spinal puncture through tattooed skin; GII, spinal puncture through tattooed skin and saline injection; and GIII, spinal puncture through skin free of tattoo and saline injection. After intravenous anesthesia with ketamine and xylazine, the subarachnoid space was punctured at S1-S2 under ultrasound guidance with a 22-gauge 2½ Quincke needle. Animals in GII and GIII received 5 μL/cm of spinal length (0.2 mL) of saline intrathecally. In GI, the needle tip was placed into the yellow ligament, and no solution was injected into the intrathecal space; after tattooed skin puncture, 1 mL of saline was injected through the needle over a histological slide to prepare a smear that was dyed by the Giemsa method to enable tissue identification if present. All animals remained in captivity for 21 days under medical observation and were killed by decapitation. The lumbosacral spinal cord portion was removed for histological analysis using hematoxylin-eosin stain. None of the animals had impaired motor function or decreased nociception during the period of clinical observation. None of the animals from the control group (GIII) showed signs of injuries to meninges. In GII, however, 4 animals presented with signs of meningeal injury. The main histological changes observed were focal areas of perivascular lymphoplasmacyte infiltration in the pia mater and arachnoid. There was no signal of injury in neural tissue in any animal of both groups. Tissue coring containing ink pigments was noted in all GI smears from the spinal needles used to puncture the tattooed skin. On the basis of the present results, intrathecal injection of saline through a needle inserted through tattooed skin is capable of producing histological changes over the meninges of rabbits. Ink fragments were entrapped inside the spinal needles, despite the presence of a stylet.