OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

AIM: To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified. INTRODUCTION: Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint. METHODS: Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview. RESULTS: Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups. CONCLUSION: Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

JUSTIFICATIVA E OBJETIVOS: A síndrome de Guillain-Barré após vacina de sarampo é rara. O diagnóstico muitas vezes é tardio, o que leva a um aumento da morbidade. O presente relato apresenta um caso avançado e os cuidados especiais exigidos durante a anestesia. RELATO DO CASO: Paciente do sexo masculino, com quatro anos de idade com síndrome de Guillain-Barré desde um ano de idade, foi submetido a gastrostomia sob anestesia geral sem intercorrências, com sevoflurano e sem bloqueadores neuromusculares. CONCLUSÕES: O caso ilustra a raridade etiológica de uma síndrome importante na prática anestésica assim como os eventos adversos pós-vacinação, a melhor escolha para a equipe anestésica e as complicações da síndrome de Guillain-Barré na infância.

BACKGROUND AND OBJECTIVES: Guillain-Barré syndrome following measles vaccination is uncommon. Diagnosis is often delayed, leading to increased morbidity. This report describes an advanced Guillain-Barré case and the special approaches required during anesthesia. CASE REPORT: Male patient, four years old, with Guillain-Barré syndrome diagnosed at 1 year of age, submitted to gastrostomy under uneventful general anesthesia with sevoflurane, without neuromuscular blockers. CONCLUSIONS: The case highlights the low frequency with which this syndrome so important for anesthetic practice is diagnosed, post-vaccination adverse events, the best choice for the anesthetic team and complications of pediatric Guillain-Barré syndrome.

JUSTIFICATIVA Y OBJETIVOS: El síndrome de Guillain-Barré después de la vacuna de sarampión es rara. El diagnóstico en la mayoría de las veces es tardío, lo que lleva a un aumento de la morbidez. Este actual relato presenta un caso avanzado y todas las atenciones especiales exigidas durante la anestesia. RELATO DEL CASO: Paciente del sexo masculino, con cuatro años de edad con síndrome de Guillain-Barré desde hace un año de edad, fue sometido a gastrostomía bajo anestesia general sin intercurrencias, con sevoflurano y sin bloqueadores neuromusculares. CONCLUSIONES: El caso ilustra la rareza etiológica de una síndrome importante en la práctica anestésica, así como los eventos adversos pos-vacunación, la mejor elección para el equipo anestésico y las complicaciones de la síndrome de Guillain-Barré en la infancia.

JUSTIFICATIVA E OBJETIVOS: Uma das mais importantes propriedades dos bloqueadores neuromusculares é o rápido início de ação, possibilitando intubação traqueal precoce. A administração de pequena dose de bloqueador não-despolarizante antes da dose plena é sabidamente redutora da latência da maioria dos bloqueadores neuromusculares utilizados. O brometo de pipecurônio é um agente aminoesteróide de longa duração com grande estabilidade cardiovascular, porém, com início de ação tardio. O objetivo desse estudo foi avaliar o efeito do priming do pipecurônio em pacientes adultos submetidos a cirurgias eletivas sob anestesia geral. MÉTODO: Foram estudados 33 pacientes adultos de ambos os sexos, com idade entre 20 e 65 anos, estado físico ASA I ou II, submetidos a cirurgias eletivas sob anestesia geral. Foram excluídos do estudo pacientes com insuficiência renal ou hepática, neuromiopatia, uso concomitante de drogas que influenciem a sua farmacocinética ou pacientes com histórico familiar de hipertermia maligna. Foram divididos em dois grupos: Grupo 1 onde foi utilizado o priming com 0,01 mg.kg-1 e três minutos depois completada a dose de 0,08 mg.kg-1 e o Grupo 2, sem dose priming (Grupo Controle). O relaxamento neuromuscular foi controlado pela aceleromiografia (Aparelho TOF-Guard) e no momento em que T1 < 10% era realizada a laringoscopia. A análise estatística foi feita pelos testes T para amostras independentes e a normalidade pelo Shapiro Wilks. RESULTADOS: Os grupos foram homogêneos e observou-se que o tempo para T1 < 10% no Grupo 1 foi de 161,4 ± 13,7 segundos e no Grupo 2 foi 217,8 ± 23,4 segundos, com p < 0,001, havendo diferença estatística significativa entre os grupos. CONCLUSÕES: Os resultados do estudo mostraram diferença estatística significativa entre os grupos com e sem priming, indicando que o pipecurônio também tem latência reduzida, assim como os demais bloqueadores neuromusculares conhecidos.

