MARIA JOSE CARVALHO CARMONA

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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

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  • conferenceObject
    A PRAGMATIC MULTI-CENTRE TRIAL ON INTRAOPERATIVE FLUID MANAGEMENT USING PULSE PRESSURE VARIATION IN HIGH-RISK PATIENTS
    (2014) MALBOUISSON, L. M. S.; SILVA JR., J. M.; CARMONA, M. J. C.; ASSUNCAO, M. C. S.; VALIATTI, J. L.; LOPES, M. R.; SIMOES, C. M.; MICHARD, E.; AULER JR., J. O. C.
  • article 10 Citação(ões) na Scopus
    Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases
    (2011) BLIACHERIENE, Fernando; CARMONA, Maria Jose Carvalho; BARRETTI, Cristina de Freitas Madeira; HADDAD, Cristiane Maria Federicci; MOUCHALWAT, Elaine Soubhi; BORTOLOTTO, Maria Rita de Figueiredo Lemos; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
    Bliacheriene F, Carmona MJC, Barretti CFM, Haddad CMF, Mouchalwat ES, Bortlotto MRFL, Francisco RPV, Zugaib M - Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases. Background and Objectives: Hemodynamic changes are observed during cesarean section under spinal anesthesia. Non-invasive blood pressure (BP) and heart rate (HR) measurements are performed to diagnose these changes, but they are delayed and inaccurate. Other monitors such as filling pressure and cardiac output (CO) catheters with external calibration are very invasive or inaccurate. The objective of the present study was to report the cardiac output measurements obtained with a minimally invasive uncalibrated monitor (LiDCO rapid) in patients undergoing cesarean section under spinal anesthesia. Case report: After approval by the Ethics Commission, four patients agreed to participate in this study. They underwent cesarean section under spinal anesthesia while at the same time being connected to the LiDCO rapid by a radial artery line. Cardiac output, HR, and BP were recorded at baseline, after spinal anesthesia, after fetal and placental extraction, and after the infusion of oxytocin and metaraminol. We observed a fall in BP with an increase of HR and CO after spinal anesthesia and oxytocin infusion; and an increase in BP with a fall in HR and CO after bolus of the vasopressor. Conclusions: Although this monitor had not been calibrated, it showed a tendency for consistent hemodynamic data in obstetric patients and it may be used as a therapeutic guide or experimental tool.
  • article 0 Citação(ões) na Scopus
    Referral to immediate postoperative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire
    (2021) SILVA JR., Joao Manoel; KATAYAMA, Henrique Tadashi; LOPES, Felipe Manuel Vasconcellos; TOLEDO, Diogo Oliveira; AMENDOLA, Cristina Prata; OLIVEIRA, Fernanda dos Santos; ANDRAUS, Leusi Magda Romano; CARMONA, Maria Jose C.; LOBO, Suzana Margareth; MALBOUISSON, Luiz Marcelo Sa
    Introduction and objective: Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. Methods: A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results: 360 physicians participated in the study, with median time of 10 (5-18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less & nbsp;conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. Conclusion: Anesthesiologists, surgeons, and intensive care physicians presented different per-spectives on postoperative referral to the ICU. (c) 2021 Sociedade Brasileira de Anestesiologia.
