Made available in DSpace on 2015-03-03T11:52:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-13Bitstream added on 2015-03-03T12:06:37Z : No. of bitstreams: 1 000805302.pdf: 309742 bytes, checksum: 94e04b0965e28b880c8b98953725f6f2 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Justificativa e Objetivo - A anestesia subaracnoidea é uma das técnicas de anestesia regional mais seguras e utilizadas. Contudo, a possibilidade de falhas há muito reconhecida é, ainda nos dias atuais, problema intrigante. A palavra falha sugere que não houve bloqueio após a introdução do anestésico local no espaço subaracnoideo ou, se o bloqueio ocorreu, ele não foi suficiente para possibilitar a realização da cirurgia. O objetivo deste estudo foi avaliar a incidência de falhas de bloqueio em pacientes submetidos à anestesia subaracnoidea correlacionando-a com os fatores que a desencadearam. Método - Participaram deste estudo prospectivo pacientes com idades superiores a 18 anos submetidos a anestesia subaracnoidea com bupivacaína a 0,5% entre dezembro de 2008 e janeiro de 2011. Foram avaliados o gênero, o índice de massa corporal, o estado físico, a especialidade cirúrgica, o biotipo, as características corporais, a anatomia espinal, a identificação das marcas anatômicas, a capacidade de flexionar a coluna, a posição do paciente no momento da realização do bloqueio, se a posição era adequada, o espaço intervertebral puncionado, a via de abordagem, o número de tentativas para o sucesso da punção, o número de espaços puncionados, o calibre e o tipo da agulha, a presença do liquor no início e no final da injeção do anestésico local, se o mesmo fluiu fácil, a característica do liquor e do anestésico local e a presença de adjuvantes, a experiência do anestesiologista e o trimestre do ano. Foram consideradas falhas as anestesias cujo bloqueio sensitivo e ou motor não se estabeleceu ou se instalou parcialmente após 15 minutos da administração do anestésico local. Quando presentes, as falhas foram caracterizadas como total ou parcial. Sempre que ocorreu falha total foi obrigatória a pesquisa das sensibilidades térmica e dolorosa em área de períneo. Para análise estatística o teste de ... / Background and Objective - Subarachnoid anesthesia is one of the safest and most used regional anesthesia techniques; however, the possibility of failures has long been recognized, and continues to be an intriguing problem to this day. The word failure suggests that no blockade occurred following the introduction of local anesthetics into the subarachnoid space, or when the blockade did occur, it was insufficient to enable surgery. The purpose of this study was to evaluate the incidence of block failure in patients submitted to subarachnoid anesthesia and correlate failure with the factors that triggered it. Method - The study participants were patients aged 18 years-old or over submitted to subarachnoid anesthesia with 0.5% bupivacaine between December 2008 and January 2011. The following factors were evaluated: patient sex, body mass index, physical status, surgical specialty, biotype, body characteristics, spinal anatomy, identification of anatomical markings, the patient’s spinal flexibility, the patient's position at the time of blockade, whether the position was adequate, the intervertebral space punctured, the puncture approach, the number of attempts needed to achieve successful puncture, the number of spaces punctured, the size and type of needle, the presence of cerebrospinal fluid (CSF) at the onset and completion of local anesthetic injection, whether the CSF flowed easily, the characteristics of the CSF and the local anesthetic and the presence of adjuvants, the clinical experience of the anesthesiologist and the time of year. Failure was considered to have occurred when sensory or motor blockade was not established or was partially established 15 min after local anesthetics administration. When present, the failures were characterized as complete or partial. Evaluation of pain and thermal sensitivity in the perineal region was required to define total failures. For statistical analysis, the ...

