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
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Evaluation of hemodynamic effects of xenon in dogs undergoing hemorrhagic shock(2013) FRANCESCHI, Ruben C.; MALBOUISSON, Luiz; YOSHINAGA, Eduardo; AULER JR., Jose Otavio Costa; FIGUEIREDO, Luiz Francisco Poli de; CARMONA, Maria Jose C.OBJECTIVES: The anesthetic gas xenon is reported to preserve hemodynamic stability during general anesthesia. However, the effects of the gas during shock are unclear. The objective of this study was to evaluate the effect of Xe on hemodynamic stability and tissue perfusion in a canine model of hemorrhagic shock. METHOD: Twenty-six dogs, mechanically ventilated with a fraction of inspired oxygen of 21% and anesthetized with etomidate and vecuronium, were randomized into Xenon (Xe; n = 13) or Control (C; n = 13) groups. Following hemodynamic monitoring, a pressure-driven shock was induced to reach an arterial pressure of 40 mmHg. Hemodynamic data and blood samples were collected prior to bleeding, immediately after bleeding and 5, 20 and 40 minutes following shock. The Xe group was treated with 79% Xe diluted in ambient air, inhaled for 20 minutes after shock. RESULT: The mean bleeding volume was 44 mL.kg(-1) in the C group and 40 mL.kg(-1) in the Xe group. Hemorrhage promoted a decrease in both the cardiac index (p<0.001) and mean arterial pressure (p<0.001). These changes were associated with an increase in lactate levels and worsening of oxygen transport variables in both groups (p<0.05). Inhalation of xenon did not cause further worsening of hemodynamics or tissue perfusion markers. CONCLUSIONS: Xenon did not alter hemodynamic stability or tissue perfusion in an experimentally controlled hemorrhagic shock model. However, further studies are necessary to validate this drug in other contexts.
bookPart Dispositivos ópticos para intubação orotraqueal(2013) CARMONA, Maria José Carvalho; SIMõES, Claudia Marques; VANE, Matheus FachiniconferenceObject Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil(2013) GARRO, Laila Sabino; CARMONA, Maria Jose Carvalho; SOARES, Iracy Silvia Correa; AUN, Marcelo Vivolo; RIBEIRO, Marisa Rosimeire; RODRIGUES, Adriana Teixeira; KALIL, Jorge; GIAVINA-BIANCHI, Pedro; MOTTA, Antonio AbilioRATIONALE: The epidemiology of intraoperative anaphylaxis is un-known in Brazil. We aimed to evaluate the incidence and clinical features of anaphylaxis during anesthesia in a University General Hospital in Sao Paulo, Brazil. METHODS: A cross-sectional, observational study analyzing data fromvoluntary notification sent by anesthesiologists, about occurrence of intraoperative anaphylaxis during the period between January and December 2010. The diagnostic criteria for anaphylaxis were based onthe World Allergy Organization Guidelines. We analyzed the incidence of intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types of surgical procedures, classification of anesthetic risk (American Society of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and type of treatment provided. RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000 surgeries. The mean age of patients with anaphylaxis was 36.7 years-old and 57% were women. The most common procedures associated with anaphylaxis were the abdominal non-vascular (17.1%) and urologic (17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and all patients who presented cardiovascular shock were classified as ASA II (42.9%) or ASA III (57.1%). Epinephrine was used preferentially in anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades 1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly etiologic drugs cited by the anesthesiologists were the neuromuscular blocking agents (22.9%). CONCLUSIONS: Our incidence of intraoperative anaphylaxis was higher than in other studies reported in the literature. These data are a warning signal to encourage measures to reduce the incidence of these severe reactions.bookPart Acesso à via aérea no obeso(2013) GABANA, Edelvan; AMORIM, Célio Gomes; CARMONA, Maria José Carvalho- The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study(2013) SILVA JR., Joao M.; OLIVEIRA, Amanda Maria Ribas Rosa de; NOGUEIRA, Fernando Augusto Mendes; VIANNA, Pedro Monferrari Monteiro; PEREIRA FILHO, Marcos Cruz; DIAS, Leandro Ferreira; MAIA, Vivian Paz Leao; NEUCAMP, Cesar de Souza; AMENDOLA, Cristina Prata; CARMONA, Maria Jose Carvalho; MALBOUISSON, Luiz M. SaIntroduction: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. Methods: We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. Results: The study included 479 patients. Mean age was 61.2 +/- 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 +/- 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P < 0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P < 0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P < 0.001), cardiovascular (63.2% vs. 39.6%, P < 0.001) and respiratory complications (34.3% vs. 11.6%, P < 0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). Conclusions: Patients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.
