RESUMO
OBJECTIVE: To evaluate patients' willingness to pay (WTP) with reference to the waiting time of public in-vitro fertilisation (IVF) treatment in order to improve the public IVF service in Hong Kong. STUDY DESIGN: A prospective multi-centred questionnaire survey. Infertile women attending infertility clinics of nine public hospitals in Hong Kong between October 2017 and August 2018 were asked to complete a questionnaire in their first clinic visit. RESULTS: Out of 1092 respondents, 10.4 % had private IVF cycles prior to their first visit at public hospitals. In general, patients were willing to pay more for a shorter waiting time for public IVF service. The proportion of respondents who were willing to pay more than HK$10,000 (US$1282) for one IVF cycle increased from 54.6% to 80.7% if the waiting time for public IVF service were hypothetically shortened from four years to one year. Likewise, 22.5 % versus 45.5 % were willing to pay more than HK$ 25,000 (US$3205) with a waiting time of four versus one year respectively. Assuming the cost per IVF cycle was HK$ 25,000 (US$3205), 23.4 % of respondents could afford one IVF cycle, 40.0 % of them could afford two IVF cycles and 31.5 % could afford three IVF cycles. A multivariate regression model demonstrated that only family income and presence of existing child(ren) were significant independent determinants of the maximum amount that an individual was willing to pay for IVF (p < 0.05). Those with family monthly income below HK$100,000 ($12,820) were less than half as likely, and those without existing child(ren) were more than double as likely, to be willing to pay higher for IVF. CONCLUSION: Patients were willing to pay more for a shorter waiting time for public IVF service. Those with family income below HK$100,000 (US$ 12,820) were less than half as likely, and those without existing children were more than double as likely, to be willing to pay higher for IVF.
Assuntos
Infertilidade Feminina , Listas de Espera , Criança , Feminino , Fertilização , Fertilização in vitro , Hong Kong , Humanos , Estudos Prospectivos , Inquéritos e QuestionáriosAssuntos
Encefalopatias/complicações , Infecções por Citomegalovirus/complicações , Perda Auditiva Neurossensorial/diagnóstico , Encefalopatias/congênito , Encefalopatias/diagnóstico por imagem , Infecções por Citomegalovirus/congênito , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Lactente , Imageamento por Ressonância MagnéticaRESUMO
OBJECTIVE: Neonatal seizures are a common problem in the neonatal intensive care unit and are frequently treated with antiepileptic drugs. Limited data exist on current or changing antiepileptic drug use for seizures in the neonatal intensive care unit.We sought to describe trends of antiepileptic drug exposure in a large volume of US neonatal intensive care unit from 2005 to 2014 and we hypothesized increasing levetiracetam exposure over the 10-year study period. STUDY DESIGN: Retrospective cohort study of infants from the Pediatrix Medical Group Clinical Data Warehouse, a large, multicenter, deidentified data set. Data were analyzed for trends in 2-year time periods. Our cohort included infants with a diagnosis of seizures who received an antiepileptic drug that were discharged from the neonatal intensive care unit from 1 January 2005 to 31 December 2014. RESULTS: Among 778 395 infants from 341 facilities, we identified 9134 infants with a seizure diagnosis who received an antiepileptic drug. Phenobarbital was used in 98% of the cohort. From 2005-2006 to 2013-2014 phenobarbital exposure declined from 99 to 96% (P<0.001), phenytoin exposure decreased from 15 to 11% (P<0.001) and levetiracetam exposure increased 10-fold from 1.4 to 14% (P<0.001). Overall, <1% of infants were exposed to carbamazepine, lidocaine or topiramate. CONCLUSIONS: Infants with seizures were overwhelmingly exposed to phenobarbital, despite a significant increase in levetiracetam exposure. The use of phenytoin declined and has been surpassed by levetiracetam as the second most widely used antiepileptic in the neonatal intensive care unit. These changes in antiepileptic drug usage patterns have occurred in the absence of novel efficacy data in neonates.
