Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.P.H.)--University of Michigan, 1974.

Esse estudo foi realizado de maneira prospectiva e randomizada com o objetivo de comparar duas técnicas de vasectomia. Foram avaliados 644 pacientes. Na técnica sem bisturi foram utilizadas duas pinças específicas. O tempo médio da técnica sem bisturi foi de 20,95 minutos e da convencional 22,95. Infecção de ferida operatória e epididimites foram menores na técnica sem bisturi. Não houve diferença entre as técnicas nas complicações intra-operatórias e pós-operatórias. Dez pacientes apresentaram espermatozóides vivos no espermograma de controle. A técnica sem bisturi apresenta um menor tempo cirúrgico e um menor índice de infecção que a técnica convencional. O índice de falha foi semelhante em ambas as técnicas / This study was carried out with objective of comparison two techiniques of vasectomy. Six hundred and fourteen four patients were assessed. For the no-scalpel technique, two specific clamps were used. The operating time for the no scalpel technique was less than for the conventional technique. There was a smaller percentage of infection of the operative wound and epididymitis in the no scalpel technique. There was no difference between the techniques with respect to complications during the operation and later complications. The no scalpel technique requires less time in surgery and has a lower infection rate than the conventional technique. The failure rate was similar for both techniques

Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients. In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend. The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use. Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects. According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective. A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis. The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings. This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.

Submitted by GABRIEL PERES (gabrielperes@uol.com.br) on 2017-01-12T17:59:41Z No. of bitstreams: 1 Dissertacao_Gabriel_Peres__MEPAREM - final_PG.pdf: 1188057 bytes, checksum: 3d743000ee2199b4bada7a4a8ceff65e (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-01-16T16:15:03Z (GMT) No. of bitstreams: 1 peres_g_me_bot.pdf: 1188057 bytes, checksum: 3d743000ee2199b4bada7a4a8ceff65e (MD5) / Made available in DSpace on 2017-01-16T16:15:03Z (GMT). No. of bitstreams: 1 peres_g_me_bot.pdf: 1188057 bytes, checksum: 3d743000ee2199b4bada7a4a8ceff65e (MD5) Previous issue date: 2016-12-14 / Outra / Fundamentos: Diversos estudos realizados visam a prevenção de complicações em cirurgia dermatológica, dentre as quais o sangramento. Trabalhos anteriores demonstraram que uma dieta com sobrecarga lipídica poderia influenciar o padrão coagulatório, reduzindo o sangramento cirúrgico. Este trabalho visa avaliar o efeito da sobrecarga lipídica nos parâmetros laboratoriais de coagulação e sangramento. Casuística e métodos: Dez indivíduos coletaram amostras de sangue em jejum e após trinta minutos da ingestão de sorvete (21g de gordura). Procederam-se exames: hemograma, tempo de sangramento, TTPA, TP, VHS, viscosidade plasmática e perfil lipídico. Os dados foram tabulados e analisados (teste t de Student para amostras dependentes ou Wilcoxon). Considerou-se significativo p<0,05. Resultados: Houve alteração no perfil lipídico (p<0,05): colesterol total (média: 190,3 para 194,4), VLDL (mediana: 19,5 para 21,0) e triglicerídeos (mediana: 101,5 para 105,0), porém, sem alteração significativa das frações LDL e HDL. A contagem de plaquetas apresentou diminuição (média: 243,2 mil para 232,1 mil; p<0,05), entretanto, sem alterações significativas no coagulograma, hemossedimentação e viscosidade sanguínea. Conclusão: A modificação no perfil lipídico indicou adequada absorção da gordura, todavia, não se demonstrou, sob os parâmetros laboratoriais avaliados, e o protocolo empregado, evidências de que a sobrecarga lipídica por via oral promova alterações coagulatórias ou de viscosidade sanguínea. / Background: Several