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Introduction: Estimating patient risk before heart surgery (HS) is crucial. Perioperative inflammation is associated with several complications and mortality. This study investigated blood cell count inflammatory indices (BCCII) to predict risks, including neutrophil-to-lymphocyte ratio (NLR), derivate NLR (DNLR), neutrophil-to-platelet-lymphocyte ratio (NLPR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), Systemic Inflammatory Index (SII), Systemic Inflammatory Reaction Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)., Methods: Data from a cohort of patients undergoing on-pump HS at a single center in Brazil were retrospectively analyzed. Data were obtained from medical records and a laboratory analyzer, and SPSS version 20.0 was used for index calculations and statistical analyses., Results: In total, 444 surgeries were performed, and 40 in-hospital deaths occurred. Except for PLR, all other indexes were independent predictors of death after multivariate adjustment (all p < 0.05). Discrimination performance was absent for PLR and AISI, and NLR, NLPR, and DNLR demonstrated the best area under the receiver operating characteristic curve (AUC > 0.7; all p < 0.0001). For survivors (n = 404), all indexes exhibited a correlation with the length of hospital stay (all p < 0.03), and NLR, NLPR, and DNLR were predictors (p < 0.026) of poor operative outcomes (acute myocardial infarction, cerebrovascular attack, cardiac arrest, low cardiac output, prolonged mechanical ventilation, renal failure, and sepsis)., Conclusions: All BCCII scores were associated with length of hospital stay. Apart from PLR, all indexes were independent predictors of in-hospital mortality. Accuracy was highest for NLR, NLPR, and DNLR; for survivors, these three factors were good predictors of poor operative outcomes., (© 2024 John Wiley & Sons Ltd.)

Background: The health risks that usually affect teachers are already known; however, the predictors of health related absenteeism, presenteeism, and sick leave have not yet been fully described., Objective: To analyze the predictors of health-related absenteeism, presenteeism, and sick leave among elementary school teachers., Methods: This study involved a probabilistic sample of 519 Brazilian elementary school teachers. The outcomes were days of health-related absenteeism, presenteeism, and sick leave in the previous 12 months. Work-place and individual factors were the independent variables analyzed., Results: Inadequate infrastructure of schools, disability, and medical consultations were positively associated with all outcomes. Teachers who reported having a chronic disease, common mental disorders, and voice disorders presented higher absenteeism and presenteeism days. Musculoskeletal pain and low job support were associated with higher presenteeism and sick leave days. Teachers who performed strength and flexibility activities presented less presenteeism, those who reported physical violence at school were more frequently absent, and teachers with depersonalization presented a higher likelihood of sick leave., Conclusions: The prevention of health-related absenteeism, presenteeism, and sick leave among elementary teachers should ensure adequate work conditions and prevention and monitoring of health risks.

Background: Diffuse large B-cell lymphoma, among non-Hodgkin lymphomas, is one of the most frequent subtypes. Clinical laboratory data and post-treatment outcomes are scarce in the Brazilian population., Objective: The main objective of this retrospective study was to assess the impact of tumor markers, including the Myeloid differentiation primary response 88 (MYD88) mutation., Method: Eighty-three patients were included and treated with R-CHOP or R-CHOP-like regimens., Results: Median age was 64-years old and 58% were female patients. The median follow-up was 42 months. The progression free survival (PFS) at this time was 63% and overall survival (OS), 66%. In the patients with tumors expressing Myc proto-oncogene protein (MYC) and B-cell lymphoma 2 (BCL2), assessed by immunohistochemistry (IHC), known as dual protein expressers, median post-progression survival was 31 (15-45) months. An increased proliferative index were associated with a high rate of progression (hazard ratio 2.31 [95% confidence interval [1.05-5.12]; p  = 0.04). The cell of origin (COO), identified by IHC, was not able to predict PFS ( p  = 0.76). The MYD88 L265P mutation was present in 10.8% (9/83) of patients and did not show a prognostic correlation., Conclusion: In conclusion, the MYD88 mutation, although an important tool for diagnosis and a possible target drug, presented at a low frequency and was not a prognostic marker in this population.

Purpose:: To investigate the effects of cyclosporine A on renal ischemia-reperfusion injury during transient hyperglycemia in rats., Methods:: In a model of ischemia-reperfusion-induced renal injury and transiently induced hyperglycemia by intraperitoneal injection of glucose, 2.5 g.kg-1, Wistar rats were anesthetized with either isoflurane or propofol and received intravenous cyclosporine A, 5 mg.kg-1, five minutes before reperfusion. Comparison groups were isoflurane and propofol sham groups and isoflurane and propofol ischemia-reperfusion-induced renal injury. Renal tubular cell viability was quantitatively assessed by flow cytometry after cell culture and classified as early apoptosis, necrotic cells, and intact cells., Results:: Early apoptosis was significantly higher in isoflurane and propofol anesthetized animals subjected to renal ischemia-reperfusion injury when compared to both cyclosporine A treated and sham groups. Necrosis percentage was significantly higher in propofol-anesthetized animals subjected to renal ischemia-reperfusion injury. The percentage of intact cells was lower in both, isoflurane and propofol anesthetized animals subjected to renal ischemia-reperfusion injury., Conclusion:: In a model of ischemia-reperfusion-induced renal injury, cyclosporine A, 5 m.kg-1, administered five minutes before renal reperfusion in rats with acute-induced hyperglycemia under either isoflurano or propofol anesthesia, attenuated early apoptosis and preserved viability in renal tubular cells, regardless of the anesthetic used.

There is a 0.138% incidence of adverse reactions related to blood transfusion. Transfusion-related acute lung injury, immunosuppression, fever, pathogen transmission, and hemolytic transfusion reactions are the most common ones. Synthetic oxygen carriers have been developed to deal with blood shortages and for use in the field where stored blood was not available. They were also designed to be pathogen free, including unknown viruses. In this study, we used Male Golden Syrian Hamsters implemented with a dorsal window chamber to determine how infusion of three different, genetically crosslinked recombinant acellular hemoglobin (rHb) solutions with different oxygen affinities and nitric oxide kinetics affect mean arterial pressure (MAP), heart rate (HR), kidney function, and kidney structure. We found that the administration of all three rHb solutions caused mild hypertension and bradycardia 30 minutes after infusion. However, acute changes in glomerular filtration rate (GFR) were not detected, even though histological analysis was performed 72 hours after treatment revealed some structural changes. All the rHb solutions resulted in hypertension 30 minutes after a 10% topload administration. Regardless of their properties, the presence of acellular Hb causes significant alterations to kidney tissue.