Orientador: Eliana Marisa Gamem / Banca: Yara Marcondes Machado Castiglia / Banca: Lais Helena Camacho Navarro / Banca: Simone Maria D'Angelo Vanni / Banca: Anita Leocádia de Mattos / Resumo: Justificativa e Objetivo - A anestesia subaracnoidea é uma das técnicas de anestesia regional mais seguras e utilizadas. Contudo, a possibilidade de falhas há muito reconhecida é, ainda nos dias atuais, problema intrigante. A palavra falha sugere que não houve bloqueio após a introdução do anestésico local no espaço subaracnoideo ou, se o bloqueio ocorreu, ele não foi suficiente para possibilitar a realização da cirurgia. O objetivo deste estudo foi avaliar a incidência de falhas de bloqueio em pacientes submetidos à anestesia subaracnoidea correlacionando-a com os fatores que a desencadearam. Método - Participaram deste estudo prospectivo pacientes com idades superiores a 18 anos submetidos a anestesia subaracnoidea com bupivacaína a 0,5% entre dezembro de 2008 e janeiro de 2011. Foram avaliados o gênero, o índice de massa corporal, o estado físico, a especialidade cirúrgica, o biotipo, as características corporais, a anatomia espinal, a identificação das marcas anatômicas, a capacidade de flexionar a coluna, a posição do paciente no momento da realização do bloqueio, se a posição era adequada, o espaço intervertebral puncionado, a via de abordagem, o número de tentativas para o sucesso da punção, o número de espaços puncionados, o calibre e o tipo da agulha, a presença do liquor no início e no final da injeção do anestésico local, se o mesmo fluiu fácil, a característica do liquor e do anestésico local e a presença de adjuvantes, a experiência do anestesiologista e o trimestre do ano. Foram consideradas falhas as anestesias cujo bloqueio sensitivo e ou motor não se estabeleceu ou se instalou parcialmente após 15 minutos da administração do anestésico local. Quando presentes, as falhas foram caracterizadas como total ou parcial. Sempre que ocorreu falha total foi obrigatória a pesquisa das sensibilidades térmica e dolorosa em área de períneo. Para análise estatística o teste de ... / Abstract: Background and Objective - Subarachnoid anesthesia is one of the safest and most used regional anesthesia techniques; however, the possibility of failures has long been recognized, and continues to be an intriguing problem to this day. The word failure suggests that no blockade occurred following the introduction of local anesthetics into the subarachnoid space, or when the blockade did occur, it was insufficient to enable surgery. The purpose of this study was to evaluate the incidence of block failure in patients submitted to subarachnoid anesthesia and correlate failure with the factors that triggered it. Method - The study participants were patients aged 18 years-old or over submitted to subarachnoid anesthesia with 0.5% bupivacaine between December 2008 and January 2011. The following factors were evaluated: patient sex, body mass index, physical status, surgical specialty, biotype, body characteristics, spinal anatomy, identification of anatomical markings, the patient's spinal flexibility, the patient's position at the time of blockade, whether the position was adequate, the intervertebral space punctured, the puncture approach, the number of attempts needed to achieve successful puncture, the number of spaces punctured, the size and type of needle, the presence of cerebrospinal fluid (CSF) at the onset and completion of local anesthetic injection, whether the CSF flowed easily, the characteristics of the CSF and the local anesthetic and the presence of adjuvants, the clinical experience of the anesthesiologist and the time of year. Failure was considered to have occurred when sensory or motor blockade was not established or was partially established 15 min after local anesthetics administration. When present, the failures were characterized as complete or partial. Evaluation of pain and thermal sensitivity in the perineal region was required to define total failures. For statistical analysis, the ... / Doutor