BACKGROUND AND OBJECTIVES: One of the most important neuromuscular blockers property is short onset, allowing early tracheal intubation. Low nondepolarizing blocker dose before the full dose is known to decrease the onset of most neuromuscular blockers. Pipecuronium bromide is a long-lasting aminosteroid with major cardiovascular stability, however, with late onset. This study aimed at evaluating pipecuronium priming effect in adult patients submitted to elective surgeries under general anesthesia. METHODS: Participated in this study 33 adult patients of both genders, aged 20 to 65 years, physical status ASA I or II, to be submitted to elective surgeries under general anesthesia. Exclusion criteria were patients with kidney or liver failure, neuromuscular diseases, in concurrent use of drugs influencing pipecuronium pharmacokinetics, and patients with family history of malignant hyperthermia. Patients were divided in 2 groups: Group 1 = priming with 0.01 mg.kg-1 and 3 minutes later the remaining 0.07 mg.kg-1 (total 0.08 mg.kg-1); Group 2 = no priming dose (group control). Neuromuscular relaxation was controlled by acceleromyography (TOF-Guard device) and laryngoscopy was accomplished when T1 < 10%. T test for independent samples was used for statistical analysis and Shapiro Wilks was used to test normality. RESULTS: Groups were homogeneous. Time for T1 < 10% was 161.4 ± 13.7 seconds for Group 1 and 217.8 ± 23.4 seconds for Group 2, with p < 0.001 and statistically significant differences between groups. CONCLUSIONS: Our results have shown statistically significant differences between groups with and without priming, indicating that pipecuronium also has its onset decreased, similarly to other known neuromuscular blockers.

JUSTIFICATIVA Y OBJETIVOS: Una de las más importantes propiedades de los bloqueadores neuromusculares es el rápido inicio de acción, posibilitando intubación orotraqueal precoz. La administración de pequeña dosis del bloqueador no despolarizante antes de la dosis completa es consabidamente reductora de la latencia de la mayoría de los bloqueadores neuromusculares utilizados. El bromuro de pipecuronio es un agente aminoesteroide de larga duración con grande estabilidad cardiovascular, sin embargo, con inicio de acción tardía. El objetivo de ese estudio es evaluar el efecto del priming del pipecuronio en pacientes adultos sometidos a cirugías electivas bajo anestesia general. MÉTODO: Fueron estudiados 32 pacientes adultos de ambos sexos, con edad entre 20 y 65 años, estado físico ASA I ó II, a ser sometidos a cirugías electivas bajo anestesia general. Fueron excluidos del estudio pacientes con insuficiencia renal o hepática, neuromiopatia, uso concomitante de drogas que influencien la farmacocinética de la droga o pacientes con histórico familiar de hipertermia maligna. Fueron divididos en dos grupos: Grupo 1 donde fue utilizada el priming con 0,01 mg.kg-1 3 minutos después de completada la dosis de 0,08 mg.kg-1 y el Grupo 2, sin dosis priming (Grupo Control). El relajamiento neuromuscular fue controlado por la aceleromiografía (Aparato TOF-Guard) y en el momento en que T1 < 10% era realizada la laringoscopia. El análisis estadístico fue hecha por la prueba T para muestras independientes y la normalidad testada por el Shapiro Wilks. RESULTADOS: Los grupos fueron homogéneos y se observó que el tiempo para T1 < 10% en el Grupo 1 fue de 161,4 ± 13,7 segundos y en el Grupo 2 fue 217,8 ± 23,4 segundos, con p < 0,001, habiendo diferencia estadísticamente significativa entre los grupos. CONCLUSIONES: Los resultados del estudio mostraron diferencia estadísticamente significativa entre los grupos con y sin priming, indicando que el pipecuronio también tiene latencia reducida, así como también los demás bloqueadores neuromusculares conocidos.