  • article 1 Citação(ões) na Scopus
    Experimental Model of Non-Controlled Hemorrhagic Shock in Pigs
    (2011) CAVALCANTE, Fernanda Paula; NANI, Ricardo Souza; ROCHA FILHO, Joel Avancini; AULER JUNIOR, Jose Otavio Costa; CARMONA, Maria Jose Carvalho; MACHADO, Marcel Cerqueira Cesar
    Cavalcante FP, Nani RS, Rocha Filho JA, Auler Junior JOC, Carmona MJC, MachadoMCC - Experimental Model of Non-Controlled Hemorrhagic Shock in Pigs. Background and objectives: A better understanding of pathophysiologic changes associated to trauma and hemorrhagic shock can help the development of therapies capable of reducing trauma-related mortality. The objective of this study was to describe a model of non-controlled hemorrhagic shock in pigs. Methods: Animals received ketamine and midazolam as pre-anesthetic medications. Anesthesia was induced with propofol, and tracheal intubation was performed with the animals on spontaneous ventilation. After intubation neuromuscular blockade was performed. Animals were maintained in controlled mechanical ventilation and normocapnia. Anesthesia was maintained with propofol and fentanyl as needed. Saline was infused during the entire preparation period. Monitoring: Cardioscope, pulse oximeter, invasive blood pressure, volumetric catheter in the pulmonary artery, and urine output by cystostomy were used. Experimental model: after the initial recording of hemodynamic, metabolic, and coagulation variables, right subcostal incision and left lobe liver biopsy were performed. Anesthetic infusion was reduced while the infusion of saline was interrupted. An incision 12 cm long 2 cm deep was performed in the right liver lobe followed by digital divulsion of the wound. During the hemorrhagic phase, an aspiration probe was placed close to the wound and the volume of aspirated blood was recorded. When mean arterial pressure reached 40 mmHg and bleeding was above 700 mL the intervention phase was initiated according to the type of study. Conclusion: The development of experimental models to reduce high mortality and costs related to trauma is important.
  • article 0 Citação(ões) na Scopus
    Association between adult and child behavioral interactions with preoperative anxiety and emergence delirium
    (2023) QUINTAO, Vinicius Caldeira; CARLOS, Ricardo Vieira; KULIKOWSKI, Leslie Domenici; LEE-ARCHER, Paul; CARMONA, Maria Jose Carvalho
  • article 3 Citação(ões) na Scopus
    Evaluation of Cytokine Levels and Pulmonary Function in Patients Undergoing Coronary Artery Bypass Graft
    (2011) MACHADO, Luciano Brandao; NEGRI, Elnara Marcia; BONAFE, Wanderley Wesley; SANTOS, Luciana Moraes; MALBOUISSON, Luis Marcelo Sa; CARMONA, Maria Jose Carvalho
    The Summary: Machado LB, Negri EM, Bonafe WW, Santos LM, Malbouisson LMS, Carmona MJC - Evaluation of Cytokine Levels and Pulmonary Function in Patients Undergoing Coronary Artery Bypass Grafts. Background and objectives: Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. Methods: This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1 beta, IL-6, IL-8, IL-10, and TNF-alpha were determined. The duration of CB and surgery, PaO(2)/FiO(2) ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements ((star)p < 0.05) and Spearman's correlation coefficient. Results: We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-beta and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1 beta, IL-8, and TNF-alpha in bronchoalveolar lavage were higher than in plasma. Conclusions: There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.
  • article 0 Citação(ões) na Scopus
    Avaliação de hiperglicemia na sala de recuperação pós-anestésica
    (2017) PEREIRA, Vinicius Rodovalho; AZUMA, Rodrigo Akio; GATTO, Bruno Emanuel Oliva; SILVA JUNIOR, Joao Manoel; CARMONA, Maria Jose Carvalho; MALBOUISSON, Luiz Marcelo Sa
    Background and objectives: Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the post anesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. Methods: We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was >120 mg.dL(-1). Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. Results: We evaluated 837 patients. The mean age was 47.8 +/- 16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR 1.031, 95% CI 1.017-1.045); BMI (OR = 1.052, 95% CI 1.005-1.101); duration of surgery (OR = 1.011, 95% CI 1.008-1.014), history of hypertension (OR = 1.620, 95% CI 1.053-2.493), and intraoperative use of corticosteroids (OR = 5.465, 95% CI 3.421-8.731) were independent risk factors for postoperative hyperglycemia. Conclusion: The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication. (C) 2016 Sociedade Brasileira de Anestesiologia.