Thoracic paravertebral block (TPVB) consists of an injection of local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. Clinically TPVB can be accomplished either as a single-injection or as a multiple-injection. It can also be used as a continuous paravertebral infusion through an indwelling catheter for continuous pain relief. However compared to an epidural block, TPVB is less well understood and not commonly used for anaesthesia and or analgesia in anaesthetic practice. I hypothesized that TPVB is effective for producing unilateral segmental thoracic anaesthesia and managing pain of unilateral origin from the thorax. / The objective of this thesis was to develop the technique of TPVB so that it becomes a useful technique for anaesthesia and pain management. So to test my hypothesis a series of clinical studies were performed on 416 patients (396 adults and 20 young infants), presenting for anaesthesia and or acute pain management, to evaluate various aspects of TPVB, namely; clinical application, anatomy of the thoracic paravertebral space, technique and safety, and pharmacology of local anaesthetic after TPVB. Also included are 9 published case reports and letters-to-editor (Appendix 1-9) based on my research that have provided new insights into the mechanism and applications of TPVB. The following section summarizes my research... / Karmakar, Manoj Kumar. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 270-285). / Appendix includes Chinese. / ABSTRACT --- p.v / PREFACE --- p.xxvii / STATEMENT OF WORK --- p.xxviii / ACKNOWLEDGEMENTS --- p.xxix / PUBLICATIONS AND PRESENTATIONS --- p.xxxii / LIST OF ABBREVIATIONS --- p.xxxviii / LIST OF TABLES --- p.xli / LIST OF FIGURES --- p.xliii / Chapter Part 1. --- Introduction --- p.1 / Chapter Chapter 1. --- Objective and Plan of Research --- p.2 / Chapter Chapter 2. --- Thoracic Paravertebral Block A Review of the Literature. --- p.7 / Chapter 2.1. --- Introduction --- p.7 / Chapter 2.2. --- History --- p.7 / Chapter 2.3. --- Anatomy: --- p.9 / Chapter 2.4. --- Techniques --- p.17 / Chapter 2.4.1. --- Anatomical Landmark Based Techniques --- p.20 / Chapter 2.4.1.1. --- Loss-of-resistance Technique --- p.20 / Chapter 2.4.1.2. --- Advancing the Block Needle by a pre-determined Distance --- p.23 / Chapter 2.4.1.3. --- Other Landmark Based Techniques --- p.24 / Chapter 2.4.2. --- Fluoroscopic Guidance or Injection of Radiopaque Contrast medium --- p.24 / Chapter 2.4.3. --- Peripheral Nerve Stimulation --- p.25 / Chapter 2.4.4. --- Pressure Measurement Technique --- p.26 / Chapter 2.5. --- Thoracic Paravertebral Catheter Placement --- p.27 / Chapter 2.6. --- Ultrasound Guided Thoracic Paravertebral Block --- p.32 / Chapter 2.6.1. --- Two Dimensional (2D) Sonoanatomy of the Thoracic Paravertebral Region --- p.32 / Chapter 2.6.1.1. --- Basic Considerations --- p.32 / Chapter 2.6.1.2. --- Transverse Scan of the Thoracic Paravertebral Region --- p.33 / Chapter 2.6.1.3. --- Sagittal Scan of the Thoracic Paravertebral Region --- p.42 / Chapter 2.6.2. --- Three Dimensional (3D) Sonoanatomy of the Thoracic Paravertebral Region --- p.46 / Chapter 2.6.3. --- Ultrasound Guided Thoracic Paravertebral Block - Techniques --- p.49 / Chapter 2.6.3.1. --- Transverse scan with short axis needle insertion (Technique 1) --- p.54 / Chapter 2.6.3.2. --- Paramedian Sagittal scan with in-plane needle insertion (Technique 2) --- p.56 / Chapter 2.6.3.3. --- Transverse scan with in-plane needle insertion or the Intercostal approach to the TPVS (Technique 3) --- p.58 / Chapter 2.7. --- Mechanism and Spread of Anaesthesia --- p.58 / Chapter 2.8. --- Indications --- p.65 / Chapter 2.9. --- Contraindications --- p.65 / Chapter 2.10. --- Drugs Used and Dosage --- p.68 / Chapter 2.11. --- Pharmacokinetic Considerations --- p.70 / Chapter 2.12. --- Failure Rate and Complications --- p.72 / Chapter 2.13. --- Clinical Applications of Thoracic Paravertebral Block --- p.76 / Chapter 2.13.1. --- Pain Relief after Thoracic Surgery --- p.76 / Chapter 2.13.2. --- Pain Relief after Multiple Fractured Ribs --- p.78 / Chapter 2.13.3. --- Anaesthesia and Analgesia for Breast Surgery --- p.80 / Chapter 2.13.4. --- Thoracic Paravertebral Block and Chronic Pain after Breast Cancer Surgery --- p.84 / Chapter 2.13.5. --- Thoracic Paravertebral Block and