Multimodal Neuromonitoring During Pediatric Cardiac Surgery.

Introduction: Neuromonitoring (electroencephalogram [EEG] and cerebral oximetry) is essential for appropriate anesthesia and neuroprotection assessment during pediatric cardiac surgery.

Methods: We describe the intraoperative pediatric multimodal and multiparametric neuromonitoring pattern of the software system Neuron-Spectrum (Kandel®) that consists of continuous electroencephalogram (cEEG), spectral analysis, amplitude-integrated electroencephalogram (aEEG), depth of anesthesia monitor (NINDEX), and regional cerebral and somatic oximetry (near-infrared spectroscopy-INVOS™). A physiological algorithm for management using neuromonitoring and physiological data is also described.

Lidocaine combined with magnesium sulfate preserved hemodynamic stability during general anesthesia without prolonging neuromuscular blockade: a randomized, double-blind, controlled trial.

Background: Lidocaine and magnesium sulfate have become increasingly utilized in general anesthesia. The present study evaluated the effects of these drugs, isolated or combined, on hemodynamic parameters as well as on the cisatracurium-induced neuromuscular blockade (NMB).

Methods: At a university hospital, 64 patients, ASA physical status I and II, undergoing elective surgery with similar pain stimuli were randomly assigned to four groups.

[Role of acute hemodilution in blood transfusion rate in patients submmited to scoliosis surgery: observational retrospective study].

Background And Objectives: The study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis.

Methods: Retrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP–USP). Medical charts of patients submitted to elective correction of scoliosis between January 1996 and December 2016 were analyzed.

Neuroprotective Anesthesia Regimen and Intensive Management for Pediatric Cardiac Surgery with Cardiopulmonary Bypass: a Review and Initial Experience.

This article describes our proposal for routine anesthesia, intraoperative medical management, cerebral and physiological monitoring during pediatric cardiac surgery with cardiopulmonary bypass that intend to provide appropriate anesthesia (analgesia, hypnosis), neuroprotection, adequate cerebral and systemic oxygen supply, and preventing against drugs neurotoxicity. A concise retrospective data is presented.

Dynamic comparison of pharyngeal stability during sleep in patients with obstructive sleep apnea syndrome treated with maxillomandibular advancement.

Purpose: To compare the dynamic differences occurring in the pharynx during sleep after maxillomandibular advancement (MMA) surgery for the treatment of patients with obstructive sleep apnea syndrome.

Methods: This was a prospective, cross-sectional study conducted on 20 patients (15 men and 5 women) with a polysomnography diagnosis of obstructive sleep apnea (OSA) submitted to surgical treatment with MMA. All patients were submitted to magnetic resonance (MR) during propofol-induced sleep before and 6 months after surgery.

Pain and cardiorespiratory responses of children during physiotherapy after heart surgery.

Objective: The aim of the present study was to determine the occurrence of pain and changes in blood pressure, heart rate, respiratory rate, and arterial oxygen saturation associated with physiotherapy in children undergoing cardiac surgery.

Methods: Eighteen extubated children were assessed for the presence of pain using the face, legs, activity, cry, consolability scale, and blood pressure, heart rate, respiratory rate and arterial oxygen saturation were simultaneously recorded. The physiological parameters were measured at the following time periods: immediately before physiotherapy, five and 10 minutes after the beginning of physiotherapy, and five minutes after its end.

Endplates changes related to age and vertebral segment.

Endplate separations are defined as the presence of a space between the hyaline cartilage and the cortical bone of the adjacent vertebral body. This study evaluates endplate separations from the vertebral body and intervertebral discs and verifies if endplate separation is related to age and the spinal level. Groups were formed based on age (20-40 and 41-85 years old) and the vertebral segment (T7-T8 and L4-L5 segments).

Changes of the retrolingual pharynx during the Muller manoeuvre and during sleep in sleep apnoea.

Objective: To determine whether the retrolingual pharynx shows the same morphometric modifications during the Muller manoeuvre and during drug-induced sleep endoscopy (DISE) with propofol in patients submitted for maxillomandibular advancement surgery.

Subjects And Methods: Eighteen patients submitted for maxillomandibular advancement surgery (MMAS) were evaluated endoscopically before and 6 month after surgery in the region of the retrolingual pharynx while seated and lying in dorsal decubitus (supine) while performing the Muller manoeuvre and during DISE with propofol, to verify and measure if the same morphometric changes occur in the retrolingual pharynx during the Muller manoeuvre and during DISE with propofol. The area, anteroposterior, and laterolateral retrolingual pharynx images were acquired using the Sony Vegas 8.

Postoperative management of severe acute anemia in a Jehovah's Witness.

Background: Low levels of hemoglobin (Hb) are not rare in patients who refuse blood components but this case is unique due to the severity of anemia and the possibility that her previous episode of acute normovolemic hemodilution has influenced her outcome.

Case Report: We report an incident involving acute blood loss after surgery with an extremely low hematocrit. Despite her Hb levels (2.

Oxytocin interference in the effects induced by inhalation of 7.5% CO(2) in healthy volunteers.

Objective: The objective of this study was to assess the acute effect of intranasally administered oxytocin (OT) on subjective states, cardiovascular, and endocrine parameters in healthy volunteers who inhaled 7.5% CO(2) .