Assuntos
Anticonvulsivantes/uso terapêutico , Uso de Medicamentos/tendências , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Convulsões/tratamento farmacológico , Convulsões/epidemiologia , Criança , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Levetiracetam , Masculino , Fenobarbital/uso terapêutico , Fenitoína/uso terapêutico , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Estudos Retrospectivos , Texas/epidemiologiaRESUMO
AIM: Although implantation of bone marrow mononuclear cells (BMI) was shown to improve outcomes in patients with severe peripheral arterial occlusive disease (PAOD), little experience has been reported in patients with an arterial occlusion level above the knee, ischemic gangrene, and high cardiovascular risk. This study sought to investigate the timing of gangrene tissue debridement and the safety of BMI in these patients. METHODS: Six "no-option" PAOD patients were enrolled with an arterial occlusion level above the knee, ischemic gangrene, and 3 systemic diseases related to a high cardiovascular risk. The ischemic status was evaluated by measuring the ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), and wound healing after BMI. RESULTS: All patients safely underwent the procedures with intravenous general anesthesia by titrating propofol. Major lower extremity amputation, minor debridement amputation, and debridement surgery were performed in 2 (33.3%), 1 (16.7%), and 2 (33.3%) patients, respectively, 3.1 2.8 months after BMI. Compared to the amputation group (N=3), the salvage group (N=3) had a significantly higher baseline ABI (P=0.02) and a shorter distance between the gangrene site and arterial occlusion site (P=0.01). In the 3 patients who underwent debridement, ABI and TcPO2 significantly improved 1 month after BMI, and gangrenous tissues were debrided 3.8 ± 3.6 (range, 1~8) months after BMI with complete healing within 1 month. CONCLUSION: Autologous BMI therapy is safe in patients at high cardiovascular risk with an arterial occlusion level above the knee and ischemic gangrene. Effective predictors of BMI include the baseline ABI and distance to the ischemia. Gangrene tissue should be debrided at least 1 month after BMI.
Assuntos
Arteriopatias Oclusivas/cirurgia , Transplante de Medula Óssea , Doenças Cardiovasculares/etiologia , Desbridamento , Artéria Femoral/cirurgia , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Idoso , Amputação Cirúrgica , Análise de Variância , Angiografia Digital , Índice Tornozelo-Braço , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico , Monitorização Transcutânea dos Gases Sanguíneos , Transplante de Medula Óssea/efeitos adversos , Constrição Patológica , Desbridamento/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Gangrena , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cintilografia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Taiwan , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento , CicatrizaçãoRESUMO
OBJECTIVE: To evaluate efficacy and safety of clobazam, a 1,5-benzodiazepine, as adjunctive therapy for Lennox-Gastaut syndrome (LGS). METHODS: Patients aged 2-60 years were randomized to placebo or clobazam 0.25, 0.5, or 1.0 mg/kg/day. Study consisted of 4-week baseline, 3-week titration, and 12-week maintenance phases, followed by a 2- or 3-week taper or continuation in an open-label extension. Primary endpoint was percentage decrease in mean weekly drop seizure rates during maintenance vs baseline phases for modified intention-to-treat (mITT) population. Secondary outcomes included other seizure types, responder rates, and physicians' and caregivers' global assessments. RESULTS: A total of 305 patients were screened, 238 were randomized, and 217 composed the mITT population. Of patients enrolled after a protocol amendment, 125/157 (79.6%) completed. Average weekly drop seizure rates decreased 12.1% for placebo vs 41.2% (p = 0.0120), 49.4% (p = 0.0015), and 68.3% (p < 0.0001) for the clobazam 0.25-, 0.5-, and 1.0-mg/kg/day groups. Responder rates (≥50%) were 31.6% (placebo) vs 43.4% (p = 0.3383), 58.6% (p = 0.0159), and 77.6% (p < 0.0001) for clobazam 0.25-, 0.5-, and 1.0-mg/kg/day groups. Physicians' and caregivers' assessments indicated clobazam significantly improved symptoms. Somnolence, pyrexia, upper respiratory infections, and lethargy were the most frequent adverse events reported for clobazam. CONCLUSIONS: Clobazam significantly decreased weekly drop seizure rates in LGS. No new safety signals were identified. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that clobazam as adjunctive therapy is efficacious, in a dosage-dependent manner, in reducing mean weekly drop seizure rates of patients with LGS over 12 weeks.
