SUELY PEREIRA ZEFERINO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- High Dose of N-Acetylcystein Prevents Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Myocardial Revascularization(2014) SANTANA-SANTOS, Eduesley; GOWDAK, Luis Henrique W.; GAIOTTO, Fabio A.; PUIG, Luiz B.; HAJJAR, Ludhmila A.; ZEFERINO, Suely P.; DRAGER, Luciano F.; SHIMIZU, Maria Heloisa M.; BORTOLOTTO, Luiz A.; LIMA, Jose J. G. DeBackground. The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial. Methods. We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney disease patients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification. Results. The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p = 0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p = 0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p = 0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p = 0.01) and abolished in patients receiving N-acetylcystein. Conclusions. Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function. (C) 2014 by The Society of Thoracic Surgeons
- S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery A prospective observational study(2016) SILVA, Fernando P.; SCHMIDT, Andre P.; VALENTIN, Livia S.; PINTO, Katia O.; ZEFERINO, Suely P.; OSES, Jean P.; WIENER, Carolina D.; OTSUKI, Denise A.; TORT, Adriano B. L.; PORTELA, Luis V.; SOUZA, Diogo O.; AULER JR., Jose O. C.; CARMONA, Maria J. C.BACKGROUND Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). OBJECTIVE The study aims to evaluate the association between POCD and serum levels of S100B and NSE after coronary artery bypass grafting surgery (CABG). DESIGN Prospective observational study. SETTING Single university teaching hospital. PATIENTS We investigated 88 patients undergoing CABG. MAIN OUTCOMES MEASURES Cognitive function was measured preoperatively, and at the 21st and 180th postoperative days (i.e. 6 months after surgery). S100B protein and NSE serum levels were evaluated preoperatively, after induction of anaesthesia, at the end of surgery and at 6 and 24 h after surgery. RESULTS The incidence of POCD was 26.1% at 21 days after surgery and 22.7% at 6 months after surgery. Increased serum levels of S100B protein and NSE were observed postoperatively and may indicate brain damage. CONCLUSION Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG.
- Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report(2021) SABA, Gabriela Tognini; QUINTÃO, Vinicius Caldeira; ZEFERINO, Suely Pereira; SIMÕES, Claudia Marquez; COELHO, Rafael Ferreira; FAZOLI, Arnaldo; NAHAS, William; VILELA, Gustavo Henrique Frigieri; CARMONA, Maria José CarvalhoAbstract Both robotic surgery and head-down tilt increase intracranial pressure by impairing venous blood outflow. Prostatectomy is commonly performed in elderly patients, who are more likely to develop postoperative cognitive disorders. Therefore, increased intracranial pressure could play an essential role in cognitive decline after surgery. We describe a case of a 69-year-old male who underwent a robotic prostatectomy. Noninvasive Brain4care™ intraoperative monitoring showed normal intracranial compliance during anesthesia induction, but it rapidly decreased after head-down tilt despite normal vital signs, low lung pressure, and adequate anesthesia depth. We conclude that there is a need for intraoperative intracranial compliance monitoring since there are major changes in cerebral compliance during surgery, which could potentially allow early identification and treatment of impaired cerebral complacency.
- 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 CarvalhoBackgroundEarly 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 0 Citação(ões) na Scopus Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial (vol 126, pg 85, 2017)(2017) HAJJAR, L. A.; VINCENT, J. L.; GALAS, Barbosa Gomes F. R.; RHODES, A.; LANDONI, G.; OSAWA, E. A.; MELO, R. R.; SUNDIN, M. R.; GRANDE, S. M.; GAIOTTO, F. A.; POMERANTZEFF, P. M.; DALLAN, L. O.; FRANCO, R. A.; NAKAMURA, R. E.; LISBOA, L. A.; ALMEIDA, J. P. de; GERENT, A. M.; SOUZA, D. H.; GAIANE, M. A.; FUKUSHIMA, J. T.; PARK, C. L.; ZAMBOLIM, C.; FERREIRA, Rocha G. S.; STRABELLI, T. M.; FERNANDES, F. L.; CAMARA, L.; ZEFERINO, S.; SANTOS, V. G.; PICCIONI, M. A.; JATENE, F. B.; AULER JR., Costa J. O.; FILHO, R. K.- Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: A randomized pilot trial(2014) GALAS, Filomena R. B. G.; ALMEIDA, Juliano P. de; FUKUSHIMA, Julia T.; VINCENT, Jean Louis; OSAWA, Eduardo A.; ZEFERINO, Suely; CAMARA, Ligia; GUIMARAES, Vanessa A.; JATENE, Marcelo B.; HAJJAR, Ludhmila A.Objectives: Acute acquired hypofibrinogenemia in children undergoing cardiac surgery is a major concern because it often results in perioperative bleeding and high rates of allogeneic blood transfusion. Fibrinogen concentrate has been proposed as an alternative to cryoprecipitate (the gold standard therapy), with minimal infectious and immunologic risks. Our objective was to investigate the efficacy and safety of fibrinogen concentrate in children undergoing cardiac surgery. Methods: In this randomized pilot study, patients were allocated to receive fibrinogen concentrate (60 mg/kg) or cryoprecipitate (10 mL/kg) if bleeding was associated with fibrinogen levels <1 g/dL after cardiopulmonary bypass weaning. The primary outcome was postoperative blood losses during the 48 hours after surgery. Results: A total of 63 patients were included in the study, 30 in the fibrinogen concentrate group and 33 in the cryoprecipitate group. The median 48-hour blood loss was not significantly different between the 2 groups (320 mL [interquartile range, 157-750] vs 410 mL [interquartile range, 215-510], respectively; P = .672). After treatment, plasma fibrinogen concentration increased similarly following administration of both products. There were no differences in allogeneic blood transfusion after intervention treatment. Conclusions: A large trial comparing fibrinogen concentrate and cryoprecipitate in the management of children with acute acquired hypofibrinogenemia during heart surgery is feasible. The preliminary results of our study showed that the use of fibrinogen concentrate was as efficient and safe as cryoprecipitate in the management of bleeding children undergoing cardiac surgery.
- Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery The VANCS Randomized Controlled Trial(2017) HAJJAR, Ludhmila Abrahao; VINCENT, Jean Louis; GALAS, Filomena Regina Barbosa Gomes; RHODES, Andrew; LANDONI, Giovanni; OSAWA, Eduardo Atsushi; MELO, Renato Rosa; SUNDIN, Marcia Rodrigues; GRANDE, Solimar Miranda; GAIOTTO, Fabio A.; POMERANTZEFF, Pablo Maria; DALLAN, Luis Oliveira; FRANCO, Rafael Alves; NAKAMURA, Rosana Ely; LISBOA, Luiz Augusto; ALMEDIA, Juliano Pinheiro de; GERENT, Aline Muller; SOUZA, Dayenne Hianae; GAIANE, Maria Alice; FUKUSHIMA, Julia Tizue; PARK, Clarice Lee; ZAMBOLIM, Cristiane; FERREIRA, Graziela Santos Rocha; STRABELLI, Tania Mara; FERNANDES, Felipe Lourenco; CAMARA, Ligia; ZEFERINO, Suely; SANTOS, Valter Garcia; PICCIONI, Marilde Albuquerque; JATENE, Fabio Biscegli; AULER JR., Jose Otavio Costa; KALIL FILHO, RobertoBackground: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome. Methods: This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l.min(-1).m(-2)) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 mu g/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days. Results: A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction. Conclusions: The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.