Cancer Recurrence after Breast Cancer Surgery --- p.85 / Chapter 2.13.6. --- Anaesthesia and Analgesia for Inguinal Herniorrhaphy --- p.87 / Chapter 2.13.7. --- Pain Relief after Cholecystectomy and Renal Surgery --- p.90 / Chapter 2.13.8. --- Anaesthesia and Analgesia for Liver and Biliary Tract Surgery --- p.91 / Chapter 2.13.9. --- Analgesia after Cardiac Surgery --- p.92 / Chapter 2.13.10. --- Thoracic Paravertebral Block and Chronic Pain Management --- p.94 / Chapter 2.13.11. --- Bilateral Thoracic Paravertebral Block --- p.94 / Chapter 2.13.12. --- Miscellaneous Applications --- p.95 / Chapter Part 2. --- Studies Evaluating the Efficacy of Thoracic Paravertebral Block in Adults. --- p.96 / Chapter Chapter 3. --- Prospective Randomized Evaluation of the Effects of Combining a Single-injection Thoracic Paravertebral Block with General Anesthesia in Patients Undergoing Modified Radical Mastectomy. --- p.97 / Chapter Chapter 4. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia A Prospective, Randomized, Double Blind, Controlled Trial. --- p.120 / Chapter Chapter 5. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Pain Management in Patients with Multiple Fractured Ribs. --- p.137 / Chapter Chapter 6. --- Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-related Quality of Life after Modified Radical Mastectomy. --- p.154 / Chapter Chapter 7. --- Right Thoracic Paravertebral Anaesthesia for Percutaneous Radiofrequency Ablation of Liver Tumours. --- p.186 / Chapter Part 3. --- Studies Evaluating The Efficacy Of Thoracic Paravertebral Block In Children. --- p.198 / Chapter Chapter 8. --- Continuous Extrapleural Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia in Young Infants. --- p.199 / Chapter Part 4. --- Studies Evaluating The Anatomy Relevant For Thoracic Paravertebral Block. --- p.213 / Chapter Chapter 9. --- Thoracic Paravertebral Sonography - A Quantitative Evaluation of the Paramedian Sagittal Window for Visualizing the Anatomy Relevant for Thoracic Paravertebral Block. --- p.214 / Chapter Chapter 10. --- Volumetric 3D Ultrasound Imaging of the Anatomy Relevant for Thoracic Paravertebral Block. --- p.228 / Chapter Part 5. --- Pharmacokinetics of Ropivacaine after Thoracic Paravertebral Block. --- p.242 / Chapter Chapter 11. --- Arterial and Venous Pharmacokinetics of Ropivacaine With and Without Epinephrine after Thoracic Paravertebral Block. --- p.243 / Chapter Part 6. --- Summary and Conclusions --- p.266 / Chapter Chapter 12. --- Summary and Conclusions --- p.266 / Chapter Part 7. --- Bibliography --- p.270 / Chapter Part 8. --- Appendix --- p.296 / Chapter A. --- Published Case Reports and Letters-to-editor. --- p.297 / Chapter Appendix: 1.0. --- Variability of a Thoracic Paravertebral Block. Are we ignoring the endothoracic fascia? (Published Commentary) --- p.297 / Chapter Appendix: 2.0. --- Ipsilateral Thoraco-lumbar Anaesthesia and Paravertebral Spread after Low Thoracic Paravertebral Injection. (Published Case Report) --- p.301 / Chapter Appendix: 3.0. --- The Use of a Nerve Stimulator for Thoracic Paravertebral Block Reply. (Published Letter-to-editor) --- p.310 / Chapter Appendix: 4.0. --- Bilateral Continuous Paravertebral Block Used for Postoperative analgesia in an Infant having Bilateral Thoracotomy. (Published Case Report) --- p.312 / Chapter Appendix: 5.0. --- Thoracic Paravertebral Block: Radiological evidence of Contralateral Spread Anterior to the Vertebral Bodies. (Published Case Report) --- p.317 / Chapter Appendix: 6.0. --- Lymphatic Drainage of the Thoracic Paravertebral Space A Reply. (Published Letter-to-editor) --- p.325 / Chapter Appendix: 7.0. --- Thoracic Paravertebral Block for Management of Pain Associated with Multiple Fractured Ribs in Patients with Concomitant lumbar Spinal Trauma. (Published Case Report) --- p.328 / Chapter Appendix: 8.0. --- Right Thoracic Paravertebral Analgesia for Hepatectomy. (Published Case Report) --- p.340 / Chapter Appendix: 9.0. --- Resolution of ST-segment Depression after High Thoracic Paravertebral Block during General Anesthesia. (Published Case Report) --- p.348 / Chapter B. --- Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36) - Appendix 10. --- p.353 / Chapter C. --- Hospital Anxiety and Depression Scale - Appendix 11. --- p.362 / Chapter D. --- Postoperative Telephone Follow Up Questionnaire: Appendix 12. --- p.364