studies have already been performed for the prevention of complications in dermatologic surgery, including bleeding. Previous researches have shown that a diet with fat overload could influence the pattern of coagulation and repair mechanisms, reducing surgical bleeding. This study aims to evaluate the effect of a lipid overload in the parameters of coagulation and bleeding. Patients and Methods: Blood samples were performed in ten individuals, collected on fasting and thirty minutes after eating ice cream (21g of fat). Held up tests: blood count, bleeding time, aPTT, PT, ESR, plasma viscosity and lipid profile. The data were tabulated and analyzed (Student t test for dependent samples or Wilcoxon). A significant p<0,05 was considered. Results: There was an increase in lipid profile (p<0,05): total cholesterol (mean: 190,3 to 194,4), VLDL (median: 19,5 to 21,0) and triglycerides (median: 101,5 to 105,0), but no significant changes on LDL and HDL fractions. The platelet count also showed a decrease (mean: 243200 to 232100; p < 0,05), however, no significant changes in coagulation, erythrocyte sedimentation rate and blood viscosity. Conclusion: The increase in lipid profile indicated adequate absorption of fat, however, not shown, under these laboratory parameters with the chosen protocol, evidences that an orally fat overload is able to modify coagulation or blood viscosity. / FUNADERSP (RESP-SBD): 28/06/2016

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T11:12:02Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Louise Amalia de Moura.pdf: 2275191 bytes, checksum: 3faef95923486346522a80421c7844e0 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T14:36:31Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Louise Amalia de Moura.pdf: 2275191 bytes, checksum: 3faef95923486346522a80421c7844e0 (MD5) / Made available in DSpace on 2015-01-30T14:36:31Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Louise Amalia de Moura.pdf: 2275191 bytes, checksum: 3faef95923486346522a80421c7844e0 (MD5) Previous issue date: 2014-04-24 / Postoperative pain (POP) is still common, especially after hospital discharge, even when advanced anesthetic and surgical techniques are adopted in pediatric outpatient surgeries. An additional concern is the intensity of POP, which may vary from moderate to severe, despite the availability of evidence guiding clinical practice. This study’s objective was to analyze the incidence of POP and factors predicting this experience among 5 to 12 year old children undergoing outpatient surgeries. A prospective cohort study was conducted in two hospitals in Goiania, Brazil between April 2013 and February 2014 with a sample of 306 children, both genders, aged from 5 to 12 years old, ASA below III and indication of outpatient surgeries level I. Data were collected in pre, trans, immediate postoperative (IPO) and in the mediate postoperative (MPO). The intensity and quality of POP were assessed using the FPS-R scale and quality cards pain, respectively. Anxiety was assessed through EAPY-m. Children verbally consented to the study and their legal guardians signed free and informed consent forms. Cox regression was used in the statistical analysis to assess the effect of variables on the progress of POP on the seventh day after surgery. SPSS version 21.0 was used. Male children aged 7.43 years old on average (sd=2.09) with an average socioeconomic level were the majority. A total of 39.9% reported pre-operatory pain and 48.2% presented signs of anxiety. The most frequent surgeries included inguinal hernia repair (48.4%), umbilical hernia repair (20.7%), postectomy (11.3%), orchidopexy (8.6%) and epigastric hernia repair (8.6%). Most children received inhalational anesthesia with halothane, local anesthetic block with 0.5% of bupivacaine, and analgesia with intramuscular dipyrone. The cumulative incidence of POP was 76.8% (CI95%:71.6%-81.1%). During IPO, the incidence of pain was 38.9% (CI95%:33.0%-44.9%) and the intensity was mild. There was report of moderate pain (5.2%), intense pain (2.3%), and the worst pain possible (7.2%). The incidence