16 minute read
PREDITORES ASSOCIADOS A DESFECHOS NO PERIOPERATÓRIO
MEMORIAL WOLNEI CAUMO
Acta Anaesthesiol Scand.2000 Aug;44(7):782-9.
Advertisement
Risk factors for postoperative anxiety in children.
Caumo W,Broenstrub JC,Fialho L,Petry SM,Brathwait O,Bandeira D,Loguercio A,Ferreira MB.
Author information 1 Serviço de Anestesia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil. Abstract BACKGROUND: Anxiety is defined as a set of behavioural manifestations that can be divided into state- and trait-anxiety. State-anxiety is a transitory emotional condition that varies in intensity and fluctuates over time. Trait-anxiety is a personality trait which remains relatively stable over time. The objective of this study was to identify and quantify perioperative risk factors for immediate postoperative anxiety in children. METHODS: A prospective cohort study was performed with 90 schoolchildren, ages ranging from 7 to 13 years old, ASA physical status I-II, submitted to elective surgery. The measuring instruments were verbal scale of pain, visual analogue scale (VAS), Trait-State Anxiety Inventory for Children (STAIC), Trait-State Anxiety Inventory (STAI) for parents, and structured questionnaire. RESULTS: Patients not submitted to analgesic block and patients with moderate and intense pain presented an estimated risk 5- and 13-fold greater for high levels of postoperative state-anxiety, respectively. High levels of preoperative state-anxiety and administration of doses of midazolam less than 0.056 mg x kg(-1) constituted an estimated risk for postoperative state-anxiety of 3- and 4-fold, respectively. A positive history of previous surgery was associated with lower risk for postoperative anxiety. CONCLUSIONS: High levels of preoperative state-anxiety, administration of less than 0.056 mg x kg(-1) of midazolam, absence of analgesic block and presence of moderate and intense postoperative pain constituted risk factors for immediate postoperative state-anxiety in children. Previous surgery reduced the risk for postoperative anxiety. No: 1 FI: 2.58 Citações: 97
Anaesthesia.2001 Aug;56(8):720-8.
Risk factors for postoperative anxiety in adults.
Caumo W1,Schmidt AP,Schneider CN,Bergmann J,Iwamoto CW,Adamatti LC,Bandeira D,Ferreira MB.
We identified risk factors for postoperative anxiety and quantified their effect on 712 adults between 18 and 60 years of age (ASA I-III physical status) undergoing elective surgery under general anaesthesia, neural blockade or both. The measuring instruments were a structured questionnaire, a pain visual analogue scale, the McGill Pain Questionnaire, the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale, a Self-Reporting Questionnaire-20, and a Self-Perception of Future Questionnaire. Multivariate conditional regression modelling taking into account the hierarchical relationship between risk factors revealed that postoperative anxiety was associated with ASA status III (OR = 1.48), history of smoking (1.62), moderate to intense postoperative pain (OR = 2.62) and high pain rating index (OR = 2.35), minor psychiatric
SEÇÃO II O TRONCO
disorders (OR = 1.87), pre-operative state-anxiety (OR = 2.65), and negative future perception (OR = 2.20). Neural block anaesthesia (OR = 0.72), systemic multimodal analgesia (OR = 0.62) and neuroaxial opioids with or without local anaesthesia (OR = 0.63) were found to be protective factors against postoperative anxiety. No: 11 FI: 2.58 Citações: 97
Acta Anaesthesiol Scand.2001 Mar;45(3):298-307.
Risk factors for preoperative anxiety in adults.
Caumo W1,Schmidt AP,Schneider CN,Bergmann J,Iwamoto CW,Bandeira D,Ferreira MB.
Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults. METHODS: A cross-sectional study was performed with 592 patients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State-Trait Anxiety Inventory; the Montgomery-Asberg Depression Rating Scale, the WHO Self-Reporting Questionnaire-20, and the future self-perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors. RESULTS: High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR= 2.30), moderate to intense depressive symptoms (3.22), high trait-anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR= 0.61) was associated with lower risk for preoperative state-anxiety. CONCLUSIONS: History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait-anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state-anxiety. Previous surgery reduced the risk for preoperative anxiety. No: 12 FI: 2.58 Citações: 325
Acta Anaesthesiol Scand.2002 Nov;46(10):1265-71.
Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery.
Caumo W 1,Schmidt AP,Schneider CN,Bergmann J,Iwamoto CW,Adamatti LC,Bandeira D,Ferreira MB.
