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Search Results: 1 - 10 of 88005 matches for " José Otávio Costa; "
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Prote??o miocárdica pelo pré- e pós-condicionamento anestésico
Pasqualin, Rubens Campana;Auler Jr., José Otávio Costa;
Revista Brasileira de Anestesiologia , 2008, DOI: 10.1590/S0034-70942008000500009
Abstract: background and objectives: perioperative myocardial ischemia is commonly observed, and it can increase significantly postoperative morbidity and mortality. the cardioprotective properties of volatile anesthetics and opioids have been studied during several decades and currently constitute powerful tools in the management of patients with ischemic coronariopathy. the objective of this review was to provide the fundaments of myocardial protection by preconditioning. contents: the concepts of cellular damage secondary to ischemia and reperfusion, ischemic preconditioning (ipc), and anesthetic preconditioning (apc), as well as the mechanisms of myocardial protection, are discussed. recent studies in cardiac surgery demonstrated that the use of short periods of ischemia during reperfusion can reduce the area of myocardial infarction. volatile anesthetic can also have a protective effect in myocardial reperfusion. independently of the signaling pathway that leads to preconditioning, both anesthetic and ischemic, mitochondrial dependent katp channels are considered the final mediators of cardioprotection by controlling the mitochondrial influx of calcium and, therefore, preventing the induction of necrosis and apoptosis. although ipc and apc effectively reduce the area of myocardial infarction and improve postoperative ventricular function, it is important to stress that those treatments should be instituted before ischemic events to justify their clinical applicability. conclusions: phenomena known as myocardial ischemic preconditioning and anesthetic preconditioning are well known, and the mechanism of protection is similar in both situations; however, not every step that leads to this protection has been fully explained. further studies are necessary to increase the clinical applicability of the cardioprotective properties of anesthetics.
Estudo retrospectivo da incidência de óbitos anestésico-cirúrgicos nas primeiras 24 horas: revis?o de 82.641 anestesias
Chan, Raquel Pei Chen;Auler Junior, José Otávio Costa;
Revista Brasileira de Anestesiologia , 2002, DOI: 10.1590/S0034-70942002000600009
Abstract: background and objectives: since the first reported anesthetic death, many attempts have been made to study the incidence of risk factors, complications and mortality associated to anesthesia and surgery. the estimated perioperative mortality risk varies from 0.05 to 10 cases per 10,000 anesthesias. this study aimed at reporting the incidence of anesthetic-surgical death in the first 24 hours, at our hospital. methods: charts had been reviewed from 82,641 surgeries performed in 1998 and 1999. deaths were analyzed according to edwards? classification, and by age, gender, physical status, (asa), type of surgery and anesthesia. results: cause of the deaths according to edwards classification has shown that 91.04% were class v, 3.77% class vi, 2.13% class vii, 2.84% class iv and 0.23% were class i. age above 65 years accounted for 1.48% of deaths; adults incidence was 0.48%; the incidence in children aged 1 to 12 years was 0.11%; in children aged 31 days to 1 year it was 1.29% and in neonates up to 30 days of life the incidence was 2.88%. death ratio as compared to total deaths was 59.2% in adults, 30.2% in patients above 65 years of age, 2.8% at the age 1 to 12, 4% in patients with 31 days of life to 1 year and 3.8% in newborn babies. males represented 66.3% of deaths and females 33.7%. the distribution by asa physical status was: asa i - 11.1%, asa ii - 5.2%, asa iii - 30.9%, asa iv - 34.4% and asa v - 18.4%. emergency surgeries accounted for 67.2% of deaths and elective surgeries for 32.8%. general incidence of the deaths was 0.51% being the highest in cardiac (1.88%) and vascular (1.87%) surgeries. conclusions: anesthetic-surgical deaths in the years 1998 and 1999 were considered inevitable according to edward?s classification. the highest incidence of deaths was in neonates. most deaths occurred in males, asa iii or above patients, and emergency vascular or cardiac surgeries.