Assuntos
Anticonvulsivantes/uso terapêutico , Benzodiazepinas/uso terapêutico , Deficiência Intelectual/tratamento farmacológico , Espasmos Infantis/tratamento farmacológico , Adolescente , Adulto , Austrália , Criança , Pré-Escolar , Clobazam , Relação Dose-Resposta a Droga , Método Duplo-Cego , Europa (Continente) , Feminino , Seguimentos , Humanos , Cooperação Internacional , Síndrome de Lennox-Gastaut , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To examine the effect of progestogens currently used in hormone therapy on growth of human breast tumor cells. METHODS: MCF-7 cells were incubated in 10 nmol/l progestogens, including progesterone (P4), medroxyprogesterone acetate (MPA), norethisterone acetate (NETA), and cyproterone acetate (CPA), with or without 17ß-estradiol (E(2), 1 nmol/l and 10 nmol/l), as well as E(2) alone. Cell proliferation, apoptosis, and the expression of caspase-3 and proliferating cell nuclear antigen (PCNA) were evaluated. RESULTS: The ratios of apoptosis : proliferation significantly increased in cultures with progestogens alone, 1 nmol/l E(2) plus progestogens (except P4), and 10 nmol/l E(2) plus NETA. Caspase-3 significantly diminished in cultures with E(2) alone; this was completely reversed when progestogens were added. MPA alone or with 1 nmol/l E(2) and 10 nmol/l E(2) plus NETA significantly increased caspase-3. Using progestogens alone, except P4, significantly decreased PCNA expression. CONCLUSIONS: The results demonstrate that various progestogens have different effects on growth of breast tumor cells, especially with the combined usage of E(2). Progestogen-induced apoptosis may be partly inhibited with the presence of E(2), but less severe with lower E(2) concentrations. Therefore, the choice of progestogens, as well as the doses of E(2) and/or progestogen, may influence breast cancer risk.
Assuntos
Antineoplásicos Hormonais/farmacologia , Apoptose/efeitos dos fármacos , Neoplasias da Mama/tratamento farmacológico , Proliferação de Células/efeitos dos fármacos , Estradiol/farmacologia , Progestinas/farmacologia , Antineoplásicos Hormonais/metabolismo , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Caspase 3/metabolismo , Linhagem Celular Tumoral , Estradiol/metabolismo , Estradiol/uso terapêutico , Feminino , Humanos , Progestinas/metabolismo , Progestinas/uso terapêuticoRESUMO
Many patients with hypothalamic hamartomas present in infancy with gelastic seizures of subcortical origin, but later develop additional seizure types, including complex partial, tonic, and generalized tonic-clonic seizures. The basic cellular mechanisms responsible for this evolution in seizure types are unknown. Using voxel-based morphometry of T1 weighted MRI scans we compared eight patients with only gelastic seizures with 16 age-matched patients with multiple seizure types and found significantly greater white matter density in the temporal lobes and cerebellum in those with multiple seizure types. This suggests that increased white matter density, perhaps resulting from maturational changes and resulting in increased brain connectivity, is associated with a higher likelihood of cortical involvement in epilepsy resulting from hypothalamic hamartoma.