Orientador: Norma Sueli Pinheiro Modolo / Coorientador: Regina Paolucci El Dib / Banca: Eliana Marisa Ganem / Banca: Lais Helena Navarro e Lima / Banca: Eneida Maria Vieira / Banca: José Fernando Amaral Meletti / Resumo: Introdução: acredita-se que a anestesia regional guiada por ultrassonografia (USG) pode melhorar a eficácia dos bloqueios de nervos periféricos e reduzir as complicações na população pediátrica, porém essa hipótese ainda não foi previamente testada de forma quantitativa. Objetivo: a proposta desta revisão sistemática de ensaios clínicos randomizados (ECR) foi avaliar se o uso da ultrassonografia em pediatria melhoraria a taxa de sucesso dos bloqueios e reduziria o índice de complicações comparativamente a outros métodos tradicionais de localização de nervos. Métodos: a pesquisa sistemática, extração dos dados, avaliação crítica e análise conjunta dos dados seguiram as recomendações para a realização de revisões sistemáticas propostas pela Colaboração Cochrane e pela declaração PRISMA. A estratégia de busca incluiu as bases CENTRAL, EMBASE, Medline e Lilacs. A última pesquisa foi realizada em novembro de 2014. O risco relativo (RR) e a diferença média (DM), com seus respectivos intervalos de confiança de 95% (IC 95%), foram calculados utilizando-se o programa estatístico Revman para dados dicotômicos e contínuos, respectivamente. Resultados: onze ensaios clínicos randomizados, publicados entre 2004 e 2013, perfazendo um total de 634 pacientes, cumpriram os critérios de inclusão. A qualidade metodológica foi considerada moderada. Houve um pequeno benefício da ultrassonografia na taxa de sucesso (RR 1,19; IC 95% 1,07-1,32) que foi variável de acordo com a região anatômica avaliada, associado a uma redução na necessidade de analgesia no pós-operatório com o uso da ultrassonografia (RR 0,2; IC 95% 0,11-0,34). Apenas uma complicação foi reportada nos estudos incluídos. Uma punção vascular em um paciente do grupo controle durante realização do bloqueio ílio-inguinal/ílio-hipogástrico (II/IH). Conclusão: existe moderada evidência de que a ultrassonografia quando utilizada para... / Abstract: Background: it has been suggested that ultrasound-guided regional anesthesia could improve the blockade efficacy and decrease complication rates in the pediatric population, but this hypothesis has not previously been adequately tested in a quantitative manner. Aim: the purpose of this systematic review of randomized clinical trials (RCT) is to assess whether the use of ultrasonography in the pediatric population has advantages over any other method of nerve location, such as the anatomical landmark-based technique, paraesthesia or use of an electrical nerve stimulator. Methods: the systematic search, data extraction, critical appraisal and pooled analysis were performed according to the Cochrane Handbook and PRISMA guidelines. The search strategy included the CENTRAL of the Cochrane Library, Medline, EMBASE, and Lilacs. The date of the last search was November 5, 2014. The relative risk (RR), mean difference (MD) and their corresponding 95% confidence intervals (95% CIs) were calculated using the Revman statistical software for dichotomous and continuous outcomes, respectively. Results: eleven randomized, clinical, controlled trials (published between 2004 and 2013) with a total 634 patients met the inclusion criteria. The methodological quality of the included studies was considered regular. There was a slight benefit of ultrasound to the success rate (RR 1.19, 95% CI 1.07 to 1.33), which was variable according to the anatomical region studied and a more important reduction of the analgesia requirement in the postoperative period with the use of ultrasound for peripheral nerve blocks (RR 0.2, 95% CI 0.11-0.34). There was only one complication reported (blood vessel puncture in one control group). Conclusions: there is moderate evidence that the use of ultrasound-guided peripheral nerve block in children reduces the number of patients requiring additional analgesia in the postoperative period and ... / Doutor