Purpose: To investigate changes in the serum concentration and renal expression of IL-1 and TNF-α cytokines in rats that received sevoflurane and glibenclamide prior to hemorrhage., Methods: Two groups of sevoflurane-anesthetized Wistar rats (n=10): G1 (control) and G2 (glibenclamide, 1 µg/g i.v.); hemorrhage of 30% blood volume (10% every 10 min), with replacement using Ringer solution, 5 ml/kg/h. Serum concentrations of IL-1 and TNF-α were studied in the first hemorrhage (T1) and 50 min later (T2), renal expression, at T2., Results: In serum, G1 TNF-α (pg/mL) was T1=178.6±33.5, T2=509.2±118.8 (p<0.05); IL-1 (pg/mL) was T1=148.8±31.3, T2=322.6±115.4 (p<0.05); in G2, TNF-α was T1=486.2±83.6, T2=261.8±79.5 (p<0.05); IL-1 was T1=347.0±72.0, T2= 327.3±90.9 (p>0.05). The expression of TNF-α and IL-1 in the glomerular and tubular cells was significantly higher in the G2 group., Conclusions: Hemorrhage and glibenclamide elevated TNF-α and IL-1 concentrations in serum and kidneys. High levels of TNF-α already present before the hemorrhage in the glibenclamide group may have attenuated the damages found in the kidneys after the ischemia event.

Purpose: To investigate whether allopurinol exerts a protective effect on kidneys by measuring new kidney injury biomarkers (NGALp, NGALu, KIM 1 and IL 18) and analysing the renal function and histology in uninephrectomised rats subjected to ischaemia-reperfusion injury., Methods: Thirty two Wistar rats were randomly allocated to four groups: Sham (S): laparotomy; Control (C): laparotomy and ischaemia-reperfusion in the left kidney; Control Allopurinol (CA): laparotomy and allopurinol at a dose of 100mg·kg 1·d 1; and Allopurinol (A): laparotomy ischaemia-reperfusion in the left kidney and allopurinol at a dose of 100mg·kg 1·d 1. The NGALp, NGALu, KIM 1, IL 18 and creatinine levels and the kidney histology were analysed. The significance level was established as p<0.05., Results: Creatinine level increased in all the groups, with A ≈ C > S ≈ CA. The NGALp, NGALu and IL 18 levels exhibited similar behaviour in all the groups. KIM 1 was higher in group A than C and showed intermediate values in groups S and CA. Severity of injury in the left kidney was greater in groups C and A compared to S and CA., Conclusion: Allopurinol did not exert protective or damaging effects on the kidneys of rats subjected to ischaemia-reperfusion injury.

Objective: 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., Methods: 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 calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels., Results: Serum cystatin C levels increased during the study (T1 = T2T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson's analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate., Conclusion: This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal renal function who are undergoing laparoscopic procedures.

Purpose: To study the effect of isoflurane (Iso) or propofol (Prop) anesthesia on renal ischemia/reperfusion injury (IRI) during transient hyperglycemia., Methods: Thirty six rats were randomly assigned into six groups of six animals each: PHS (Sham-Prop=1mg.kg-1.min-1 + Hyperglycemia=2.5g.kg-1 of glucose solution administered intraperitoneally); HIS (Sham-Iso + Hyperglycemia); PHI (Prop + Hyperglycemia + Ischemia); IHI (Iso + Hyperglycemia + Ischemia); PI (Prop + Ischemia), and II (Iso + Ischemia). After 30 minutes of anesthesia induction, right nephrectomy was performed (all animals) and the left renal artery was clamped during 25 minutes (ischemia). The animals were sacrificed after 24 hours and blood collection (to dose creatinine) and left kidney removal were performed for histological analysis, and flow cytometry (FCM): percentage of initial apoptosis (APTi) and viable cells (VC)., Results: Serum creatinine (mg/dL) was statistically different in groups PHI (3.60±0.40) and IHI (3.23±1.08), p<0.05. Histological analysis was statistically different in groups PHI (4.0[4.0;5.0]) and IHI (4.5[4.0;5.0]), p<0.05. APTi percentage was statistically different in groups PHI (73.2±7.1), and IHI (48.1±14). VC percentage was statistically different in groups PHI (25.8±6.9) and IHI (38.5±9.2), p<0.05., Conclusions: Propofol and isoflurane showed the same level of protection against ischemia/reperfusion injury in the normoglycemic groups. Transient hyperglycemia is associated with an increase in IRI.

Purpose: To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (RL) in a rodent model of non-septic renal ischemia., Methods: Forty male Wistar rats were randomized to receive HES 2 ml.kg(-1).hr(-1) or RL 5 ml.kg(-1).hr(-1) that underwent 30 minutes of renal ischemia followed by reperfusion. Twelve hours after kidney ischemia, the kidneys were evaluated for histological changes. Serum NGAL levels were obtained at different times of the experimental protocol., Results: Rodents in the HES group had a median (IQR) grade of renal injury 3 (3 to 5) compared to 2 (2 to 4) in the RL group (p=0.03). NGAL levels were not associated with the severity of kidney injury., Conclusion: Hydroxyethyl starch administration caused more kidney injury than Ringer's lactate in a non-infectious model of renal hypoperfusion.

A fluorimetric microassay that uses a redox dye to determine the viability of the flagellate Trichomonas vaginalis has been optimised to provide a more sensitive method to evaluate potential trichomonacidal compounds. Resazurin has been used in recent years to test drugs against different parasites, including trichomonadid protozoa; however, the reproducibility of these resazurin-based methods in our laboratory has been limited because the flagellate culture medium spontaneously reduces the resazurin. The objective of this work was to refine the fluorimetric microassay method previously developed by other research groups to reduce the fluorescence background generated by the media and increase the sensitivity of the screening assay. The experimental conditions, time of incubation, resazurin concentration and media used in the microtitre plates were adjusted. Different drug sensitivity studies against T. vaginalis were developed using the 5-nitroimidazole reference drugs, new 5-nitroindazolinones and 5-nitroindazole synthetic derivatives. Haemocytometer count results were compared with the resazurin assay using a 10% solution of 3 mM resazurin dissolved in phosphate buffered saline with glucose (1 mg/mL). The fluorimetric assay and the haemocytometer counts resulted in similar percentages of trichomonacidal activity in all the experiments, demonstrating that the fluorimetric microtitre assay has the necessary accuracy for high-throughput screening of new drugs against T. vaginalis.

Purpose: To evaluate the effect of N-acetylcysteine, as a renoprotective agent, when administered early after anesthesia induction, against ischemia/reperfusion injury in rats anesthetized with isoflurane., Methods: Eighteen male Wistar rats weighing > 300 g were anesthetized with isoflurane. The internal jugular vein and the left carotid artery were dissected and cannulated. The animals were randomly divided into GAcetyl, receiving intravenous N-acetylcysteine, 300 mg/kg, and GIsot, isotonic saline. After 30 minutes, right nephrectomy was performed and the left renal artery was clamped during 45 minutes. The animals were sacrificed after 48 hours and blood samples were taken after anesthetic induction and upon sacrificing of the animals to evaluate blood creatinine. The kidneys were sent for histological analysis., Results: The variation in serum creatinine was 2.33 mg/dL ± 2.21 in GAcetyl and 4.38 mg/dL ± 2.13 in GIsot (p=0.074). Two animals presented intense tubular necrosis in GAcetyl, compared to 5 in GIsot. Only GAcetyl presented animals free of tubular necrosis (two) and tubular degeneration (one)., Conclusion: After renal ischemia/reperfusion, the rats which were given N-acetylcysteine presented less variation in serum creatinine and milder kidney injuries than the control group.