Assuntos
Encéfalo/patologia , Hamartoma/patologia , Neoplasias Hipotalâmicas/patologia , Convulsões/patologia , Adolescente , Idade de Início , Cerebelo/patologia , Criança , Pré-Escolar , Epilepsias Parciais/complicações , Epilepsias Parciais/patologia , Feminino , Hamartoma/complicações , Humanos , Neoplasias Hipotalâmicas/complicações , Imageamento por Ressonância Magnética , Masculino , Convulsões/complicações , Lobo Temporal/patologiaRESUMO
BACKGROUND: Hypothalamic hamartomas (HHs), rare developmental abnormalities of the inferior hypothalamus, often cause refractory, symptomatic, mixed epilepsy, including gelastic seizures. We present 37 patients with HH who underwent transcortical transventricular endoscopic resection. METHODS: Between October 2003 and April 2005, 42 consecutive patients with refractory epilepsy who underwent endoscopic resection of HH were studied prospectively. The endoscope was held by an articulated pneumatic arm and tracked with a frameless stereotactic neuronavigation system. Data collection and follow-up were performed by personal interview. Five patients were excluded. The remaining 37 patients (22 males, 15 females; median age 11.8 years; range 8 months to 55 years) had frequent and usually multiple types of seizures. RESULTS: Postoperative MRI confirmed 100% resection of the HH from the hypothalamus in 12 patients. At last follow-up (median 21 months; range 13-28 months), 18 (48.6%) patients were seizure free. Seizures were reduced more than 90% in 26 patients (70.3%) and by 50% to 90% in 8 patients (21.6%). Overall, the mean postoperative stay was shorter in the endoscopic patients compared with our previously reported patients who underwent transcallosal resection (mean 4.1 days vs 7.7 days, respectively; p = 0.0006). The main complications were permanent short-term memory loss in 3 patients and small thalamic infarcts in 11 patients (asymptomatic in 9). CONCLUSIONS: Endoscopic resection of hypothalamic hamartoma (HH) is a safe and effective treatment for seizures. Its efficacy seems to be comparable to that of transcallosal resection of HH, but postoperative recovery time is significantly shorter.
Assuntos
Endoscopia/estatística & dados numéricos , Epilepsia/cirurgia , Hamartoma/cirurgia , Neoplasias Hipotalâmicas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Hamartoma/patologia , Humanos , Neoplasias Hipotalâmicas/patologia , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Convulsões/cirurgia , Resultado do TratamentoRESUMO
Respiratory syncytial virus is an extremely common cause of childhood respiratory infections resulting in significant morbidity and mortality. Although apnea is a well-known complication in young infants with respiratory syncytial virus bronchiolitis, the encephalopathy associated with this infection is not well recognized. Our study reveals an incidence of encephalopathy of 1.8% in a total of 487 patients with respiratory syncytial virus bronchiolitis studied over a period of almost 4 years. Seizures were the presenting complication. Based on our study of a cohort of children with respiratory syncytial virus bronchiolitis, we believe that neurologic complications, although relatively uncommon, represent a significant component of this common childhood illness. Furthermore, respiratory syncytial virus has been shown to release several mediators that could directly or indirectly be neurotoxic and induce an encephalopathy associated with the respiratory illness.
Assuntos
Bronquiolite Viral/complicações , Bronquiolite Viral/virologia , Encefalite Viral/virologia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/patogenicidade , Bronquiolite Viral/epidemiologia , Estudos de Coortes , Diagnóstico Diferencial , Epilepsia/virologia , Feminino , Humanos , Incidência , Lactente , Masculino , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Estudos Retrospectivos , Texas/epidemiologiaRESUMO
The most effective method for the screening and monitoring of optic pathway gliomas in children with neurofibromatosis type 1 remains a dilemma. Children less than 6 years of age are the group at highest risk for the development of optic pathway gliomas. Although an annual ophthalmologic examination currently is recommended as the most efficient method to screen for optic pathway gliomas, this method is often unreliable and inaccurate in young children. Magnetic resonance imaging remains the most sensitive test; however, cost and the need for sedation or general anaesthetic preclude its use as a routine screening test. We previously have recommended visual-evoked potentials (VEPs) as a possible alternative or aid in the assessment of optic pathway gliomas in this group of patients. The aims of this study were to ascertain the sensitivity of VEPs in detecting optic pathway gliomas and to determine whether VEPs are useful in monitoring the progress of optic pathway gliomas. This study provides further evidence of the sensitivity of VEPs in detecting optic pathway gliomas. In addition, VEPs may provide additional useful information concerning the progression of optic pathway gliomas once they have been detected.
