Orientador: Agricio Nubiato Crespo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T03:08:57Z (GMT). No. of bitstreams: 1 Souza_LincolnSantos_M.pdf: 2464973 bytes, checksum: 81ed3b16855d56592736b0ed9d8ed7bb (MD5) Previous issue date: 2008 / Resumo: A lesão do ramo externo do nervo laríngeo superior é complicação importante após tireoidectomia, em virtude da dificuldade diagnóstica geralmente presente, e pelo impacto causado pela dificuldade do paciente emitir voz em registros mais agudos, principalmente em profissionais da voz. O objetivo do presente estudo foi determinar a freqüência de lesão do ramo externo do nervo laríngeo superior, comparar a intensidade da disfonia e as alterações da rima glótica, em pacientes submetidos à tireoidectomia sob anestesia local e hipnosedação. Foram avaliados prospectivamente, 35 pacientes consecutivos e não randomizados, submetidos à tireoidectomia sob anestesia local e hipnosedação. Todos os pacientes foram submetidos à avaliação perceptiva auditiva da voz, avaliação acústica da voz e videolaringoestroboscopia nos períodos pré-operatório e pós-operatório, com uma semana e também, 30 dias após a cirurgia. Foi realizada eletromiografia do músculo cricotireóideo bilateralmente, no trigésimo dia do período pós-operatório, para confirmar lesão do ramo externo do nervo laríngeo superior. O exame eletromiográfico foi considerado padrão ouro para o diagnóstico de lesão do ramo externo do nervo laríngeo superior. As avaliações perceptiva auditiva e acústica da voz apresentaram alterações estatisticamente significantes, na maioria dos parâmetros avaliados, em relação aos períodos pré-operatório, pós-operatório uma semana após a cirurgia e pós-operatório um mês após a cirurgia, considerando o grupo total ou o grupo das mulheres. Foi evidenciada glote oblíqua em cinco pacientes no período pré-operatório. No período pós-operatório uma semana após a cirurgia, oito pacientes apresentaram glote oblíqua e três destes, tiveram diagnóstico eletromiográfico de lesão do ramo externo do nervo laríngeo superior. A freqüência de lesão temporária e definitiva do ramo externo do nervo laríngeo superior foi, respectivamente, de 8,57% e 2,85% dos pacientes e 5,03% e 1,69%, considerando 59 nervos em risco. A alteração vocal ou o desvio de rima glótica podem ocorrer em pacientes normais. Portanto, são inespecíficos na detecção de lesão do ramo externo do nervo laríngeo superior. Glote oblíqua pode estar presente em pacientes normais, porém o seu aparecimento após tireoidectomia, pode ser indicativo de lesão do ramo externo do nervo laríngeo / Abstract: The lesion of the external branch of the superior laryngeal nerve is an important complication after thyroidectomy, because of the generally difficulty diagnosis and to the impact it causes because of the patient's impossibility of reaching high notes, especially in professionals who use their voices. The objective of this study was to determine the frequency of injuries of the external branch of the superior laryngeal nerve, comparing the intensity of dysphonia and changes of glottic rhyme in patients who underwent thyroidectomy under local anesthesia and hypnosedation. Thirty five patients were evaluated prospectively, consecutive and not randomized, who underwent thyroidectomy under local anesthesia and hypnosedation. All patients were submitted to an auditive perceptive evaluation of the voice, acoustic evaluation of voice and videolaryngostroboscopy before the surgery and post operative period at one week and also, 30 days after surgery. It was performed electromyography of the cricothyroid muscle bilaterally, on the thirtieth day of the postoperative period to confirm the injury of the external branch of the superior laryngeal nerve. The electromyographic examination was considered gold standard for the diagnosis of lesion of the external branch of the superior laryngeal nerve. The auditive perceptive evaluation and acoustic evaluation of voice had presented statistically significant alterations in the majority of the evaluated parameters, in relation to the periods before the surgery, postoperative one week after the surgery and one month after the surgery, considering the whole group or the group of women. It was evidenced oblique glottis in five patients in the preoperative period. In the postoperative period one week after the surgery, eight patients had oblique glottis and three of them had electromyographic diagnosis of injury to the external branch of the superior laryngeal nerve. The frequency of the lesion to the external branch of the superior laryngeal nerve was temporary in 8.57% and definitive in 2.85% of the patients and 5,03% and 1.69%, considering respectively, 59 nerves at risk. The vocal alteration or the rhyme glottic deviation may occur in normal patients. So, are nonspecific in detecting lesions of the external branch of the superior laryngeal nerve. Oblique glottis can be present in normal patients, but its appearance after thyroidectomy, may be indicative of the injury of the external branch of the superior laryngeal nerve / Mestrado / Otorrinolaringologia / Mestre em Ciências Médicas

Att opereras under lokalanestesi innebär att patienten kan vara vaken under operationen, forskning visar på både positiva och negativa upplevelser av detta. Ångest och oro är påtagligt och att patienterna känner att de tappar kontrollen över situationen. Samtidigt är anestesisjuksköterskans roll viktig för att se och bekräfta patienten. Att låta patienten lyssna på musik kan vara ett verktyg som sjuksköterskan kan ta till, eftersom musik har kunnat minska ångest hos andra patientgrupper. Syftet med denna studie är att utforska upplevelser hos patienter som lyssnar på musik perioperativt i lokalanestesi. Den metod som används är en systematisk litteraturöversikt med en integrativ design. Resultatet baserades på 21 artiklar, varav 18 är kvantitativa och 3 kvalitativa. Studien utmynnar i fem teman; ångest, smärta, välbefinnande, coping och upplevelser utöver musiken. Musik påverkar patienternas ångest och smärta på olika sätt. Ofta lindras ångest och smärta men i flera studier har musiken ingen eller tveksam inverkan. Musiken har även effekter på patienternas välbefinnande och påverkar deras copingstrategi. Studien visar på viktiga upplevelser utöver musiken, där sjuksköterskans betydelse för patienten är framträdande. Musik visas öka patienternas välbefinnande men att sjuksköterskan har kännedom om hur smärtsamt och ångestladdat ett ingrepp är, kan vara angeläget för att inte lägga för stor tilltro till musikens effekt på patienten. Ytterligare forskning krävs för att få en ännu djupare förståelse och beskrivning av patienters upplevelse. Att även belysa olika ingrepps inverkan på patienternas upplevelse av musik, är av vikt.