Purpose: To investigate the influence of intravenous nonselective cyclooxygenase inhibitor, ketoprofen (keto), on kidney histological changes and kidney cytokines, tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1), levels after hemorrhage of 30% of volemia (three times 10%, intervals of 10 min) in rats., Methods: Under sevoflurane (sevo) anesthesia, sevo and sevo+keto groups (10 rats each) were instrumented for Ringer solution (5 mL/kg/h) administration and mean arterial pressure (MAP) evaluation, plus keto (1.5mg/kg) administration in sevo+keto group in the beginning of anesthesia. Rectal temperature was continuously measured. The baseline data of temperature and MAP were collected at the first hemorrhage (T1), the third hemorrhage (T2) and 30 min after T2 (T3). Bilateral nephrectomy was achieved for histology and immunohistochemistry., Results: In both groups, temperature and MAP diminished from initial values. Hypothermia was greater in sevo group (p=0.0002). Tubular necrosis was more frequent in sevo group (p=0.02). The studied cytokines were equally present in the kidneys of both groups., Conclusion: Ketoprofen was more protective to the rat kidney in condition of anesthesia with sevoflurane and hypovolemia, but it seems that TNF-α and IL-1 were not involved in that protection.

Background and Objectives: Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP., Methods: A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis., Results: 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27)., Conclusions: Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks., (Copyright © 2011 Elsevier Editora Ltda. All rights reserved.)

Purpose: To investigate blood creatinine and renal histology in rats anesthetized with S(+)-ketamine (keta) or dexmedetomidine (dex) and submitted to kidney ischemia/reperfusion injury (IRI)., Methods: Under intraperitoneal (ip) S(+)-ketamine, 20 male Wistar rats were divided into two groups (n=10): maintenance with iv S(+)-ketamine or dex (keta and dex groups), and submitted to right (R) nephrectomy and left (L) renal artery clamping for 45 min. Blood creatinine was measured before ischemia (T1) and 48h after reperfusion (T2), when L nephrectomy was performed. Histological analysis was performed in all kidneys., Results: Blood creatinine was significantly higher at T2 in both groups, but dex group results were lower than those of keta group. Histological changes: between groups, R kidneys did not differ; there were significant high scores for vascular dilation: keta L kidneys; for vascular congestion, tubular dilation, and necrosis: L kidneys from both groups; for tubular degeneration: keta R kidneys., Conclusion: S(+)-ketamine plus IRI were aggressive to rat kidneys, according to histological changes, and dexmedetomidine may have not totally protected the kidneys from these injuries, despite the better results of blood creatinine.

Context and Objective: Anesthesiologist-patient relationships are established preoperatively and intraoperatively. These are opportunities for providing correct information about anesthesia/anesthesiologists, thereby improving outcomes. The aim here was to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions., Design and Setting: Prospective cross-sectional study using data obtained in 2007-2008, at a tertiary university hospital., Methods: 518 patients aged 16 years or over were interviewed before and after anesthesia exposure. A questionnaire was used to determine patient characteristics and perceptions of anesthesia/anesthesiologists., Results: The patients were 16-89 years of age and 59.8% had attended elementary school. 79.1% said that anesthesiologists were specialized physicians. Anesthesiologists' roles were associated with loss of consciousness (35.5% pre-anesthesia; 43.5% post-anesthesia), pain relief (29.7% pre-anesthesia, 31.7% post-anesthesia), vital sign monitoring (17.6% pre-anesthesia, 35% post-anesthesia; P < 0.05); and drug administration (10.8% pre-anesthesia, 43.9% post-anesthesia; P < 0.05). The level of confidence in the physician was rated high (82.2% and 89.8% pre- and post-anesthesia, respectively; P < 0.05) or intermediate (5.8% and 6.6% pre- and post-anesthesia, respectively; P < 0.05). The care provided by anesthesiologists was classified as: elucidating (52.8%), encouraging (52.6%), neutral (10.2%) and careless (0.8%)., Conclusion: Patients' perceptions of anesthesiologists' roles were fairly good, but improvements in this relationship still need to be pursued, to achieve better outcomes. Anesthetic care was important in providing information, confidence and reassurance among patients, regarding their perceptions. Anesthesiologists should not miss opportunities to provide excellent professional care for patients, thereby improving anesthesia outcomes and their image.

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), γ-glutamyltransferase (γGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2)., Results: Values of γGT, γGT/Ucr, and AP × γGT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m(2)) presented increased γGT/Ucr and AP × γGT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m(2)) presented increased γGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltaγGT, deltaγGT/Ucr, deltaAP/Ucr, and deltaAP × γGT/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.

Objective: The aim of this study was to compare cystatin C versus creatinine as a marker for acute kidney injury in patients submitted to cardiac surgery with cardiopulmonary bypass., Methods: Fifty consecutive patients submitted to coronary artery bypass grafting were studied. Renal function was evaluated by serum cystatin C and creatinine. Blood samples were obtained from each patient at three time points: before operation, and on the first and fifth postoperative days. Glomerular filtration rate (GFR) was calculated by Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Larsson (Cys-GFR) formulas., Results: Creatinine and GFR by CG and MDRD formulas did not show statistical difference between study times. After renal injury from surgery, there was an increase in cystatin C on the 1st and 5th day after surgery, being significantly different on the 5th postoperative (P<0.01). The GFR by Larson formula was higher in the preoperative time (105.2 +/- 41.0 ml/min) than in the 5th postoperative day (89.5+/- 31.5 ml/min; P<0.012)., Conclusion: The cystatin C and the Cys-GFR showed significant changes after cardiac surgery when compared with the creatinine and respective GFR calculated by the Cockcroft-Gault and MDRD formulas.