Methods: Forty-five subjects were allocated into three matched groups of subjects who received 24 international units (IU) of OT, 2 mg of lorazepam (LZP), or placebo (PL).

Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA).

Introduction: Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR).

Comparison of the area of the pharynx during wakefulness and induced sleep in patients with obstructive sleep apnea (OSA).

Unlabelled: The study of obstructive sleep apnea (OSA) has received growing attention over the past years since various aspects have not been sufficiently established.

Aim: To evaluate, with the use of magnetic resonance imaging (MRI), changes in the area of the pharynx during wakefulness and induced sleep in patients with OSA.

Materials And Methods: A prospective study of thirty-two patients with a polysomnographic diagnosis of OSA.

SjO2/SvO2 correlation during pediatric cardiac surgery with cardiopulmonary bypass.

Objectives: To compare the SjO2 (cerebral oxygenation indicator) and SvO2 (cardiac output indicator) during pediatric cardiac surgery with cardiopulmonary bypass (CPB).

Methods: Retrospective study. Data of SjO2 and SvO2 measured simultaneously at critical time periods during cardiac surgery with CPB were analyzed by the Spearman correlation test and Bland- Altman plot.

Morphometric endoscopic study of the pharynx in patients with sleep apnea.

Purpose: The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed.

Materials And Methods: Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.

Effects of 2 mg.kg⁻¹ of intravenous lidocaine on the latency of two different doses of rocuronium and on the hemodynamic response to orotracheal intubation.

Background And Objectives: Lidocaine potentiates the effects of neuromuscular blockers and attenuates the hemodynamic response to orotracheal intubation. The objective of the present study was to test the effects of lidocaine on the latency of two different doses of rocuronium and on the hemodynamic response to intubation.

Methods: Eighty patients were distributed in 4 groups: Groups 1 and 2 received 0.

Effects of Dexmedetomidine-Fentanyl Infusion on Blood Pressure and Heart Rate during Cardiac Surgery in Children.

Background. The purpose of this study was to access the effects of dexmedetomidine-fentanyl infusion on blood pressure (BP) and heart rate (HR) before surgical stimulation, on their changes to skin incision, and on isoflurane requirement during cardiac surgery in children. Methods.

Effects of acute normovolemic hemodilution on blood coagulation: comparison between tests of an in vivo and an in vitro model.

Background And Objectives: Normovolemic hemodilution produces conflicting results on hemostasis, since works differ according to the fluids used, degree of hemodilution, method used to evaluate hemostasis, and the way used to produce hemodilution. The effects of hemodilution on hemostasis can depend on how it is done and whether an in vivo or an in vitro model is used. The objective of this study was to evaluate and compare hemostasis in two different degrees of hemodilution in both models.

Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass.

Background And Objectives: To evaluate the efficacy of the combined infusion of dexmedetomidine and fentanyl on the hemodynamic response during cardiac surgery with cardiopulmonary bypass (CPB) in children.

Methods: Thirty-two children, ages 1 month to 10 years, scheduled for cardiac surgery with cardiopulmonary bypass were randomly divided in two groups: the MDZ Group received midazolam 0.2 mg.

[Anesthesia for cesarean section in a patient with familiar hypertrophic cardiomyopathy: case report.].

Background And Objectives: Familiar Hypertrophic cardiomyopathy (FHC) is a rare hereditary cardiac disorder characterized by hypertrophy of the ventricular septum and variable degrees of subvalvular aortic stenosis. In this disease, the increase in myocardial contractility and reduction in peripheral vascular resistance can aggravate left ventricular outlet obstruction, leading to arrhythmias and cardiac ischemia. The objective of this report was to discuss the anesthetic management of cesarean section in a patient with FHC.

[Perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries.].

Background And Objectives: The present study was developed to evaluate the analgesic effects of the epidural administration of a combination of morphine and clonidine, whose efficacy has been demonstrated in adults, on the consumption of isoflurane and postoperative consumption of analgesics in children.

Methods: Twenty-six children scheduled for intra-abdominal surgeries were randomly divided in two groups. Both groups received an epidural bolus of morphine (8 microg.

[Anesthesia for transurethral resection of the prostate: comparison between two periods in a university hospital.].

Background And Objectives: Anesthesia for transurethral resection of the prostate (TURP) has been studied for years due to the uniqueness of the surgical procedure. This study aimed at comparing TURP anesthetic techniques and possible surgical complications in two different time periods with a ten-year interval, to detect evolution of those techniques and decrease in morbidity-mortality rates.

Methods: Medical records of all patients submitted to TURP in HC-FMRP-USP in two different 4-year periods were retrospectively evaluated: GI - surgical procedures (TURP) performed between 1989 and 1992; GII - surgical procedures (TURP) performed between 1999 and 2002.

[Methylene blue to treat anaphylaxis during anesthesia: case report.].

Background And Objectives: The risk of perioperative anaphylaxis should always be considered. The incidence of anesthetic allergic reactions is controversial, varying from 1/3,000 to 1/20,000, with mortality range between 3 and 9%. This report describes the use of methylene blue as coadjuvant drug to treat anaphylaxis refractory to conventional therapy.