- Frequency of intraoperative cardiac arrest and medium-term survival(2013) SEBBAG, Ilana; CARMONA, Maria Jose Carvalho; GONZALEZ, Maria Margarita Castro; ALCANTARA, Hermes Marcel; LELIS, Rolison Gustavo Bravo; TOLEDO, Flavia de Oliveira; ARANHA, Gustavo Fabio; NUZZI, Rafael Ximenes do Prado; AULER JUNIOR, Jose Otavio CostaCONTEXT AND OBJECTIVE: Although advances in surgical and anesthetic techniques have reduced perioperative morbidity-mortality, the survival rate following cardiac arrest remains low. The aim of this study was to evaluate, over the course of one year, the prevalence of intraoperative cardiac arrest and the 30-day survival rate after this event in a tertiary teaching hospital. DESIGN AND SETTING: Prospective cohort study in a tertiary teaching hospital. METHODS: Following approval by the institutional ethics committee, anesthetic procedures and cases of intraoperative cardiac arrest between January and December 2007 were evaluated. Patients undergoing cardiac surgery were excluded. The data were gathered prospectively using the modified Utstein model, with evaluation of demographic data, pre-arrest conditions, intraoperative care, care during arrest and postoperative outcome up to the 30th day. The data were recorded by the attending anesthesiologist. RESULTS: During the study period, 40,379 anesthetic procedures were performed, and 52 cases of intraoperative cardiac arrest occurred (frequency of 13: 10,000). Among these, 69% presented spontaneous return of circulation after the initial arrest, and only 25% survived for 30 days after the event. The following factors were associated with shorter survival: American Society of Anesthesiologists physical status IV and V, emergency surgery, hemorrhagic events, hypovolemia as the cause of arrest and use of atropine during resuscitation. CONCLUSIONS: Although the frequency of cardiac arrest in the surgical environment has declined and resources to attend to this exist, the survival rate is low. Factors associated with worst prognosis are more frequent in critical patients.
conferenceObject IMPACT OF DIFFERENT HAEMODYNAMIC RESUSCITATION STRATEGIES ON BRAIN PERFUSION AND TISSUE EDEMA MARKERS IN A MODEL OF SEVERE HAEMORRHAGIC SHOCK(2013) MALBOUISSON, L. M.; IDA, K. K.; OTSUKI, D. A.; CASTRO, L. U.; SANCHES, T. R.; SHIMIZU, M. M.; ANDRADE, L. C.; CARMONA, M. C.- Outcomes of patients with trauma and intraoperative cardiac arrest(2013) TOLEDO, Flavia O.; GONZALEZ, Maria M.; SEBBAG, Ilana; LELIS, Rolison G. B.; ARANHA, Gustavo F.; TIMERMAN, Sergio; CARMONA, Maria J. C.Background: Although the occurrence of intraoperative cardiac arrest is rare, it is a severe adverse event with a high mortality rate. Trauma patients have additional causes for intraoperative arrest, and we hypothesised that the survival of trauma patients who experienced intraoperative cardiac arrest would be worse than nontrauma patients who experienced intraoperative cardiac arrest. Objectives: The aim of the present study was to compare the outcomes of trauma and nontrauma patients after intraoperative cardiac arrest. Methods: In a tertiary university hospital and trauma centre, the intraoperative cardiac arrest cases were evaluated from January 2007 to December 2009, excluding patients submitted to cardiac surgery. Data were prospectively collected using the Utstein-style. Outcomes among the patients with trauma were compared to the patients without trauma. Results: We collected data from 81 consecutive intraoperative cardiac arrest cases: 32 with trauma and 49 without trauma. Patients in the trauma group were younger than the patients in the nontrauma group (44 +/- 23 vs. 63 +/- 17, p < 0.001). Hypovolaemia (63% vs. 35%, p = 0.022) and metabolic/hydroelectrolytic disturbances (41% vs. 2%, p < 0.001) were more likely to cause the cardiac arrest in the trauma group. The first documented arrest rhythm did not differ between the groups, and pulseless electrical activity was the most prevalent rhythm (66% vs. 53%, p = 0.698). The return of spontaneous circulation (47% vs. 63%, p = 0.146) and survival to discharge with favourable neurological outcome (16% vs. 14%, p = 0.869) did not differ between the two groups. Conclusions: The outcomes did not differ between patients with trauma and nontrauma intraoperative cardiac arrest.
