Study of pain perception and techniques and analgesic, anesthetic and adjuvant drugs used in anesthesia and analgesic therapy

Description: Experimental studies in animals or clinical research to study the factors that influence the pain perception and the anesthetic or analgesic action of different forms of pharmacological or non-pharmacological treatment. The anesthetic technique may interfere in the outcome of the surgical patient and the pharmacokinetic/pharmacodynamic modeling study applied to the drugs used in the perioperative period allows a better understanding of the mechanism of action, the monitoring of the concentrations in different organic sites and the optimization of the therapeutic regimens used.

Related projects:

  • Evaluation of predictive factors and outcomes of nausea, vomiting and acute postoperative pain in cancer patients (CEP-FMUSP 508/13/ CAAE 6312513.0.0000.0065)
  • Characterization of chronic pain in the elderly population emphasizing the differences between genders (CAPPESQ CAAE: 43535915.0.0000.0068)
  • Pain control of the locomotor system in horses using ropivacaine in continuous infusion through the technique of ultrasound-guided peripheral nerve catheterization (CEUA 175/14 - CEUA/ FMVZUSP 7941181114)
  • Duloxetine as an analgesic agent in surgery on the spine: assessment of the use of Fentanyl in patient-controlled analgesia (CAPPESQ CAAE: 43535915.0.0000.0068)
  • Effect of magnesium sulfate dose time cisatracurium in obese patients: clinical trial randomized (CAPPESQ 665564)
  • Comparative clinical study on the impact of the anesthetic technique on uterine tone and fetal heart rate in pregnancies that present with intrauterine growth restriction (CAPPESQ/ CAAE 45.992815.0.0000.0068)
  • Comparative study between venous and subarachnoid clonidine in postoperative caesarean analgesia (CAPPESQ/ CAAE 05847312.8.0000.0068)
  • Study of the effect of neurokinin 1 receptor antagonist combination on the dexamethasone and ondansetron regimen in the incidence of postoperative nausea and vomiting in high-risk cancer patients by the Apfel scale (CEP-FMUSP 280-12)
  • Gene expression of purinergic receptors linked to nociception in the dorsal root ganglion in the postoperative pain model in rats (CEUA 064/16)
  • Risk factors for post-cesarean nausea: a prospective observational study (CAPPESQ/ CAAE 62884716.0.0000.0065)
  • Influence of androgenic blockade with flutamide on the behavior of pain and expression of voltage-dependent sodium channels, Nav1.7 and Nav1.8, in a model of postoperative pain in rats (CEUA 008/14)
  • Resilience, depression, quality of life, functional capacity and religiosity in the elderly with chronic pain (CAPPESQ/ 18551513.8.0000.0068)
  • Intraoperative use of methadone in the prevention of postoperative pain in bariatric surgeries (CAPPESQ/ CAAE 52792616.9.0000.0068)

Blood and blood component transfusion and assessment of organic responsiveness to vasoactive fluids and drugs

Description: The surgical patient has a risk of volemic and hemodynamic changes that may contribute to perioperative morbidity and mortality. There is great controversy regarding ideal techniques for monitoring blood volume, the best fluid for volume replacement, indications for transfusion of blood components and also the consequences of hypovolemia and excessive volemic replacement. Experimental and clinical models allows the critical analysis of the evidence on protective measures in situations of risk for renal failure and other organic lesions in response to hypovolemia, the use of crystalloid solutions, colloids and blood components, as well as the excessive use of these therapeutic options.

Related projects:

  • Comparative effects of ephedrine, phenylephrine and metaraminol on maternal cardiac output, utero-placental and cerebral fetal circulation in patients with preeclampsia under spinal anesthesia for cesarean section (CAPPESQ 10090/CAAE 09693013.3.0000.0068)
  • Hemodynamic strategy guided by cardiac index compared to the standard strategy in the postoperative period of large oncologic abdominal surgeries (CEP-FMUSP 335/13)
  • A prospective clinical study of volume replacement in the postoperative period of cardiac surgery (CAPPESQ 9117/ 14522313.1.0000.0068)
  • Study of coagulation in the arterial filter of the extracorporeal circulation circuit. impact on postoperative hemostasis of cardiac surgery (CAPPESQ/ 50566315.5.0000.0068)
  • Prospective and randomized study of fibrinogen concentrate in reducing the need for allogeneic transfusion in the perioperative period of pediatric cardiac surgery with extracorporeal circulation (CAPPESQ/ CAAE 13421913.3.0000.0068)
  • Hemodynamic therapy guided by continuous central venous saturation in pediatric patients undergoing cardiac surgery randomized clinical trial (CAPPESQ 10548/ CAAE: 23463714.0.0000.0068)
  • Prophylactic use of desmopressin in heart valve surgery to reduce perioperative bleeding (CAPPESQ/ CAAE 24147913.1.0000.0068)