Made available in DSpace on 2016-07-01T13:10:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-26. Added 1 bitstream(s) on 2016-07-01T13:14:07Z : No. of bitstreams: 1 000864068.pdf: 1262302 bytes, checksum: 4c6431d5e7e0e90796d45aa103531bb2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: acredita-se que a anestesia regional guiada por ultrassonografia (USG) pode melhorar a eficácia dos bloqueios de nervos periféricos e reduzir as complicações na população pediátrica, porém essa hipótese ainda não foi previamente testada de forma quantitativa. Objetivo: a proposta desta revisão sistemática de ensaios clínicos randomizados (ECR) foi avaliar se o uso da ultrassonografia em pediatria melhoraria a taxa de sucesso dos bloqueios e reduziria o índice de complicações comparativamente a outros métodos tradicionais de localização de nervos. Métodos: a pesquisa sistemática, extração dos dados, avaliação crítica e análise conjunta dos dados seguiram as recomendações para a realização de revisões sistemáticas propostas pela Colaboração Cochrane e pela declaração PRISMA. A estratégia de busca incluiu as bases CENTRAL, EMBASE, Medline e Lilacs. A última pesquisa foi realizada em novembro de 2014. O risco relativo (RR) e a diferença média (DM), com seus respectivos intervalos de confiança de 95% (IC 95%), foram calculados utilizando-se o programa estatístico Revman para dados dicotômicos e contínuos, respectivamente. Resultados: onze ensaios clínicos randomizados, publicados entre 2004 e 2013, perfazendo um total de 634 pacientes, cumpriram os critérios de inclusão. A qualidade metodológica foi considerada moderada. Houve um pequeno benefício da ultrassonografia na taxa de sucesso (RR 1,19; IC 95% 1,07-1,32) que foi variável de acordo com a região anatômica avaliada, associado a uma redução na necessidade de analgesia no pós-operatório com o uso da ultrassonografia (RR 0,2; IC 95% 0,11-0,34). Apenas uma complicação foi reportada nos estudos incluídos. Uma punção vascular em um paciente do grupo controle durante realização do bloqueio ílio-inguinal/ílio-hipogástrico (II/IH). Conclusão: existe moderada evidência de que a ultrassonografia quando utilizada para... / Background: it has been suggested that ultrasound-guided regional anesthesia could improve the blockade efficacy and decrease complication rates in the pediatric population, but this hypothesis has not previously been adequately tested in a quantitative manner. Aim: the purpose of this systematic review of randomized clinical trials (RCT) is to assess whether the use of ultrasonography in the pediatric population has advantages over any other method of nerve location, such as the anatomical landmark-based technique, paraesthesia or use of an electrical nerve stimulator. Methods: the systematic search, data extraction, critical appraisal and pooled analysis were performed according to the Cochrane Handbook and PRISMA guidelines. The search strategy included the CENTRAL of the Cochrane Library, Medline, EMBASE, and Lilacs. The date of the last search was November 5, 2014. The relative risk (RR), mean difference (MD) and their corresponding 95% confidence intervals (95% CIs) were calculated using the Revman statistical software for dichotomous and continuous outcomes, respectively. Results: eleven randomized, clinical, controlled trials (published between 2004 and 2013) with a total 634 patients met the inclusion criteria. The methodological quality of the included studies was considered regular. There was a slight benefit of ultrasound to the success rate (RR 1.19, 95% CI 1.07 to 1.33), which was variable according to the anatomical region studied and a more important reduction of the analgesia requirement in the postoperative period with the use of ultrasound for peripheral nerve blocks (RR 0.2, 95% CI 0.11-0.34). There was only one complication reported (blood vessel puncture in one control group). Conclusions: there is moderate evidence that the use of ultrasound-guided peripheral nerve block in children reduces the number of patients requiring additional analgesia in the postoperative period and ...

