MARIA JOSE CARVALHO CARMONA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
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- Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study(2019) VANE, Matheus F.; CARMONA, Maria J. C.; PEREIRA, Sergio M.; KERN, Karl B.; TIMERMAN, Sergio; PEREZ, Guilherme; VANE, Luiz Antonio; OTSUKI, Denise Aya; JR, Jose O. C. AulerData on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80-0.93]), with a sensitivity and specificity of 78.4% [69.6-86.3%] and 89.3% [80.4-96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792-0.956]), with a sensitivity of 79.3% [65.5-93.1%] and specificity of 86.1 [74.4-95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.
- Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions(2018) GARRO, Laila S.; V, Marcelo Aun; SOARES, Iracy Silvia C.; RIBEIRO, Marisa R.; MOTTA, Antonio A.; KALIL, Jorge; CASTELLS, Mariana C.; CARMONA, Maria Jose C.; GIAVINA-BIANCHI, PedroOBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
- Up to 206 Million People Reached and Over 5.4 Million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative(2020) BOETTIGER, Bernd W.; LOCKEY, Andrew; AICKIN, Richard; CARMONA, Maria; CASSAN, Pascal; CASTREN, Maaret; RAO, S. S. C. Chakra; CAEN, Allan De; ESCALANTE, Raffo; GEORGIOU, Marios; HOOVER, Amber; KERN, Karl B.; KHAN, Abdul Majeed S.; LEVI, Cianna; LIM, Swee H.; NADKARNI, Vinay; NAKAGAWA, Naomi V.; NATION, Kevin; NEUMAR, Robert W.; NOLAN, Jerry P.; MELLIN-OLSEN, Jannicke; PAGANI, Jacopo; SALES, Monica; SEMERARO, Federico; STANTON, David; TOPORAS, Cristina; GROOTVEN, Heleen van; WANG, Tzong-Luen; WIJESURIYA, Nilmini; WONG, Gillian; PERKINS, Gavin D.Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. ""All citizens of the world can save a life-CHECK-CALL-COMPRESS."" With these words, the International Liaison Committee on Resuscitation launched the 2019 global ""World Restart a Heart"" initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, ""CHECK-CALL-COMPRESS,"" will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.
- Approach to Endoscopic Procedures: A Routine Protocol from a Quaternary University Referral Center Exclusively for Coronavirus Disease 2019 Patients(2020) FRANZINI, Tomazo Antonio Prince; KOTINDA, Ana Paula Samy Tanaka; MOURA, Diogo Turiani Hourneaux de; BADANA, Marcia Lopes Vicente; MEDEIROS, Marion Sielfeld de; LIMA, Patricia Goulart Rodrigues; MELLO, Brigitte Feiner de; KAYANO, Rafael Priante; CARMONA, Maria Jose Carvalho; ROCHA, Marcelo Cristiano; CAMPOS, Aleia Faustina; MCCARTY, Thomas R.; GUIMARAES, Thais; MOURA, Maria Luisa do Nascimento; THOMPSON, Christopher C.; MOURA, Eduardo Guimaraes Hourneaux deOBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in Sao Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.
- Two years of the COVID-19 pandemic: an anesthesiology perspective(2022) SCHMIDT, André P.; MÓDOLO, Norma S.P.; DE AMORIM, Célio G.; SIMÕES, Cláudia M.; KRAYCHETE, Durval C.; JOAQUIM, Eduardo H.G.; LINEBURGER, Eric B.; PAPA, Fábio V.; FERNANDES, Fátima C.; MENDES, Florentino F.; GUIMARÃES, Gabriel M.N.; BARROS, Guilherme A.M.; SILVA-JR, João M.; LIMA, Laís H. Navarro e; AZI, Liana M.T.A.; CARVALHO, Lorena I.M.; STEFANI, Luciana C.; GARCIA, Luis V.; CARMONA, Maria José C.; SALGADO FILHO, Marcello F.; NASCIMENTO JUNIOR, Paulo do; ALVES, Rodrigo L.; CARVALHO, Vanessa H.; QUINTÃO, Vinicius C.
- Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction(2015) VALENTIN, Lívia Stocco Sanches; PIETROBON, Ricardo; AGUIAR JUNIOR, Wagner de; RIOS, Ruth Pinto Camarão; STAHLBERG, Mariane Galzerano; MENEZES, Iolanda Valois Galvão de; OSTERNACK-PINTO, Kátia; CARMONA, Maria José CarvalhoObjective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.