of pain during MPO (1 st day at home) was 39.2% (CI95%:33.8%-45.9%) with mild intensity. There was report of moderate pain (3.6%), intense (3.6%) and the worst pain possible (4.0%). The incidence diminished on the 4 th day to 1.5% (CI95%:0.4%-3.3%), and the intensity of pain remained mild. There was report of moderate pain (1.5%) and the worst pain possible (0.4%). No new cases were identified on the 7 th day. A total of 10.7% (n=28) of the children experienced pain up to the 7 th day postoperative. There was report of moderate pain (0.8%) and intense pain (0.4%). Over the course of follow-up, children described POP through sensory, affective and evaluative descriptors. The variable preoperatory pain remained as a predictor factor for POP, increasing by three (3) times the risk of pain on the 7 th postoperative day (p=0.018). POP is still common among children undergoing outpatient surgeries. The management of preoperative pain may prevent persistent postoperative pain. / A dor pós-operatória (DPO) ainda é frequente, principalmente, após a alta hospitalar, mesmo com os avanços nas técnicas anestésicas e cirúrgicas adotadas no atendimento da cirurgia pediátrica com abordagem ambulatorial. Preocupação adicional centra-se na intensidade da DPO que pode variar de moderada a grave, apesar da disponibilidade de evidências que orientam a prática clínica. O objetivo desse estudo foi analisar a incidência de DPO e os fatores preditores dessa experiência, em crianças de 5 a 12 anos, submetidas a cirurgias ambulatoriais. Estudo de coorte prospectiva, conduzido em dois hospitais de Goiânia, Brasil, entre abril de 2013 e fevereiro de 2014, com amostra de 306 crianças, de ambos os sexos, com idade entre 5 e 12 anos, ASA menor que III, e indicação de cirurgias ambulatoriais, porte I. Os dados foram coletados no pré, trans e pós-operatório imediato (POI) e mediato (POM). A intensidade e qualidade da DPO foram avaliadas por meio da escala FPS-R e dos Cartões das Qualidades da Dor, respectivamente. A ansiedade foi avaliada pela EAPY-m. As crianças deram o assentimento verbal e seus responsáveis assinaram o Termo de Consentimento Livre e Esclarecido. Para a análise estatística, foi feita regressão de Cox para avaliar o efeito das variáveis sobre a evolução da DPO no sétimo dia de pós-operatório. Foi utilizado o programa SPSS versão 21.0. Prevaleceram crianças do sexo masculino, idade média de 7,43 anos (dp=2,09) e nível socioeconômico médio. No pré-operatório, 39,9% delas referiram dor pré-operatória, e 48,2% apresentaram sinais de ansiedade. As cirurgias mais frequentes incluíram a herniorrafia inguinal (48,4%), herniorrafia umbilical (20,7%), postectomia (11,3%), orquidopexia (8,6%) e herniorrafia epigástrica (8,6%). A maioria das crianças recebeu anestesia inalatória com halotano, bloqueio anestésico local com bupivacaína 0,5% e analgesia com dipirona por via intramuscular. A incidência acumulativa de DPO foi 76,8% (IC95%:71,6%-81,1%), No período POI, a incidência de dor foi de 38,9% (IC95%:33,0%-44,9%) e a intensidade leve. Houve relato de dor moderada (5,2%), dor intensa (2,3%) e a pior dor possível (7,2%). No POM (1º dia em casa), a incidência de dor foi de 39,2% (IC95%:33,8%-45,9%), e a intensidade classificada como leve. Houve relato de dor moderada (3,6%), intensa (3,6%) e a pior dor possível (4,0%). No 4º dia, a incidência diminui para 1,5% (IC95%:0,4%-3,3%), a intensidade da dor permaneceu leve. Houve relato de dor moderada (1,5%) e pior dor possível (0,4%). No 7º dia, nenhum caso novo foi identificado. Permaneceram com dor até esse dia 10,7% (n=28) das crianças. Houve relato de dor moderada (0,8%) e dor intensa (0,4%). Ao longo do seguimento, as crianças descreveram a DPO por meio de descritores sensitivos, afetivos e avaliativos. A variável dor pré-operatória manteve-se como fator preditor para a DPO aumentando em três (3) vezes o risco de dor no sétimo dia pósoperatório (p=0,018). DPO ainda é frequente entre crianças submetidas a cirurgias ambulatoriais. O manejo da dor pré-operatória pode prevenir prejuízos como a persistência da dor pós-operatória.