Li, Xiang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 161-184). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

Made available in DSpace on 2015-05-14T16:53:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-11-26Bitstream added on 2015-05-14T16:59:12Z : No. of bitstreams: 1 000829044.pdf: 414488 bytes, checksum: 9ccb90602e34bd027befe2e9c3a9d742 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: O câncer é doença caracterizada por desvio dos mecanismos de controle que regulam a sobrevida, proliferação e diferenciação de células. A cirurgia, quimioterapia e a radioterapia são os tratamentos utilizados em pacientes oncológicos. Agentes quimioterápicos como o metotrexate (MTX) são considerados antineoplásicos efetivos. Ele pertence à classe dos antimetabólitos que atuam sobre o metabolismo intermediário das células em proliferação. Por ser cada vez mais utilizado nos protocolos de tratamento de câncer, e com doses progressivamente maiores, a ocorrência de toxicidade do tecido nervoso central pelo MTX está aumentada. O mecanismo exato desencadeador de neurotoxicidade não foi elucidado. A manifestação clínica da neurotoxicidade após sua administração pela via subaracnóidea é a aracnoidite química e ocorre em aproximadamente 50% dos pacientes. Relatos de casos associaram-no também a síndrome da cauda equina. Objetivo: Avaliar os efeitos que doses múltiplas de MTX administradas pela via subaracnoidea determinam sobre a medula espinal e as meninges de coelhos. Método: Trinta coelhos adultos jovens, machos, da raça Grupo Genético de Botucatu, pesando entre 3000 g e 3900 g, comprimento de coluna vertebral entre 36 e 40 cm e superfície corpórea entre 0,19 e 0,22 m2 foram divididos, por sorteio, em três grupos (G): G1, punção subaracnóidea, G2, solução fisiológica e G3, MTX. Após anestesia venosa com xilaziana e cetamina foi realizada a punção subaracnoidea em S1-S2 e injetada a solução sorteada no G2 e G3. Os animais de G3 receberam MTX em volume correspondente a 12 mg.m2 de superfície corpórea (0,1mL), os de G2 igual volume de solução fisiológica e nos de G1 foi realizada somente punção subaracnóidea. Este procedimento foi repetido quatro vezes em intervalos de 7 dias. Os animais foram avaliados clinicamente quanto à sensibilidade e motricidade por 21 dias e após ... / Background: Cancer is a disease characterized by deviation of control mechanisms that regulate the survival, proliferation and differentiation of cells. Surgery, chemotherapy and radiotherapy are treatments used in oncology patients. Chemotherapeutic agents such as methotrexate (MTX) are considered effective antineoplastic agents. MTX belongs to the class of antimetabolites that act on the intermediary metabolism of cells on proliferation. For being increasingly used in cancer treatment protocols with progressively larger doses, the occurrence of central nervous tissue toxicity by MTX is increasing. The exact mechanism for triggering neurotoxicity has not been elucidated. The most common clinical manifestation of neurotoxicity after MTX administration is chemical aracnoiditis. Cases of cauda equina syndrome were also described. Objectives: To evaluate the effects of multiple subarachnoid doses of MTX over spinal cord and meninges of rabbits. Method: Thirty male young adults rabbits, breed genetic Group Botucatu, weighing between 3000 and 3900 g, with spinal length between 36 and 40 cm, and corporeal surface area between 0.22 and 0.19 m2 were divided by lot into three groups (G): G1, subarachnoid puncture; G2, saline solution; and G3, methotrexate. After intravenous anesthesia with xilaziana and ketamine, subarachnoid puncture was performed in S1-S2. Solution ion was performed inject in G2 and G3. G3 animals received MTX volume corresponding to 12 mg. m2 (0.1 mL); in G2, an equal volume of saline solution, was administered G1 only subarachnoid puncture was performed in S1- S2 intervertebral space. Solution injection was performed in G2 and G3. G3 animals received intrathecal MTX volume corresponded to 12mg.m2 (0.1 ml); in G2, an equal volume of saline solution was administered, while in G1 only subarachnoid puncture was performed. The same procedure was repeated four times at 7 days interval. Animals ... / FAPESP: 2011/02291-7