Objective: Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia., Methods: Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 microg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison., Results: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination., Conclusion: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

Introduction: Halogenated anesthetics can cause changes in the variables that modify the cardiac output necessary to maintain renal hemodynamic during hemorrhagic shock and resuscitation. However, halogenated anesthetics seem to protect against renal ischemia-reperfusion injury. In a model of pressure-guided hemorrhagic shock in dogs, we studied the comparative effects of three halogenated anesthetics-halothane, sevoflurane, and isoflurane-at equipotent concentrations on renal responses after resuscitation., Methods: Thirty dogs were anesthetized with 1.0 minimum alveolar anesthetic concentration (MAC) of halothane, sevoflurane, or isoflurane. The dogs were splenectomized and hemorrhaged to hold mean arterial pressure at 40-50 mm Hg over 45 min and then resuscitated with the shed blood volume. Hemodynamic variables were measured at baseline, after 45 min of hemorrhage, and 15 and 60 min after resuscitation. Renal variables were measured at baseline and 15 and 60 min after resuscitation., Results: Hemorrhage induced reductions of mean arterial pressure, filling pressures, and cardiac index (p < 0.05), without significant differences among groups (p > 0.05). After 60 min of shed blood replacement, all groups restored hemodynamic and renal variables to the prehemorrhage levels (p > 0.05), without significant differences among groups (p > 0.05), with the exception of sodium fractional excretion, the values for which were significantly higher in isoflurane group, in relation to the other groups after 15 min of re-transfusion (p < 0.05), and renal vascular resistance, the values for which remain lower than baseline in halothane group (p < 0.05)., Conclusions: We conclude that no difference could be detected between choosing equipotent doses of halothane, sevoflurane, or isoflurane in relation to renal variables in dogs submitted to pressure-adjusted hemorrhagic shock and resuscitation.

Some properties of the volatile anesthetics, such as vasodilatation and myocardial depression, combined with the sympathetic inhibition that alpha2-agonists can produce, may determine hemodynamic alterations during aortic surgery. The interaction between dexmedetomidine (DEX), an alpha2-agonist, and sevoflurane during aortic surgery is unknown. We studied the effects of DEX on hemodynamics and systemic oxygenation during aortic cross-clamping (Aox) and unclamping (UAox) in sevoflurane-anesthetized dogs. Twenty dogs were anesthetized with sevoflurane and were randomly assigned to two groups prior to Aox and UAox: control, n = 10, received saline infusion only, and DEX (1 microg x kg(-1) load followed by 1 microg x kg(-1) x h(-1) infusion), n = 10. Hemodynamic and oxygenation variables were measured at baseline, after saline or DEX loading dose, 20 and 40 min after Aox, and 20 and 40 min after UAox. After DEX administration, heart rate, cardiac index (CI) and systemic oxygen transport index (DO(2)I) were lower than in control group. Aox increased mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) in both groups, but the effects were greater with DEX. CI, heart rate, and DO(2)I were lower, while central venous pressure (CVP) and pulmonary artery occlusion pressure were higher in DEX compared to control. After UAox, MAP, CVP and SVRI were maintained higher in DEX in relation to control. We conclude that in sevoflurane-anesthetized dogs DEX alters the cardiovascular response during aortic surgery.

Context and Objective: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor., Design and Setting: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista., Methods: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 microg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score)., Results: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination., Results: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination., Conclusion: Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.

Context and Objective: The significant relationship between upper abdominal surgery and early (perioperative) pulmonary events was investigated among patients with preoperative pulmonary conditions undergoing general anesthesia., Design and Setting: Retrospective study for which data were obtained prospectively from 1999 to 2004, at a tertiary university hospital., Methods: We retrospectively studied 3107 patients over 11 years old presenting American Society of Anesthesiologists (ASA) status I, II or III who underwent upper abdominal surgery under general anesthesia and were discharged to the recovery room. The preoperative conditions analyzed using logistic regression were: age, sex, ASA physical status, congestive heart failure, asthma, chronic obstructive pulmonary disease (COPD), respiratory failure and smoking. The outcomes or dependent variables included intraoperative and postoperative events: bronchospasm, hypoxemia, hypercapnia, prolonged intubation and airway secretion., Results: Among these patients (1500 males, 1607 females, mean age 48 years, 1088 ASA I, 1402 ASA II and 617 ASA III), there were 80 congestive heart failures, 82 asthmatics, 122 with COPD, 21 respiratory failures and 428 smokers. Logistic regression analysis showed that female sex (p < 0.001), age over 70 years (p < 0.01), smoking (p < 0.001) and COPD (p < 0.02) significantly influenced pulmonary event development, particularly hypoxemia and bronchospasm, at both times but not in the same patients. Asthma and congestive heart failure cases did not present pulmonary events in the recovery room., Conclusion: In upper abdominal surgery under general anesthesia, female sex, age over 70, smoking and COPD were independent risk factors for intra and postoperative pulmonary events.

Purpose: About 50 % of indications for dialysis in acute renal failure are related to problems originated during the perioperative period. Intraoperative hemodynamic changes lead to renal vasoconstriction and hypoperfusion. Previous studies have not defined the dexmedetomidine renal role in hemorrhage situations. This study evaluated the effect of dexmedetomidine on renal function and histology after acute hemorrhage in rats., Methods: Covered study with 20 Wistars rats, anesthetized with sodium pentobarbital, 50 mg.kg(-1), intraperitoneal, randomized into 2 groups submitted to 30% volemia bleeding: DG - iv dexmedetomidine, 3 microg.kg(-1) (10 min) and continuous infusion - 3 microg.kg(-1).h(-1); CG - pentobarbital. For renal clearance estimative, sodium p-aminohippurate and iothalamate were administered. Studied attributes: heart rate, mean arterial pressure, rectal temperature, hematocrit, iothalamate and p-aminohippurate clearance, filtration fraction, renal blood flow, renal vascular resistance, and histological evaluations of the kidneys., Results: DG showed smaller values of heart rate, mean arterial pressure, and renal vascular resistance, but iothalamate clearance and filtration fraction values were higher. There was similarity in p-aminohippurate clearance and renal blood flow. Both groups had histological changes ischemia-like, but dexmedetomidine determined higher tubular dilatation scores., Conclusion: In rats, after acute hemorrhage, dexmedetomidine determined better renal function, but higher tubular dilation scores.

Context and Objective: Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication., Design and Setting: Prospective and randomized study at Hospital das Clínicas, Universidade Estadual Paulista, Botucatu., Methods: Thirty patients presenting American Society of Anesthesiologists (ASA) physical status I and II who were scheduled for elective lower abdominal surgery were utilized. The patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. Ten patients (Gcontrol) received preoperative and intraoperative passive thermal insulation. Ten patients (Gpre+intra) underwent preoperative and intraoperative active warming. Ten patients (Gintra) were only warmed intraoperatively., Results: After 45 min of preoperative warming, the patients in Gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (Gcontrol and Gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). The patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in Gcontrol at the end of surgery (p < 0.05). All the patients were hypothermic at admission to the recovery room (T CORE < 36 degrees C)., Conclusions: Forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.

