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Search Results: 1 - 10 of 142386 matches for " CARMONA Maria José Carvalho "
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Avalia??o da fun??o pulmonar em pacientes submetidos à cirurgia cardíaca com circula??o extracorpórea
Barbosa, Ricardo Antonio Guimar?es;Carmona, Maria José Carvalho;
Revista Brasileira de Anestesiologia , 2002, DOI: 10.1590/S0034-70942002000600005
Abstract: background and objectives: pulmonary complications are still a major postoperative problem for cardiac surgeries with cardiopulmonary bypass (cpb). this study aimed at evaluating pulmonary function changes in patients undergoing myocardial revascularization, as compared to those submitted to valve replacement. methods: participated in this study patients undergoing myocardial revascularization (mr group, n=15) and valve replacement (vr group, n=15) who were evaluated by the ratio between oxygen blood pressure and its inspired fraction (pao2/fio2), oxygen alveolar-arterial gradient (ga-ao2), pulmonary shunt, best compliance peep and static peep, evaluated in the preoperative period, after anesthetic induction, 1, 3 and 6 postoperative hours and 1st and 2nd postoperative days. data were analyzed by analysis of variance for repeated measures (p < 0.05). results: alveolar-arterial gradient and pulmonary shunt results were significantly higher for the mr group as compared to the vr group. pao2/fio2 ratio was significantly higher in the vr group. there were no differences between groups in static compliance. postoperative best compliance peep was significantly higher in the mr group as compared to the vr group. conclusions: our study has shown that patients submitted to myocardial revascularization presented pulmonary function changes different from those submitted to valve replacement.
Avalia o da fun o pulmonar em pacientes submetidos à cirurgia cardíaca com circula o extracorpórea
Barbosa Ricardo Antonio Guimar?es,Carmona Maria José Carvalho
Revista Brasileira de Anestesiologia , 2002,
Abstract: JUSTIFICATIVA E OBJETIVOS: As complica es pulmonares permanecem como um grande problema no pós-operatório de cirurgia cardíaca com circula o extracorpórea (CEC). O objetivo do presente estudo foi avaliar as altera es da fun o pulmonar ocorridas em pacientes submetidos à cirurgia cardíaca de revasculariza o miocárdica, comparando-os àqueles submetidos à cirurgia cardíaca de troca valvar. MéTODO: Quinze pacientes submetidos à revasculariza o (Grupo RM) e 15 pacientes submetidos à troca valvar (Grupo TV) foram avaliados através da rela o entre a press o arterial de oxigênio e sua fra o inspirada (PaO2/FiO2), do gradiente alvéolo-arterial de oxigênio (GA-aO2), do shunt pulmonar, da PEEP de melhor complacência e da complacência estática, avaliados no pré-operatório, após a indu o da anestesia, 1, 3 e 6 horas de pós-operatório e no 1o e 2o dias de pós-operatório. Os dados foram analisados através da análise de variancia para medidas repetidas (p < 0,05). RESULTADOS: Os resultados mostraram valores de gradiente alvéolo-arterial de oxigênio e shunt pulmonar significativamente maiores para o grupo RM em rela o ao grupo TV. A rela o PaO2/FiO2 foi significativamente maior no grupo TV. Os grupos n o diferiram quanto à complacência estática. No grupo RM, a PEEP de melhor complacência obtida no pós-operatório foi significativamente maior que no grupo TV. CONCLUS ES: No presente estudo observamos que os pacientes submetidos à cirurgia cardíaca de revasculariza o miocárdica apresentam altera es da fun o pulmonar diferentes daqueles submetidos à cirurgia cardíaca de troca valvar
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.
Abuso de fármacos anestésicos pelos anestesiologistas
Jungerman, Flavia Serebrenic;Alves, Hamer Nastasy Palhares;Carmona, Maria José Carvalho;Conti, Nancy Brisola;Malbergier, André;
Revista Brasileira de Anestesiologia , 2012, DOI: 10.1590/S0034-70942012000300010
Abstract: background and objectives: physicians has a slightly higher rate of psychoactive substance use when compared to the population in general. anesthesiology is one of the most affected medicine specialties, especially due to overwork and easier access to drugs. this paper aims to carry out a literature review on the topic. therefore, research was conducted by searching topic-related keywords on papers from the last 30 years available on medline. content: despite the fact that alcohol abuse is the most common among anesthesiologists, the abuse of anesthetic agents causes more concern, due to its high dependence potential and consequences, which are often fatal. the most widely used drugs are opioids (fentanyl and sufentanil), propofol and inhalational anesthetics. young professionals are the most affected. among the consequences of drug abuse are workplace absence and even death. the return to operating rooms seems to increase the risk of relapse. in europe and in the usa there are specialized treatment programs for the middle class, as well as preventive measures, such as strict control of drugs and identification of professionals at high risk of abuse. in brazil, anesthesiology is the second medicine specialty with most drug addicts, but the topic has not been much studied and there are few specialized programs in the field. conclusions: substance abuse by anesthesiologists is an issue that needs to be discussed further, especially due to the possibility of severe consequences for professionals and patients.
