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Search Results: 1 - 10 of 150443 matches for " Maria José Carvalho;AULER Jr. "
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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.
Prote??o miocárdica em cirurgia cardíaca
Malbouisson, Luiz Marcelo Sá;Santos, Luciana Moraes dos;Auler Jr, José Otávio Costa;Carmona, Maria José Carvalho;
Revista Brasileira de Anestesiologia , 2005, DOI: 10.1590/S0034-70942005000500012
Abstract: background and objectives: myocardial protection defines the set of strategies aiming at attenuating the intensity of myocardial ischemia-reperfusion injury during heart surgery and its harmful consequences on myocardial function. a better understanding of pathophysiological phenomena related to ischemia-reperfusion events and of the anesthetic-induced heart protection has given to the anesthesiologist a major role in intraoperative myocardial protection. the objective of this update was to review the mechanisms of ischemia-reperfusion-induced myocardial injury and myocardial protection modalities focusing on anesthetic techniques. contents: ischemia-reperfusion-induced myocardial injury mechanisms and their clinical consequences on heart as well as myocardial protection techniques used during heart surgery are addressed in this review. special emphasis is given to the role of anesthetic drugs and techniques such as inhaled halogenate anesthetics, opioids and adjuvant anesthetic drugs, since they have been shown to have heart protecting effects during cardiac surgery. conclusions: the association of adequate anesthetic technique using heart protecting agents to usual myocardial protection modalities performed by the surgeon may contribute to the prevention of cardiac surgery-induced myocardial dysfunction and improve postoperative outcome.
Causas incomuns de instabilidade hemodinamica durante revasculariza??o miocárdica sem circula??o extracorpórea
Santos, Luciana Moraes dos;Carmona, Maria José Carvalho;Kim, Silvia Minhye;Dias, Ricardo Ribeiro;Auler Jr, José Otávio Costa;
Revista Brasileira de Anestesiologia , 2010, DOI: 10.1590/S0034-70942010000100010
Abstract: background and objectives: myocardial revascularization (mr) in patients with ventricular hypertrophy and/or dysfunction is frequently performed without cardiopulmonary bypass (cb), since it can be difficult to wean those patients off cb. intraoperative control demands strict hemodynamic adjustment, as well as partial clamping of the aorta to minimize hemodynamic changes. the objective of this study was to report two cases of hemodynamic instability during mr without cb after partial clamping of the aorta. case report: the first case is a female patient, whose aortic diameter was slightly reduced (2.8 cm); the second case refers to a patient with left ventricular ejection fraction (lvef) of 24% on the echocardiogram. in both cases, significant hypotension and increase in pulmonary blood pressure were observed immediately after clamping of the aorta. the surgical teams were informed of the problem, and in both cases the hemodynamic instability was reverted after unclamping of the aorta. afterwards, smaller areas of the aorta were clamped and proximal anastomoses were performed without intercurrence. conclusions: although cardiac manipulation and changes in ventricular preload represent the most common causes of hemodynamic instability during mr without cb, in the cases presented here, hypotension and pulmonary hypertension were most likely secondary to a reduction in cardiac output due to the increase in afterload in patients with a relatively small aortic diameter or ventricular dysfunction even with partial clamping. adequate intraoperative monitoring and immediate correction of the hemodynamic changes can minimize surgical morbidity and mortality.