O uso do propofol em sedação para colonoscopia e outros procedimentos endoscópicos é cada vez mais frequente, devido ao seu rápido início de efeito e curto período de recuperação, com poucos efeitos residuais, o que o torna um anestésico ideal para o uso em condutas médicas realizadas em regime ambulatorial. Seu perfil farmacológico o posiciona como um anestésico adequado a métodos de administração endovenosa contínuos ou titulados, possibilitando maior controle na sua concentração plasmática. Devido à sua alta lipossolubilidade, o propofol difunde-se rapidamente ao sistema nervoso e outros tecidos aonde exercerá seu efeito clínico, intimamente ligado à propofolemia, com diminuição da atividade do sistema nervoso central, que determinará tanto a sedação nos seus diversos níveis, quanto os indesejados efeitos depressores do sistema cardiovascular e respiratório, podendo levar a uma diminuição importante do débito cardíaco e pressão arterial e também a uma depressão central do sistema regulatório da respiração, que pode gerar apneia ou hipoventilação significativas. O presente estudo teve como objetivo avaliar clinicamente, e com dosagem sérica, o propofol em três esquemas diferentes de infusão endovenosa. Foram avaliados aleatoriamente 50 pacientes submetidos à colonoscopia nos Serviços de Endoscopia do Hospital Ana Costa (Santos - SP) e no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (São Paulo-SP). Os pacientes foram divididos em três grupos, conforme o esquema de sedação que foi utilizado. O Grupo 1 recebeu fentanil no início, uma dose inicial de propofol de um miligrama por quilo em um minuto na indução, posteriormente recebeu propofol em infusão intermitente de doses fracionadas de 30 mg (bolus) conforme necessidade clínica durante o exame. O Grupo 2 recebeu fentanil no início, uma dose inicial de propofol de 1 mg/kg em um minuto na indução, após essa, recebeu propofol contínuo em uma solução diluída a 0,2% em solução glicosada a 5%, em uma dose inicial de 1 gota/kg de peso do paciente, o que equivale a aproximadamente 100 ug/kg/min, controlada manualmente e alterada conforme a necessidade clínica do exame. O Grupo 3 recebeu fentanil no início do exame, e propofol com dose calculada e administrada por bomba eletrônica computadorizada (Diprifusor®) em esquema de infusão contínua alvo controlada, numa dose inicial de indução de 4 ug/mL administrada em um minuto, baixada a 2 ug/mL após a dose inicial completada, e alteradas para mais ou para menos conforme a necessidade clínica do exame. Os pacientes foram monitorizados com eletrocardiografia contínua, pressão arterial não invasiva medida de dois em dois minutos, oximetria de pulso, capnografia de aspiração lateral e índice bispectral (BIS). As dosagens séricas de propofol foram feitas em três amostras de sangue colhidas por paciente. A primeira amostra, cinco minutos após a indução, a segunda ao endoscopista alcançar o ceco durante o exame e a terceira a cinco minutos após a última dose de propofol administrada ou ao término da infusão contínua, no final do exame. Não houve diferença estatística significativa entre os Grupos em relação às características físicas pessoais dos pacientes como: sexo (p = 0,976), estado físico de acordo com a American Society of Anestesiology (ASA) (p = 0,945), idade (p = 0,896), peso (p = 0,340), altura (p = 0,947), índice de massa corpórea (IMC) (p = 0406), nos parâmetros clínicos observados como menor valor de índice BIS (p = 0,871) e o tempo para alcançá-lo (p = 0,052), tempo médio do exame (p = 0,123) e efeitos adversos observados como a queda da saturação de oxigênio abaixo de 90% (p = 0,054). Houve diferença estatisticamente significativa nas pressões arteriais iniciais dos Grupos 2 e 3, que foram ligeiramente elevadas em relação ao Grupo 1 a sistólica (p = 0,008), diastólica (p = 0,018) e média (p = 0,008), porém após a indução, a média das pressões arteriais sistólica (p = 0,440), diastólica (p = 0,960) e média (p = 0,815), e as menores pressões alcançadas não foram estatisticamente diferentes: sistólica (p = 0,656), diastólica (p = 0,783) e média (p = 0,993). Não houve diferença estatística em relação à frequência cardíaca inicial (p = 0,453), média após indução (p = 0,702), e menor frequência cardíaca alcançada (p = 0,788). Houve diferença entre o número de agitações médias entre os Grupos (p = 0,001), sendo maior no Grupo 1, porém este número foi relacionado ao esquema de administração do propofol no Grupo 1, que foi administrado após a indução quando o paciente apresentou algum grau de agitação que necessitou aprofundamento anestésico. Houve queda de saturação de oxigênio em seis pacientes (12%) da amostra avaliada, revertidas em tempo menor que cinco minutos com manobras de elevação da mandíbula do paciente ou utilização de cânula de Guedel para desobstrução das vias aéreas. Antes das quedas na saturação de oxigênio, foram percebidas alterações típicas de obstrução de vias aéreas, hipopneia ou apneia nas ondas de capnografia em 16 pacientes (32%), sendo que, em alguns pacientes por mais de uma vez, demonstrando esse ser um bom parâmetro de monitorização para prevenir hipóxia, não houve diferença entre os Grupos no parâmetro de obstrução de vias aéreas/apneia (p = 0,543). Em relação à propofolemia, o