BACKGROUND: Pain is a sensory and emotional experience that is influenced by physiologic, sensory, affective, cognitive, socio-cultural, and behavioral factors. Consistent with the perspective to improve the postoperative pain control, the present study has the purpose of assessing the effect of presurgical clinical factors, psychological and demographic characteristics as predictors for reporting moderate to intense acute
MEMORIAL WOLNEI CAUMO
postoperative pain. METHODS: A prospective cohort study was performed with 346 inpatients undergoing abdominal elective surgery (ASA physical status I-III, age range 18-60 years). The measuring instruments were Pain Visual Analog Scale, the State-Trait Anxiety Inventory, and the Montgomery-Asberg Depression Rating Scale. Multivariate conditional regression modeling was used to determine independent predictors for moderate to intense acute postoperative pain. RESULTS: Moderate to intense acute postoperative pain was associated with status ASA III (odds ratio (OR) = 1.99), age (OR = 4.72), preoperative moderate to intense pain (OR = 2.96), chronic pain (OR = 1.75), high trait-anxiety and depressive mood moderate to intense (OR = 1.74 and OR = 2.00, respectively). Patients undergoing surgery to treat cancer presented lower risk for reporting moderate to intense pain OR = 0.39, as well as those that received the epidural analgesia and multimodal analgesia with systemic opioid (OR = 0.09 and OR = 0.16, respectively). CONCLUSIONS: The identification of predictive factors for intense acute postoperative pain may be useful for designing specific preventive interventions to relieve patient suffering. Especially because few of these variables are accessible for medical intervention, which would improve the clinical outcomes and quality of life of patients at risk of moderate to intense acute postoperative pain. No: 13 FI: 2.58 Citações: 308
PLoS One.2017 Oct 30;12(10):e0187122. doi: 10.1371/journal.pone.0187122. e Collection 2017. Derivation and validation ofa preoperative risk model for postoperative mortality (SAMPE model): An approach to care stratification.
Stefani LC1,2,3,4,Gutierrez CS2,3,Castro SMJ5,Zimmer RL3,Diehl FP2,Meyer LE2,Caumo W1,2,3,4.
Ascertaining which patients are at highestriskof poorpostoperativeoutcomes could improvecareand enhance safety. This study aimed to construct and validate a propensity index for 30-daypostoperativemortality. A retrospective cohort study was conducted at Hospital de Clínicas de Porto Alegre, Brazil, over a period of 3 years. A dataset of 13524 patients was used to develop themodeland another dataset of 7254 was used to validate it. The primary outcome was 30-day in-hospital mortality. Overall mortality in the development dataset was 2.31% [n = 311; 95% confidence interval: 2.06-2.56%]. Four variables were significantly associated with outcome: age, ASA class, nature of surgery (urgent/emergency vs elective), and surgical severity (major/intermediate/minor). The index with this set of variables to predictmortalityin thevalidationsample (n = 7253) gave an AUROC = 0.9137, 85.2% sensitivity, and 81.7% specificity. This sensitivity cut-off yielded four classes of death probability: class I, <2%; class II, 2-5%; class III, 5-10%; class IV, >10%.Modelapplication showed that, amongst patients inrisk class IV, the odds of death were approximately fivefold higher (odds ratio 5.43, 95% confidence interval: 2.82-10.46) in those admitted to intensivecareafter a period on the regular ward than in those sent to the intensivecareunit directly after surgery. The SAMPE (Anaesthesia and Perioperative Medicine Service) model accurately predicted 30- daypostoperativemortality. Thismodelallows identification of high-risk patients and could be used as a practical tool forcarestratificationand rationalpostoperativeallocation of criticalcareresources. No: 14 FI: 2.85 Citações: 11
SEÇÃO II O TRONCO
Rev Bras Anestesiol.2018 Sep - Oct;68(5):492-498. doi: 10.1016/j.bjan.2018.04.001. Epub 2018 May 30. Predictors of in-hospital mortality in patients undergoing elective surgery in a university hospital: a prospective cohort
Stahlschmidt A1,Novelo B2,Alexi Freitas L2,Cavalcante Passos S2,Dussán-Sarria JA2,Félix EA2,Wajnberg Gamermann P2,Caumo W2,Cadore Stefani LP2.