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SyfteAtt undersöka hur stor bedövningseffekt som kan uppnås efter injektion med aktiv (lidokain) eller in-aktiv substans (koksaltlösning) samt att undersöka om deltagarna korrekt kan identifiera vilken injektion de fått, när de vet att det är en 50/50 chans att de har fått lidokain eller koksalt.Material och metod20 friska frivilliga deltagare randomiserades in i två grupper. En grupp fick injektion med aktiv substans och en med in-aktiv substans. Deltagarna informerades om att chansen att få aktiv eller in-aktiv substans var lika, 50 %. Deltagarna utsattes för ett specifikt smärtsamt stimulus före och efter injektionen. De graderade sedan sin smärtintensitet på en 0-10 NRS-skala. Följande dag tillfrågades deltagarna vilken substans de trodde de hade fått.Students T-test användes för att beräkna skillnaden i smärtintensitet före och efter injektion i båda grupperna. Fischer’s exakta test användes för att beräkna kvalitativa data. P <0,05 ansågs vara statistiskt signifikant.ResultatDet var en statistiskt signifikant skillnad mellan den aktiva (NRS 2,9) och den in-aktiva (NRS 0,0) gruppen gällande förändringen i smärtintensitet före injektion och efter injektion. Alla deltagare kunde korrekt identifiera vilken injektion de fått.SlutsatsIngen bedövningseffekt kunde mätas efter injektion med inaktiv substans hos friska individer när deltagarna visste att det var en 50/50 möjlighet att de skulle få den aktiva substansen. Alla individer kunde korrekt avgöra om de fått injektion med aktivt bedövningsmedel eller in-aktivt koksalt. / AimTo investigate the amount of anesthetic effect that can be achieved following injection with active (lidocaine) or non-active (saline) agent and to examine if the participants correctly can identify which injection they received when there is a 50/50 chance that they have received lidocaine or saline.Materials and Method20 healthy volunteers were randomized in two groups. One group got injection with active agent and one with non-active agent. The participants were instructed that chances of receiving active versus non-active agent were equal, 50 %. The participants were exposed to a specific painful stimulus before and after the injection and they had to rate their pain score on an 0-10 NRS-scale. The following day, the participants were asked what agent they thought they had received.Students T-test was used to calculate the difference in pain intensity between pre- and post-injection in both groups. Fisher's exact test was used to calculate qualitative variables. P<0.05 was considered statistically significant.ResultsThere was a statistically significant difference between the active (NRS 2.9) and the non-active (NRS 0.0) group regarding the change in pain intensity rating from pre-injection to post-injection. All participants could correctly identify which injection they received.ConclusionNo anesthetic effect could be measured after injection with non-active substance in healthy individuals when there was a 50/50 level of uncertainty that the individual would receive the active agent. All individuals could correctly determine whether they received active anesthesia or non-active saline.

Purpose: The aim of this study was to determine if the use of local anesthesia with general anesthesia results in less postoperative pain. The alternative hypothesis is that children will experience less postoperative discomfort when utilizing intraligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria: English speaking children age 3-6 years, ASA I/II requiring general anesthesia for dental treatment. Randomization was done to place patients in groups of no local anesthetic vs. local anesthetic administration. A Wong-Baker Faces Pain Scale was utilized to evaluate pre-operative and postoperative pain. Data were compared using a two way mixed model ANCOVA controlling for sex, ethnicity, pre-op pain, and intra-op meds given. Results: Data was collected and evaluated on 90 patients. There was a statistically significant difference in postoperative pain for patients who received extractions without local anesthesia vs. those with local anesthetic. There was no statistically significant difference in pain outcomes based solely on whether local anesthetic was administered regardless of treatment type. Conclusions: The outcome of this study shows evidence for provision of local anesthetic during general anesthesia in patients receiving extractions to reduce postoperative pain.