  • article 3 Citação(ões) na Scopus
    Percutaneous Radiofrequency Ablation for Trigeminal Neuralgia Management: A Randomized, Double-Blinded, Sham-Controlled Clinical Trial
    (2023) MANSANO, Andre Marques; FREDERICO, Thiago Nouer; VALENTIN, Raquel Elisa B.; CARMONA, Maria Jose Carvalho; ASHMAWI, Hazem Adel
    Trigeminal neuralgia, considered by many the worst pain that humankind can experience, has been called ""the suicide disease."" Neuroablative procedures are good options when conservative treatment fails to promote pain relief or in those whose side effects are unbearable. The objective was to compare the effectiveness and safety of trigeminal percutaneous radiofrequency ablation in classical refractory trigeminal neuralgia in a prospective, randomized, double-blind, sham-controlled clinical trial. We included 30 consecutive patients with classical trigeminal neuralgia who had failed to respond to drug treatment. The patients were randomly assigned into two groups: a thermal radiofrequency and a sham group. The thermal radiofrequency group were submitted to a 75 degrees C lesion for 60 seconds after proper sensory and motor stimulation. All steps were carried out in the sham group except the thermal lesion. Patients were evaluated using the Numerical Rating Scale (NRS), the 36-Item Short-Form Health Survey questionnaire, and anticonvulsant dose. After 1 month, the mean NRS score decreased from 9.2 to 0.7 in the radiofrequency group and from 8.9 to 5.8 in the sham group. This significant reduction was measurable starting at day one after the procedure and remained significant throughout the first month. Changing groups was allowed after one month, after which the pain reduction was similar between the two groups. Percutaneous trigeminal radiofrequency ablation results in statistically and clinically significant greater pain relief than the sham procedure after 1 month of follow-up. These results support using radiofrequency nerve ablation as a treatment for refractory trigeminal neuralgia.
  • article 2 Citação(ões) na Scopus
    Comparison of intravenous and inhalation anesthesia on postoperative behavior changes in children undergoing ambulatory endoscopic procedures: A randomized clinical trial
    (2023) QUINTAO, Vinicius Caldeira; CARLOS, Ricardo Vieira; CARDOSO, Priscilla Ferreira Neto; ZEFERINO, Suely Pereira; KULIKOWSKI, Leslie Domenici; LEE-ARCHER, Paul; CARMONA, Maria Jose Carvalho
    BackgroundEarly and delayed behavioral changes are well recognized after anesthesia. Intravenous anesthesia may prevent emergence delirium. However, it has not been evaluated as a preventive strategy for delayed postoperative behavior changes. AimsWe aimed to determine whether intravenous anesthesia is effective at reducing postoperative behavior changes in children undergoing ambulatory endoscopic procedures when compared to inhalation anesthesia. MethodsThis randomized, double-blinded controlled trial was approved by the local IRB. Children aged 1-12 years who underwent ambulatory endoscopic procedures were recruited. Preoperative anxiety was evaluated through the modified Yale Preoperative Anxiety Scale. All children underwent face mask inhalation induction with sevoflurane. After a peripheral line was placed, each child was allocated to sevoflurane or propofol maintenance. Emergence delirium was evaluated through the Pediatric Anesthesia Emergence Delirium scale. The child was discharged home, and behavioral changes were assessed through the Posthospitalization Behavior Questionnaire for Ambulatory Surgery on Days 1, 7, and 14. ResultsOverall, 175 children were enrolled. On Day 1 after the procedure, 57 children presented at least one negative behavior. On Days 7 and 14, 49 and 44 children presented at least one negative behavior, respectively. The median number of negative behaviors was similar between the groups. Post hoc analyses showed a moderate correlation between emergence delirium and negative postoperative behavior on Day 7 (r = .34; p = <.001) and an increase of 3.31 (95% CI 1.90; 4.36 p < .001) points in the mean summed score of new negative behaviors for individuals with emergence delirium. ConclusionThe incidence of postoperative behavior changes in children undergoing ambulatory endoscopic procedures was similar when comparing intravenous with inhalation anesthesia. Children who experience emergence delirium might show a greater incidence of negative postoperative behavior changes.
  • article 52 Citação(ões) na Scopus
    Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study
    (2021) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno Adler Maccagnan Pinheiro; MALBOUISSON, Luiz Marcelo Sa; TANIGUCHI, Leandro Utino; MENDES, Pedro Vitale; COSTA, Eduardo Leite Vieira; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; SILVA-JR, Joao M.; CARMONA, Maria Jose Carvalho; CARVALHO, Carlos R. R.
    Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 +/- 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 +/- 1.3 mL/kg of ideal body weight, plateau pressure was 24 +/- 5 cmH(2)O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH(2)O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.