Study of the perception of pain and the techniques and analgesic drugs, anesthetics and adjuvants used in anesthesia and pain 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:

  • Assessment and prediction of outcomes phenomena of nausea, vomiting and severe pain in postoperative cancer patients (CEP-FMUSP 508/13/ CAAE 6312513.0.0000.0065)
  • Chronic pain in elderly population characterization with emphasis on gender differences (CAPPESQ CAAE: 43535915.0.0000.0068)
  • Locomotor system pain control in equine using ropivacaine on continuous infusion through the technique of peripheral nerves in guided ultrasound catheterization (CEUA 175/14 - CEUA/FMVZUSP 7941181114)
  • Duloxetine as analgesic agent in surgery on column: assessment by fentanyl consumption controlled by the own patient (CAPPESQ CAAE: 43535915.0.0000.0068)
  • Effect of magnesium sulfate dose time cisatracurium in obese patients: clinical trial randomized (CAPPESQ 665564)
  • Comparative clinical trial on the impact of anesthetic technique in tone cancer and heart rate in fetal pregnancies that occur with intrauterine growth restriction (CAPPESQ / CAAE 45.992815.0.0000.0068)
  • Comparative study between clonidine venosa and subarachnoid in postoperative analgesia cesarean (CAPPESQ / CAAE 05847312.8.0000.0068)
  • Effect of combination of neurokinin 1 receptor antagonist aprepitant the scheme dexamethasone and ondansetron in the incidence of postoperative nausea and vomiting in cancer patients at high risk for Apfel scale (CEP-FMUSP 280-12)
  • Gene expression of purinergic receptors in nociception connected to the dorsal root ganglion in the model of postoperative pain in rats (CEUA 064/16)
  • Risk factors for nausea after caesarean section: a prospective observational study (CAPPESQ / CAAE 62884716.0.0000.0065)
  • Influence of androgen blockade with flutamide on pain behavior and expression of voltage dependent sodium channel, nav1.7 and nav1.8, a model of post-operative pain in rats (CEUA 008/14)
  • Resilience, depression, quality of life, functional capacity and religiosity in older adults with chronic pain (CAPPESQ / 18551513.8.0000.0068)
  • Intraoperative use of methadone for 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 volume 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 volume replacement. Experimental and clinical models allow 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 management tools and conflicts 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, quality control and 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 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)

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:

  • 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)

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.

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.

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.

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.

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.