JUSTIFICATIVA E OBJETIVOS: A distrofia muscular de Duchenne é uma afecção recessiva ligada ao cromossomo X, geralmente diagnosticada na infância, acentuando-se progressivamente até agravar a função respiratória. O objetivo deste relato é apresentar um caso de um paciente com distrofia muscular de Duchenne diagnosticada há 2 anos, submetido à postectomia, sob anestesia geral com cetamina S. RELATO DO CASO: Paciente com 9 anos de idade com Distrofia Muscular de Duchenne diagnosticada há 2 anos, submetido à anestesia geral com levo-cetamina (1,5 mg.kg-1), por via venosa, sob ventilação espontânea assistida manualmente por sistema de Baraka (Mapleson A) e bloqueio peniano com bupivacaína a 0,5% (25 mg). Foram usados monitores de pressão arterial não invasiva, oximetria de pulso, cardioscopia e temperatura esofagiana. No decorrer da cirurgia, o caso evoluiu sem intercorrências, sendo que no período pós-operatório o paciente apresentou alguns episódios de vômitos sem outras alterações significativas. Permaneceu internado por 24 horas, tendo alta hospitalar assintomático. CONCLUSÕES: A avaliação pré-anestésica cuidadosa, o uso de monitorização adequada e medicações que não predisponham o aparecimento de complicações tornam seguro o procedimento em pacientes portadores de Distrofia Muscular de Duchenne e seu pós-operatório.

BACKGROUND AND OBJECTIVES: Duchenne’s Muscular Dystrophy is an X-linked recessive disorder, generally diagnosed in childhood, which progressively worsens to degenerate respiratory function. This report aimed at presenting the case of a patient with Duchenne’s Muscular Dystrophy diagnosed 2 years before, submited to postectomy under general anesthesia with ketamine S. CASE REPORT: Male patient, 9 years old, with Duchenne’s Muscular Dystrophy diagnosed 2 years before, submitted to general anesthesia with intravenous levo-ketamine (1.5 mg.kg-1), under spontaneous ventilation manually assisted by Mapleson A Baraka system and penile block with 25 mg of 0.5% bupivacaine. Monitoring consisted of non invasive blood pressure, pulse oximetry, cardioscopy and esophageal temperature. There were no incidents during surgery, and after surgery patient had a few vomiting episodes, without other significant complications. Patient remained in hospital for 24 hours and was discharged asymptomatic. CONCLUSIONS: Very careful pre-anesthetic evaluation, adequate monitoring and drugs not predisposing to complications make surgery and postoperative period safe for Duchenne’s Muscular Dystrophy patients.

JUSTIFICATIVA Y OBJETIVOS: La distrofia muscular de Duchenne es una afección recesiva ligada al cromosoma X, generalmente diagnosticada en la infancia, acentuándose progresivamente hasta agravar la función respiratoria. El objetivo de este relato es presentar un caso de un paciente con distrofia muscular de Duchenne diagnosticada hace 2 años, sometido a la postectomia, sobre anestesia general con cetamina S. RELATO DEL CASO: Paciente con 9 años de edad con Distrofia Muscular de Duchenne diagnosticada hace 2 años, sometido a la anestesia general con levo-cetamina (1,5 mg.kg-1), por vía venosa, sobre ventilación espontanea auxiliada manual por sistema de Baraka (Mapleson A) y bloqueo peniano con bupivacaína a 0,5% (25 mg). Fueron usados monitores de presión arterial no invasiva, oximetria de pulso, cardioscopia y temperatura esofagiana. En el recurrir de la cirugía, el caso evoluyó sin interocurrencias siendo que en el período pós-operatorio el paciente presentó algunos episodios de vómitos sin otras alteraciones significativas. Permaneció internado por 24 horas, teniendo alta hospitalar asintomático. CONCLUSIONES: La evaluación pré-anestésica cuidadosa, el uso de monitorización adecuada y medicaciones que no predispongan al aparecimiento de complicaciones tornan seguro el procedimiento y el pós-operatorio en pacientes portadores de Distrofia Muscular de Duchenne.

