Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on t...Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.展开更多
Introduction: Experimental Clinical studies have shown that loss of up to 77.0% of red cell mass can be tolerated as long as it kept the blood volume. However, the blood volume loss of about 34.0% is fatal. The initia...Introduction: Experimental Clinical studies have shown that loss of up to 77.0% of red cell mass can be tolerated as long as it kept the blood volume. However, the blood volume loss of about 34.0% is fatal. The initial attention in patients with bleeding should be given to maintaining blood volume and oxygen transport. Thus, transfusions of allogeneic blood products are associated with an increased risk of morbidity and mortality in cardiac surgery. Some transfusion risk scores have been proposed for cardiac surgery patients. Objective: To review and discuss literature blood transfusion (blood components gradient) in cardiovascular surgery versus polytrauma, gastrointestinal bleeding, and neoplastic diseases. Methods: The model followed for the review was PRISMA. We used the databases as Scielo, Lilacs, Google Scholar, PubMed articles and works of scientific and doctoral theses master. Results: According to the discussion in the literature, the acute bleeding of large volumes is challenging to emergency services. Accordingly, the need to support hemotherapeutics led to the development of protocols for more rational utilization of the monitored blood components. Conclusion: Hemotherapy services have adopted a very dynamic approach to the clinical condition presented by patients, the need for four or more red blood cell units.展开更多
<strong>Introduction:</strong> The perioperative nurse plays an important role throughout the surgical period, especially in the context of predicting the risks to which patients are exposed when entering ...<strong>Introduction:</strong> The perioperative nurse plays an important role throughout the surgical period, especially in the context of predicting the risks to which patients are exposed when entering a surgical center. These can be skin, muscle, tendon, and even burn injuries from the scalpel or chemicals. <strong>Objective:</strong> The aim of this study was to verify the degree of risk for the development of injuries resulting from surgical positioning in patients of a university hospital. <strong>Methods:</strong> This is cross-sectional, exploratory research with a quantitative approach conducted with 70 surgical patients in a Municipal University Hospital with data collection through a socioeconomic and health questionnaire and the Risk Assessment Scale for Development of Surgical Positioning Injuries (SISP). Statistical analyses included simple descriptive evaluation, correlations of variables using the Chi-square test and Pearson’s coefficient with a significance level of 5%. <strong>Results: </strong>The results found pointed to a population mainly composed of women (60%), married, with an average age of 49 years, with hypertension and high-risk scores to develop injuries due to surgical positioning. There was also a positive and significant correlation between having hypertension and having a higher risk of developing lesions, with R<sup>2</sup> = 96.4% and p < 0.05.<strong> Conclusion:</strong> The results reinforce the need to implement protocols and the acquisition of materials aimed at reducing the risk of injuries related to surgical positioning in order to improve the quality of care offered and thus minimize the harm to users.展开更多
SARS-CoV-2 is a novel RNA coronavirus responsible of a deadly pandemic: the clinical illness COVID-19. With only one authorized drug for emergency use in critically ill patients: Remdesivir, there is not any other app...SARS-CoV-2 is a novel RNA coronavirus responsible of a deadly pandemic: the clinical illness COVID-19. With only one authorized drug for emergency use in critically ill patients: Remdesivir, there is not any other approved drug or vaccine yet with proven potential to overcome this infection. We exposed here many scientific evidences to support our novel idea that a macrolide, basically Clarithromycin, could be effective as a single agent for treatment and prophylaxis of COVID-19. Clarithromycin could change the history of this pandemic. It could reduce the costs of treatment and the potential adverse effects when combining more than one drug such as with Hydroxychloroquine. Clarithromycin treatment and prophylaxis as a single agent could be much more simple, safe and cheaper as giving Chloroquine or Hydroxychloroquine alone or in combination with Azithromycin as well as other therapeutic options.展开更多
文摘Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.
文摘Introduction: Experimental Clinical studies have shown that loss of up to 77.0% of red cell mass can be tolerated as long as it kept the blood volume. However, the blood volume loss of about 34.0% is fatal. The initial attention in patients with bleeding should be given to maintaining blood volume and oxygen transport. Thus, transfusions of allogeneic blood products are associated with an increased risk of morbidity and mortality in cardiac surgery. Some transfusion risk scores have been proposed for cardiac surgery patients. Objective: To review and discuss literature blood transfusion (blood components gradient) in cardiovascular surgery versus polytrauma, gastrointestinal bleeding, and neoplastic diseases. Methods: The model followed for the review was PRISMA. We used the databases as Scielo, Lilacs, Google Scholar, PubMed articles and works of scientific and doctoral theses master. Results: According to the discussion in the literature, the acute bleeding of large volumes is challenging to emergency services. Accordingly, the need to support hemotherapeutics led to the development of protocols for more rational utilization of the monitored blood components. Conclusion: Hemotherapy services have adopted a very dynamic approach to the clinical condition presented by patients, the need for four or more red blood cell units.
文摘<strong>Introduction:</strong> The perioperative nurse plays an important role throughout the surgical period, especially in the context of predicting the risks to which patients are exposed when entering a surgical center. These can be skin, muscle, tendon, and even burn injuries from the scalpel or chemicals. <strong>Objective:</strong> The aim of this study was to verify the degree of risk for the development of injuries resulting from surgical positioning in patients of a university hospital. <strong>Methods:</strong> This is cross-sectional, exploratory research with a quantitative approach conducted with 70 surgical patients in a Municipal University Hospital with data collection through a socioeconomic and health questionnaire and the Risk Assessment Scale for Development of Surgical Positioning Injuries (SISP). Statistical analyses included simple descriptive evaluation, correlations of variables using the Chi-square test and Pearson’s coefficient with a significance level of 5%. <strong>Results: </strong>The results found pointed to a population mainly composed of women (60%), married, with an average age of 49 years, with hypertension and high-risk scores to develop injuries due to surgical positioning. There was also a positive and significant correlation between having hypertension and having a higher risk of developing lesions, with R<sup>2</sup> = 96.4% and p < 0.05.<strong> Conclusion:</strong> The results reinforce the need to implement protocols and the acquisition of materials aimed at reducing the risk of injuries related to surgical positioning in order to improve the quality of care offered and thus minimize the harm to users.
文摘SARS-CoV-2 is a novel RNA coronavirus responsible of a deadly pandemic: the clinical illness COVID-19. With only one authorized drug for emergency use in critically ill patients: Remdesivir, there is not any other approved drug or vaccine yet with proven potential to overcome this infection. We exposed here many scientific evidences to support our novel idea that a macrolide, basically Clarithromycin, could be effective as a single agent for treatment and prophylaxis of COVID-19. Clarithromycin could change the history of this pandemic. It could reduce the costs of treatment and the potential adverse effects when combining more than one drug such as with Hydroxychloroquine. Clarithromycin treatment and prophylaxis as a single agent could be much more simple, safe and cheaper as giving Chloroquine or Hydroxychloroquine alone or in combination with Azithromycin as well as other therapeutic options.