Altera??es hemodinamicas durante a revasculariza??o do miocárdio sem utiliza??o de circula??o extracorpórea
Kim, Silvia Minhye;Malbouisson, Luiz Marcelo Sá;Auler Jr, José Otávio Costa;Carmona, Maria José Carvalho;
Revista Brasileira de Anestesiologia , 2011, DOI: 10.1590/S0034-70942011000400005
Abstract: background and objective: cardiac positioning and stabilization during myocardial revascularization without extracorporeal circulation (ecc) may cause hemodynamic changes dependent to the surgical site. the objective of this study was to evaluate these changes during distal coronary anastomosis. methods: twenty adult patients undergoing myocardial revascularization without ecc were monitored by pulmonary artery catheter and transesophageal echo doppler. hemodynamic data were collected at the following times before removing the stabilizer wall: (1) after volume adjustments, (2) at the beginning of distal anastomosis, and (3) after 5 minutes. treated coronary arteries were grouped according to their location in the lateral, anterior, or posterior wall. two-way anova with repetition and newman-keuls post-test were used in the analysis. a p value < 0.05 was considered statically significant. results: during myocardial revascularization without ecc, pulmonary artery wedge pressure showed elevation from 17.7 ± 6.1 to 19.2 ± 6.5 (p < 0.001) and 19.4 ± 5.9 mmhg (p < 0.001), while the central venous pressure went from 13.9 ± 5.4 to 14.9 ± 5.9 mmhg (p = 0.007) and 15.1 ± 6.0 mmhg (p = 0.006). intermittent cardiac output was reduced from 4.70 ± 1.43 to 4.23 ± 1.22 (p < 0.001) and 4.26 ± 1.25 l.min-1 (p < 0.001). according to transesophageal doppler, a significant group-time interaction was observed in cardiac output, which was reduced in the lateral group from 4.08 ± 1.99 to 2.84 ± 1.82 (p = 0.02) and 2.86 ± 1.73 l.min-1 (p = 0.02), and aortic blood flow, which went from 2.85 ± 1.39 to 1.99 ± 1.26 (p = 0.02) and 2.00 ± 1.21 l.min-1 (p = 0.02). other hemodynamic changes were not observed during anastomoses. conclusions: a significant hemodynamic deterioration was observed during myocardial revascularization without ecc. transesophageal doppler detected a decrease in cardiac output only in the lateral group.
Associa??o de paralisia diafragmática bilateral e paralisia da cintura escapular após corre??o de aneurisma de aorta: relato de caso
MALBOUISSON, Luiz Marcelo Sá;PERES, Denise;AYAMA, Sérgio;CARMONA, Maria José Carvalho;AULER Jr., José Otávio Costa;
Revista Brasileira de Cirurgia Cardiovascular , 2001, DOI: 10.1590/S0102-76382001000200011
Abstract: the association of bilateral diaphragmatic paralysis and scapular girdle paralysis is a rare complication after aortic aneurysm correction. such a complication induces to a severe form of hypercapnic respiratory failure in which the success of weaning from mechanical ventilation depends on the capacity of remaining respiratory muscles to compensate extra respiratory work load. intensive respiratory physiotherapy with muscle training, hydroelectrolityc inbalances correction, treatment of ventilation associated infections and a well planned nutritional support were essential to the successful weaning of mechanical ventilation.
Perioperative cefuroxime pharmacokinetics in cardiac surgery
Nascimento, Jorge Willian Leandro;Carmona, Maria José Carvalho;Strabelli, Tania Mara Varej?o;Auler Jr, José Otávio Costa;Santos, Sílvia Regina Cavani Jorge;
Clinics , 2007, DOI: 10.1590/S1807-59322007000300009
Abstract: objective: the objective was to investigate the plasma levels and to compare the pharmacokinetics of cefuroxime during and after surgery in adult patients with elective indication for coronary artery bypass grafting. methods: seventeen patients received three 1.5-g bolus iv doses of cefuroxime, one every 12 hrs. serial blood samples (3 ml) were collected 1, 3, 6, 9, and 12 hrs after the first dose (given during the intervention) and after the second and third doses (postsurgery). blood samples were centrifuged and stored frozen until being assayed. for assessment of the cefuroxime plasma levels by liquid chromatography, only 200 μl of plasma were required. determination of cefuroxime plasma levels was followed by a pharmacokinetic (pk)-modeling using pk solutions 2.0 software. results: the kinetic parameters obtained remained unchanged after the first, second, and the third dose as follows: elimination half-life: 1.8 h, 1.9 h, and 1.8 h; clearance: 1.4, 1.5, and 1.5 ml/min/kg, respectively. additionally, the apparent volume of distribution did not change during and after the intervention: 0.19, 0.25, and 0.22 l/kg, after the first, second, and the third dose, respectively. since the drug has a low volume of distribution, plasma levels obtained after a 1.5-g iv bolus injection of cefuroxime decreased rapidly due to the high plasma clearance, with a consequent short half-life. conclusions: the kinetic disposition of cefuroxime remains unaltered in patients undergoing coronary artery bypass grafting; to reduce the fluctuation in plasma concentrations so that the antibiotic prophylaxis in the peri-operative period is guaranteed, the dose regimen should be reviewed.