- Atorvastatin for high-risk statin-naive patients undergoing noncardiac surgery: The Lowering the Risk of Operative Complications Using Atorvastatin Loading Dose (LOAD) randomized trial(2017) BERWANGER, Otavio; SILVA, Pedro G. M. de Barros e; BARBOSA, Roberto Ramos; PRECOMA, Dalton Bertolim; FIGUEIREDO, Estevao Lanna; HAJJAR, Ludhmila Abrahao; KRUEL, Cleber Dario Pinto; ALBOIM, Carolina; ALMEIDA, Adail Paixao; DRACOULAKIS, Marianna Deway Andrade; VARGAS FILHO, Hugo; CARMONA, Maria Jose Carvalho; MAIA, Lilia Nigro; OLIVEIRA FILHO, Joao Bosco de; SARAIVA, Jose Francisco Kerr; SOARES, Rafael M.; DAMIANI, Lucas; PAISANI, Denise; KODAMA, Alessandra A.; GONZALES, Beatriz; IKEOKA, Dimas T.; DEVEREAUX, Philip J.; LOPES, Renato D.Background Preliminary evidence suggests that statins may prevent major perioperative vascular complications. Methods We randomized 648 statin-naive patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18 hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12 hours after the surgery, and then 40 mg/d (or placebo) for 7 days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30 days. Results The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P = .46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P = .74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P = .50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P = .26), and stroke (0.9% vs 0%, P = .25). Conclusion In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naive patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naive patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population.
- Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial(2016) VALENTIN, Livia Stocco Sanches; PEREIRA, Valeria Fontenelle Angelim; PIETROBON, Ricardo S.; SCHMIDT, Andre P.; OSES, Jean P.; PORTELA, Luis V.; SOUZA, Diogo O.; VISSOCI, Joao Ricardo Nickenig; LUZ, Vinicius Fernando da; TRINTONI, Leticia Maria de Araujo de Souza; NIELSEN, Karen C.; CARMONA, Maria Jose CarvalhoPostoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100 beta was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100 beta serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100 beta might be related with some degree of neuroprotection.
- World Restart a Heart 2020: How to keep a life-saving awareness campaign alive in a pandemic(2021) ROTT, Nadine; LOCKEY, Andrew; BOETTIGER, Bernd W.; BOUCIF, Salome; CARMONA, Maria; CASSAN, Pascal; RAO, Siddha S. C. Chakra; ESCALANTE-KANASHIRO, Raffo; GARG, Rakesh; GEORGIOU, Marios; HOOVER, Amber V.; KHAN, Abdulmajeed; LEVI, Cianna; LIM, Swee Han; MAHAJAN, Hitendra Chandrakant; MEAR, Teghan; MONSIEURS, Koenraad; NADKARNI, Vinay; NAKAGAWA, Naomi Kondo; NATION, Kevin; NEUMAR, Robert; O'SHAUGHNESSY, Krista; SALES, Monica; SEMERARO, Federico; GROOTVEN, Heleen Van; WANG, Tzong-Luen; WIJESURIYA, Nilmini
- Lung Perfusion and Ventilation During Cardiopulmonary Bypass Reduces Early Structural Damage to Pulmonary Parenchyma(2016) FREITAS, Claudia Regina da Costa; MALBOUISSON, Luiz Marcelo Sa; BENICIO, Anderson; NEGRI, Elnara Marcia; BINI, Filipe Minussi; MASSOCO, Cristina Oliveira; OTSUKI, Denise Aya; MELO, Marcos Francisco Vidal; CARMONA, Maria Jose CarvalhoBACKGROUND: It is unclear whether maintaining pulmonary perfusion and ventilation during cardiopulmonary bypass (CPB) reduces pulmonary inflammatory tissue injury compared with standard CPB where the lungs are not ventilated and are minimally perfused. In this study, we tested the hypothesis that maintenance of lung perfusion and ventilation during CPB decreases regional lung inflammation, which may result in less pulmonary structural damage. METHODS: Twenty-seven pigs were randomly allocated into a control group only submitted to sternotomy (n = 8), a standard CPB group (n = 9), or a lung perfusion group (n = 10), in which lung perfusion and ventilation were maintained during CPB. Hemodynamics, gas exchanges, respiratory mechanics, and systemic interleukins (ILs) were determined at baseline (T0), at the end of 90 minutes of CPB (T90), and 180 minutes after CPB (T180). Bronchoalveolar lavage (BAL) ILs were obtained at T0 and T180. Dorsal and ventral left lung tissue samples were examined for optical and electron microscopy. RESULTS: At T90, there was a transient reduction in Pao(2)/Fio(2) in CPB (126 64 mm Hg) compared with the control and lung perfusion groups (296 +/- 46 and 244 +/- 57 mm Hg; P < 0.001), returning to baseline at T180. Serum ILs were not different among the groups throughout the study, whereas there were significant increases in BAL IL-6 (P < 0.001), IL-8 (P < 0.001), and IL-10 (P < 0.001) in both CPB and lung perfusion groups compared with the control group. Polymorphonuclear counts within the lung tissue were smaller in the lung perfusion group than in the CPB group (P = 0.006). Electron microscopy demonstrated extrusion of surfactant vesicles into the alveolar spaces and thickening of the alveolar septa in the CPB group, whereas alveolar and capillary histoarchitecture was better preserved in the lung perfusion group. CONCLUSIONS: Maintenance of lung perfusion and ventilation during CPB attenuated early histologic signs of pulmonary inflammation and injury compared with standard CPB. Although increased compared with control animals, there were no differences in serum or BAL IL in animals receiving lung ventilation and perfusion during CPB compared with standard CPB.