GABRIEL MAGALHAES NUNES GUIMARAES

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LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 6 Citação(ões) na Scopus
    Tramadol wound infiltration is not different from intravenous tramadol in children: a randomized controlled trial
    (2016) GIRALDES, Ana Laura Albertoni; SOUSA, Angela Maria; SLULLITEL, Alexandre; GUIMARAES, Gabriel Magalhaes Nunes; SANTOS, Melina Genevieve Mary Egan; PINTO, Renata Evangelista; ASHMAWI, Hazem Adel; SAKATA, Rioko Kimiko
    Study Objective: The purpose of this trial was to assess if tramadol wound infiltration is superior to intravenous (IV) tramadol after minor surgical procedures in children because tramadol seems to have local anesthetic like effect. Design: Randomized double-blind controlled trial. Setting: Postanesthesia care unit. Patients: Forty children, American Society of Anesthesiologists physical status I or II, scheduled to elective inguinal hernia repair. Interventions: Children were randomly distributed in 1 of 2 groups: IV tramadol (group 1) or subcutaneous infiltration with tramadol (group 2). At the end of the surgery, group 1 received 2 mg/kg tramadol (3 mL) by IV route and 3-mL saline into the surgical wound; group 2 received 2 mg/kg tramadol (3 mL) into the surgical wound and 3-mL saline by IV route. Measurements: In the postanesthesia care unit, patients were evaluated for pain intensity, nausea and vomiting, time to first rescue medication, and total rescue morphine and dipyrone consumption. Main Results: Pain scores measured during the postanesthesia recovery time were similar between groups. Time to first rescue medication was shorter, but not statistically significant in the IV group. The total dose of rescue morphine and dipyrone was also similar between groups. Conclusions: We concluded that tramadol was effective in reducing postoperative pain in children, and there was no difference in pain intensity, nausea and vomiting, or somnolence regarding IV route or wound infiltration.
  • article 20 Citação(ões) na Scopus
    Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study
    (2014) SOUSA, Angela Maria; SANTANA NETO, Jose de; GUIMARAES, Gabriel M. N.; CASCUDO, Giovana M.; NETO, Jose Osvaldo B.; ASHMAWI, Hazem A.
    The WHO analgesic ladder supports medication choice according to pain intensity. The use of the analgesic ladder in an inverse way, has the advantage of using the same principles of the original ladder to treat crisis of pain in cancer patients. The purpose of this study is to describe the use of intravenous patient-controlled analgesia (IV-PCA) technique in patients admitted to an oncological Hospital. This is a case series study. Patients assigned to receive IV-PCA between March 2011 and May 2012 were selected for the study. Medical records were reviewed, patients stratified according to the Karnofsky Performance Score (KPS). The primary outcome was to verify if different IV-PCA opioid solutions could be equally effective providing pain relief. Secondary outcomes were the incidence of clinical side effects that can be associated to IV-PCA infusions. A total of 95 medical records were reviewed. Most patients used IV-PCA with morphine (42.1 %), fentanyl (42.1 %) or methadone (15.7 %) to treat exacerbation periods of cancer pain. IV-PCA used as supplementary therapy successfully improved pain control in 78.9 % of the patients, without any difference related to opioid solution. KPS < 40 was related to higher rate of pain relief, without any difference in side effects in this group of patients. The most common side effects were sedation (10.5 %) followed by constipation (9.4 %) and nausea (4.2 %). Morphine presented a higher risk than fentanyl for sedation. Analgesia-related delirium or respiratory depression were not reported in this case series study. IV-PCA provided timely, safe and useful analgesia for patients with severe breakthrough pain and may be useful to help titration of opioids, weaning to oral analgesia and to decide for interventional procedures.
  • article 3 Citação(ões) na Scopus
    Dexmedetomidine reduces postoperative cognitive and behavioral dysfunction in adults submitted to general anesthesia for non-cardiac surgery: meta-analysis of randomized clinical trials
    (2021) GOVêIA, Catia Sousa; MIRANDA, Denismar Borges de; OLIVEIRA, Lucas Valente de Brito; PRAXEDES, Felícia Benevides; MOREIRA, Larissa Govêia; GUIMARÃES, Gabriel Magalhães Nunes
    Abstract Introduction and objectives Dexmedetomidine (DEX) has been associated with a decrease in postoperative cognitive and behavioral dysfunction in patients submitted to general anesthesia, whether inhalation or total intravenous anesthesia. Consequently, the DEX effects on postoperative agitation and delirium in patients submitted to general anesthesia for non-cardiac surgery have been investigated. Method A systematic review and meta-analysis of randomized and double-blind clinical trials (RCTs) was undertaken assessing adults submitted to elective procedures under general anesthesia receiving DEX or placebo. The search included articles published in English in the Pubmed and Web of Science databases using keywords such as dexmedetomidine, delirium, and agitation. Duplicate publications, studies involving cardiac surgery or using active control (other than saline solution) were included. A random effects model was adopted using the DerSimonian-Laird method and estimate of Odds Ratio (OR) for dichotomous variables, and weighted mean difference for continuous variables, with their respective 95% Confidence Intervals (95% CI). Results Of the 484 articles identified, 15 were selected comprising 2,183 patients (1,079 and 1,104 patients in the DEX and control group, respectively). The administration of DEX was considered a protective factor for postoperative cognitive and behavioral dysfunction (OR = 0.36; 95% CI 0.23-0.57 and p < 0.001), regardless of the anesthesia technique used. Conclusion Dexmedetomidine administration reduced by at least 43% the likelihood of postoperative cognitive and behavioral dysfunction in adult patients submitted to general anesthesia for non-cardiac surgery.
