CLAUDIA MARQUEZ SIMOES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 16 Citação(ões) na Scopus
    Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade
    (2012) MENEZES, Cassio Campelo de; PECEGUINI, Lilian Akemi Moore; SILVA, Enis Donizetti; SIMOES, Claudia Marquez
    Menezes CC, Peceguini LAM, Silva ED, Simoes CM Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade. Background and objectives: Neuromuscular blockers (NMB) have been used for more than half of a century in anesthesia and have always been a challenge for anesthesiologists. Until recently, the reversal of nondepolarizing neuromuscular blockers had only one option: the use of anticholinesterase agents. However, in some situations, such as deep neuromuscular blockade after high doses of relaxant, the use of anticholinesterase agents does not allow adequate reversal of neuromuscular blockade: Recently, sugammadex, a gamma-cyclodextrin, proved to be highly effective for reversal of NMB induced by steroidal agents. Case report: A female patient who underwent an emergency exploratory laparotomy after rapid sequence intubation with rocuronium 1.2 mg.kg(-1). At the end of surgery, the pat ent received neostigmine reversal of NMB. However, neuromuscular junction monitoring did not show the expected recovery, presenting residual paralysis. Sugammadex 2 mg.kg(-1) was used and the patient had complete reversal of NMB in just 2 minutes time. Conclusion: Adequate recovery of residual neuromuscular blockade is required for full control of the pharynx and respiratory functions in order to prevent complications. Adequate recovery can only be obtained by neuromuscular junction monitoring with TOF ratio greater than 0.9. Often, the reversal of NMB with anticholinesterase drugs may not be completely reversed. However, in the absence of objective monitoring this diagnosis is not possible. The case illustrates the diagnosis of residual NMB even after reversal with anticholinesterase agents, resolved with the administration of sugammadex, a safe alternative to reverse the NMB induced by steroidal non-depolarizing agents.
  • conferenceObject
    In-hospital mortality prediction by American Society of Anesthesiology and POSSUM score in patients with cancer undergoing abdominal surgery
    (2012) SIMOES, Claudia Marquez; CARVALHO, Maria Jose; LUDHMILA, Carmona; HAJJAR, Abrahao; REGINA, Filomena; GALLAS, Barbosa; FUKUSHIMA, Julia Tizue
    Introduction: Preoperative evaluation and risk stratification is essential to perioperative planning. There are multiple risk scores applied to predict different outcomes. However, specific populations as patients with cancer may have specific risk factors, so it is needed to evaluate if global risk scoresas ASA and POSSUM or P POSSUM are able to assist the surgical team. Objective: To retrospectively assess the value of the ASA classification (American Society of Anesthesiology), POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity), and Porthsmouth POSSUM in prediction of hospital mortality in patients with cancer undergoing abdominal surgery. Methods: Three hundred and thirteen patients who under-went three hundred and nineteen oncologic abdominal surgeries were evaluated using ASA, POSSUM and Porthsmouth-POSSUM in relation to hospital mortality. The variables observed were: age, gender, ASA classification, pul- monary diseases, cardiovascular diseases, preoperative sys-tolic arterial pressure and cardiac rate, Glasgow scale, urea, potassium, sodium, hemoglobin, white cell count, number of simultaneous surgical procedures, observed blood losses, peritoneal contamination, oncological disease and dissemination, elective, emergent or urgent surgery, intensive care support and hospital mortality. Results: The overall hospital mortality rate was 5.59%. These results showed that POSSUM over predicted in-hospital deaths when compared to American Society of Anesthesiologists classification (relative risk, 0.55; P=.07) and Porths- mouth POSSUM (relative risk, 0,43; P=.0007) didn’t equally correspond to ASA predicted perioperative mortality. All evaluated scores didn’t equally predict observed mortality as the standardized mortality rate was 2.25 for ASA classification, 0.4 for POSSUM and 0.8 for P-POSSUM. Conclusion: The ASA classification, POSSUM and P POSSUM scores were not useful in predicting perioperative mortality for patients with cancer submitted to abdominal surgeries. It is needed to evaluate specific populations to adjust the existing perioperative prediction scores to serve as objective methods to assist the surgical team in classifying patients into risk groups with different probabilities of perioperative complications. ASA classification is based mainly on subjective clinical judgments and probably POSUUM and P-POSSUM need to have the equations balanced to specific populations.