RESUMO Comparou-se os períodos de latência e duração da lidocaína 2% associada à adrenalina 1:100.000 (Lidocaína 100 ® da DFL), e da articaína 4% associada à adrenalina 1:200.000 (Septanest 1:200.000 ® da Septodont) e 1:100.000 (Septanest 1:100.000 ® da Septodont), na polpa dentária e gengiva vestibular, em anestesias locais infiltrativas maxilares. Vinte pacientes voluntários, saudáveis, de ambos os sexos, entre 18 e 50 anos de idade receberam tratamento restaurador de baixa complexidade ou selamento de cicatrículas e fissuras nas superfícies oclusais de três dentes superiores posteriores de uma mesma hemiarcada. Cada paciente recebeu, aleatoriamente, um tubete (1,8 ml) de cada solução anestésica local em três consultas. Os períodos de latência e duração da anestesia local na polpa dentária foram monitorados com um aparelho estimulador pulpar elétrico (Vitality Scanner Model 2005 ® da Analytic Endodontics) e na gengiva vestibular por meio do estímulo com a ponta de um explorador. Através do Teste de Kruskal-Wallis foram detectadas diferenças estatisticamente significantes ao nível de 5% entre lidocaína 2% associada à adrenalina 1:100.000, quando comparada tanto com a articaína 4% associada à adrenalina 1:200.000 quanto com a articaína 4% associada à adrenalina 1:100.000, para as variáveis: período de latência e duração na polpa dentária e período de duração na gengiva, sendo que a lidocaína 2% associada à adrenalina 1:100.000 apresentou a maior média para o período de latência pulpar e as menores médias para os períodos de duração na polpa dentária e na gengiva (respectivamente, 2,8, 39,2 e 42,2 minutos),quando comparada à articaína 4% associada à adrenalina 1:200.000 (respectivamente, 1,6, 56,7 e 55,3 minutos) e 1:100.000 (respectivamente, 1,4, 66,3 e 64,7 minutos). Houve diferença estatisticamente significante entre as duas soluções de articaína apenas para o período de duração na gengiva, cuja maior média foi a da articaína 4% associada à adrenalina 1:100.000. Não houve diferença estatisticamente significante entre os grupos para o período de latência gengival. Conclui-se que as soluções de articaína apresentam latência mais curta e duração mais longa do que a solução de lidocaína quando da anestesia pulpar. Para a latência gengival não há diferença entre as três soluções testadas, porém, para a duração gengival, a solução de articaína 4% associada à adrenalina 1:100.000 apresenta a maior duração. / SUMMARY Local anesthesias by maxillar infiltration with 2% lidocaine associated with 1:100.000 adrenalin (Lidocaina 100 ® by DFL), 4% articaine associated with 1:200.000 (Septanest 1:200.000 ® by Septodont) and 1:100.000 adrenalin (Septanest 1:100.000 ® by Septodont) were compared concerning to their onset and duration on dental pulp and gingiva. Twenty healthy volunteer patients, of both gender, between 18 and 50 years of age, received filling treatment of low complexity or fissure sealing on the occlusal surface of three superior posterior teeth of the same side. Each patient randomly received an ampoule (1,8ml) of each local anesthetic solution on three appointments. The onset and duration periods of local anesthesia on dental pulp were monitored with an electric pulptester (Vitality Scanner Model 2005 ® by Analytic Endodontics) and on buccal gingiva by the stimulus performed with the point of a probe. Kruskall-Wallis test identified statistic significant difference by the level of 5% between 2% lidocaine associated with 1:100.000 adrenalin when compared with both 4% articaine associated with 1:200.000 or 1:100.000 adrenalin for the following variants: onset and duration periods on dental pulp and duration period on gingiva. 2% lidocaine associated with 1:100.000 adrenalin presented the longest average for onset period on dental pulp and the minorest averages for duration periods on dental pulp and gingiva (respectively, 2,8, 39,2 and 42,2 minutes), when compared with 4% articaine associated with 1:200.000 (respectively, 1,6, 56,7 and 55,3 minutes) and 1:100.000 adrenalin (respectively, 1,4, 66,3 and 64,7 minutes). There was statistic significant difference between the two articaine solutions just for duration period on gingiva, whose longest average was that of 4% articaine associated with 1:100.000 adrenalin. There was no statistic significant difference between the groups for onset period on gingiva. It can be concluded that both articaine solutions present faster onset and longer duration than the lidocaine solution on pulpal anesthesia. For gingival onset there is no difference between the three tested solutions, however, for gingival duration, 4% articaine associated with 1:100.000 adrenalin presents the longest duration.