JOAQUIM EDSON VIEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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- Failure of reversion of neuromuscular block with sugammadex in patient with myasthenia gravis: case report and brief review of literature(2019) FERNANDES, Hermann dos Santos; XIMENES, Jorge Luiz Saraiva; NUNES, Daniel Ibanhes; ASHMAWI, Hazem Adel; VIEIRA, Joaquim EdsonBackground Myasthenia gravis (MG) is a challenge for anesthesia management. This report shows that the use of rocuronium-sugammadex is not free from flaws and highlights the importance of cholinesterase inhibitors management and neuromuscular block monitoring in the perioperative period of myasthenic patients. Case presentation Myasthenic female patient submitted to general balanced anesthesia using 25 mg of rocuronium. Under train-of-four (TOF) monitoring, repeated doses of sugammadex was used in a total of 800 mg without recovery of neuromuscular blockade, but TOF ratio (TOFR) was stabilized at 60%. Neostigmine administration led to the improvement of TOFR. Conclusions Although the use of rocuronium-sugammadex seems safe, we should consider their unpredictability in myasthenic patients. This report supports the monitoring of neuromuscular blockade as mandatory in every patient, especially the myasthenic ones.
- Intraoperative use of methadone improves control of postoperative pain in morbidly obese patients: a randomized controlled study(2018) MACHADO, Felipe Chiodini; PALMEIRA, Claudia Carneiro de Araujo; TORRES, Joao Nathanael Lima; VIEIRA, Joaquim Edson; ASHMAWI, Hazem AdelObjectives: Surgical patients still commonly experience postoperative pain. With the increasing prevalence of obesity, there is a growing demand for surgical procedures by this population. Intraoperative use of methadone has not been well assessed in this population. Materials and methods: Patients with a body mass index of 35 kg/m(2) or more undergoing bariatric surgery were randomly assigned to receive either fentanyl (group F) or methadone (group M) in anesthesia induction and maintenance. The primary outcome was morphine consumption during the first 24 hours after surgery through a patient-controlled analgesia device. Secondary outcomes were pain scores at rest and while coughing, opioid related side effects, and patient satisfaction. The patients were also evaluated 3 months after surgery for the presence of pain, dysesthesia, or paresthesia at surgical site. Results: Postoperative morphine consumption was significantly higher for patients receiving fentanyl than methadone during the postoperative period at 2 hours (mean difference [MD] 6.4 mg; 95% CI 3.1-9.6; P<0.001), 2-6 hours (MD 11.4 mg; 95% CI 6.5-16.2; P<0.001), 6-24 hours (MD 10.4 mg; 95% CI 5.0-15.7; P<0.001), and 24-48 hours (MD 14.5 mg; 95% CI 3.9-25.1; P=0.01). Patients from group F had higher pain scores until 24 hours postoperatively, higher incidence of nausea and vomiting, lower satisfaction, and more evoked pain at surgical scar at the 3-month postoperative evaluation than group M. Conclusion: Intraoperative methadone can safely lower postoperative opioid consumption and improve postoperative pain scores compared with fentanyl in morbidly obese patients.
- Factor structure and psychometric properties of the Dispositional Resilience Scale among Brazilian adult patients(2016) SOLANO, Joao Paulo Consentino; BRACHER, Eduardo Sawaya Botelho; FAISAL-CURY, Alexandre; ASHMAWI, Hazem Adel; CARMONA, Maria Jose Carvalho; NETO, Francisco Lotufo; VIEIRA, Joaquim EdsonObjective: Verifying the psychometrics of a Brazilian version of the Dispositional Resilience Scale (DRS-15). Methods: Cross-cultural adaptation was done interviewing 65 adult patients. Validation was evaluated by application of the Lipp Brazilian Stress Symptoms Inventory (ISSL), Self-Report Questionnaire (SRQ), and other measuresto 575 participants from the psychiatric ambulatories (for borderline personality, anxiety or post-traumatic stress disorders) and non-psychiatric ambulatories (chronic pain, pre-anesthetic consultation and companions for the latter). Temporal stability was verified with 123 participants. Results: Exploratory factor analysis yielded a three-factor solution. Psychometrics were acceptable (alpha coefficient, 0.71; intraclass correlation coefficient, 0.81). Correlations with the ISSL, SRQ and other measures were noted except for factor 3. In the psychiatric sample, hardiness scores of borderline patients were lower than those of patients with anxiety disorders. Conclusion: This version of the DRS-15 exhibited good reliability in a sample of Brazilian patients; validity was confirmed in two of the scale factors.
- Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial(2020) GRIGIO, Thiago Ramos; SOUSA, Angela Maria; MAGALHAES, Gabriel Guimaraes Nunes; ASHMAWI, Hazem Adel; VIEIRA, Joaquim EdsonOBJECTIVES: To evaluate the addition of a fourth antiemetic intervention in patients at high risk for postoperative nausea and vomiting (PONV). METHODS: High-risk patients (Apfel score 3 or 4) scheduled for unilateral mastectomy were randomly allocated in one of two groups, oral aprepitant (oral aprepitant 80 mg, intravenous dexamethasone 8 mg, and palonosetron 0.075 mg) and oral placebo (oral placebo, intravenous dexamethasone 4 mg, and palonosetron 0.075 mg). Patients and caregivers were blinded to the group assignments. The primary efficacy endpoints included the incidence of nausea and vomiting, and the secondary endpoints included use of rescue antiemetics during a 48-hour postoperative period. ClinicalTrials.gov: NCT02431286. RESULTS: One hundred patients were enrolled in this study and 91 were analyzed, 48 in group A and 43 in group P. No patient presented with nausea or vomiting in the first 2 hours after surgery. From the 2nd to the 6th hour, the incidence of PONV was 8.33% in group A and 9.30% in group P. In the first 24 hours, the incidence of PONV was 27.08% in the group A and 20.93% in group P. From the 24th to the 48th hour, the incidence of PONV was 8.33% in group A and 13.95% in group P. There were no statistically significant differences in PONV between groups. CONCLUSION: The addition of aprepitant as a third antiemetic resulted in no significant reduction in the incidence of PONV in this population. However, the incidence of PONV was reduced in relation to the general population.