Assuntos
Potenciais Evocados Visuais/fisiologia , Glioma do Nervo Óptico/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Programas de Rastreamento , Oftalmoscopia , Nervo Óptico/patologia , Nervo Óptico/fisiopatologia , Glioma do Nervo Óptico/fisiopatologia , Valor Preditivo dos TestesRESUMO
The sphenoid sinus is often referred to as the "neglected sinus." Isolated sphenoid sinusitis is a rare disease with potentially devastating complications. It occurs at an incidence of about 2.7% of all sinus infections. Although headache is the most common presenting symptom, there is no typical headache pattern. Three cases of children with isolated sphenoid sinusitis presenting with acute, subacute, and chronic headache symptoms are presented. The sensory innervation of the sphenoid sinus is derived from the ophthalmic and maxillary branches of the trigeminal nerve, which may explain the pathophysiology of the headache, similar to the trigeminovascular pain theory of migraine. There are few reports on sphenoid sinusitis and headache; however, modern neuroimaging has made this probably under-recognized disorder easier to diagnose and treat. Although the diagnosis can be difficult to differentiate from migraine headache, early and appropriate treatment usually results in an excellent outcome without morbidity.
Assuntos
Transtornos de Enxaqueca/diagnóstico , Sinusite Esfenoidal/diagnóstico , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Sinusite Esfenoidal/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
Although rhabdomyolysis is an uncommon disorder, especially in children, it can present as a severe, life-threatening event. Paediatricians need to be aware of this important, probably underdiagnosed disorder in order to implement appropriate early treatment. In this report, seven children with rhabdomyolysis of both forms, endogenous and exogenous, are presented. Despite comprehensive 'up-to-date' investigations being performed on paediatric patients with endogenous (often recurrent) rhabdomyolysis, the majority of these patients' underlying disorders will remain undiagnosed. Overall, these patients usually have a very good prognosis even if repeated, severe life-threatening episodes occur. It is recommended that a regimen of early therapy with fluids and sodium bicarbonate be instituted in all patients with rhabdomyolysis.
Assuntos
Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Hidratação/métodos , Humanos , Masculino , Bicarbonato de Sódio/uso terapêuticoRESUMO
BACKGROUND: Backache is a common postoperative complaint after lumbar epidural anesthesia. Our study was aimed to compare the effect of the local addition of ketoprofen on the incidence of postepidural backache after nonobstetric surgery. METHODS: One thousand patients scheduled for hemorrhoidectomy were randomly given 4 ml of 1% lidocaine with ketoprofen 1:400 (ketoprofen group) or without ketoprofen (control group) for local skin infiltration prior to epidural needle placement. Each of them received a single epidural injection of 25 ml 2% lidocaine with epinephrine 1:200000, and was interviewed 24, 48, and 72 hours postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. RESULTS: The incidence of postepidural backache in the ketoprofen-group patients for the 3 days was 9.8%, 4.6%, and 1.8%, all rates which were significantly less than those observed in the control-group patients (22.8%, 17.4%, and 9.2%, p < 0.001). There was also a significant association between postepidural backache and multiple attempts at epidural needle insertion. CONCLUSION: In summary, the local addition of ketoprofen reduced the incidence and severity of postepidural backache.
Assuntos
Anestesia Epidural/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Dor nas Costas/prevenção & controle , Cetoprofeno/administração & dosagem , Adulto , Idoso , Dor nas Costas/epidemiologia , Feminino , Hemorroidas/cirurgia , Humanos , Incidência , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-IdadeRESUMO
A series of 33 patients with juvenile dermatomyositis was reviewed in terms of their prognosis in relation to their drug therapy. This retrospective study was intended to help clarify the use of various therapies in this rare, heterogeneous disease from our hospital's experience in the last 24 years. The results confirmed that oral corticosteroids should remain the undisputed first line of treatment. For more refractory, chronic patients, the results suggest that azathioprine should be the favored drug of first choice (in addition to corticosteroids). There may be a role for cyclosporine as a "rescue" treatment, but this needs to be further defined.