INTRODUCTION: Morbidity andmortalityassociated with urgent or emergency surgeries are high compared to elective procedures. Perioperative risk scores identify the non-elective character as an independent factor of complications and death. The present study aims to characterize the population undergoing non-elective surgeries at the Hospital de Clínicas de Porto Alegre and identify the clinical and surgical factors associated with death within 30 days postoperatively. METHODOLOGY: A prospective cohort study of 187 patients undergoing elective surgeries between April and May 2014 at the Hospital de Clínicas, Porto Alegre. Patient-related data, pre-operative risk situations, and surgical information were evaluated. Death in 30 days was the primary outcome measured. RESULTS: The mean age of the sample was 48.5 years, and 84.4% of the subjects had comorbidities. The primary endpoint was observed in 14.4% of the cases, with exploratory laparotomy being the procedure with the highestmortality(47.7%). After multivariate logistic regression, age (odds ratio [OR] 1.0360, p <0.05), anemia (OR 3.961, p <0.05), acute or chronic renal insufficiency (OR 6.075, p <0.05), sepsis (OR 7.027, p <0.05), and patient-related risk factors formortality, in addition to the large surgery category (OR 7.502, p <0.05) were identified. CONCLUSION: The highmortalityrate found may reflect the high complexity of the institution’s patients. Knowing the profile of the patients assisted helps in the definition of management priorities, suggesting the need to create specific care lines for groups identified as high risk in order to reduce perioperative complications and deaths. No: 16 FI: 0.98 Citações: 1
PREDITORES A DOR CRÔNICA, RITMICIDADE CIRCADIANA E COMPORTAMENTO
Neurol Sci.2002 Apr;23(1):35-9.
Sleep disturbances associated with minor psychiatric disorders in medical students.
Hidalgo MP1,Caumo W.
We performed a cross-sectional study with 342 medical students (age range, 18-35 years) to identify, among a group of sleep disturbances, those which are related to minor psychiatric disorders in this population. The instruments employed for data collection were the self-reporting questionnaire (SRQ-20), the morningness/ eveningness questionnaire, the Epworth sleepiness scale, and a general questionnaire regarding demographic characteristics, use of drugs, history of psychopathology, usual fall-asleep time, usual wake-up time, amount of sleep, arousal during the night, and insomnia. We used a logistic regression model to determine independent
MEMORIAL WOLNEI CAUMO
factors associated with minor psychiatric disorders. Daytime sleepiness [odds ratio (OR), 2.12; 95% CI, 1.21- 3.71], arousal [OR, 4.54; 95% CI, 1.97-10.47], insomnia [OR 2.45; 95% CI, 1.32-4.56], and sleeping less than 7 hours per night [OR, 2.02; 95% CI, 1.11-3.67] were associated with minor psychiatric disorders. This group of variables determined a cumulative risk ratio of 5.47 [95% CI, 2.87-10.41] for the main outcome. No: 17 FI: 1.44 Citações: 94
Psychiatry Clin Neurosci.2009 Jun;63(3):283-90. doi: 10.1111/j.1440-1819.2009.01965.x. Relationship between depressive mood and chronotype in healthy subjects.
Hidalgo MP1,Caumo W,Posser M,Coccaro SB,Camozzato AL,Chaves ML.
The endogenous circadian clock generates daily variations of physiological and behavior functions such as the endogenous interindividual component (morningness/eveningness preferences). Also, mood disorders are associated with a breakdown in the organization of ultradian rhythm. Therefore, the purpose of the present study was to assessed the association between chronotype and the level of depressive symptoms in a healthy sample population. Furthermore, the components of the depression scale that best discriminate the chronotypes were determined. METHODS: This cross-sectional study involved 200 volunteers, aged 18-99 years, 118 women and 82 men. The instruments were the Montgomery-Asberg Depression Rating Scale (MADRS), the Morningness/Eveningness Questionnaire, the Self-Reporting Questionnaire-20, and the future self-perception questionnaire. RESULTS: Logistic regression showed that subjects with the eveningness chronotype had a higher chance of reporting more severe depressive symptoms compared to morning- and intermediate-chronotypes, with an odds ratio (OR) of 2.83 and 5.01, respectively. Other independent cofactors associated with a higher level of depressive symptoms were female gender (OR, 3.36), minor psychiatric disorders (OR, 3.70) and low future self-perception (OR, 3.11). Younger age, however, was associated with a lower level of depressive symptoms (OR, 0.97). The questions in the MADRS that presented higher discriminate coefficients among chronotypes were those related to sadness, inner tension, sleep reduction and pessimism. CONCLUSION: Identification of an association between evening typology and depressive symptoms in healthy samples may be useful in further investigation of circadian typology and the course of depressive disease. No: 18 FI:3.48 Citações: 200
Psychiatry Res.2012 Dec 30;200(2-3):489-93. doi: 10.1016/j.psychres. 2012.07.004. Epub 2012 Aug 18. Night eating patterns and chronotypes: a correlation with binge eating behaviors.