Background and Objectives: The association of an opioid with a local anesthetic improves the quality of labor analgesia and reduces the risk of systemic toxicity of the local anesthetic. However, opioids are not devoid of side effects. The aim of this study was to compare the side effects of subarachnoid sufentanil associated with bupivacaine to those caused by epidural sufentanil associated with ropivacaine in the doses used in the Anesthesiology Department in pregnant women undergoing labor analgesia., Methods: Sixty pregnant women, ASA physical status I and II, ages between 15 and 42 years, at term and with healthy fetuses, undergoing labor analgesia were enrolled in this study. They were randomly divided in two groups: G1 - combined spinal epidural anesthesia - 0.5% bupivacaine (2.5 mg) and subarachnoid sufentanil (5 microg); G2 - Epidural Block - 0.2% ropivacaine (20 mg), and epidural sufentanil (10 microg). Complementary doses of 0.2% ropivacaine (12 mg) were administered whenever necessary, and 1% ropivacaine (50 mg) was administered for labor resolution. Patients were evaluated after analgesia (M1) regarding the presence of hypotension, maternal bradycardia, pruritus, nausea, vomiting, respiratory depression, and sedation. They were also evaluated postoperatively (M2) regarding the presence of nausea, vomiting, pruritus, sedation, urinary retention, and pain. Newborns were evaluated by the Apgar score. The test t Student, Mann-Whitney test, and Chi-Square test were used for the statistical analysis., Results: Both groups were similar regarding age, weight, height, duration of labor after analgesia, Apgar score of the newborns, hypotension, maternal bradycardia, nausea, vomiting, pruritus, and urinary retention. Sedation was more frequent in patients in G2 at M1 (50%), which was statistically significant., Conclusion: Subarachnoid or epidural sufentanil, in the doses used in this study, associated with local anesthetics, had the same effect on the duration of labor after analgesia and in the Apgar score of newborns. Sedation was the most frequent side effect in patients receiving epidural sufentanil.

Background and Objectives: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery., Contents: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described., Conclusions: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

Introduction: 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., Material and Methods: 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., Results: 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., Conclusion: Treatment with glibenclamide attenuated acutely the renal histological changes after hemorrhage in rats under sevoflurane anesthesia.

Purpose: To investigatge right-to-left shunt determination in dog lungs under inhalantion anesthesia with non-rebreathing and rebreathing systems and fraction of inspired oxygen (F I O2) of 0.9 and 0.4, respectively., Methods: Two groups of 10 dogs each under inhalation anesthesia with sevoflurane: GI in which it was utilized non-rebreathing semiclosed system and F I O2 = 0.9, and GII in which it was utilized rebreathing semiclosed system and F I O2 = 0.4. The study parameters were: heart rate, medium arterial pressure, right-to-left intrapulmonary shunt, hematocrit, hemoglobin, arterial partial pressure of oxygen, mixed venous partial pressure of oxygen, mixed venous oxygen saturation, arterial partial pressure of carbon dioxide, partial pressure of water in the alveoli., Results: Shunt results were significantly different between the two groups - GI data were higher than GII in all the evaluated moments. Hence, the group with nonrebreathing (GI) developed a superior grade of intrapulmonary shunt when compared with the rebreathing group (GII). The partial pressure of water in the alveoli was significantly higher in GII., Conclusion: The inhalation anesthesia with non-rebreathing system and F I O2 = 0.9 developed a higher grade of intrapulmonary right-to-left shunt when compared with the rebreathing system and F I O2 = 0.4. The higher humidity in GII contributed to the result.

Background and Objectives: There are controversies regarding whether labor analgesia can interfere with labor and the vitality of the newborn. The objective of this study was the interaction between labor analgesia, using the continuous epidural and combined spinal-epidural techniques with a small dose of local anesthetic, and the type of delivery analyzing the newborn's weight and Apgar score., Methods: The results of 168 labor analgesias (from January 2002 to January 2003) were analyzed. They were divided in 4 groups: G1 (n = 58), continuous epidural and evolution to vaginal delivery; G2 (n = 69), combined spinal-epidural and evolution to vaginal delivery; G3 (n = 25), continuous epidural and evolution to cesarean; G4 (n = 16), combined spinal-epidural and evolution to cesarean. G1 received 0.125% ropivacaine (12 to 15 mL), G2 received subarachnoid 0.5% bupivacaine (0.5 to 1 mL) and sufentanil (10 mg). Epidural ropivacaine 0.5% for the vaginal delivery (8 mL) and for cesarean (20 mL). The patient's age, weight, height, body mass index (BMI), gestational age, number of prior pregnancies, and complications (arterial hypotension, bradycardia, and hypoxia) and the newborn's weight and Apgar score (at 1, 5, and 10 minutes) were evaluated., Results: The majority of pregnant women were primiparous and presented with a term pregnancy (one with gestational age of 28 weeks and none post-term pregnancy); weight, G2 < G4; and MBI, G2 pound G4. For the weight of the newborn, G1 < G3 and G2 < G4, and for the Apgar score at 1st minute, G1 > G3., Conclusions: If the analysis focuses the newborn's weight and Apgar score, the techniques of analgesia, continuous epidural and combined spinal-epidural with small doses of local anesthetic, do not interfere with the result of the delivery.

Purpose: To study in rats the effect of S(+) ketamine on the renal histology after intraoperative hemorrhage., Methods: Twenty male Wistar rats, anesthetized with sodium pentobarbital, were randomly divided in 2 groups: G1 - control (n=l0) and G2 - S(+)-ketamine (n=10), both submitted to arterial hemorrhage of 30% of volemia in 3 moments (10% each 10 min) 60 min after anesthesia. G2 received S(+)-ketamine, 15 mg. kg-1, i.m., 5 min after anesthesia and 55 min before the 1st hemorrhage moment (Ml). Medium arterial pressure (MAP), rectal temperature (T) and heart rate were monitored. The animals were sacrificed in M4, 30 min after the 3rd hemorrhage moment (M3) and the kidneys and blood collected from hemorrhage were utilized for histological study and hematocrit (Ht) determination., Results: There were significant reduction of MAP, T, and Ht. The histological study verified G1 = G2 for tubular dilation, congestion, and necrosis. The total score addition were significantly different and G2 > G 1., Conclusion: Hemorrhage and hypotension determined changes in kidney histology. The rise in catecholamine blood concentration probably was the cause of S(+)-ketamine-induced higher score of histological changes.

Background and Objectives: Lidocaine concentration potentially able to determine nervous tissue injury is still not well established. This study aimed at investigating the effect of increasing spinal lidocaine concentrations in single injection through Quincke needle., Methods: After the Animal Experiment Ethical Committee approval, 40 adult animals were anesthetized with fentanyl and etomidate and submitted to spinal puncture with 22G 21/2 Quincke needle for the introduction of 1 mL of 7.5% glucose solution in 10 seconds - Group 1; 5% lidocaine in 7.5% glucose solution - Group 2; 7.5% lidocaine in 7.5% glucose solution - Group 3; 10% lidocaine in 7.5% glucose solution - Group 4. After intravenous anesthesia recovery and in the presence of spinal block, the following parameters were observed: presence of motor block, anal sphincter tone (normal or relaxed) and sensory block level in different cervical, thoracic, lumbar and sacral dermatomes. Animals remained in captivity for 72 hours. Anal sphincter tone, hind paws mobility, painful fore and hind paws and sacral, lumbar and thoracic dermatomes sensitivity were evaluated. Were euthanized by electrocution under anesthesia and spinal cord and meningeal lumbar and sacral portions were removed for histological exam under optic microscopy., Results: No Group 1 and 2 animal presented clinical or histological injuries. Three Group 3 animals presented hind paws motor changes and anal sphincter relaxation with foci of posterior necrosis (two dogs) and fascial necrosis in all spinal cord surface (one dog). In a different animal of this group in which foci of necrosis were observed in less than 5% histological field, no clinical changes were found. Seven Group 4 animals presented clinical changes (paralysis or decreased muscle strength in hind paws, anal sphincter relaxation) or histological changes (spinal cord surface band necrosis or nervous tissue necrosis foci)., Conclusions: In this study, spinal lidocaine in concentrations above 7.5% in single injection through Quincke needle has determined histological changes on spinal cord, but not on meninges.