- Factor structure and psychometric properties of the Connor-Davidson resilience scale among Brazilian adult patients(2016) SOLANO, Joao Paulo Consentino; BRACHER, Eduardo Sawaya Botelho; FAISAL-CURY, Alexandre; ASHMAWI, Hazem Adel; CARMONA, Maria Jose Carvalho; LOTUFO NETO, Francisco; VIEIRA, Joaquim EdsonCONTEXT AND OBJECTIVE: Personal resilience is associated with several mental health outcomes. The Connor-Davidson resilience scale (CD-RISC) is a widely used self-report measurement of resilience. This study aimed to investigate the reliability and validity of a Brazilian Portuguese version of the CD-RISC. DESIGN AND SETTING: Cross-sectional validation study carried out in the outpatient clinics of a public university hospital. METHODS: The cross-cultural adaptation followed established guidelines and involved interviews with 65 adults in psychiatric and non-psychiatric outpatient clinics at a teaching hospital. Validation was assessed through concurrent application of the Lipp Brazilian Stress Symptom Inventory (ISSL), Self-Report Questionnaire (SRQ), Sheehan Disability Scales (SDS) and Chronic Pain Grade (CPG) to 575 patients at the same setting. Temporal stability was verified through a second application to 123 participants. RESULTS: Factor analysis identified four factors, named tenacity, adaptability-tolerance, reliance on support from outside and intuition. The alpha coefficient of 0.93 and intraclass correlation coefficient of 0.84 indicated good internal consistency and temporal stability. Significant correlations between this version of the CD-RISC and the ISSL, SRQ, SDS and CPG were noted. The patients at the outpatient clinic for borderline personality had resilience scores that were significantly lower than those of the patients at the general anxiety or post-traumatic stress outpatient clinics. CONCLUSION: This Brazilian Portuguese version of the Connor-Davidson resilience scale exhibited adequate reliability and validity among a sample of Brazilian adult patients.
- Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients(2016) SOLANO, Joao Paulo Consentino; SILVA, Amanda Gomes da; SOARES, Ivan Agurtov; ASHMAWI, Hazem Adel; VIEIRA, Joaquim EdsonBackground: The balance between hope-hopelessness plays an important role in the way terminally ill patients report quality of life, and personal resilience may be related to hope at the end of life. The objective of this study was to explore associations between personal resilience, hope, and other possible predictors of hope in advanced cancer patients. Methods: A cross-sectional pilot study was carried out with metastatic colorectal cancer patients in a tertiary hospital. The patients answered the Connor-Davidson Resilience Scale, Herth Hope Index, Barthel Index, an instrument addressing family and social support, visual-numeric scales for pain and suffering, a two-item screening for depression, socio-demographic and socio-economic information about the family. Results: Forty-four patients were interviewed (mean age 56 years; range 29-86). A strong correlation was noted between resilience and hope (0.63; p < 0.05). No correlation was found between hope and independence for activities of daily living, support from family and community, and pain and suffering levels. Of the 44 patients, 20 presented with depressive symptoms. These depressive patients had lower resilience (p = 0.005) and hope (p = 0.003), and higher scores of suffering (p < 0.001). The association between resilience and hope kept stable after adjusting for age, gender, and presence of depression (p < 0.001). Conclusion: Given that resilience is a dynamic, changeable path that can improve hope, resilience-fostering interventions should be most valued in palliative care settings and should be commenced as soon as possible with cancer patients. Patients with advanced stages of non-malignant conditions would also probably benefit from such interventions.
- Continuous peripheral nerve block for in-patients with lower limb ischemic pain(2021) FERNANDES, Hermann dos Santos; XIMENES, Jorge Luiz Saraiva; TAGUCHI, Paloma Kiyomi; ESPADA, Eloisa Bonetti; GOUVEA, Aquila Lopes; VIEIRA, Joaquim Edson; ASHMAWI, Hazem AdelOBJECTIVES: Demonstrate that continuous peripheral nerve block (CPNB) may be an alternative with adequate analgesia and a lower incidence of side effects for ischemic pain due peripheral obstructive arterial disease (POAD). METHODS: Retrospective cohort study with 21 patients with POAD, Fontaine IV graded, with foot pain. Patients were submitted to continuous sciatic nerve block (CSNB), through a perineural catheter. Primary outcomes were pain intensity (by numerical rating scale) and opioid consumption (in oral morphine equivalents). RESULTS: During CSNB, pain scores markedly decreased in comparison to the pre-block period. CONCLUSIONS: CPNB may be a good option for ischemic pain treatment in in-patients, as it provides effective pain control with fewer adverse effects.