  • article 0 Citação(ões) na Scopus
  • article 28 Citação(ões) na Scopus
    Magnesium sulfate improves postoperative analgesia in laparoscopic gynecologic surgeries: a double-blind randomized controlled trial
    (2016) SOUSA, Angela M.; ROSADO, Giovanna M. C.; NETO, Jose de S.; GUIMARAES, Gabriel M. N.; ASHMAWI, Hazem A.
    Study objective: The aim of this study is to compare the analgesic effect of intravenous infusion of magnesium sulfate to ketorolac during laparoscopic surgeries. Design: Double-blind randomized controlled trial. Setting: University-affiliated teaching hospital. Patients: Sixty women submitted to laparoscopic gynecologic oncology surgeries. Interventions: Intravenous ketorolac 30 mg in bolus followed by saline infusion (group K), intravenous magnesium sulfate 20 mg/kg in bolus followed by magnesium 2 mg kg(-1) h(-1) (group M) or intravenous saline solution 20 mL in bolus followed by saline infusion during the entire procedure (group S). Measurements: Postoperative pain, nausea, vomiting, sedation, opioid consumption, time to first dose of analgesic. Main results: Magnesium sulfate reduced opioid consumption compared with placebo in the postoperative, but not in the intraoperative, period. Nausea, not vomiting, was reduced in ketorolac but not in the magnesium group. Pain intensity was higher in placebo than in the other 2 groups during all periods of observation. In the first 60 minutes, pain intensity was lower in the magnesium than in the ketorolac or the placebo group.
  • article 21 Citação(ões) na Scopus
    Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: a double-blind, randomized trial
    (2018) MORAIS, L. C. de; SOUSA, A. M.; FLORA, G. F.; GRIGIO, T. R.; GUIMARAES, G. M. N.; ASHMAWI, H. A.
    BackgroundPost-operative nausea and vomiting (PONV) is one of the most important causes of patient discomfort after laparoscopic surgeries despite the use of a multimodal pharmacological approach. This study assessed whether the addition of aprepitant to a multimodal regimen would further decrease the incidence of PONV in high-risk patients. MethodsApfel-score three or four patients, scheduled for laparoscopic procedures to treat abdominal or pelvic cancer, were randomized to receive oral starch (control group) or 80 mg of oral aprepitant (treatment group) before induction of anaesthesia in a double-blind study. All patients received 4-8 mg of intravenous dexamethasone (at induction) and 4-8 mg of ondansetron (at the end) and a standardized total intravenous anaesthesia (TIVA) technique combined with neuraxial blockade. PONV was defined as any episode of nausea, vomiting or retching in the first 24 h after anaesthesia. ResultsSixty-six patients completed the study. Vomiting occurred in 13/32 (40.6%) patients in the control group and in 1/34 (2.9%) patients in the treatment group (P = 0.0002, 95%CI: 18-54%) in the first 24 h after anaesthesia. Severe nausea occurred in two (6.3%) patients, and severe vomiting occurred in four (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 post-operative hours. ConclusionEighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements. This study was registered in the ClinicalTrials.gov (NCT 02357693) database.
  • article 15 Citação(ões) na Scopus
    Does previous chemotherapy-induced nausea and vomiting predict postoperative nausea and vomiting?
    (2015) SILVA, H. B. G. da; SOUSA, A. M.; GUIMARAES, G. M. N.; SLULLITEL, A.; ASHMAWI, H. A.
    BackgroundPostoperative nausea and vomiting (PONV) remains a problem in the postoperative period. Previous PONV in oncology patients has recently been associated with chemotherapy-induced nausea and vomiting (CINV). We assessed if CINV could improve Apfel's heuristic for predicting PONV. MethodsWe conducted a retrospective study of 1500 consecutive patients undergoing intermediate or major cancer surgery between April and July 2011. PONV was assessed in the first postoperative day during post-anaesthesia care. The assigned anaesthetist completed an electronic medical record with all of the studied variables. Multiple logistic regression analyses were performed to assess whether any of the variables could add predictive ability to Apfel's tallying heuristic, and receiver operating characteristic (ROC) curves were modelled. The areas under the curve (AUC) were used to compare the model's discriminating ability for predicting patients who vomited from those who did not vomit. ResultsThe overall incidence of PONV was 26%. Multiple logistic regressions identified two independent predictors for PONV (odds ratio; 95% CI), Apfel's score (1.78; 1.23-2.63) and previous chemotherapy-induced vomiting (3.15; 1.71-5.9), Hosmer-Lemeshow's P<0.0001. Previous CINV was the most significant predictor to be added to Apfel's heuristic in this population. ConclusionsA history of chemotherapy-induced nausea vomiting was a strong predictor for PONV and should be investigated as an added risk factor for PONV in the preoperative period of oncology surgery in prospective studies.
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