Estudo retrospectivo da incidência de óbitos anestésico-cirúrgicos nas primeiras 24 horas: revis o de 82.641 anestesias
Chan Raquel Pei Chen,Auler Junior José Otávio Costa
Revista Brasileira de Anestesiologia , 2002,
Abstract: JUSTIFICATIVA E OBJETIVOS: Desde o primeiro relato de óbito por anestesia, muitas tentativas têm sido feitas para estudar a incidência de fatores de risco, complica es e mortalidades associadas à anestesia e cirurgia. O risco estimado peri-operatório de mortalidade varia de 0,05 a 10 casos para 10.000 anestesias. O objetivo deste estudo foi reportar a incidência de óbitos anestésicos-cirúrgicos nas primeiras 24 horas, ocorridos no Hospital das Clínicas da FMUSP. MéTODO: Foram revisados os prontuários de pacientes anestesiados nos anos 1998 e 1999, num total de 82.641 cirurgias. Os óbitos foram classificados quanto à causa de óbito pela classifica o de Edwards, faixa etária, sexo, estado físico (ASA), especialidade e tipo de anestesia. RESULTADOS: A causa de óbito pela classifica o de Edwards demonstrou que 91,04% eram da categoria V; 3,77% da categoria VI; 2,13% da VII; 2,84% da IV e 0,23% da I. A faixa etária acima de 65 anos teve incidência de óbito de 1,48%; a dos adultos de 0,48%; crian as de 1 a 12 anos de 0,11%; crian as de 31 dias a 1 ano de 1,29% e neonatos até 30 dias de 2,88%. A propor o de óbitos em rela o ao total é de 59,2% de adultos; 30,2% acima de 65 anos; 2,8% de 1 a 12 anos; 4% de 31 dias a 1 ano e 3,8% de neonatos. Os homens representam 66,3% e as mulheres 33,7% dos óbitos. A distribui o por ASA foi a seguinte: ASA I -11,1%, ASA II- 5,2%, ASA III- 30,9%, ASA IV- 34,4% e ASA V- 18,4%. Cirurgias de emergência contabilizaram 67,2% dos óbitos e as eletivas 32,8%. A incidência geral de óbitos foi de 0,51% (sendo 1,88%, a mais elevada, em cirurgia cardíaca, e 1,87% em vascular). CONCLUS ES: Os óbitos anestésico-cirúrgicos nos anos 1998 e1999 foram considerados inevitáveis, considerando-se a classifica o de Edwards. A incidência mais alta de óbitos ocorreu em neonatos, O predomínio dos óbitos foi do sexo masculino, de pacientes ASA III ou mais, em cirurgias de emergência, cardíacas ou vasculares.
Pediatric cardiac postoperative care
Auler Jr., José Otávio Costa;Barreto, Alessandra Costa;Gimenez, Solange Coppola;Abellan, Deipara Monteiro;
Revista do Hospital das Clínicas , 2002, DOI: 10.1590/S0041-87812002000300007
Abstract: the heart institute of the university of s?o paulo, medical school is a referral center for the treatment of congenital heart diseases of neonates and infants. in the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. the purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. the main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.
Pediatric cardiac postoperative care
Auler Jr. José Otávio Costa,Barreto Alessandra Costa,Gimenez Solange Coppola,Abellan Deipara Monteiro
Revista do Hospital das Clínicas , 2002,
Abstract: The Heart Institute of the University of S o Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.
Impacto hemodinamico de manobra de recrutamento alveolar em pacientes evoluindo com choque cardiogênico no pós-operatório imediato de revasculariza??o do miocárdio
Malbouisson, Luiz Marcelo Sá;Brito, Marcelo;Carmona, Maria José Carvalho;Auler Jr, José Otávio Costa;
Revista Brasileira de Anestesiologia , 2008, DOI: 10.1590/S0034-70942008000200004
Abstract: background and objectives: alveolar recruitment maneuver (arm) with pressures of 40 cmh2 o in the airways is effective in the reversal of atelectasis after myocardial revascularization (mr); however, there is a lack of studies evaluating the hemodynamic impact of this maneuver in patients who evolve with cardiogenic shock after mr. the objective of this study was to test the hemodynamic tolerance to arm in patients who develop cardiogenic shock after mr. methods: ten hypoxemic patients in cardiogenic shock after mr were evaluated after admission to the icu and hemodynamic stabilization. ventilatory adjustments included tidal volume of 8 ml.kg-1, peep 5 cmh2o, rr 12, and fio2 0.6. continuous pressure of 40 cmh2o was applied to the airways for 40 seconds in three cycles. between cycles, patients were ventilated for 30 seconds, and after the last cycle, peep was set at 10 cmh2o. hemodynamic measurements were obtained 1, 10, 30, and 60 minutes after arm, and arterial and venous blood samples were drawn 10 and 60 minutes after the maneuver to determine lactate levels and blood gases. anova and the friedman test were used to analyze the data. a p of 0.05 was considered significant. results: alveolar recruitment maneuver increased the ratio pao2/fio2 from 87 to 129.5 after 10 minutes and to 120 after 60 minutes (p < 0.05) and reduced pulmonary shunting from 30% to 20% (p < 0.05). hemodynamic changes or changes in oxygen transport immediately after or up to 60 minutes after the maneuver were not detected. conclusions: in patients who evolved to cardiogenic shock and hypoxemia after mr, arm improved oxygenation and was well tolerated hemodynamically.