Introduction: The renal prostaglandins (PGs), vasodilators, preserve kidney function during increased activity of the renin-angiotensin system or renal sympathetic nerves (renal PG-dependent state [RPGD]). Ketoprofen (Ket) inhibits cyclooxygenase and, therefore, the synthesis of PGs. The aim of this study was to determine, in the rat, the action of Ket in the renal histology and function in a RPGD state (stress of anesthesia and hemorrhage)., Material and Methods: Twenty male Wistar rats, anesthetized with sodium pentobarbital, were randomly divided into two groups: G1--control (n = 10) and G2-Ket (n = 10) submitted to arterial hemorrhage of 30% of volemia (estimated as 6% of body weight) three times (10% each 10 min), 65 min after anesthesia. G2 animals received Ket, 1.5 mg. kg(-1), venously, 5 min after anesthesia and 60 min before the first hemorrhage moment (first moment of the study [M1]). Medium arterial pressure (MAP), rectal temperature (T), and heart rate were monitored. G1 and G2 received para-aminohippurate sodium (PAH) and iothalamate sodium (IOT) solutions during the entire experimental time in order to determine clearance of PAH (effective renal plasma flow [ERPF]) and clearance of IOT (glomerular filtration rate [GFR]) without urine collection (determination of blood concentrations of PAH and IOT through the high-performance liquid chromatography), filtration fraction (FF), and renal vascular resistance (RVR). The animals were sacrificed in M3, 30 min after the third hemorrhage (M2) moment, and the kidneys and blood collected during the hemorrhage periods were utilized for histological study and determinations of hematocrit (Ht), serum creatinine (SCr), ERPF, GFR, FF, and RVR, respectively., Results: There were significant reductions of MAP, T, and Ht and a significant increase of SCr. During the experiment, ERPF and GFR did not change, but ERPF was always higher in G1 than in G2. Ket did not alter FF, which increased in G1 over the duration of experiment. The Ket group had significantly higher RVR than the control group. The histology verified that both G1 and G2 were similar for tubular dilation and necrosis, but they were significantly different for tubular degeneration: G1 > G2., Conclusion: The changes observed in kidney histology probably were determined by hemorrhage and hypotension. Ket inhibited the synthesis of PGs and diminished tubular degeneration.

Background and Objectives: Anesthetic quality and patients' satisfaction has been increasingly praised. Our objective was to evaluate anesthetic management of children and adolescents in our Hospital, by interviewing parents and/or tutors., Methods: 230 parents or tutors of children and adolescents submitted to anesthesia in the period April-December 2003 were interviewed during the postoperative visit through a four-item questionnaire: children and adolescents and their parents or tutors identification (item 1); explanations during preanesthetic evaluation (item 2) about anesthesia (item 3) and post-anesthetic recovery (PACU) (item 4). Person informing respondents was identified and the presence of post-anesthetic complications made known. Respondents have scored the Anesthesiology Department from 0 to 10., Results: Survey was answered by mothers in 189 (82.2%) of cases. Most respondents (114, 75.6%) were aged 20 to 39 years, were married (148, 64.3%), and 140 (60.9%) had no job. Anesthesiologists have introduced themselves to 89%; for 37% and 77.4% they have explained the importance and duration the fasting period; 82% were informed about anemia; 90% were informed about allergy; 46.8% were informed about PACU importance; 42.2% were explained about length of stay; 72.9% were informed about the health status of their children. There have been no concerns for 49%, 58% and 58%, respectively about pre, intra and post-anesthetic period; 78.9% would like to have been with their children at PACU arrival. Pre, intra and post-anesthetic concerns were related to patients' age and gender - no concern whatsoever for most respondents - and to respondents' education - the better the education the lower the number and diversity of reported concerns. Scores to the Anesthesiology department were mostly between 7 and 10 (97.4%)., Conclusions: The Anesthesiology Department provides satisfactory services, in spite of communication failures, which are easy to solve and depend more on Department's willingness than on scientific knowledge.

Background and Objectives: There are still few strictu sensu Post-Graduation Programs in Anesthesiology in Brazil. Aiming at fostering post-graduation in Anesthesiology in Brazil, we present the experience of ten years at Universidade Estadual Paulista (UNESP)., Contents: Strictu sensu post-graduation program in Anesthesiology - UNESP was accredited by CAPES since its beginning in 1994, for Master and Doctoral programs. The program is developed around three fields of study: Organs and Systems Risk and Protection in Anesthesia and Surgery; Quality and Safety in Anesthesiology; and Clinical and Experimental Models for Pain Therapy, with their respective 14 research lines. The number of regular students is compatible with the number of faculty advisers (12), with three students per adviser in average. From its beginning to September 2004, there were 45 Master and 24 Doctoral reports, in a total of 69 presentations, most of them with scholarships and funding granted by Research Fostering Agencies. After receiving their doctor's degree, 65% of students dedicate themselves to teaching and researching in Brazilian public and private universities. Most studies are published in Qualis A Brazilian journals with a lower number of publications in international Qualis A or B journals. The program was scored 4.0 by CAPES, in a scale from 1 to 7, in its three most recent evaluations., Conclusions: The program has positively evolved throughout its 10 years of existence and major objectives have been reached, such as qualification of professors and investigators in Anesthesiology for Brazilian universities.

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.

