Browsing by Author "Cruzat, Francisco"

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    Anestesia obstétrica en Chad. Volviendo a los orígenes
    (Sociedad de Anestesiologia de Chile, 2022) Ghiringhelli, Juan Pablo; López, Rodrigo; Catalán, Cynthia; Kattan, Eduardo; Urzúa, Miguel; Cruzat, Francisco
    © 2022 Authors. All rights reserved.Background: Most maternal deaths occur in low- and middle-income countries, with Chad being one of the countries with the most alarming figures. There aren't many reports of anesthetic management for cesarean delivery in these countries. Aim: To report the obstetrical anesthetic experience in a hospital in Chad, Africa in the context of an international cooperation project to reduce the global shortage of anesthesiologists. Material and Methods: Case series of pregnant woman who were admitted to the ward of the Good Samaritan University Hospital Complex. Results: Thirty-two cesarean sections were performed, all using spinal anesthesia. The median age was 22 years, seven of them being adolescents. In two cases sedation with ketamine was used due to insufficient level and in one case general anesthesia with halothane was converted due to total spinal diagnosis. In twelve patients the interruption was due to immediate maternal/fetal vital risk (emergency cesarean section), the main causes being fetal bradycardia and placental abruption. Three patients presented uterine inertia refractory to medical treatment and resolved with the B-Lynch technique. Two patients decided to have immediate skin-to-skin contact. Three neonates had to be resuscitated with positive pressure ventilation, one of them died. No operative deaths were reported in the patients who underwent c-section, but there was one maternal death due to severe preeclampsia and postpartum hemorrhage after vaginal delivery. No epidural analgesia was requested for labor. Conclusions: This individual report provides insight into a particular reality with very limited staff and resources.
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    Assessment of the antinociceptive effect of a single fentanyl bolus dose in children: A pharmacokinetic and pharmacodynamic analysis based on the nociception level index during sevoflurane general anesthesia
    (WILEY, 2024) Cruzat, Francisco; Ibacache, Mauricio; González, Alejandro; Pedemonte, Juan Cristobal; Contreras, Victor; Giordano, Ady; Cortínez, Ignacio
    Background The Nociception Level Index has shown benefits in estimating the nociception/antinociception balance in adults, but there is limited evidence in the pediatric population. Evaluating the index performance in children might provide valuable insights to guide opioid administration.AimsTo evaluate the Nociception Level Index ability to identify a standardized nociceptive stimulus and the analgesic effect of a fentanyl bolus. Additionally, to characterize the pharmacokinetic/pharmacodynamic relationship of fentanyl with the Nociception Level Index response during sevoflurane anesthesia.MethodsNineteen children, 5.3 (4.1-6.7) years, scheduled for lower abdominal or urological surgery, were studied. After sevoflurane anesthesia and caudal block, a tetanic stimulus (50 Hz, 60 mA, 5 s) was performed in the forearm. Following the administration of fentanyl 2 mu g/kg intravenous bolus, three similar consecutive tetanic stimuli were performed at 5-, 15-, and 30-min post-fentanyl administration. Changes in the Nociception Level Index, heart rate, mean arterial pressure, and bispectral index were compared in response to the tetanic stimuli. Fentanyl plasma concentrations and the Nociception Level Index data were used to elaborate a pharmacokinetic/pharmacodynamic model using a sequential modeling approach in NONMEM (R).ResultsAfter the first tetanic stimulus, both the Nociception Level Index and the heart rate increased compared to baseline (8 +/- 7 vs. 19 +/- 10; mean difference (CI95) -12(-18--6) and 100 +/- 10 vs. 102 +/- 10; -2(-4--0.1)) and decrease following fentanyl administration (19 +/- 10 vs. 8 +/- 8; 12 (5-18) and 102 +/- 10 vs. 91 +/- 11; 11 (7-16)). In subsequent tetanic stimuli, heart rate remained unchanged, while the Nociception Level Index progressively increased within 15 min to values similar to those before fentanyl. An allometric weight-scaled, 3-compartment model best characterized the pharmacokinetic profile of fentanyl. The pharmacokinetic/pharmacodynamic modeling analysis revealed hysteresis between fentanyl plasma concentrations and the Nociception Level Index response, characterized by plasma effect-site equilibration half-time of 1.69 (0.4-2.9) min. The estimated fentanyl C50 was 1.93 (0.73-4.2) ng/mL.ConclusionThe Nociception Level Index showed superior capability compared to traditional hemodynamic variables in discriminating different nociception-antinociception levels during varying fentanyl concentrations in children under sevoflurane anesthesia.
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    Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds): study protocol and statistical analysis plan for a multicentre international observational cohort study
    (BMJ PUBLISHING GROUP, 2024) Quintao, Vinicius Caldeira; de Sousa, Gabriel Soares; Torborg, Alexandra; Vieira, Alexandra; Consonni, Francesco; Rodrigues, Samuel; Proenca, Julia; Carlos, Ricardo Vieira; Clemente, Marcella; Alonso, Nivaldo; Neville, Mariana; Leite, Fernanda; Tonello, Cristiano; Evans, Faye; Garcia-Marcinkiewicz, Annery; Guris, Rodrigo; Herrera, Jose; Andersen, Ana; Schaigorodsky, Lorena; Biondini, Nanci; Cajas, Ninon; Cruzat, Francisco; Cortínez, Luis Ignacio; Giraldo, Marisol; Valle, Alioth; Pozo, Cristian; Betancourt, Ana; Echeto, Maria Alejandra; Dominguez, Alma; Sarmiento, Lina; Gonzalez, Kenya; Abrego, Gesely; Leguizamon, Lorena; Paula, Leila; Lauber, Clarisa; Lopez, Gabriela; Biccard, Bruce M.; Carmona, Maria Jose; Hajjar, Ludhmila Abrahao
    Introduction Surgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries.Methods and analysis LASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission.Ethics and dissemination This study received approval from the Institutional Review Board of the coordinating centre (Hospital das Cl & iacute;nicas, Faculdade de Medicina, Universidade de S & atilde;o Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences.Trial registration number NCT05934682.