Journal of the Portuguese Society of Anesthesiology

A sustainable legacy

Carmen Oliveira — 2025-01-03

PERSONALIZED MEDICINE IN ANESTHESIOLOGY: CHALLENGES AND FUTURE DIRECTIONS FOR PRECISION ANESTHETICS CARE.

Manuel Vico — 2025-01-03

Documento de consenso da Sociedade Europeia de Anestesiologia e Cuidados Intensivos sobre sustentabilidade 4 âmbitos para alcançar uma prática mais sustentável

Carmen Oliveira — 2025-01-03

As alterações climáticas são um tema determinante para a nossa geração. A pegada de carbono da prática clínica é responsável por 4,7 % das emissões europeias de gases com efeito de estufa, estando a União Europeia classificada como o terceiro maior contribuinte para a pegada de carbono da indústria da saúde a nível global, atrás dos Estados Unidos e da China. Reconhecendo a importância de uma ação urgente, a Sociedade Europeia de Anestesiologia e Cuidados Intensivos (ESAIC) adotou a Declaração de Glasgow sobre Sustentabilidade Ambiental em junho de 2023. Com base nesta iniciativa, o Comité de Sustentabilidade da ESAIC apresenta agora um documento de consenso sobre a sustentabilidade perioperatória. Reconhecendo dimensões mais amplas da sustentabilidade, além da ambiental, o documento reconhece os profissionais de saúde como pilares para o cuidado sustentável e apresenta recomendações em quatro áreas principais: emissões diretas, energia, cadeia de abastecimento e gestão de resíduos; e cuidados psicológicos e autocuidados dos profissionais de saúde. Dada a necessidade urgente de reduzir as emissões globais de carbono e a escassez de literatura baseada em dados científicos sobre sustentabilidade perioperatória, a metodologia usada para estas recomendações é baseada em pareceres de peritos.

Um total de 90 recomendações foram elaboradas por 13 peritos em sustentabilidade em anestesia, em março de 2023 e depois validadas por 36 peritos de 24 países diferentes, num processo Delphi em duas etapas em maio e junho de 2023. Para acomodar diferentes possibilidades de ação em países de rendimentos elevados vs. médios, foi estabelecido um limiar de concordância de 80 % para facilitar a implementação das recomendações em toda a Europa. Todas as recomendações ultrapassaram o limiar de concordância de 80% na primeira ronda Delphi e 88 recomendações alcançaram uma concordância >90 % na segunda ronda. As recomendações incluem a utilização de fluxo de gás fresco muito baixo, a escolha do fármaco anestésico, medidas de preservação de energia e água, políticas “5R”, incluindo a escolha de plásticos e a sua eliminação, e recomendações para um ambiente de trabalho saudável, referindo também a importância da fadiga na prática clínica.

Portuguese Recommendations for the Treatment of Acute Pain 2024

Rui Ferreira Valente — 2025-01-03

Acute pain has been undertreated for decades. The solution does not appear to lie in the creation of novel drugs or analgesic technologies; instead, a viable solution seems to involve establishing a well-organized system that effectively use existing knowledge. While there is a consensus on the beneficial role of acute pain units in enhancing pain treatment and overall outcomes, their implementation poses a challenge and has not achieved the expected results. The General Directorate of Health published, in 2012, a standard requiring the establishment of an Acute Pain Unit in all hospitals. This standard regulates every aspect of its organization and operation, outlining specific criteria for evaluating its successful implementation. In 2017, the Portuguese Society of Anesthesiology created a working group to address the inquiries posed by the standard. The group aimed to develop practical clinical consensus, leading to the recommendations published in 2018. As we approach the six-year mark, a review of the document is necessary, with a focus on incorporating developments in the field.

: Comparison of Laryngeal mask airway versus Endotracheal intubation in general anaesthesia for endovascular neurosurgery: A Prospective, Randomized Controlled Trial.

Deepa Kerketta Khurana — 2025-01-03

Introduction- Endovascular treatment of intracerebral aneurysms/arteriovenous malformations requires the neuro-anaesthesiologist to control and manipulate the haemodynamic parameters with minimum fluctuations. The aim of this study was to compare the performance of endotracheal intubation versus Laryngeal Mask Airway (LMA) ProSeal with respect to hemodynamic stability and adverse respiratory events in such procedures.

Material and Methods- Ninety patients, with a pre-procedure Hunt and Hess Scale ≤ 2 and Glasgow Coma Scale (GCS) ≥ 13, scheduled for digital subtraction angiography (DSA) guided coiling of intracerebral aneurysms/AV malformations were randomly divided into two demographically comparable groups, namely endotracheal intubation (Group T) and ProSeal LMA (Group L).Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP) and oxygen saturation (SpO2) were noted at baseline and compared at 1min, 3min, 5min and 10min after intubation and extubation. Respiratory adverse events if any, were recorded.

Results- With baseline vitals being comparable, a significant difference was seen post intubation in the HR at 1 min (p- 0.0355) and 3min (p-0.0217), SBP at 1min (p-0.0164) and 3 min (p-0.0008) and MAP at 1min (p–0.0001), 3min (p-0.0024) and 5min (p- 0.0031) after intubation, with Group T showing higher values. Post extubation, the rise in HR and MAP was higher in Group T (p- 0.0110 and 0.0190 respectively). Respiratory adverse were higher in Group T.