Compara o entre ventila o controlada a volume e a press o no tratamento da hipoxemia no período pós-operatório de cirurgia de revasculariza o do miocárdio
Castellana Fábio Bonini,Malbouisson Luiz Marcelo Sá,Carmona Maria José Carvalho,Lopes Célia Regina
Revista Brasileira de Anestesiologia , 2003,
Abstract: JUSTIFICATIVA E OBJETIVOS: Ventila o controlada à press o tem sido utilizada como modalidade ventilatória de elei o em pacientes que desenvolvem hipoxemia importante no período pós-operatório de cirurgia de revasculariza o do miocárdio. Contudo n o existem estudos mostrando que a ventila o controlada à press o é mais efetiva na revers o da hipoxemia pós-operatória que ventila o controlada a volume. O objetivo deste estudo foi comparar os efeitos de ventila o controlada à press o e ventila o controlada a volume sobre a oxigena o sistêmica em pacientes que desenvolvem hipoxemia caracterizada por uma rela o PaO2/FiO2 menor que 200 no período pós-operatório imediato de cirurgia cardíaca. MéTODO: Sessenta e um pacientes com rela o PaO2/FiO2 menor que 200 foram alocados em um grupo submetido à ventila o controlada a press o e outro a volume. O volume corrente, a freqüência respiratória, a rela o inspira o/ expira o e a press o positiva ao final da expira o foram as mesmas no dois grupos. Após a admiss o na UTI e após períodos de 1 ou 2 horas de ventila o mecanica, a rela o PaO2/FiO2 e o shunt pulmonar foram quantificados. RESULTADOS: Houve um aumento significativo na rela o PaO2/FiO2 e uma diminui o significativa no shunt pulmonar após 1 ou 2 horas de ventila o mecanica; contudo n o foram observadas diferen as entre as modalidades ventilatórias. CONCLUS ES: As modalidades ventilatórias controladas a volume e press o foram igualmente eficientes no tratamento da hipoxemia observada em pacientes no pós-operatório imediato de cirurgia de revasculariza o do miocárdio, mostrando que o padr o de administra o do fluxo inspiratório é pouco relevante para o tratamento da hipoxemia pós-operatória.
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
Revista Brasileira de Cirurgia Cardiovascular , 2001,
Abstract: A associa o de paralisia diafragmática bilateral e paralisia da cintura escapular é uma complica o rara após corre o de aneurisma de aorta ascendente. Esta associa o leva à uma forma grave de insuficiência respiratória cujo sucesso do desmame da ventila o mecanica é dependente da capacidade da musculatura respiratória remanescente em compensar o trabalho respiratório excedente. Fisioterapia respiratória intensiva com treinamento da musculatura, corre o dos distúrbios metabólicos, tratamento das infec es respiratórias associadas à ventila o mecanica e otimiza o do suporte nutricional foram fundamentais para o sucesso do desmame.
Anestesia para trasplante hepático en hepatitis fulminante Anaesthesia for Liver Transplantation in Fulminant Hepatic Failure A practical approach
Joel Avancini Rocha Filho,Ricardo Souza Nani,Maria José Carvalho Carmona,Mauricio Vanegas Ballesteros
Revista Colombiana de Anestesiología , 2009,
Abstract: La falla hepática fulminante (FHF) es definida como el comienzo súbito de encefalopatía, coagulopatía e ictericia en un individuo que se encontraba en condiciones normales de salud. La falla hepática fulminante termina en un deterioro progresivo de múltiples órganos con un impacto dramático en el cerebro. El edema cerebral severo es un hallazgo frecuente que, finalmente, conlleva a hipertensión intracraneal y a la muerte. El manejo de pacientes con FHF apunta principalmente a prevenir o reversar el incremento de la presión intracraneal, asociada con el tratamiento de soporte para la falla de otros órganos. El tratamiento definitivo para pacientes con FHF es el trasplante de hígado. Este artículo tiene como objetivo presentar una aproximación práctica al cuidado anestésico e intraoperativo para el manejo de pacientes con FHF. Fulminant hepatic failure (FHF) is defined by sudden onset of encephalopathy, coagulopathy and jaundice in an otherwise normal individual. Fulminant hepatic failure results in progressive multi-organ failure with a dramatic impact in the brain. Severe cerebral edema is a frequent finding that ultimately lead to intracranial hypertension and death. The management of patients with FHF is aimed mainly in prevent or reversing increased intracranial pressure associated with support treatment for other failing organs. The definitive treatment for patients with FHF is liver transplantation. This article aims to present a practical approach to anesthesia care and intraoperative management of patients with FHF.
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.
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