comportamento médio dos pacientes dos três Grupos foi estatisticamente igual ao longo dos momentos de avaliação (p = 0,830), não havendo diferença média estatisticamente significativa entre os Grupos (p = 0,964). Não houve diferença entre o consumo do propofol médio por minuto de exame (p = 0,748). Em relação à análise de custos com a administração do propofol, o Grupo 1 apresentou o menor valor médio para as colonoscopias avaliadas com gasto médio de R$ 7,00, o Grupo 2 gastou em média R$ 17,50 e o Grupo 3 gastou em média R$ 112,70 com diferença estatisticamente significativa entre eles (p < 0,001). A conclusão é que os esquemas de administração do propofol testados foram seguros, e houve semelhança entre os Grupos nos parâmetros avaliados incluindo a propofolemia, porém com custos diferenciados entre eles. Em relação ao Grupo 1, devido ao maior número de agitações por minuto este pode ser um bom método para procedimentos mais curtos, para procedimentos mais longos os Grupos 2 e 3 se mostraram mais confortáveis para o responsável pela sedação / The use of propofol sedation for colonoscopies and other endoscopic procedures is increasing due to the rapid onset of effect and short recovery time with few residual effects, which makes it an ideal anesthetic for usingin outpatient medical procedures. Its pharmacological profile places it as a suitable anesthetic to continuous or titred intravenous administration, providing increased control in its plasma levels. Due to its high liposolubility, propofol diffuses rapidly to the central nervous system and other tissues where it shall perform its clinical effects, closely related to plasma concentration, and providing sedation at different levels, as much as the unwanted depressant effects of the cardiovascular and respiratory system, it may lead to a significant reduction in cardiac output and blood pressure and also a central regulatory breathing system depression, that can result in significant apnea or hypoventilation. This study aimed to evaluate clinically and serum, propofol in three different regimens of intravenous infusion. 50 patients submitted to colonoscopy in the endoscopy centers at Hospital Ana Costa (Santos - SP), and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (São Paulo-SP), have been randomly assessed. Such patients were divided into three groups, according to the sedation scheme that was used for them. Group 1 received fentanyl at first, then a one milligram per kilogram propofol dose, at induction, in a minute, later they received intermittent infusion of propofol in fractionated doses of 30 mg (Bolus) according to clinical needs during the test. Group 2 received fentanyl in the beginning, a starting dose of propofol 1 mg/kg at induction in one minute, after that received propofol in a 0.2% solution diluted in 5% glucose solution at an initial 1 drop/kg of patient weight dose, equivalent to about one 100 u100/min, manually controlled and changed according to clinical need of the examination. Group 3 received in the beginning of the examination fentanyl and propofol calculated by target controlled continuous infusion electronic device (Diprifusor®), an initial loading dose of 4 ug/mL was administered in one minute, reduced at 2 ug/mL after the initial dose, changed up or down according to clinical needs of examination. Patients were monitorized with continuous electrocardiography, non-invasive blood pressure measured every two minutes, pulse oximetry, side suction capnography and bispectral index (BIS). Serum levels of propofol were performed on three samples of blood taken by each patient. The first sample, five minutes after the induction, the second when the endoscopist reached the cecum during the examination and the third sample five minutes after the last administered dose or the end of continuous infusion of propofol, at the end of the test. No statistically significant difference between groups with respect to personal physical characteristics of patients as: sex (p = 0.976), physical state according to the American Society of Anesthesiology (ASA) (p = 0.945), age (p = 0.896), weight (p = 0.340), height (p = 0.947), body mass index body (BMI) (p = 0.406) in clinical parameters observed as a minor reached bispectral index value (BIS) (p = 0.871) and time to reach it (p = 0.052), mean procedure time (p = 0.123) and adverse effects observed as a drop in oxygen saturation below 90% (p = 0.054). There was a difference between the number of averages agitations between groups (p = 0.001), being higher in Group 1, but that number was related to propofol administration scheme in Group 1, as this was administered after induction when the patient had some agitation that required deeper anesthesia. There was a statistically significant difference in initial blood pressures of groups 2 and 3, which were slightly higher compared to Group 1: systolic (p = 0.008), diastolic (p = 0.018) and mean (p=0.008), but after induction, the average systolic (p = 0.440), diastolic (p = 0.960) and average (p = 0.815), and lower pressures achieved: systolic (p = 0.656) and diastolic (p = 0.783) and average (p = 0.993), were not statistically different. There was no statistical difference from the initial heart rate (p = 0.453), average heart rate