Background and Objectives: Plasmapheresis is the technique of choice for severe hemolytic anemia patients. A consequence is plasma cholinesterase depletion, which interferes with metabolism of some neuromuscular blockers currently used in anesthesiology., Case Report: Pregnant patient, 26 years old, physical status ASA IV, 30 weeks and 3 days gestational age, with sickle cell anemia, thalassemic trait and allo-immunization for high frequency antigens. Patient presented sickling crisis being transfused with incompatible blood. Patient evolved with massive hemolysis being admitted with 3 g/dL hemoglobin and 10% hematocrit, severe jaundice, tachycardia, apathic and pale. Hematological evaluation has concluded for the inexistence of compatible blood for transfusion. Patient was treated with steroids, immunoglobulins and plasmapheresis. In the second admission day patient evolved with acute renal failure and pulmonary edema, general state worsening and hemodynamic instability. Gestation resolution was indicated due to patient's clinical conditions and consequent acute fetal suffering. Patient was admitted to the operating room conscious, pale, with dyspnea, jaundice, 91% SpO2 in room air, heart rate of 110 bpm and blood pressure of 110 x 70 mmHg, under dopamine (1 microg.kg-1.min-1) and dobutamine (10 microg.kg-1.min-1). We decided for balanced general anesthesia with alfentanil (2.5 mg), etomidate (14 mg), atracurium (35 mg) and isoflurane. There were no anesthetic-surgical intercurrences. Patient was referred to ICU after surgery completion under tracheal intubation and vasoactive drugs, being extubated 3 hours later., Conclusions: This case was a challenge for the team since patient was hemodynamically instable with coagulogram abnormalities counterindicating regional anesthesia. In addition, plasmapheresis potentially depletes plasma cholinesterase reserves, interfering with anesthesia. However, available drug armamentarium has allowed for the safe management of this situation.

Background and Objectives: 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., Methods: 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): mL.min-1; filtration fraction (FF); sodium clearance (C NA): mL.min-1; potassium clearance (C K): mL.min-1; sodium fractional excretion (FE NA): %; sodium urinary excretion (U NA V): microEq.min-1; potassium urinary excretion (U K V): microEq.min-1. Experiment consisted of three 20-minute moments. Data were collected at 10 minutes of each moment and diuresis was measured in the beginning and end of each moment. At the end of M1, clonidine or saline were epidurally injected. After 20 minutes data were repeated in M2 and M3., Results: Epidural 10 microg.kg-1 clonidine in dogs has promoted significant changes with decreased heart rate and cardiac output and increased sodium para-aminophurate clearance/cardiac output ratio., Conclusions: In our conditions and doses, clonidine has not promoted renal function changes, but has decreased hemodynamic parameters (heart rate and cardiac output).

Background and Objectives: 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., Methods: 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)., Results: 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., Conclusions: 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.

Background and Objectives: Dexmedetomidine, alpha2-adrenergic agonist with alpha1:alpha2 specificity of 1:1620, does not promote respiratory depression and is intraoperatively used for sedation and analgesia. It has been used associated to opioids in anesthesia for procedures with high painful stimulation, such as intraperitoneal surgeries, and there are no references to its use as single agent. Dexmedetomidine was compared to sufentanil during intraperitoneal procedures in patients above 60 years of age., Methods: Participated in this study 41 patients randomly distributed in two groups: GS (n = 21), receiving sufentanil, and GD (n = 20) receiving dexmedetomidine for anesthetic induction and maintenance. Patients were given etomidate (GS and GD) with midazolam (GD) for induction and isoflurane and nitrous oxide for maintenance. Hemodynamic attributes (mean blood pressure and heart rate), emergence and extubation times, extubation site (OR or PACU), PACU stay, need for additional analgesia and antiemetics in PACU, OR and PACU complications, Aldrete-Kroulik index at PACU discharge and the need for oxygen mask at PACU discharge were evaluated., Results: There were no differences in hemodynamic stability. GD group has remained for a shorter time in PACU with lower need for oxygen mask at PACU discharge., Conclusions: Dexmedetomidine may be used as single analgesic for intraperitoneal procedures in patients above 60 years of age, promoting hemodynamic stability similar to sufentanil, with better recovery profile.

Background and Objectives: Ropivacaine was introduced in the clinical practice a little more than 10 years ago, and has been associated to low risk for central nervous system and cardiovascular complications. These reports aimed at presenting a case of cardiac arrest and another one of neurological toxicity after accidental intravascular ropivacaine injection during epidural anesthesia., Case Reports: Two patients undergoing cosmetic plastic surgeries were submitted to thoracic epidural anesthesia with 0.5% ropivacaine. After anesthetic injection, one has presented cardiac arrest in asystole and the other had signs of neurological toxicity. Patients were promptly treated and presented fast recovery, in a way that both surgical procedures could be performed., Conclusions: The prompt Identification and treatment of the accidental intravascular injection, as well as ropivacaine pharmacological profile, were decisive in both cases for the satisfactory recovery of our patients.

Background and Objectives: Accidental injection of non-spinal drugs in epidural and spinal spaces is a possible anesthetic complication. This report presents a case of inadvertent spinal metoclopramide injection., Case Report: Female patient, 17 years old, 69 kg, BMI = 26.2, physical status ASA I, 36 weeks and 4 days gestation, with acute fetal suffering and C-section indication. Patient presented with heart rate of 82 bpm, blood pressure of 130 x 70 mmHg, SpO2 of 97% and regular sinusoidal cardiac rhythm. Spinal anesthesia performed with a local anesthetic and opioid association, 15 mg of 0.25% hyperbaric bupivacaine and 25 microg fentanyl. Patient referred unspecific 'discomfort' 5 minutes after blockade installation. Blood pressure was 190 x 120 mmHg, heart rate was 145 bpm and SpO2 was 95%. Checking the vials, one bupivacaine vial and one metoclopramide vial were found. Symptoms were severe frontal headache, blurred view, nausea, vomiting and initial agitation evolving to sleepiness and torpor, in addition to hypertension and tachycardia. Tramadol, dipyrone, ondansetron and support measures were administered. Patient was asymptomatic 30 minutes after with BP of 150 x 100 mmHg and HR of 120 bpm. Patient was discharged from PACU to the ward 140 minutes after with sensory, motor and autonomic block recovery and normal hemodynamic parameters. Patient was discharged 48 hours later without neurological sequelae, together with the neonate., Conclusions: Close attention should be paid to any administered drug, regardless of the route. It is desirable to standardize vial colors and storage sites aiming at minimizing this type of accident.

Background and Objectives: Low spinal morphine doses are effective in relieving postoperative pain of patients submitted to Cesarean sections, with low incidence of side-effects. This study aimed at evaluating postoperative analgesia and the incidence of side-effects in patients submitted to Cesarean sections under spinal anesthesia with hyperbaric bupivacaine and 0.05 mg and 0.1 mg morphine associated to intravenous and oral ketoprofen., Methods: Sixty pregnant women, physical status ASA I and II, undergoing elective Cesarean sections, were divided in two groups: group 1 patients were given 0.1 mg spinal morphine, while group 2 received 0.05 mg morphine, both associated to 15 mg hyperbaric bupivacaine. All patients received perioperative 100 mg intravenous ketoprofen and oral ketoprofen at 8-hour intervals in the first postoperative day. Patients were assessed at 6, 12 and 24 hours after surgery for pain intensity and side-effects (sedation, pruritus, nausea and vomiting). Side-effects were also evaluated in the perioperative period., Results: Both groups were similar in demographics and surgery and anesthesia duration. They were also homogeneous in postoperative pain intensity and presence of pruritus, sedation, nausea and vomiting., Conclusions: Spinal 0.05 mg and 0.1 mg morphine associated to intravenous and oral ketoprofen have provided the same postoperative analgesia and have determined the same incidence of side-effects.