Nowadays, the sport practice has been initiated precociously. These precocious beginning of competitive sports may result in changes on the young athletes' posture alignment, because the child's bone and muscle systems are still developing and these systems are more susceptible to stress and injuries. The purpose of this study was to verify the indoor soccer (Futsal) injuries and the changes of posture alignment in players between 9 to 16 years old. We examined the posture of 50 volunteers young futsal male players, volunteers, from a first division club team. These athletes were divided in two different groups: the group one (G1) was formed by those players who have suffered injuries related to Futsal; and group two (G2) was composed by athletes who did not have injuries related to futsal. First, the athletes or their parents answered a questionnaire about anthropometric characteristics of the subjects, player position, how long they have been practicing Futsal, how often they practiced Futsal and previous injuries related to Futsal practice. Then, we evaluated the postural alignment using an specific protocol to check the postural alterations. Both groups showed changes on the body alignment. The most common changes seen were in ankle and knee in both groups. The changes of the alignment in lumbar spine was more common in group 1. Considering injuries in group 1, the most common injury was in ankle (45.2% of all injuries) and the second most common injury was in knee (19% of all injuries). Considering the kind of injury, sprain and fracture/dislocate were the two most common (26.2% each one) and muscle injury comes in second with 21.4% of all kinds of injuries. We could discuss the relationship between the changes of posture alignment and sports injuries, once the changes of posture alignment result in stress in muscle and ligaments and it may result in injuries. We couldn't find a relationship between the cause and the consequence of these factors.

JUSTIFICATIVA E OBJETIVOS: O abscesso periamigdaliano é uma complicação incomum, porém predispõe a comprometimento grave das vias aéreas superiores. O objetivo deste relato é apresentar um caso de obstrução de vias aéreas após drenagem cirúrgica de abscesso periamigdaliano numa paciente jovem sem outras doenças de base. RELATO DO CASO: Trata-se de uma paciente de 26 anos com grave abscesso periamigdaliano que submeteu-se à anestesia geral para drenagem e após a extubação apresentou grave insuficiência respiratória, necessitando de reintubação traqueal e ventilação controlada mecânica por 24 horas. CONCLUSÕES: O planejamento anestésico e a adequada indicação cirúrgica são fundamentais para a prevenção de complicações em cirurgia otorrinolaringológica.

BACKGROUND AND OBJECTIVES: Peritonsillar abscess is an unusual complication, but predisposes to severe upper airway complications. This report aimed at presenting a case of upper airway obstruction after surgical drainage of a peritonsillar abscess in a healthy young female patient. CASE REPORT: Young female patient, 26 years old, with severe peritonsillar abscess and submitted to general anesthesia for drainage. After extubation, she presented a severe respiratory failure requiring reintubation and controlled ventilation for 24 hours. CONCLUSIONS: The anesthetic strategy and the adequate surgical indication are fundamental in preventing complications during ENT surgeries.

JUSTIFICATIVA Y OBJETIVOS: El absceso periamigdaliano es una complicación incomún, sin embargo predisponen al comprometimiento grave de las vías aéreas superiores. El objetivo de este relato es presentar un caso de obstrucción de las vías aéreas después de drenaje quirúrgico de absceso periamigdaliano en una paciente joven sin otras enfermedades de base. RELATO DE CASO: Se trata de una paciente de 26 años con grave absceso periamigdaliano que se sometió a anestesia general para drenaje y después de la extubación presentó grave insuficiencia respiratoria, necesitando de reintubación traqueal y ventilación controlada mecánica por 24 horas. CONCLUSIONES: El planeamiento anestésico y la adecuada indicación quirúrgica son fundamentales para la prevención de complicaciones en cirugía otorrinolaringológica.