Orientador: Eliana Marisa Ganem / Coorientador: Lais Helena Navarro e Lima / Banca: Guilherme Antonio Moreira de Barros / Banca: Geraldo Rolim Rodrigues Junior / Banca: Giane Makamura / Banca: Eneida Maria Vieira / Resumo: Introdução: O câncer é doença caracterizada por desvio dos mecanismos de controle que regulam a sobrevida, proliferação e diferenciação de células. A cirurgia, quimioterapia e a radioterapia são os tratamentos utilizados em pacientes oncológicos. Agentes quimioterápicos como o metotrexate (MTX) são considerados antineoplásicos efetivos. Ele pertence à classe dos antimetabólitos que atuam sobre o metabolismo intermediário das células em proliferação. Por ser cada vez mais utilizado nos protocolos de tratamento de câncer, e com doses progressivamente maiores, a ocorrência de toxicidade do tecido nervoso central pelo MTX está aumentada. O mecanismo exato desencadeador de neurotoxicidade não foi elucidado. A manifestação clínica da neurotoxicidade após sua administração pela via subaracnóidea é a aracnoidite química e ocorre em aproximadamente 50% dos pacientes. Relatos de casos associaram-no também a síndrome da cauda equina. Objetivo: Avaliar os efeitos que doses múltiplas de MTX administradas pela via subaracnoidea determinam sobre a medula espinal e as meninges de coelhos. Método: Trinta coelhos adultos jovens, machos, da raça Grupo Genético de Botucatu, pesando entre 3000 g e 3900 g, comprimento de coluna vertebral entre 36 e 40 cm e superfície corpórea entre 0,19 e 0,22 m2 foram divididos, por sorteio, em três grupos (G): G1, punção subaracnóidea, G2, solução fisiológica e G3, MTX. Após anestesia venosa com xilaziana e cetamina foi realizada a punção subaracnoidea em S1-S2 e injetada a solução sorteada no G2 e G3. Os animais de G3 receberam MTX em volume correspondente a 12 mg.m2 de superfície corpórea (0,1mL), os de G2 igual volume de solução fisiológica e nos de G1 foi realizada somente punção subaracnóidea. Este procedimento foi repetido quatro vezes em intervalos de 7 dias. Os animais foram avaliados clinicamente quanto à sensibilidade e motricidade por 21 dias e após ... / Abstract: Background: Cancer is a disease characterized by deviation of control mechanisms that regulate the survival, proliferation and differentiation of cells. Surgery, chemotherapy and radiotherapy are treatments used in oncology patients. Chemotherapeutic agents such as methotrexate (MTX) are considered effective antineoplastic agents. MTX belongs to the class of antimetabolites that act on the intermediary metabolism of cells on proliferation. For being increasingly used in cancer treatment protocols with progressively larger doses, the occurrence of central nervous tissue toxicity by MTX is increasing. The exact mechanism for triggering neurotoxicity has not been elucidated. The most common clinical manifestation of neurotoxicity after MTX administration is chemical aracnoiditis. Cases of cauda equina syndrome were also described. Objectives: To evaluate the effects of multiple subarachnoid doses of MTX over spinal cord and meninges of rabbits. Method: Thirty male young adults rabbits, breed genetic Group Botucatu, weighing between 3000 and 3900 g, with spinal length between 36 and 40 cm, and corporeal surface area between 0.22 and 0.19 m2 were divided by lot into three groups (G): G1, subarachnoid puncture; G2, saline solution; and G3, methotrexate. After intravenous anesthesia with xilaziana and ketamine, subarachnoid puncture was performed in S1-S2. Solution ion was performed inject in G2 and G3. G3 animals received MTX volume corresponding to 12 mg. m2 (0.1 mL); in G2, an equal volume of saline solution, was administered G1 only subarachnoid puncture was performed in S1- S2 intervertebral space. Solution injection was performed in G2 and G3. G3 animals received intrathecal MTX volume corresponded to 12mg.m2 (0.1 ml); in G2, an equal volume of saline solution was administered, while in G1 only subarachnoid puncture was performed. The same procedure was repeated four times at 7 days interval. Animals ... / Doutor