Early extubation, also known as fast track, is desirable after intracranial hematoma surgery to avoid ventilator-associated complications associated with admission to an intensive care unit (ICU). The objective of the present study was to determine whether ICU stay and ventilator-associated complications are reduced in patients who received surgery for intracranial hematoma if they are extubated early. A total of 17 patients were randomly assigned to two groups: In Group 1, patients were extubated early or using the fast track method, while those in Group 2 were conventionally extubated at a later stage and were managed at the ICU. Patients from both groups were assessed on admission to the operating room per the established standards and after the selection criteria had been confirmed, general anesthesia was applied. Extubation time and hemodynamic stability (number of anesthetic adjustments required to maintain hemodynamic parameters within 20% of the predicted values) were assessed post-operatively. Patients in the conventional group (n=10) were transferred to the ICU and extubated at 8 h post-operatively; hemodynamic stability and the presence of complications were evaluated. The fast track group had no complications associated with ventilation or any other parameter. All patients extubated in a conventional manner and who were transferred to the ICU presented with complications, including seizures, aspiration, atelectasis or failed extubation. In the future, fast track should be regarded as a routine technique in patients who meet the required criteria, so that they may be discharged quickly and with fewer complications. The present study was authorized by the ethics committee of the hospital and the research sub-directorate with the number AN14-003; it was submitted to and approved by the ISRCTN registry for clinical trials (ID, ISRCTN16924441).

Introduction:The incidence of post-operative pain is between 46% and 53% due to a lack of the use of analgesics. Up to 30-50% of operated patients present moderate-to-intense pain in the post-operative period. Objective: The objective of this study was to evaluate pain in the immediate post-operative period and to identify its association with schooling, surgery, anesthesia, and analgesia. Materials and methods: An observational, descriptive, and transversal study was carried out with a sample of 158 patients between 18 and 90 years old, in both genders of the recovery area. Inclusion criteria: Age 18-90 years, previous or post-surgical hospitalization, patients in the recovery area, and outpatients were included in the study. Exclusion criteria: Glasgow < 14 points and/or psychiatric patients were excluded from the study. A survey was conducted. Results: Our sample was 49.4% male and 50.6% female; 55 patients underwent abdominal surgery, 23 underwent trauma surgery, 22 underwent urological surgery, 19 underwent head surgery, 17 underwent gynecological surgery, 15 underwent reconstructive surgery, 4 underwent thoracic surgery, and 2 underwent vascular surgery. The incidence of pain was 45.6%. Of the total, 93.1% presented visual analog scale < 4. Conclusions: Almost half of the patients presented pain in the post-operative period; however, the pain was mild. There was a direct relationship between schooling and level of pain referred to by the patient. Less pain was reported with combined analgesia and, compared to other studies, there was a lower incidence of acute pain.

Introduction:The ex utero intrapartum treatment (EXIT) involves the partial removal of the fetus from the uterine cavity during a cesarean section while maintaining placental circulation and oxygenation. This procedure is indicated when we expect a difficult access to the respiratory airway. Clinical Case: A 33-year-old female patient, with 35.4 weeks of pregnancy and a diagnosis of placenta accreta and a fetus with Bochdaleck's diaphragmatic hernia diagnosed by prenatal ultrasound, was scheduled for elective cesarean with the EXIT procedure. The chosen anesthetic technique for the patient was neuraxial anesthesia. Conclusion: The EXIT procedure is a challenge for the anesthesiologist, and they should be aware and prepared for the physiological changes of pregnancy and uteroplacental physiology. This case demonstrates that even though the preferred technique in the EXIT procedure is general anesthesia, it can also be performed effectively and safely under a neuraxial technique with invasive monitoring.

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