after induction (p=0.702), and lower heart rate achieved (p = 0.788). There was oxygen dessaturation below 90% in six patients (12%) of the study sample, reversed in less than five minutes with patient jaw thrust maneuver or use of Guedel cannula, for airway clearance. Before the declines in oxygen saturation, typical tract obstruction, hypopnea or apnea wave changes were noted in capnography in sixteen patients (32%), and in some patients for more than once, showing this to be a good monitoring parameter to prevent hypoxia in patients, there was no difference between Groups in the airway obstruction/apnea parameter (p = 0.543). Regarding serum propofol, the average behavior of patients in the three Groups were statistically similar over the time (p = 0.830), with no statistically significant mean difference between groups (p = 0.964). There was no difference between the average propofol consumption per minute examination (p = 0.748). Regarding cost analysis with the administration of propofol, Group 1 had the lowest average value for colonoscopies evaluated with an average expense of R$ 7.00, Group 2 spent on average R$ 17.50 and the Group spent 3 on average R$ 112.70 with a statistically significant difference (p < 0.001). The conclusion is that propofol administration schemes tested were safe and there was similarity between the Groups in the evaluated parameters including propofolemia, but with different costs among them. With respect to Group 1 due to the larger number of agitations per minute, this is a good method for shorter procedures, for longer procedures groups 2 and 3 were more comfortable for the person responsible for sedation

A cirurgia guiada é uma das técnicas mais precisas em implantodontia. Porém, ainda apresenta problemas devido a ligeiros desvios dos implantes.Objetivo:Avaliar um sensor experimental de aproximação por refletância digital, aplicado à cirugía guiada para inserção de implantes para evitar o risco de fenestração. Métodos: foram confeccionados 10 modelos, protótipos de arcos desdentados totais, simulando a maxila, osso e tecido mucoso, divididos em 2 grupos. Um dos modelos foi tomografado para ser realizado o planejamento virtual da inserção dos implantes com cirurgia guiada. Dois implantes de 3.5 x 11.5mm foram inseridos em cada modelo, sendo que no grupo 1 de controle (G1), foi utilizado o guia estereolitográfico, do kit NeoGuide; no grupo 2 (G2), foi empregado o sensor experimental de aproximação por reflectância digital para a inserção dos implantes. A avaliação dos resultados foi realizada pela sobreposição das imagens do planejamento virtual com as tomografias dos modelos com os implantes inseridos. Resultados:Mostraram que não houve diferenças estatisticamente significantes para os desvios angulares e lineares entre o guia e o sensor. As médias e desvio padrão observados na angulação do guia foi de 4,15 (2,65) e 5,48 (2,85) no sensor. Os desvios lineares ao nível cervical de 0,002 (1,37) e 0,11 (1,47) e, ao nível apical, de 0,19 (1,28) e 0,21 (1,42) respectivamente. Conclusões: O uso de guia é importante para a estabilização das brocas, sendo que o maior desafio é controlar a posição apical dos implantes, principalmente em rebordos altamente reabsorvidos. O sensor experimental pode ser uma ferramenta auxiliar aos guias estereolitográficos, porém, várias dificuldades devem ser ainda superadas para que se preconize o uso do sensor. / Guided surgery is one of the most accurate techniques in implantology. However, it still presents problems due to slight deviations. Objective: The purpose of this research was to develop and evaluate an experimental sensor of approximation by digital reflectance, aiming to contribute to the avoidance, at the time of insertion of implants, the risk of fenestration in more complex cases, without flap detachment, mainly related to severe bone resorption. Methods: 10 models, total edentulous arches, simulating the maxilla, bone and soft tissue, were divided into 2 groups. One of the models was scanned to perform the virtual implant insertion planning with guided surgery. Two implants of 3.5 x 11.5 mm were inserted in each model, in the control group 1 (G1), the stereolithographic guide of the NeoGuide kit was used; in group 2 (G2), the experimental digital reflectance sensor was used to insert the implants. The evaluation of the results was performed by overlapping the virtual planning images with the tomographies of the models with the implants inserted. Results: showed that there were no statistically significant differences for the angular and linear deviations between the guide and the sensor. The averages and standard deviation observed at the angulation in G1 was 4.15 (2.65) and 5.48 (2.85) at the G2. The linear deviations at the cervical level were 0.002 (1.37) and 0.11 (1.47) and at the apical level were 0.19 (1.28) and 0.21 (1.42) respectively. Conclusions: The use of a guide is important for the stabilization of the drills, the greatest challenge is to control the apical position of the implants, especially in highly absorption ofalveolar ridge. The experimental sensor could be an auxiliary tool to the stereolithographic guides, however several difficulties must still be overcome in order to recommend the use of the sensor.