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A neurólise do plexo celíaco guiada por tomografia computadorizada tornou‐se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0‐5), 2 (0‐4), 3 (0‐6), 3 (2‐6) e neurolise celíaca com agulha única = 3 (0‐5), 2 (0‐5), 2 (0‐4), 4 (2‐6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal. Computerized tomography‐guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0‐5), 2 (0‐4), 3 (0‐6), 3 (2‐6) and single needle celiac neurolysis = 3 (0‐5), 2 (0‐5), 2 (0‐4), 4 (2‐6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the magnitude of cyclotorsion during cataract surgery in patients with indication for intraocular toric lenses comparing the results after peribulbar and after topical anesthesia. Methods: This prospective study comprised 112 eyes that underwent cataract surgery with implantation of toric intraocular lens by topical anesthesia or peribulbar block. We estimated how many degrees of cyclotorsion occurred after topical anesthesia and peribulbar block with the patient in supine position. A tag was performed in the position of 180 degrees of the right eye and zero degrees of the left eye, with the patient seated. Afterwards, it was requested a change to the supine position and then a new dial in 180 and zero degrees respectively from right and left eye were made. Results: The current study demonstrated that patients submitted to cataract surgery with implantation of toriclens under local anesthesia showed approximately 6.89 degrees of incyclotorsion (82 eyes) and 6.93 degrees of excyclotorsion (38 eyes) and a mean of cyclotorsion of 6.91 degrees. Patients undergoing peribulbar block showed 5.68 degrees of incyclotorsion (73 eyes) and 4.81 degrees of excyclotorsion (47 eyes) and a mean of cyclotorsion of 4.92 degrees. Conclusion: Through the study we can see that the movement of incyclotorsion in patients undergoing peribulbar anesthesia was lower when compared to topical anesthesia. This is relevant since the greater the incyclotorsion, the lower the predictability of the surgery and the lower the chance of obtaining excellent results in the final refractometric.

Purpose: Evaluate the magnitude of cyclotorsion during cataract surgery in patients with indication for intraocular toric lenses comparing the results after peribulbar and after topical anesthesia. Methods: This prospective study comprised 112 eyes that underwent cataract surgery with implantation of toric intraocular lens by topical anesthesia or peribulbar block. We estimated how many degrees of cyclotorsion occurred after topical anesthesia and peribulbar block with the patient in supine position. A tag was performed in the position of 180 degrees of the right eye and zero degrees of the left eye, with the patient seated. Afterwards, it was requested a change to the supine position and then a new dial in 180 and zero degrees respectively from right and left eye were made. Results: The current study demonstrated that patients submitted to cataract surgery with implantation of toriclens under local anesthesia showed approximately 6.89 degrees of incyclotorsion (82 eyes) and 6.93 degrees of excyclotorsion (38 eyes) and a mean of cyclotorsion of 6.91 degrees. Patients undergoing peribulbar block showed 5.68 degrees of incyclotorsion (73 eyes) and 4.81 degrees of excyclotorsion (47 eyes) and a mean of cyclotorsion of 4.92 degrees. Conclusion:Through the study we can see that the movement of incyclotorsion in patients undergoing peribulbar anesthesia was lower when compared to topical anesthesia. This is relevant since the greater the incyclotorsion, the lower the predictability of the surgery and the lower the chance of obtaining excellent results in the final refractometric. [ABSTRACT FROM AUTHOR]

Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach., Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia., Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05)., Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy., (Copyright © 2019. Publicado por Elsevier Editora Ltda.)

Patients in intensive care often require the use of an artificial airway, it has its depressed level of consciousness, respiratory failure, trauma or need for aspiration of secretions, making them susceptible to pneumonia associated with mechanical ventilation. The objective of this study is to investigate the effectiveness of elevating the head by 30 to 45 among other prevention measures. The method used was a computerized literature search in the databases online, over the period 2007 to 2012. It was observed that the elevation of the head at 30 and 45, is one of the most simple and effective prevention. We conclude that good nursing practices associated with elevated bed rest at 30 and 45, may prevent ventilator-associated pneumonia. It is recommended the creation of a protocol for prevention, constant training of staff and preparation of posters displaying the results of the performance of the team in prevention. [ABSTRACT FROM AUTHOR]