- Cardiac Compression of Lung Lower Lobes after Coronary Artery Bypass Graft with Cardiopulmonary Bypass(2013) NEVES, Flavio H.; CARMONA, Maria J.; AULER JR., Jose O. C.; RODRIGUES, Roseny R.; ROUBY, Jean Jacques; MALBOUISSON, Luiz M. S.Background: Atelectasis is a major cause of hypoxemia after coronary artery bypass grafting (CABG) and is commonly ascribed to general anesthesia, high inspiratory oxygen concentration and cardiopulmonary bypass (CPB). The objective of this study was to evaluate the role of heart-induced pulmonary compression after CABG with CPB. Methods: Seventeen patients without pre-operative cardiac failure who were scheduled for coronary artery bypass graft underwent pre-and postoperative thoracic computed tomography. The cardiac mass, the pressure exerted on the lungs by the right and left heart and the fraction of collapsed lower lobe segments below and outside of the heart limits were evaluated on a computed tomography section 1 cm above the diaphragmatic cupola. Results: In the postoperative period, cardiac mass increased by 32% (117 +/- 31 g versus 155 +/- 35 g, p<0.001), leading to an increase in the pressure that was exerted on the lungs by the right (2.2 +/- 0.6 g.cm(-2) versus 3.2 +/- 1.2 g.cm(-2), p<0.05) and left heart (2.4 +/- 0.7 g.cm(-2) versus 4.261.8 g.cm(-2), p, 0.001). The proportion of collapsed lung segments beneath the heart markedly increased [from 6.7% to 32.9% on the right side (p<0.001) and from 6.2% to 29% on the left side (p<0.001)], whereas the proportion of collapsed lung segments outside of the heart limits slightly increased [from 0.7% to 10.8% on the right side (p<0.001) and from 1.5% to 12.6% on the left side (p<0.001)]. Conclusion: The pressure that is exerted by the heart on the lungs increased postoperatively and contributed to the collapse of subjacent pulmonary segments.
- Hemostatic Resuscitation in Traumatic Hemorrhagic Shock: Case Report(2013) BARBOSA NETO, Jose Osvaldo; MORAES, Marcos Fernando Breda de; NANI, Ricardo Souza; ROCHA FILHO, Joel Avancini; CARMONA, Maria Jose CarvalhoBackground and objectives: The aim of this paper is to report a case in which the damage control resuscitation (DCR) approach was successfully used to promote hemostatic resuscitation in a polytraumatized patient with severe hemorrhagic shock. Case report: Female patient, 32 years of age, with severe hemorrhagic shock due to polytrauma with hip fracture, who developed acidosis, coagulopathy, and hypothermia. During fluid resuscitation, the patient received blood products transfusion of fresh frozen plasma/packed red blood cells/platelet concentrate at a ratio of 1:1:1 and evolved intraoperatively with improvement in perfusion parameters without requiring vasoactive drugs. At the end of the operation, the patient was taken to the intensive care unit and discharged on the seventh postoperative day. Conclusion: The ideal management of traumatic hemorrhagic shock is not yet established, but the rapid control of bleeding and perfusion recovery and well-defined therapeutic protocols are fundamental to prevent progression of coagulopathy and refractory shock.