Methodologies and teaching-learning processes in the health area

Description: Andragogy and teaching-learning processes related to the perioperative are dynamic and require directed actions so that the student deepens and amplifies the meanings elaborated through active participation that must lead to the acquisition of specific skills, abilities and attitudes. On the other hand, the teacher should carry out continuous reflective work and be available to monitor the evolution of the learner. Specific projects aim at the critical analysis of the tools used for teaching and student evaluation. Methodologies such as theoretical classes, practical learning, training workshops, simulation and the use of crisis and conflicts management tools should be analyzed together in the search for greater efficiency in teaching. Presentation, discussion and improvement of the methodological concepts on teaching, strategies and use of simulators, with evaluation of their results for undergraduate students, resident physicians, anesthesiologists, surgeons and intensivists can contribute to the optimization of teaching in the area.

Related projects:

  • The experimental course of the Faculty of Medicine of the University of São Paulo: History and memory, 1968-1974 (CEP-FMUSP: 290-13/ CAAE 18212613.1.0000.0065)

Quality and safety in surgical patient care

Description: Safety is a fundamental attribute of quality in surgical patient care, and the risks involved in any procedure should be known, reduced and controlled. Research aimed at the standardization of perioperative processes can contribute to the reduction of adverse events, to quality control and to cost reduction. Specific research related to the planning, implementation and monitoring of the adoption of good safety practices in perioperative care. In addition to producing knowledge about patient safety, a critical study of the risk factors and cost-effectiveness of different surgical, anesthetic and perioperative procedures may contribute to a reduction in surgical morbidity and mortality and an improvement in postoperative quality of life.

Related projects:

  • Evaluation of lean mass loss through quadriceps ultrasound in severe patients (CEP-FMUSP/ CAAE 60705216.5.3001.0065)
  • Evaluation of the Edmonton Classification System in cancer patients hospitalized at ICESP (CAPPESQ 16256-17 / CAAE 65277217.1.0000.0065)
  • Effects on bleeding in knee arthroplasty after ischemic preconditioning with sevoflurane. Randomized clinical trial (CAPPESQ 7643 / CAAE 03735612.7.0000.0068)
  • Epidemiology and characterization of patients with high surgical risk in Brazil (CAPPESQ/ CAAE 55828016.1.2007.0068)
  • Study of the application of a simplified algorithm for the prevention of postoperative nausea and vomiting in a cancer hospital (CEP-FMUSP/ CAAE 02657918.3.0000.0065)
  • Impact of hypothermia on the postoperative outcome of large surgeries in patients admitted to the Intensive Care Unit (CAPPESQ/ CAAE 55828016.1.2007.0068)
  • Genetic polymorphism associated with the occurrence of postoperative nausea and vomiting in patients undergoing oncological surgeries (CEP-FMUSP/ CAAE)
  • A comprehensive analysis of the surgical system in Amazonas (CAPPESQ/ CAAE 55327516.2.3001.0068)

Pathophysiology, development and surgical modifications of body structures

Description: Experimental and clinical studies of procedures related to surgical modifications of body structures, with emphasis on the evaluation of healing and quality of life in cases of correction of craniofacial anomalies and treatment of adipose tissue redundancy in patients with complex metabolic disorders and morbid obesity.

