Evaluation of the use of Topical Anesthesia on the airway with Lidocaine and Ropivacaine in patients undergoing Total Thyroidectomy surgery: a randomized study

开始日期2025-06-01

申办/合作机构

Hospital São Domingos Ltda.

[+1]

NCT06305455

/ Not yet recruitingN/AIIT

Change in the Resistance Profile of Escherichia Coli in Infections of Community Origin: The Importance of Antimicrobial Stewardship

The main objective of the study is to describe the antimicrobial resistance profile of E. coli isolated in patients from the community - defined as those with cultures collected within 48 hours of hospital admission - and admitted to the intensive care unit.

开始日期2024-04-01

申办/合作机构

Hospital São Domingos Ltda.

NCT06244381

/ CompletedN/AIIT

NUTRITIONAL OPTIMIZATION IN THE DIFFERENT PHASES OF CRITICAL ILLNESS. Comparison of the Urea/Creatinine Ratio With Indirect Calorimetry.

This study aims to evaluate the efficiency of the urea/creatinine ratio as a catabolism marker compared to indirect calorimetry to optimize nutritional support in critically ill patients.

开始日期2024-03-01

申办/合作机构

Hospital São Domingos Ltda.

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2025-04-01·Critical Care Medicine

The Association of ICU Acuity and Organizational Factors With Outcomes of Low-Risk Patients

作者: Spector, Nelson ; Corrêa, Thiago D. ; Bastos, Leonardo S.L. ; Melo, Ulisses O. ; Rabahi, Marcelo F. ; Ferez, Marcus A. ; Santino, Marcelo S. ; Veiga, Viviane C. ; Kurtz, Pedro ; Saturnino, Saulo F. ; Salgueiro, Emmanuel S. ; Antunes, Aline R.S. ; de Freitas, Flávio G.R. ; Burghi, Gaston ; Bozza, Fernando A. ; Varaschin, Pedro A. ; Boniatti, Márcio M. ; Salluh, Jorge I.F. ; Ramos, Grazielle V. ; Borges, Lunna P. ; Maia, Marcelo O. ; de Marco, Fernando V.C. ; de Azevedo, José R.A. ; Zampieri, Fernando G. ; Soares, Marcio ; Machado, Flavia R. ; Pastore, Laerte ; Lisboa, Thiago C. ; Cravo, Victor S. ; de Almeida, Samantha L.S.

OBJECTIVE:Outcomes of low-risk patients may be affected by the overall acuity of the ICU to which they were admitted. Studies addressing this topic are very scarce and the underlying mechanisms supporting this association remain incompletely understood. Here, we investigated the effects of ICU acuity (defined as the mean Simplified Acute Physiology Score 3 of all admitted patients in the bimester in which a given patient was admitted) and organizational factors on the outcomes of patients with a low risk of dying admitted to ICUs.DESIGN:Retrospective cohort study.SETTING:One hundred and thirty-four ICUs from Brazil and Uruguay.PATIENTS:All low-risk (defined as a Simplified Acute Physiology Score 3 probability of death < 3%) patients admitted between 2016 and 2018.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The primary outcome was hospital mortality; secondary outcomes were ICU mortality, and ICU and hospital lengths of stay (LOS). ICU acuity was evaluated as a continuous variable. Multilevel multivariable regression analyses were used to explore the association between ICU acuity, organizational characteristics, and outcomes. Of 285,553 patients, 69,675 (24.4%) were considered low risk. Elective surgeries (66.2%) were the main admission reason. In the models adjusted for patient- and ICU-level characteristics, ICU acuity was not associated with hospital mortality (odds ratio [OR] = 1.095 [0.942–1.274]) and all secondary outcomes. These results were consistent in sensitivity analyses. The presence of dedicated pharmacists in the ICU (OR = 0.531 [0.365–0.773]) and the number of implemented clinical protocols (OR = 0.817 [0.688–0.970]) were independently associated with lower hospital mortality. Clinical protocols were also associated with shorter ICU and hospital LOS.CONCLUSIONS:ICU acuity was not associated with outcomes in low-risk patients. Appropriate multidisciplinary staffing coupled with adherence to best clinical practices are essential to optimize efficiency and minimize variability of care for this population.

2025-03-01·Obesity Surgery

Evaluation of Postoperative Pain and Visual Field in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Under Moderate and Deep Neuromuscular Blockade: Randomized Clinical Trial

Article

作者: da Cunha Leal, Plínio ; Valadão, José Aparecido ; de Lima, Roclides Castro ; Braga, Hiago Parreão ; Dibai Filho, Almir Vieira ; Oliveira, Caio Marcio Barros ; Moura, Ed Carlos Rey ; da Silva, Marcelo Nogueira Cruz ; Nogueira Neto, João

BACKGROUNDThe sustained administration of deep neuromuscular blockade (NMB) improves surgical conditions compared to moderate NMB and might be effective in the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to evaluate the effect of sustained intravenous deep NMB on improving surgical conditions and pain intensity following LRYGB.METHODSThis randomized, double-blind clinical trial was conducted in São Luís, Maranhão, Brazil, between October 2021 and December 2023. Patients undergoing LRYGB were randomly assigned to moderate (reversed with 2 mg/kg of sugammadex) or deep NMB (reversed with 4 mg/kg of sugammadex).RESULTSSeventy-one patients were evaluated in the study, divided into moderate NMB with 37 patients and deep NMB group with 34 patients. There was no difference between the groups regarding gender, age, weight, height, and comorbidities. Also, in the duration of anesthesia (moderate, 2 h 26 min; deep, 2 h 27 min; p = 0.876), duration of surgery (moderate, 1 h 39 min; deep NMB: 1 h 40 min; p = 0.931), time to extubation (moderate, 5 min; deep, 7 min; p = 0.252), time to the first morphine request (moderate, 30 min; deep, 25 min on average; p = 0.776), mean morphine consumption in 24 h (moderate, 14 mg; deep, 10 mg; p = 0.133), and sevoflurane consumption (moderate, 50 mL; deep 50 mL; p = 0.884). There was no significant difference between the groups in pain scores at none of the evaluated moments. The Leiden-Surgical Rating Scale revealed a significant difference between the groups at 20/30 min (p = 0.015) and 60/70 min (p = 0.027), respectively.CONCLUSIONThis study demonstrated improved surgical field visibility with deep compared to moderate NMB, without significant differences in other evaluated variables.

2025-01-01·Brazilian Journal of Anesthesiology (English Edition)

Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial

Article

作者: Ferraro, Leonardo Henrique Cunha ; Winkeler, Vitória Luiza Locatelli ; Nobre, Layana Vieira ; Muniz, Luis Flávio França Vinhosa ; Júnior, Juscelino Afonso de Oliveira ; Braga, Hiago Parreão ; Leal, Plínio da Cunha

BACKGROUNDRebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain.METHODSThis was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure.RESULTSThe incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain.CONCLUSIONThe administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.

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