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- Effect of propofol and remifentanil on a somatosensory evoked potential indicator of pain perception intensity in volunteersPublication . Castro, Ana; Amorim, Pedro; Nunes, Catarina S.; Almeida, Fernando Gomes deSomatosensory evoked potentials (SEPs) have been linked to noxious activation and stimulus intensity. In this exploratory study we investigated the impact of anaesthetic drugs on SEPs and pain ratings, to assess their applicability as an objective measure of the nociception/anti-nociception balance. Following institutional approval and written informed consent, 10 healthy adult volunteers were enrolled (29.5 ± 9.1 years, 63.0 ± 8.9 kg and 171.4 ± 7.2). Median nerve electrical stimulation was adjusted according to volunteers' sensitive, motor and painful thresholds (PT). Baseline SEPs were registered, and remifentanil and propofol administered using a stair scheme TCI. For each drug combination a 1.3×PT stimulus was administered, and volunteers evaluated pain intensity in a numerical rating scale (0-10). SEPs' amplitudes and latencies were normalized by the baseline values, reducing volunteers' intervariability. Stimulation currents varied between 6-52 mA (1.3×PT) and pain ratings between 0 and 9. Cortical SEPs latencies were decreased for higher stimulus intensities (P < 0.01), accompanied by increased pain ratings (P < 0.01). An individually adjusted/normalized ratio based on cortical SEPs amplitude and interpeak latency is proposed([Formula: see text]): [Formula: see text] and NSR were significantly correlated in three out of nine subjects, and [Formula: see text] and remifentanil Ce were significantly correlated in two (low number of evaluation points). [Formula: see text] was shown to decrease with increasing doses of propofol and remifentanil (P < 0.05). The proposed metric was depressed by anaesthetics and reflected pain evaluations. Further research is necessary to increase the number of volunteers and drugs' combination, to assess its applicability during surgically adequate anesthetic leves.
- Deceased-donor kidney transplantation: predictive factors and impact on postoperative outcomePublication . Santos, F.; Guimarães, J.; Araújo, A. M.; Nunes, Catarina S.; Casal, M.Kidney transplantation (KT) is the treatment of choice in end stage renal disease. Patients proposed for KT have multiple comorbidities, which makes KT a challenge. Our aim was to assess predictive factors for postoperative complications in deceased-donor KT. For data statistical analysis, logistic and linear regressions were used. Between 2012 and 2013, 113 KTs were performed in patients with a mean age 49.9 years. The most prevalent etiology was unknown (32.7%). All patients were in kidney replacement therapy (KRT), for an average of 5.7 years. Most had comorbidities before KT (84.1%), the most frequent hypertension (82.3%). Mean ischemia time (IT) was 1056 minutes. Complications occurred in 93.8% of cases. There were reinterventions in 12.4% of cases, and reinterventions in 13.3%. The time in KRT, IT, and ischemic heart disease had predictive power for the length of hospital stay. Diabetes mellitus before KT and IT were predictors for nephrourologic complications; anemia before KT for hematologic complications; and anemia before KT and time in KRT for cardiovascular complications. The morbidity associated with this disease points to the need to identify and improve the patient-dependent variables influencing its outcome, so as to improve short-term success.
- Effect of boussignac continuous positive airway pressure ventilation on Pao2 and Pao2/Fio2 ratio immediately after extubation in morbidly obese patients undergoing bariatric surgery: a randomized controlled trialPublication . Guimarães, Joana; Pinho, Daniela; Nunes, Catarina S.; Cavaleiro, Carla S.; Machado, Humberto S.Pathophysiological changes after laparoscopic Roux-en-Y gastric bypass may increase the risk of pulmonary complications in morbidly obese patients. The purpose of the study was to assess the impact of immediate postextubation use of Boussignac continuous positive airway pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The hypothesis is that the use of CPAP may improve oxygenation in the postoperative period when compared to Venturi mask.