Related projects:

  • Effect of the addition of mesenchymal cells derived from adipose tissue in vein conduit in sciatic nerve reconstruction: experimental study (CEUA 039/15)
  • Augmentation Mentoplasty through autogenous fat graft: evaluation of volumetry and projection by computed tomography and photogrammetry and evaluation of satisfaction by the Face-Q questionnaire (CAPPESQ/ CAAE: 013529 18.7.0000.0068)
  • Segmental endoscopic resection of the stomach through gastrostomy using Stapler: feasibility and outcome in animals (CEUA 028/16)
  • Rhinosseptoplasty in fissured: prospective evaluation (CAPPESQ/ CAAE: 63909417.2.000.0068)

Study of the epidemiology and individual response to trauma and surgical stress, with evaluation of the impact of the techniques of organic protection in the postoperative outcome

Description: Preoperative risk factors, individual inflammatory response, and coagulation disorders related to trauma and the organic response to anesthetic-surgical trauma are generally involved in the genesis of critical patient failures. Experimental and clinical research on trauma and surgical stress generate evidence that interferes with prevention and treatment methods, with a positive impact on the early and late outcome. Specific research projects generate knowledge that enables a critical analysis of perioperative organic protection measures.

Related projects:

  • Evaluation of prognostic factors in trauma patients (CAPPESQ/ CAAE 04942512.9.0000.0068)
  • Epidemiological evaluation of patients admitted to an Intensive Care Unit specialized in Surgical Emergencies and Trauma (CAPPESQ/ CAAE 63077116.6.0000.0068)
  • Characterization of the epidemiological profile of the cancer patient at the Cancer Institute of the State of São Paulo: determination of the factors associated with the length of hospital stay in the surgical patient (CEP-FMUSP 434/12)
  • Continuous vs. Intermitent Vancomycin Infusion in Critical Patients: A Randomized, Controlled, Multicenter Clinical Trial (CAPPESQ/ CAAE 81226617.8.1001.0065)
  • Study of the influence of transfusion of blood components on the complications and survival of children submitted to liver transplantation with a living donor (CEP-FMUSP 243/12)
  • Prospective and randomized study of red blood cell transfusion in cancer patients: liberal vs. restrictive strategy (CEP-FMUSP 002/11)
  • Randomized comparative study between early and late parenteral nutrition in cancer patients submitted to elective gastrointestinal surgery: a randomized, controlled clinical study (CEP-FMUSP 423/12)
  • ICU DISCHARGE: Impact of the standardization of ICU discharge in the postoperative period of myocardial revascularization surgery (CEP-FMUSP 15294/2016)
  • Treatment of trauma-induced coagulopathy guided by thromboelastography in polytraumatized patients - Comparative study: cryoprecipitate x fibrinogen concentrate (CEP-FMUSP/ CAAE 12633713.4.0000.0068)
  • Early empiric use of antimicrobials in suspected nosocomial infection in stable critical patients (CAPPESQ/ CAAE 44661615.7.0000.0068)

Clinical and surgical aspects and molecular basis of cancer

Description: Epidemiology, prevention, diagnosis, treatment, evolution and rehabilitation in cancer require multidisciplinary involvement, generation of knowledge and critical analysis of the evidences related to the cancer surgical patient. Experimental and clinical scientific research on the genomic, proteomic, molecular, cellular and immunological mechanisms of cancer and the characterization of the immunohistochemical profile of the different types of cancer contribute to the establishment of clinical correlations, treatment and evaluation of the therapeutic response, with monitoring of the onset of metastases and the impact of the prognosis. The study of surgical and adjuvant interventions in the perioperative period may contribute to the optimization of treatment and improvement of the outcome and quality of life in the long term.

Related projects:

  • Clinical and molecular analysis of factors related to the death of patients with differentiated carcinoma of the thyroid gland (CEP-FMUSP 176/15)
  • Evaluation of postoperative biochemical tumor recurrence in patients undergoing radical prostatectomy with opioid-free anesthesia compared to conventional opioid analgesic agents (CAPPESQ/ CAAE 55378616.1.0000.0065)
  • Translational assessment of pain in patients undergoing antalgic radiotherapy (CEP-FMUSP/ CAAE: 91205118.7.0000.0065)
  • Echidocoduodenostomy in the palliation of malignant tumors of the bilioduodenopancreatic confluence: a comparative study between plastic and metallic prostheses (CAPPESQ 10417-13/ CAAE 13768713.0.0000.0068)
  • Comparison of training models for chest drainage with medical students (CEUA 150/15)
  • Comparison between magnetic resonance imaging and computed tomography in the diagnosis of mandibular invasion in oral cancer: a systematic review of diagnostic studies (CEP-FMUSP/ CAAE 79077217.0.0000.0065)
  • Efficacy of a hyperproteic dietary intervention on functional capacity in surgical oncology patients admitted to the Intensive Care Unit: a randomized clinical trial (CAPPESQ/ CAAE 77623917.0.0000.0065)
  • Study of the relationship between inflammatory response in cachectic patients with malignant tumors and cerebrospinal fluid composition (CEP-FMUSP 175/14)
  • Expression of PDL-1 and PDL-2 in locally advanced skin epidermoid carcinomas in territories of head and neck (CEP-FMUSP/ CAAE 55131416.0.0000.0065)
  • Impact of the sentinel lymph node method on the quality of life of patients with squamous cell carcinoma of the oral cavity (T1/T2N0) (CEP-FMUSP 018/15)
  • Prognostic predictors in patients with retroperitoneal liposarcoma (CAPPESQ/ CAAE 59463716.0.0000.0068)
  • Supplementation with beta-hydroxy-beta-methylbutyrate in patients with cancer-associated cachexia (CEP-FMUSP 018/16)

