CONTEXT AND OBJECTIVE: Cervical cancer is a serious public health problem in Brazil. For patients with unsatisfactory colposcopic examinations without visible lesions, but with cervical cytological tests suggesting high-grade squamous intraepithelial lesion (HSIL), the national recommendation is to repeat cervical cytological tests after three months. Our aim was to assess the prevalence of HSIL and cancer among patients with initial cervical cytological tests suggestive of HSIL but with unsatisfactory colposcopic examinations without visible lesions, in order to contribute towards the discussion regarding a more effective clinical approach that might diminish the likelihood of patient abandonment of follow-up before appropriate diagnosis and treatment. RESULTS:Sixty-five such patients were included, comprising 33.8% with HSIL and 4.6% with cancer, confirmed histologically. The other patients presented low-grade squamous intraepithelial lesion (26.1%), glandular dysplasia (1.5%) and absence of disease (33.8%). CONCLUSION:The observed prevalence of cancer and HSIL does not seem to be enough to justify immediate referral for cone biopsies to investigate the cervical canal in these cases. The findings suggest that the recommendation of repeated cytological tests following an initial one with HSIL, among patients with unsatisfactory colposcopic examinations without visible lesions, is appropriate in our setting. Efforts are needed to ensure adherence to follow-up protocols in order to reduce the chances of losses. RESUMOINTRODUÇÃO: O câncer de colo uterino é um grave problema de saúde pública no Brasil. Em pacientes com colpocitologias sugestivas de lesão intraepitelial escamosa de alto grau (HSIL) e colposcopia insatisfatória sem lesão visível, a recomendação nacional é repetir a colpocitologia após três meses.Nosso objetivo foi medir a prevalência de HSIL e câncer em pacientes com a primeira colpocitologia sugestiva de HSIL e colposcopia insatisfatória sem lesão visível, no intuito de contribuir para a discussão sobre uma conduta clínica mais efetiva e que diminua a probabilidade de perdas de acompanhamento antes do diagnóstico e tratamento adequados. TIPO DE ESTUDO E LOCAL: RESULTADOS:Foram incluídas 65 pacientes na situação descrita e encontrados 33,8% de HSIL e 4,6% de câncer confirmados histologicamente. Os demais casos apresentaram lesão intra-epitelial escamosa de baixo grau (26,1%), displasia glandular (1,5%) e ausência de doença (33,8%).CONCLUSÃO: A prevalência de HSIL ou câncer encontrada não parece suficiente para defender a conduta de encaminhar as pacientes de imediato para conização a fim de investigar o canal cervical. Os achados sugerem que a recomendação de repetir a citologia após uma primeira com HSIL sem lesão visível e colposcopia insatisfatória é apropriada no nosso cenário. Devem ser implementados esforços para adesão às recomendações de acompanhamento e reduzir a chance de perdas.

Objectives: This review aims to evaluate the efficacy of the combination of dexmedetomidine and ketamine (KD) and focuses on pediatric perioperative and periprocedural applications of KD as well as its limitations e adverseevents. Despite the concomitant use of these two drugs is well described in adult population, there are few studies on its administration in pediatric anesthesia. Discussion: Drug combination proves to be an attractive regimen when adverse effects of one agent counteract the effects of another. When used together, dexmedetomidine can prevent ketamine’s tachycardia, hypertension, sialorrhea and emergency agitation, while accelerating the onset of sedation, thus excluding prolonged dexmedetomidine latency as a single agent. Such profile may be favorable for pediatric patients in order to conceive adequate anxiolysis, prevention of emergency delirium, also allowing its use for procedures with significant algic stimulus. A literature search was conducted in PubMed, Lilacs and Embase to identify 21 articles from 2015 to 2019 that address the use of ketamine and dexmedetomidine simultaneously during anesthetic procedures in population between birth and18 years old. Conclusion: The literature is favorable to the use of KD for invasive and noninvasive procedures, inside and outside of the operating room, presenting an attractive profile for pediatric patients.