- Rocuronium continuous infusion for profound neuromuscular blockade: a systematic review and meta-analysisPublication . Couto, Mafalda; Nunes, Catarina S.; Vide, Sérgio; Amorim, Pedro; Mendes, JoaquimRocuronium is a muscle relaxant with increased use, because of the binding relation with the reversal agent sugammadex. Its continuous infusion benefits the maintenance of deeper levels of neuromuscular blockade (NMB) ensuring an improved and stable solution for daily surgical anesthesia. This is systematic review on current approaches on rocuronium infusion and monitoring parameters when using rocuronium continuous infusion for profound muscle relaxation (0-2 posttetanic count).
- Patterns of hysteresis between induction and emergence of neuroanesthesia are present in spinal and intracranial surgeriesPublication . Ferreira, Ana Isabel Leitão; Correia, Rui; Vide, Sérgio; Ferreira, Ana Dias; Kelz, Max B.; Mendes, Joaquim; Nunes, Catarina S.; Amorim, PedroRecovery of consciousness is usually seen as a passive process, with emergence from anesthesia depicted as the inverse process of induction resulting from the elimination of anesthetic drugs from their central nervous system sites of action. However, that need not be the case. Recently it has been argued that we might encounter hysteresis to changes in the state of consciousness, known as neural inertia. This phenomenon has been debated in neuroanesthesia, as manipulation of the brain might further influence recovery of consciousness. The present study is aimed at assessing hysteresis between induction and emergence under propofol-opioid neuroanesthesia in humans using estimated propofol concentrations in both spinal and intracranial surgeries.
- Living-donor and deceased-donor renal transplantation: differences in early outcome: a single-center experiencePublication . Guimarães, J.; Araújo, A. M.; Santos, F.; Nunes, Catarina S.; Casal, M.Living-donor renal transplant (LDRT) yields better long-term outcomes than cadaver-donor renal transplant (CDRT). The aim of the present study was to identify the differences in the early postoperative period between LDRT and CDRT recipients. A retrospective study was conducted including all patients receiving a LDRT and CDRT in this center in 2012 and 2013. A total of 153 recipients were identified (CDRT n = 113, LDRT n = 40). On average, LDRT recipients were younger by 12.7 years (P < .001) and had fewer comorbidities (P < .05). There were no differences in gender or primary kidney disease. Mean time on dialysis, dialytic technique, and ischemia time were different between groups (P < .001, P < .01, P < .001, respectively). On average the length of hospital stay for LDRT recipients was 7 days shorter (P < .001). We found significant differences in the occurrence of early complications (P < .001) and its subtypes, with the exception of neurologic and respiratory complications. There were no differences in reinterventions and readmissions between groups. Recipients' age was an independent risk factor for overall postoperative complications and infectious complications; hypertension before renal transplant and cold ischemia time were predictors for cardiovascular complications; and cold ischemia time also was a predictor of nephrourologic and endocrine complications. CDRT patients had more postoperative complications during hospital stay. The variables identified as predictors of early outcome were different for the 2 groups of patients. Modifiable risk factors for better early outcomes and the impact of immediate complications in long-term graft survival must be investigated.
- Living-donor kidney transplantation: predictive factors and impact on post-transplant outcomePublication . Araújo, A. M.; Santos, F.; Guimarães, J.; Nunes, Catarina S.; Casal, M.Renal transplantation from living donors represents a valuable opportunity for patients with end-stage renal disease due to short- and long-term outcomes. Nevertheless, it requires that a detailed set of conditions be considered for donor and recipient selection, with possible implications arising from these criteria in the post-transplant outcome. The present work aims to study demographic and clinical characteristics of donors and kidney recipients that predict post-transplantation outcomes after living donor kidney transplantation. With this aim, all patients who underwent donor nephrectomy and living donor transplantation between January 2012 and December 2013 were selected. Demographics, medical comorbidities, and postoperative outcomes were transcribed from electronic patient records. Linear and logistic regressions were applied for data analysis. The study sample consists of 40 patients who underwent living donor kidney transplantation. The presence of peripheral arterial disease and the etiology of end-stage renal disease were the only pretransplant variables that seem to independently predict hospitalization time. Simultaneously, the occurrence of urorenal and infectious complications had a statistically significant correlation with hospitalization time. Additionally, the incidence of cardiovascular complications was correlated with surgical reinterventions at a significant level. The results suggest that careful selection of the donor and the kidney recipient appears to be a prerequisite for a successful transplantation in vivo.