Microsurgery, minimally invasive surgeries, new techniques and surgical materials

Description: Experimental and clinical studies for the construction of evidence and the critical analysis of techniques involving microsurgery, minimally invasive surgeries, robotic surgeries, new procedures, materials and prostheses, with emphasis on the early and late outcome. The critical analysis of the evidences related to the latest surgical techniques, the study of the learning curve and the immediate and long-term cost-effectiveness contribute to the generation of knowledge and to the decisions of incorporation of new technologies by the health system.

Related projects:

  • Study of the anatomical relationships between the superior mesenteric artery and the left renal vein in a population of effective renal donor individuals, through angio-tomography (CAPPESQ/ CAAE 69135617.9.0000.0068)
  • Impact of bilateral inguinal hernioplasty on the fertility of rats: study of the vas deferens and testes (CEUA 089/15)
  • Prophylactic use of polypropylene mesh in patients at high risk for evisceration in emergency and emergency surgeries (CAPPESQ 13073/ CAAE 40334514.9.0000.0068)

Evaluation of hemodynamic variables, tissue perfusion and therapeutic response in shock states

Description: Clinical and experimental studies for the evaluation of physiological changes and therapeutic responses in the various types of shock and cardiac arrest, aiming at minimizing multiple organ failure and improving the outcomes in the critical patient. Emphasis on the investigation of changes in tissue perfusion and initial metabolic and hemodynamic repercussions, which contribute to late complications and shock-related mortality.

Related projects:

  • Evaluation of renal function in patients with severe preeclampsia submitted to cesarean section under restrictive intraoperative water therapy (CAPPESQ 9159/ CAAE 01945012.6.0000.0068)
  • Evaluation of the effect of continuous administration of anesthetic agents on the myocardial function of pigs submitted to cardiac arrest (CEUA 028/15)
  • Effect of n-acetylcysteine in a model of prolonged hemorrhagic shock: analysis by intravital microscopy and immunohistochemistry (CEUA 927/2017)
  • Effect of methylene blue as an adjuvant on the outcome of cardiac arrest: an experimental study in rats (CEUA 021/16)
  • Case study in high-risk patients undergoing coronary artery bypass grafting and valvular procedures: cost-effectiveness analysis of the goal-guided hemodynamic therapy algorithm (CAPPESQ 0565/11)
  • Study of the effects of heparin on hemorrhagic shock in rats (CEUA 961/2017)
  • Use of mesenchymal stem cells in porcine sepsis model: evaluation of the central nervous system (CEUA 1136/2018)
  • Vasopressin or norepinephrine in vasopregic shock in patients undergoing non-cardiac surgery (VANCS III) (CAPPESQ 15960-16/ CAAE 62586316.6.0000.0065)

Cardiorespiratory impact of anesthetic-surgical trauma

Description: Perioperative cardiorespiratory changes or those related to access to the airway contribute to morbidity and mortality related to the surgical patient. Line of research for the clinical and experimental study of cardiorespiratory changes and the effects of mechanical ventilation in patients with or without preoperative risk factors. The critical evaluation of the methods of diagnosis and treatment of cardiorespiratory complications may contribute to a better understanding of respiratory failure and cardiovascular alterations in the surgical or critical patient.