Discussion and Conclusions- ProSeal LMA is an effective alternative in endovascular neurosurgery, providing stable perioperative haemodynamics and fewer respiratory adverse events. In cases where long term ventilation might be anticipated endotracheal intubation may be chosen.

A clinical study on the effectiveness of lignocaine preconditioning to treat protamine-induced catastrophic pulmonary vasoconstriction in paediatric cardiac surgery

Sanjeev Singh — 2025-01-03

Background: Protamine is a peptide rich in arginine and highly alkaline. When intravenously injected, protamine interacts with the polyanionic heparin to form a neutral charge, which isolates heparin from antithrombin III and leads to the loss of its anticoagulating properties. Therefore, protamine has been often used in cardiac surgeries to counteract anticoagulating unfractionated heparin. Methods: This was a single-centre, prospective, double-blind, and randomised study conducted among eight-eight paediatric patients with acyanotic congenital cardiac disease, scheduled for elective on-pump cardiac surgery under general anaesthesia. In this study, the participants were divided into four groups: group I- non-pulmonary hypertension with lignocaine preconditioning; group II – non-pulmonary hypertension with normal saline (as a placebo); group III- pulmonary hypertension with lignocaine preconditioning; and group IV- pulmonary hypertension with normal saline (as a placebo). Results: Pulmonary vasoconstriction occurred in 9.09% of cases after protamine administration. Both the II and IV groups exhibited an increase in mean airway pressure (Paw), respiratory index (RI), alveolar-arterial oxygen difference (A-aDO2), pulmonary artery pressure (PAP), and decreased dynamic pulmonary compliance (Cydn) and oxygen index (OI) after protamine administration. However, these changes were not observed in the I and III groups with lignocaine preconditioning. Plasma levels of TXB2 in the II and IV groups were higher than in the I and III groups, but 6-keto-PGF1 alpha levels were lower in the II and IV groups than in the I and III groups. Conclusion: Most congenital corrective cardiac surgeries are not possible without cardiopulmonary bypass and heparin. Lignocaine preconditioning reverses protamine-induced pulmonary vasoconstriction and improves pulmonary function before reversing unfractionated heparin with protamine.

Manejo anestesiológico em cirurgias para tratamento de feocromocitoma: Relato de dois casos

Luciana Hahmann Abreu Luciana Hahmann Abreu — 2025-01-03

Introduction: Pheochromocytomas are rare neuroendocrine tumors of the adrenal medulla that synthesize excessive catecholamines and have the classic clinical triad of headache, sweating and palpitations. It has surgical treatment, requiring pre-operative preparation and adequate anesthetic management for blood pressure control according to its varied pharmacodynamic profiles pre-, intra- and post-operatively. Objective: To report the anesthetic management of two cases of pheochromocytoma, from a pre-anesthetic consultation to a tall patient. Methodology: This is a descriptive case-based study, using intraoperative information in hospitals and different surgical data. Conclusion: Regional anesthesia combined with balanced general anesthesia was used, with no significant interferences in hemodynamic stability, analgesia and hospital discharge.

The portuguese path in environmental sustainability in Anesthesia – Portuguese Society of Anesthesia contribution

Carmen Oliveira — 2025-01-03

Health Care Without Harm Europe: Empowering healthcare professionals to drive sustainable change in the sector

Mireia Figueras Alsius — 2025-01-03

The healthcare sector is one of Europe’s largest industries and has a tremendous environmental, economic, and social footprint.^[1]

Whereas its mission is to promote health, the sector is a contributor to the ongoing environmental crisis, and it is estimated to be responsible for 4.6% of global carbon emissions.^[2] Additionally, chemicals with toxic properties, such as endocrine disruptors, are still widely used, single-use products are common practice, and pharmaceutical residues in water systems are contributing to the rise of antimicrobial resistance (AMR), a growing global health threat.

It’s fundamental that the healthcare sector minimises its own environmental impact while working to protect people’s health.

Research in sustainability: highly needed and feasible!

Nicolaas Sperna Weiland — 2025-01-03

We are currently living in a new geological era: the Anthropocene, where humanity has become the dominant force in the shaping of the Earth’s environment.(1) The evolving challenges of environmental pollution, climate change, biodiversity loss and the associated health consequences demand that healthcare, itself a polluting sector responsible for 5-10% of global greenhouse gas emissions, develops sustainable solutions.(2,3) The European Society for Anaesthesiology and Intensive Care (ESAIC) has put forward the Glasgow Declaration, defining priority areas to mitigate the carbon footprint of anaesthesia.(4) Delivering these goals requires a profound transformation of our profession and the healthcare system in general. To help us navigate this challenge, we need scientific research to guide us. In the context of 'planetary health', it is crucial to create effective strategies for climate mitigation and adaptation, facilitate their implementation, build relevant datasets to inform policy, and develop innovative approaches to planetary health research.