Harb A1,Levandovski R,Oliveira C,Caumo W,Allison KC,Stunkard A,Hidalgo MP.
This cross-sectional studyexamined the association between the morningness/eveningness dimension and eating patterns. The sample consists of 100 subjects who were screened at a nutrition clinic and was composed of 77% women; mean age was 39.5 (±11.7) years; and 66% were overweight. Significant bivariate correlations were found between theMorningness-EveningnessQuestionnaire (MEQ) total score and the BingeEatingScale (BES) and the NightEatingQuestionnaire (NEQ). The NEQ and BES were also significantly correlated. Body mass index (BMI) was correlated with the NEQ and BES, but it was not a confounding variable as noassociationswere found between the MEQ and BMI. To control for potential multicollinearity
SEÇÃO II O TRONCO
effects among variables, we also used multivariate regression analysis in which the values of the correlation coefficients were adjusted. Only the BES remained statistically associated with the MEQ. In conclusion, these results suggest that thestudyof chronotype may be an important issue to be considered when characterizing disorderedeating. Thisstudyserves as an impetus for examining circadian intakepatternsin more detail between those with bingeeatingdisorder (BED) and nighteating syndrome (NES) to help discern these important nosological questions. No: 19 FI: Citações:
PLoS One.2018 May 2;13(5):e0196718. doi: 10.1371/journal.pone.0196718. eCollection 2018. Comparison of pain burden and psychological factors in Brazilian women living with HIV and chronic neuropathic or nociceptive pain: An exploratory study.
de Souza A1,2,Caumo W2,3,4,5,Calvetti PU1,2,Lorenzoni RN1,da Rosa GK1, Lazzarotto AR1,Dussan-Sarria JA2,3.
Psychological factors including pain catastrophizing and resilience associate with adjustment and quality of life in people living with chronic pain. Nevertheless, their presentation among females living with HIV and chronic pain has been poorly studied. Given that chronic pain in those living with HIV might occur due to different mechanisms (nociceptive or neuropathic), we hypothesize that the associated psychological states could also differ between these groups. We aimed to compare pain frequency and interference, psychological factors and sleep quality between females living with chronic nociceptive or neuropathic pain. Also, we explored correlations betweenpsychological factors,pain severity and interference in femaleslivingwithHIVandchronicpain. We performed a cross sectionalstudyassessing femaleslivingwithHIV andchronicpain, and compared it with a femaleHIV-positive,pain-free control sample in Brazil. To discriminate the most likely underlying mechanism for thechronicpain, we applied the Leeds Assessment forNeuropathicSigns and Symptoms (LANSS). Fortynine femalesliving withHIVandchronicpainwere assessed, and divided in control (n = 12),nociceptive(n = 10) andneuropathicpain(n = 27) groups. Using validated scales, theirpaincatastrophizing, resilience, depression, anxiety and sleep disorders were assessed between May 2014 and August 2015. Compared to controls, femaleslivingwithHIVandneuropathicchronicpainhad higherpainfrequency (p<0.001), interference on activities (p = 0.002), interference with emotions (p<0.001), catastrophizing (p<0.001), depression (p = 0.015), and lower resilience (p = 0.011). Catastrophizing was also significantly correlated to theburdenofchronicpain. The type ofchronicpainin femaleslivingwithHIV should raise concerns regarding significantburdeninpsychologicalstates in this population (particularlyneuropathicpain). Using scales such as the LANSS to identify the type of chronicpain, could be of use to address relevant issues for the patients, and to propose tailored therapies No: 20 FI: 2.22 Citações: 46
MEMORIAL WOLNEI CAUMO
A dor crônica, além de ser definida pelo aspecto cronológico, é também um processo de neuroplasticidade mal adaptativa consequente à incapacidade das vias e redes neurais da neuromatrix da dor em serem suficientes para o processamento da carga alostática. Como mencionado ao longo deste memorial, o desbalanceamento entre os mecanismos neuroquímicos que determinam a excitabilidade e a inibição das vias de processamento da dor ativa, mecanismos fisiológicos de ajustamento que envolvem os sistemas neuro-imuneendócrino. Esta ação em cadeia, ativa mecanismos neurobiológicos, neuro inflamatórios, proto-oncogenes, a neurogênese e a secreção de neurotrofinas. Resultante desta sequência de eventos moleculares, a capacidade de processamento é aumentada em níveis cortical e infra cortical. Essas mudanças compreendem o fenômeno de sensibilização central à dor, que reflete os processos de neuroplasticidade, cujos marcadores mensuráveis em nível periférico, que aqui destacamos, são o BDNF e a proteína S100-B. Também podemos incluir as variantes genéticas presentes no gene do BDNF, particularmente o polimorfismo de nucleotídeo único Val66Met (rs6265), que têm sido associado com a resposta terapêutica às técnicas neuromoduladoras.