Related projects:

  • Evaluation of the incidence of hemodynamic depression in patients submitted to carotid angioplasty or carotid endarterectomy at Hospital das Clínicas, FMUSP (CAPPESQ/CAAE 61285916.4.0000.0068)
  • Evaluation of the post-conditioning effect of captopril, losartan and association in rats submitted to cardiorespiratory arrest (CEUA 034/16)
  • Prospective assessment of the incidence of complications associated with invasive mechanical ventilation: a new quality indicator in care (CAPPESQ 10595/ CAAE )
  • Determination of ideal PEEP and evolution of pulmonary function by electrical impedance tomography (EIT) during intraoperative elective surgery (CAPPESQ 10417-13/ CAAE 13768713.0.0000.0068)
  • Effect of the application of tetanic electrical stimulation on the performance of the neuromuscular junction monitor in pediatric patients submitted to abdominal and/or perineal surgical procedures with the use of rocuronium (CAPPESQ 11398/ CAAE parecer 521.595)
  • Randomized clinical trial comparing percutaneously guided percutaneous tracheostomy with bronchoscopy-guided percutaneous tracheostomy (CAPPESQ 11410/2013/ CAAE 22270213.9.0000.0068)
  • Randomized pilot study evaluating mechanical ventilation with limited driving pressure compared to the strategy with limited tidal volume and plateau pressure in patients without ARDS and limited in comparison to the conventional strategy (ARDSNet) in patients with ARDS (CAPPESQ/ 33167414.3.2010.0068)
  • Comparative study of intravenous administration and nebulization of vancomycin in healthy lung of mechanically ventilated pigs (CEUA/ 281/13)
  • Impact of the anesthetic technique on the postoperative evolution of pediatric patients submitted to surgical correction of congenital heart diseases (CAPPESQ 14510/ CAAE 54337316.9.0000.0068)
  • Inhaled nitric oxide in the postoperative period of pediatric cardiac surgery: genetic and physiological factors associated with response (CAPPESQ 11185-13/ CAAE 30573114.5.0000.0068)
  • Health-related quality of life and quality of life adjusted survival time in cancer patients hospitalized in Intensive Care Units (CEP-FMUSP Parecer 2.728.647/ CAAE 17365713.4.1001.0065)

Impact of surgical-anesthetic trauma on the brain and the perioperative neurological and cognitive outcome

Description: The patient's age and clinical status, neurotrauma, cardiopulmonary bypass, volume replacement, and anesthetic technique may alter blood flow and brain function to varying degrees. Complications such as stroke, delirium and postoperative cognitive dysfunction have significant incidence in some types of surgery, especially in elderly patients. Clinical and experimental studies are necessary to determine the causes, ways of prevention, diagnosis, treatment and rehabilitation of patients with complications that contribute to the increase of postoperative morbidity and mortality.

Related projects:

  • Evaluation of postoperative cognitive dysfunction in patients undergoing anesthesia for transurethral prostate resection (CAPPESQ 0953/09)
  • Diagnosis of POCD, validation of the digital game MentalPlus® as a tool for evaluation of cognitive functions and possible rehabilitation resource (CAPPESQ 14086/ CAAE 49463315.5.1001.0068)
  • Effect of the anesthetic act on the occurrence of changes in visual acuity in the postoperative period of non-cardiac surgery (CAPPESQ/ CAAE 20029213.2.0000.0068)
  • Effects of resuscitation with 0.9% saline solution and terlipressin on perfusion and cerebral oxygenation in a model of traumatic brain injury and hemorrhagic shock (CEUA 120/16)
  • Randomized clinical trial comparing liberal or restrictive transfusion strategies in traumatic brain injury: a pilot study (CAPPESQ 12213-15/ CAAE 32520914.3.0000.0068)
  • Investigation of the DNA methylation profile in children who presented awakening delirium after general anesthesia (CAPPESQ 2.427.013/ CAAE 79023617.1.0000.0068)
  • Perioperative use of balanced crystalloid solution compared to sodium chloride 0.9% in children submitted to resection of brain tumor: randomized clinical trial (CAPPESQ 14266-15/ CAAE 44552315.1.3001.0068)
  • Validation of MentalPlus® as neuropsychological tests for evaluation of cognitive, postoperative functions from the results of the instrument (CAPPESQ 14086/ CAAE 49463315.5.1001.0068)