Background and Objectives: Anesthesia in children with upper airway infection (UAI) is a major challenge for Anesthesiologists. This paper aimed at discussing why and when to induce anesthesia in UAI children., Contents: Preoperative clinical history, factors contributing to peri and postoperative complications and the type of surgery and anesthetic technique favoring such complications are highlighted., Conclusions: The understanding of post-UAI respiratory tract changes, of the importance of accurately evaluating the severity of symptoms, of factors contributing to complications and of the best anesthetic technique will allow for the choice of patients at the lowest risk to develop perioperative complications.

Background and Objectives: 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., Methods: 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., Results: 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 of these dogs and in two other dogs which had no histological changes. There has been focal necrosis in the spinal cord nervous tissue of one G3 animal. All G3 animals remained clinically normal., Conclusions: Large volumes of 2% lidocaine have determined more intensive clinical and histological changes as compared to 1% ropivacaine.

Background and Objectives: The use of alpha2-agonists to control heart rate and blood pressure, to attenuate hemodynamic responses to tracheal intubation and extubation and to reduce anesthetics requirement are already well established in the literature since clonidine introduction for therapeutic use. Dexmedetomidine, recently approved for clinical use, presents more alpha2-adrenergic receptors selectively, and therefore less adverse effects combined with marked analgesic and sedative properties. This has raised the interest in using it to replace opioids, known for their potent analgesic and sedative properties. This study aimed at comparing dexmedetomidine and sufentanil analgesias during continuous infusion for ENT, head and neck procedures., Methods: Sixty patients were randomly distributed in two groups of 30: G1 - sufentanil and G2 - dexmedetomidine, for anesthetic induction and maintenance. Nitrous oxide and propofol in a target controlled continuous infusion were also used for anesthetic maintenance. The following parameters were evaluated: hemodynamic variables (systolic, diastolic blood pressure and heart rate), emergence and extubation times after propofol withdrawal, place where patients were extubated (operating room - OR, or post-anesthetic recovery unit - PACU), PACU stay, Aldrete Kroulik index, and OR or PACU complications., Results: G1 had lower systolic and diastolic blood pressure, lower heart rate values, longer emergence and extubation times, higher number of PACU extubations, longer PACU stay, lower Aldrete-Kroulik index and higher number of peri and postoperative complications., Conclusions: Dexmedetomidine as intraoperative analgesic was more effective as compared to sufentanil in the procedures selected for this study regarding hemodynamic stability, emergence and anesthetic recovery conditions.

Background and Objectives: Some studies have shown differentiated dose-dependent effects of ephedrine on cardiovascular and renal functions. This study aimed at verifying whether different ephedrine doses determine differentiated hemodynamic and renal effects., Methods: Cardiovascular and renal hemodynamics and renal function were evaluated in 32 dogs anesthetized with sodium pentobarbital (SP) for surgical preparation, catheterization, extracellular fluid volume expansion and mechanical ventilation. Dogs were randomly distributed in four groups: G control (n = 8), in which dogs remained only under the effect of SP; G ephedrine 2 microg (n = 8); G ephedrine 10 microg (n = 8); and G ephedrine 100 microg (n = 8), in which dogs received 2, 10, and 100 microg.kg-1.min-1 ephedrine, respectively. Cardiovascular and renal parameters were studied at control (M1 and M2), during ephedrine infusion (M3 and M4) and after ephedrine infusion withdrawal (M5)., Results: There were no significant differences among groups. There has been a significant increase in heart rate, aortic blood flow, urinary output and fractional sodium excretion in G ephedrine 2 microg. There has been a significant increase in heart rate and filtration fraction in G ephedrine 10 microg while in G ephedrine 100 microg there has been a significant increase in heart rate, mean blood pressure, aortic blood flow, central venous pressure, renal vascular resistance and hematocrit, and a significant decrease in renal plasma and blood flow., Conclusions: Our study has shown that ephedrine has differentiated dose-dependent hemodynamic and renal effects.

Background and Objectives: Although affecting a small obstetric population, pre-eclampsia is responsible for considerable maternal morbidity and mortality. Therefore, the adequate anesthetic control of this group is yet a challenge for anesthesiologists. This paper aimed at presenting pathophysiology, pharmacological treatment and anesthetic options to normal or surgical delivery in pre-eclampsia patients., Contents: Classification and terminology of pregnancy-induced arterial hypertension, its pathophysiology, changes in different systems and organs, general principles for patients control and anesthetic options for normal or surgical delivery are described., Conclusions: The anesthesiologists knowledge of the pathophysiology, treatment options, and pharmacological characteristics of drugs used to control arterial hypertension and prevent seizures, as well as their interactions with anesthetic drugs and techniques, may decrease perioperative complications and maternal and fetal mortality.

Background and Objectives: The separation of conjoined twins has always raised considerable interest because of surgical and anesthetic complexity, pathology rarity and few survival chances. The goal of this description was to contribute to existing literature by reporting the challenges faced by our team during an anesthetic-surgical procedure for ischiopagus twins separation., Case Report: Term conjoined twins, born from Cesarean section, weighing together 5100 g, who were classified as ischiopagus tetrapus. Two anesthetic-surgical teams were present and the anesthetic procedure was programmed using two units of each device: anesthesia machine, cardioscope, capnograph, pulse oximetry, electric thermometer and esophageal stethoscope. Halothane and fentanyl were used for anesthesia induction, with the twins in the lateral position and 45 masculine head rotation to allow tracheal intubation. Ventilation was manually controlled using Rees-Baraka systems. Anesthesia was also maintained with halothane, fentanyl and oxygen. Double abdominal organs were found during surgery, except for the single colon. Bladders and ischia were joined. At surgery completion, twins had stable vital signs. They remained in Neonatal Intensive Care Unit for four weeks and were discharged in good general conditions., Conclusions: The importance of the teams 'meshing of gears', multidisciplinary retrospective studies, adequate and careful monitoring and good clinical observation is emphasized. All those factors contributed for twins good evolution.

Background and Objectives: Although rare, spinal anesthesia-induced neurological complications may determine serious sequelae. This study aimed at presenting these complications in order to elucidate triggering factors and help in the diagnosis of such injuries., Contents: The following complications are presented: needle and catheter-induced nerve injury, post dural puncture headache, anterior spinal artery syndrome, spinal hematoma, septic meningitis, aseptic meningitis, adhesive arachnoiditis, cauda equina syndrome, and transient neurological symptoms., Conclusions: The understanding of triggering factors of spinal anesthesia-induced neurological complications may prevent injuries and help early diagnosis and treatment, therefore changing patients prognosis.