Avalia??o dos níveis séricos de horm?nios tireóideos em revasculariza??o miocárdica
Messias, Elaine Rahal Rodas;Auler Jr, José Otávio Costa;Carmona, Maria José Carvalho;
Revista Brasileira de Anestesiologia , 2007, DOI: 10.1590/S0034-70942007000500004
Abstract: background and objectives: thyroid hormones, thyroxine (t4) and triiodothyronine (t3), regulate anabolism of proteins, lipids, and carbohydrates, and increase oxygen consumption. surgical stress and cardiopulmonary bypass (cpb) can change active hormone levels by interfering with the peripheral conversion and reducing serum levels of t3, without changing the levels of thyrotropin (tsh), which are the characteristics of the euthyroid syndrome. the objective of this work was to compare serum levels of t3, t4 and tsh in patients undergoing myocardial revascularization (mr) with or without ecc. methods: eighteen patients scheduled for elective mr divided as follows: cpb group (n = 9): patients undergoing cpb, and the group without cpb (n = 9): patients that did not undergo cpb. the serum levels of t3, t4 and tsh were determined before anesthetic induction (initial or), at the end of the surgery (final or), in the first (1st po) and in the second (2nd po) postoperative days. statistical analysis (analysis of variance for repeated measures, mann-whitney test, and friedman test) considered significant a p < 0.05. results: there was a reduction in serum levels of t3 in both groups. serum levels of t4 showed differences in final or and 1st po, which were elevated in the group that did not undergo cpb. serum levels of tsh remained within normal limits. conclusions: serum levels of t3 are reduced after myocardial revascularization with and without cpb, with greater reduction in t4 in the group that underwent cpb. the absence of pituitary response to changes in serum levels of t3 and t4 characterized the euthyroid syndrome in both groups.
Peculiaridades no pós-operatório de cirurgia cardíaca no paciente idoso
Vasconcelos Filho, Paulo de Oliveira;Carmona, Maria José Carvalho;Auler Júnior, José Otávio Costa;
Revista Brasileira de Anestesiologia , 2004, DOI: 10.1590/S0034-70942004000500014
Abstract: background and objectives: elderly patients have their own physiologic characteristics, and sometimes may have organic deficits or severe diseases, which by themselves may complicate the postoperative period. this article is aimed at reviewing post-cardiac surgery procedures in the elderly, describing their most frequent problems. contents: elderly patients intraoperative approaches should be decided taking into account lower postoperative morbidity. at icu arrival, the same criteria for other adult patients of cardiac surgeries should be adopted to maintain service standardization and routine, thus preventing mistakes. establishing an intensive care plan for the post-cardiac surgery period may result in optimal use of resources, effective attention and decreased time of care. subsidiary exams should also follow the standards of the service, unless any problem be identified. neurological, pulmonary and circulatory complications, renal failure, infections and hypothyroidism outlined in this article are frequent and unique in the elderly, and should be fully understood by the icu physician. conclusions: complications outlined in this article are those of greatest concern for the icu physician when there are elderly patients in the post-cardiac surgery period. these patients need special care, even when surgery is perfectly normal, because there is major surgical stress and the elderly have decreased functional reserves.
índice de mecaniza??o de propriedades orizícolas no Rio Grande do Sul, Brasil
Schlosser, José Fernando;Machado, Otávio Dias da Costa;Debiasi, Henrique;Pinheiro, Eder Dornelles;
Ciência Rural , 2004, DOI: 10.1590/S0103-84782004000300021
Abstract: characterized as activity of high economic expression in rio grande do sul, the rice production is practiced in an intense way, above all in the applied mechanization. tends as objective to diagnose the mechanization level (kw/ha), in function of the agricultural area used with rice (aarr) and of the total agricultural area (aagt), a sample of 87 properties, that its amoung their activities develop the rice production, was analyzed. for the representation of the scale of the properties in the studied index, they were applied 8 strata in function of the area agricultural total of the same ones, being considered for the available potency the agricultural tractors in activity and the declared productive areas. the differentiated participation of the area of cultivation of rice in the different strata carted in expressive differences of the mechanization index, when analyzed the area of rice and the total agricultural area. the bedding was shown efficient in the determination of the variation of the mechanization index along the studied strata, just happening significant difference between the strata 3 (31 a 45 ha) and 4 (46 a 90 ha) and the strata 6 (131 a 180 ha) and 7 (181 a 400 ha), when related the index studied to the area of rice, being represented by intervals of class indeed differentiated for the other averages.
Volume management in critically ill patients: new insights
Lopes, Marcel Rezende;Auler Jr, José Otávio Costa;Michard, Frédéric;
Clinics , 2006, DOI: 10.1590/S1807-59322006000400012
Abstract: in order to turn a fluid challenge into a significant increase in stroke volume and cardiac output, 2 conditions must be met: 1) fluid infusion has to significantly increase cardiac preload and 2) the increase in cardiac preload has to induce a significant increase in stroke volume. in other words, a patient can be nonresponder to a fluid challenge because preload does not increase during fluid infusion or/and because the heart (more precisely, at least 1 of the ventricles) is operating on the flat portion of the frank-starling curve. volumetric markers of cardiac preload are therefore useful for checking whether cardiac preload effectively increases during fluid infusion. if this is not the case, giving more fluid, using a venoconstricting agent (to avoid venous pooling), or reducing the intrathoracic pressure (to facilitate the increase in intrathoracic blood volume) may be useful for achieving increased cardiac preload. arterial pulse pressure variation is useful for determining whether stroke volume can/will increase when preload does increase. if this is not the case, only an inotropic drug can improve cardiac output. therefore, the best option for determining the usefulness of, and monitoring fluid therapy in critically ill patients is the combination of information provided by the static indicators of cardiac preload and arterial pulse pressure variation.
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