Assuntos
Analgésicos Opioides/efeitos adversos , Artralgia/tratamento farmacológico , Buprenorfina/efeitos adversos , Dor no Peito , Infarto do Miocárdio/diagnóstico , Administração Cutânea , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Angioplastia Coronária com Balão , Artralgia/etiologia , Buprenorfina/administração & dosagem , Buprenorfina/uso terapêutico , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Isquemia Miocárdica/complicações , Osteoartrite do Quadril/complicações , StentsRESUMO
UNLABELLED: We evaluated the analgesic efficacy and safety of two continuous constant-dose infusions of IV remifentanil, without infusion rate increments or the addition of boluses, in patients with severe postoperative pain during the first 4 h after general anesthesia with IV propofol-remifentanil. Thirty patients were randomly assigned to two groups of 15 subjects each according to the remifentanil dose administered: 0.1 microg. kg(-1). min(-1) IV (Group A) or 0.05 microg. kg(-1). min(-1) IV (Group B). Rescue analgesia was provided with meperidine (0.5 mg/kg IV) when pain intensity on the simple verbal scale (SVS) > or =2. The criteria for adequate analgesia (SVS 0-1, respiratory frequency >8/min. and SpO(2) >90%) after 4 h were met by 78% and 75% of the patients in Groups A and B, respectively (P = ns). "Meperidine rescue" analgesia was significantly more in Group B (26%) than in Group A (6%) (P < 0.05). There were no cases of respiratory depression, and nausea and emesis occurred in one patient in each group (6.5%). We conclude that IV remifentanil is an effective and safe opioid for the treatment of postoperative pain at a constant dose of 0.1 microg. kg(-1). min(-1) with a need for rescue analgesia 4 times less than a constant dose of 0.05 microg. kg(-1). min(-1). IMPLICATIONS: Our study suggests that the use of a constant continuous infusion of remifentanil 0.1 microg.kg(-1).min(-1)IV is an effective alternative in the treatment of severe postoperative pain.
Assuntos
Analgésicos Opioides/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Piperidinas/administração & dosagem , Adulto , Idoso , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Piperidinas/efeitos adversos , RemifentanilAssuntos
Adjuvantes Anestésicos/efeitos adversos , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Fentanila/efeitos adversos , Ondansetron/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Prurido/tratamento farmacológico , Antagonistas da Serotonina/uso terapêutico , Adjuvantes Anestésicos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Fentanila/administração & dosagem , Humanos , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Prurido/induzido quimicamente , Espaço SubaracnóideoRESUMO
OBJECTIVE: To evaluate the efficacy, side effects and hemodynamic characteristics of induction by vital capacity breath in adults using 6% sevoflurane and oxygen versus 4.5% sevoflurane and 50% nitrous oxide. PATIENTS AND METHODS: We assigned 50 ASA I-II patients aged 20 to 70 years old randomly to two groups of 25 to receive either 6% sevoflurane in oxygen or 4.5% sevoflurane in nitrous oxide. All patients were premedicated with oral bromazepam (1.5 to 3 mg). Induction was by vital capacity breath using a Mapleson A circuit (8 l. min-1) for 5 min. We recorded induction time, side effects, hemodynamic variables and patient opinion after surgery. RESULTS: Induction time was significantly faster for the sevoflurane-oxygen group (60 +/- 10 s) than for the sevoflurane-nitrous oxide group (71 +/- 8 s) (p < 0.001). Complications were minor and hemodynamic variables stable in both groups, with no statistically significant differences. The patients expressed satisfaction with both induction techniques. CONCLUSIONS: A vital capacity breath of 6% sevoflurane provided rapid induction. Induction was no more rapid when 50% nitrous oxide was added and the incidence of side effects did not decrease. Hemodynamic variables are stable during induction with sevoflurane with or without nitrous oxide, making this a well-tolerated alternative technique that is positively evaluated by patients.