Avalia??o pulmonar em crian?as portadoras de cardiopatia congênita acianótica e hiperfluxo pulmonar através de tomografia computadorizada
Gimenez, Solange;Teixeira, Mariana Limeira;Myashiro, Rodrigo;Carmona, Maria José Carvalho;Auler Jr, José Otávio Costa;Malbouisson, Luiz Marcelo Sá;
Revista Brasileira de Anestesiologia , 2009, DOI: 10.1590/S0034-70942009000500003
Abstract: background and objectives: respiratory dysfunction is common in children with acyanotic congenital heart defects (achd) with pulmonary hyperflow; however, little is known about the pulmonary structure of those patients. the objective of this study was to quantify the volumes of air and tissue, as well as the distribution of pulmonary aeration in this population. methods: after approval by the ethics committee of the institution and signing of an informed consent, seven children with achd with pulmonary hyperflow underwent computed tomographies of the chest. all images included the left and right pulmonary contour, and pulmonary volumes and weight were calculated using volumetric data. paired student t test was used to compare left and right, and exponential regression was used for correlations. results: patients had a mean age of 20 months and weight of 9.9 kg. total pulmonary volume (tpv) was 66.7 ± 23.1 ml.kg-1, tissue volume of 33.5 ± 15.7 ml.kg-1, and air volume of 33.1 ± 8.3 ml.kg-1. the right lung represented 57.9% of tpv and the left, 42.1% (p < 0.001). the pulmonary volume of air on the right was 60.5% of the total air volume (p < 0.001), and the volume of pulmonary parenchyma normally aerated was significantly lower on the left (27.6 ± 6.8 vs . 18.1 ± 8%, p < 0.001). conclusions: the volume of lung tissue was greater than expected in children with achd with pulmonary hyperflow, possibly due to interstitial edema. pulmonary aeration is reduced in the left lung due to the compression of the lung by the heart.
Ensino de anestesiologia durante a gradua??o por meio de uma liga acadêmica: qual o impacto no aprendizado dos alunos?
Ramalho, Alan Saito;Silva, Felipe Duarte;Kronemberger, Tatiana Barboza;Pose, Regina Albanese;Torres, Marcelo Luis Abramides;Carmona, Maria José Carvalho;Auler Jr, José Otávio Costa;
Revista Brasileira de Anestesiologia , 2012, DOI: 10.1590/S0034-70942012000100009
Abstract: background and objectives: academic leagues have been consolidated as instruments of medical teaching and for the introducing of medical students to practice of specialties, including anesthesiology. as the role of leagues in the development process of competencies and learning of their students is not well known, the learning of members of an anesthesiology academic league was evaluated after participating in its activities for one year. method: students of an anesthesiology academic league were followed up from march to december 2010 and evaluated through objective cognitive tests of multiple choice applied before the beginning of activities and after their conclusion. attendance in activities and epidemiologic profile of students were correlated with the tests results. results: twenty medical students from 3rd to 6th year were analyzed, with an average age of 22.8 (21-26) years. the average participation in the proposed activities was 10.4/13 (80%). the average of right answers on the first test was 8.1/17 (47.6%), and 3rd year students had lower grades (p < 0.02) compared with other students. in the post league test, the average of right answers was 11.9/17 (70%), showing an improvement in performance (p < 0.05), and there was no difference between grades of different years of the medical undergraduation. a strong relationship between participation in activities and improved grades was found (r = 0.719; p < 0.001). conclusions: students who participated in the league had improvement in knowledge evaluation tests, suggesting that the league is a useful teaching instrument that can provide improved learning of anesthesiology. participation in activities was connected with improved performance. activities developed in leagues may have a positive role in students' academic education, more specifically in this article, in anesthesiology
Atelectasias durante anestesia: fisiopatologia e tratamento
Malbouisson, Luiz Marcelo Sá;Humberto, Flávio;Rodrigues, Roseny dos Reis;Carmona, Maria José Carvalho;Auler Jr., José Otávio Costa;
Revista Brasileira de Anestesiologia , 2008, DOI: 10.1590/S0034-70942008000100011
Abstract: background and methods: the incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. this complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. the objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. contents: this review discusses the concepts about the incidence of intraoperative atelectasis, factors that influence their development, both mechanical and those related to mechanical ventilator settings during the surgery, diagnostic criteria, and strategies to prevent and treat this complication. conclusions: understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.
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