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.
- Ultrasound-guided peripheral abdominal wall blocks(2021) FERNANDES, Hermann dos Santos; AZEVEDO, Artur Salgado de; FERREIRA, Thiago Camargo; SANTOS, Shirley Andrade; ROCHA-FILHO, Joel Avancini; VIEIRA, Joaquim EdsonThe practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative techniques for postoperative analgesia of abdominal surgeries, such as transversus abdominis plane block, oblique subcostal transversus abdominis plane block, rectus abdominis muscle sheath block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum plane block, have proven useful, with good analgesic efficacy, especially when neuroaxial techniques (spinal anesthesia or epidural anesthesia) are not possible. This review discusses such blockades in detail, including the anatomical principles, indications, techniques, and potential complications.
- 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.
- Comparison of different injection volumes on spread of lumbar erector spinae plane block: An anatomical study(2021) AZEVEDO, Artur S.; SILVA, Vinicius T. G.; XAVIER, Andre L.; SILVA, Luiz F. F. da; HOJAIJ, Flavio C.; ASHMAWI, Hazem A.; VIEIRA, Joaquim E.; FERNANDES, Hermann S.
- Plasmatic catecholamines after neuraxial labour analgesia: A randomised controlled trial comparing epidural versus combined spinal-epidural(2022) SANTOS, Shirley Andrade; FERNANDES, Hermann Dos Santos; NANI, Fernando Souza; BARTILOTTI, Andreza Gonzaga; FRANCISCO, Rossana Pulcineli Vieira; CARMONA, Maria Jose Carvalho; BLIACHERIENE, Fernando; VIEIRA, Joaquim EdsonBackground: Combined spinal-epidural technique (CSE) for labour analgesia has been associated with fetal bradycardia and uterine hypertonia when compared with epidural analgesia (EA), possibly due to a decrease in epinephrine levels following neuraxial anaesthesia. However, there are no recent studies comparing plasmatic catecholamines levels between those two techniques. This study aimed to compare CSE versus EA regarding pre- and post-analgesia catecholamines levels, uterine tone and fetal heart rate.Patients and methods: Randomised clinical trial with 47 labouring patients divided in two groups (CSE and EA). Primary outcome was plasmatic catecholamine measurements before and after neuraxial block. Secondary outcomes were fetal heart rate changes, uterine hypertonia, hypotension episodes, pain relief and fetal outcomes. Results: For CSE group, the median decrease of plasmatic epinephrine was 0 pg/mL [(-) 480-(+) 41] and for norepinephrine was -21 pg/mL [(-) 2507-(+) 94]. For EA group, the median decrease for epinephrine was 0 pg/mL [(-) 326-(+) 15] and for norepinephrine was -5 pg/mL [(-) 190-(+76)]. There were no differences between groups (p = 0.96 and p = 0.63 for epinephrine and norepinephrine, respectively). There were no differences for secondary outcomes.Conclusions: There was no evidence of a more significant decrease of catecholamines with CSE when compared with EA. Catecholamines decrease theory may not be valid for modern labour analgesia techniques. ⠃C 2022 Socie acute accent te acute accent franc , aise d'anesthe acute accent sie et de re acute accent animation (Sfar).
- Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report(2024) V, Marcio Pimenta; NAKAMURA, Amanda T.; ASHMAWI, Hazem A.; VIEIRA, Joaquim E.; FERNANDES, Hermann dos SantosIntroduction: Bone cancer metastasis may produce severe and refractory pain. It is often difficult to manage with systemic analgesics. Chemical neurolysis may be an effective alternative in terminally ill patients. Case report: Female terminally ill patient with hip metastasis of gastric cancer in severe pain. Neurolytic ultrasound-guided blocks of the pericapsular nerve group and obturator nerve were performed with 5% phenol. This led to satisfactory pain relief for 10 days, until the patient's death. Discussion: This approach may be effective and safe as an analgesic option for refractory hip pain due to metastasis or pathologic fracture in terminally ill patients. (c) 2021 Sociedade Brasileira de Anestesiologia.
- Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study(2024) SANTOS, Shirley Andrade; NANI, Fernando Souza; MOURA, Elaine Imaeda de; CARVALHO, Diogo Lima de; MIGUEL, Guilherme Jorge Mattos; HADDAD, Cristiane Maria Federicci; VIEIRA, Joaquim Edson; BUNDUKI, Victor; CARVALHO, Mario Henrique Burlacchini de; FRANCISCO, Rossana Pulcineli Vieira; CARDEAL, Daniel Dante; FERNANDES, Hermann dos SantosBackground: Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as b2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. Methods: Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. Results: Twenty- five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 +/- 0.05 vs. 7.396 +/- 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 +/- 12.76 mg.dL - 1 vs. 13.06 +/- 6.35 mg.dL - 1 , for atosiban, p = 0.001) levels. Conclusions: Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair. (c) 2024 Sociedade Brasileira de Anestesiologia.