Os estudos do Laboratório de Dor e Neuromodulação têm contribuído de maneira importante neste campo do conhecimento. O primeiro artigo em humanos, demonstrando que a elevação do BDNF em sujeitos saudáveis está associada à diminuição do limiar de dor em homens e que o contrário foi observado nas mulheres, foi publicado pelo nosso grupo. Este estudo fez parte da tese doutorado da minha orientada Dra. Luciana Stefani e foi publicado no Neuroscience Letters. Nosso Laboratório tem adicionado conhecimento no campo da ciência que evidencia a relação entre os níveis séricos e liquóricos do BDNF com medidas de dor e como preditor de desfechos. Até o presente, publicamos 36 artigos nesta temática que relaciona o BDNF ao processamento da dor a partir da publicação no Neurociência Letter, em 2012. Destacase aqui que, em outros estudos, demonstramos a relação entre os níveis séricos de BDNF e a capacidade inibitória do sistema descendente de dor, assim como sua relação com a função da via corticoespinhal por meio do potencial evocado motor (MEP). Nossos estudos demonstraram que a elevação desta neurotrofina aumenta a potência do sistema inibitório descendente de dor nas mulheres, enquanto em homens eleva a excitabilidade da via corticoespinhal mensurada por meio do MEP. Entende-se que o aumento na amplitude do MEP indica uma via menos inibida. Este estudo está no prelo da revista Pain Medicine. Nosso Laboratório também foi o primeiro a
SEÇÃO II O TRONCO
contribuir para este campo da ciência ao demonstrar que a elevação dos níveis séricos da proteínaS100-B está associada à redução do limiar de dor na fibromialgia. Este resultado foi publicado na revista Molecular Pain. Além disso, publicamos o primeiro artigo que relaciona a desinibição do córtex motor primário e do sistema modulatório descendente da dor em condições com lesões estruturais presentes, como na osteoartrite, comparado a condições com escasso dano estrutural, como visto na fibromialgia. Observamos que o nível de disfunção do sistema modulatório descendente de dor está relacionado positivamente com os níveis séricos de BDNF. Alinhados com esta perspectiva, demonstramos que os níveis de BDNF estão relacionados à gravidade de sintomas de sensibilização central. Enquanto o BDNF é um marcador de plasticidade neuronal, a S100B demonstra o papel da neuroglia, que representa as mudanças estruturais da substância branca, e indica que ela pode ser um marcador substituto para as mudanças na neuroglia. Nosso estudo também tem proporcionado insights que vinculam o estado neuroplástico avaliado por meio dessas neurotrofinas com a resposta terapêutica. Enquanto a sensibilização central na dor crônica inclui a disfunção de extensas redes cortical e subcortical, o córtex motor primário M1 emergiu como um alvo para avaliar a excitabilidade cortical e para tratar condições de dor crônica. A mudança na plasticidade cortical pode mediar o desequilíbrio nas entradas excitatórias e inibitórias. O aporte da pesquisa desenvolvida pelo nosso grupo tem contribuído para demonstrar que as alterações em marcadores, muitas vezes considerados correlatos, estão relacionadas ao impacto da dor, níveis de incapacidade, aspectos cognitivos e comportamentais. Esses estudos demonstraram que a disfunção dos processos neurobiológicos nas vias da dor, mensuradas por meio de parâmetros neurofisiológicos de excitabilidade cortical, função do sistema inibitório descendente da dor, marcadores neuroquímicos e medidas relacionadas ao comportamento e incapacidade funcional devido à dor, permitem constituir um mapeamento da dor crônica como uma doença complexa e multifacetada.
