RICARDO VIEIRA CARLOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
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bookPart Componentes dos Aparelhos de Anestesia(2021) TORRES, Marcelo Luis Abramides; CARLOS, Ricardo Vieira- The effect of prior tetanic stimulation on train-of-four monitoring in paediatric patients A randomised open-label controlled trial(2017) CARLOS, Ricardo V.; BOER, Hans Donald de; TORRES, Marcelo Luis Abramides; CARMONA, Maria Jose CarvalhoBACKGROUND In clinical research, neuromuscular monitoring must present a stable response for a period of 2 to 5 min before administration of a neuromuscular blocking agent. The time required to reach this stable response may be shortened by applying a 5-s tetanic stimulus. OBJECTIVES The aim of this study was to test whether tetanic stimulation interferes with onset and recovery times after a single dose of rocuronium 0.6 mg kg(-1) followed by spontaneous recovery. DESIGN A randomised, open-label, controlled trial. SETTING A single-centre trial, study period from January 2014 to July 2015. PATIENTS Fifty children aged 2 to 11 years scheduled for elective paediatric surgery. INTERVENTION Patients were randomly allocated to receive either tetanic stimulation (group T) or not (group C) before calibration of the neuromuscular monitor. MAIN OUTCOME MEASURES Onset and recovery times. Initial and final T1 height, time to obtain initial T1 height stability and monitor settings were also analysed. RESULTS There was no significant difference in mean onset time [(C: 57.5 (+/- 16.9) vs. T: 58.3 (+/- 31.2) s; P = 0.917]. Mean times to normalised train-of-four (TOF) ratios of 0.7, 0.8 and 0.9 were significantly shorter in the tetanic stimulation group [C: 40.1 (+/- 7.9) vs. T: 34.8 (+/- 10) min; P = 0.047, C: 43.8 (+/- 9.4) vs. T: 37.4 (+/- 11) min; P = 0.045 and C: 49.9 (+/- 12.2) vs. T: 41.7 (+/- 13.1) min; P = 0.026, respectively]. The mean time required for T1 height stabilisation was similar in the two groups [C: 195.0 (+/- 203.0) vs. T: 116.0 (+/- 81.6) s; P = 0.093], but the initial and final T1 height values were significantly lower in the tetanic stimulation group (C: 98.0 vs. T: 82.7%; P<0.001 and C: 95.3 vs. T: 69.3%; P<0.001, respectively). CONCLUSION Tetanic stimulation shortened the mean times to normalised TOF ratios of 0.7, 0.8 and 0.9, but there was no difference in the mean onset time or the mean time required for T1 height stabilisation after a single dose of rocuronium 0.6 mg kg(-1) followed by spontaneous recovery in children aged 2 to 11 years.
- Why should we invest in objective neuromuscular monitoring anyway?(2016) CARLOS, Ricardo Vieira; BOER, Hans Donald de
- 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
- First Brazilian pediatric hospital to adopt 1-hour preoperative fasting time for clear fluids for elective surgeries(2021) CARDOSO, Priscilla Ferreira Neto; QUINTAO, Vinicius Caldeira; PERINI, Bruno; CARMONA, Maria Jose Carvalho; CARLOS, Ricardo Vieira; SIMOES, Claudia Marquez
- Is lower-dose sugammadex a cost-saving strategy for reversal of deep neuromuscular block? Facts and fiction(2018) BOER, Hans D. de; CARLOS, Ricardo V.; BRULL, Sorin J.BackgroundSugammadex, a -cyclodextrin derivative, belongs to a new class of selective relaxant binding agents. Sugammadex was approved 10-years ago by the European medicines agency and today is used in clinical anesthesia and emergency medicine globally. In this review, indications for neuromuscular block, the challenge of neuromuscular monitoring and the practice of under-dosing of sugammadex as a potential cost-saving strategy are discussed.Main bodyReversal of neuromuscular block is important to accelerate the spontaneous recovery of neuromuscular function. Sugammadex is able to reverse a rocuronium- or vecuronium-induced neuromuscular block rapidly and efficiently from every depth of neuromuscular block. However, since sugammadex was introduced in clinical anesthesia, several studies have reported administration of a lower-than-recommended dose of sugammadex. The decision to under-dose sugammadex is often motivated by cost reduction concerns, as the price of sugammadex is much higher than that of neostigmine outside the United States. However, under-dosing of sugammadex leads to an increased risk of recurrence of neuromuscular block after an initial successful (but transient) reversal. Similarly, when not using objective neuromuscular monitoring, under-dosing of sugammadex may result in residual neuromuscular block in the postoperative care unit, with its attendant negative pulmonary outcomes. Therefore, an appropriate dose of sugammadex, based on objective determination of the depth of neuromuscular block, should be administered to avoid residual or recurrent neuromuscular block and attendant postoperative complications. Whether the reduction in perioperative recovery time of the patient can be translated into additional procedural cases performed, faster operative turnover times, or improved organizational resource utilization, has yet to be determined in actual clinical practice that includes verification of neuromuscular recovery prior to tracheal extubation.ConclusionsThe current review addresses the indications for neuromuscular block, the challenge of neuromuscular monitoring, the practice of under-dosing of sugammadex as a potential cost-saving strategy in reversal of deep neuromuscular block, the economics of sugammadex administration and the potential healthcare cost-saving strategies.
bookPart Princípios físico-químicos aplicados à anestesiologia(2017) TORRES, Marcelo Luis Abramides; CARLOS, Ricardo VieirabookPart Equipamentos Eletromédicos na Sala de Cirurgia(2021) TORRES, Marcelo Luis Abramides; CARLOS, Ricardo VieirabookPart Via aérea em pediatria(2013) MARQUES, Francisco Eberth Marinho; CARLOS, Ricardo VieiraconferenceObject Case Report: New Nociception Monitor Use in a Pediatric Patient during Inguinal Hernia Repair(2021) DONATO, Anne Di; QUINTAO, Vinicius Caldeira; CARLOS, Ricardo Vieira; NOBREGA, Vinicius de Sousa
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