Assuntos
Azatioprina/administração & dosagem , Dermatomiosite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Imunossupressores/administração & dosagem , Prednisolona/administração & dosagem , Administração Oral , Adolescente , Adulto , Azatioprina/efeitos adversos , Criança , Pré-Escolar , Doença Crônica , Dermatomiosite/diagnóstico , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Lactente , Masculino , Prednisolona/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
At the present time, a patient with a pacemaker who undergoes an anesthesia for a surgical procedure is very common, but a parturient with a permanent pacemaker scheduled for elective cesarean section (c/s) is very rare. Complete heart block in pregnancy is not a common event and it may be congenital or acquired, particularly secondary to cardiac surgery. In normal women, the heart rate is physiologically increased commensurate with need, whereas in a parturient with installment of an implanted fixed rate pacemaker of VVI mode her heart rate cannot accelerate to cope with increased physiological demand because of the fixed pacing rate. For cesarean section, because of destabilized cardiovascular adaptation, an anesthesiologist must focus on detecting the early signs of compromised cardiac output in order to avoid maternal as well as fetal distress. He may run considerable risk to administer general or regional anesthesia to this kind of parturient. We present a case report in managing the parturient installed a with non-rate response type pacemaker undergoing C/S under epidural anesthesia.
Assuntos
Anestesia Obstétrica/métodos , Marca-Passo Artificial , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Feminino , Humanos , GravidezRESUMO
Simple O2 mask has been used in patient under regional anesthesia for increasing the FiO2, especially in the aged and the pregnant. The relationships between maternal FiO2 and umbilical arterial (UA) and venous (UV) PO2, PCO2, pH, and neonatal Apgar score were studied in 45 patients receiving Cesarean section under epidural anesthesia. 2% xylocaine 18-20 ml with adrenaline 1:200,000 was used to attain the sensory level of T-4. Patients were allocated randomly into three groups. Group I, acting as a control group, breath only room air during the course of anesthesia. Group II was breathing through a simple face mask with an oxygen inflow of 6L/min. Group III was breathing oxygen with a flow rate of 10L/min through a simple face mask. UA and UV blood samples were collected separately at the time of delivery for blood gas analysis. The 1-min, and 5-min Apgar scores were recorded also. Mean values of the UA blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--16.50 mmHg, 20.20 mmHg and 19.50 mmHg; PCO2--49.20 mmHg, 48.10 mmHg and 50.3 mmHg; pH--7.31, 7.30 and 7.30. Mean values of the UV blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--28.6 mmHg, 36.9 mmHg and 36.5 mmHg; PCO2--38.20 mmHg, 38.80 mmHg and 40.40 mmHg; pH--7.36, 7.36 and 7.34. There was a significant increase in UA and UV PO2 when using a simple O2 mask (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anestesia Epidural , Anestesia Obstétrica , Cesárea , Oxigênio/administração & dosagem , Adulto , Índice de Apgar , Feminino , Humanos , Recém-Nascido , Máscaras , Oxigênio/sangue , GravidezRESUMO
The use of spinal opioids for postoperative analgesia has gained popularity in recent years. In this study, subarachnoid fentanyl 20 micrograms was evaluated to determine its efficacy for postoperative analgesia, its possible side effects and its effects on the newborn. Sixty ASA class I or II at-term parturients undergoing elective cesarean section were randomly divided into two groups. In one group fentanyl 20 micrograms (0.4 ml) with 0.5% heavy marcaine 2.0 ml was given intrathecally and in the other group only 0.5% heavy marcaine 2.0 ml with CSF 0.4 ml was given intrathecally. The average time for patients in the fentanyl group to demand the first dose of narcotic for pain was 6.8 +/- 3.2 h and in the control group it was 3.9 +/- 1.1 h. The incidences of postoperative nausea and vomiting were higher in the fentanyl group than in the control group. Pruritus was only found in the fentanyl group and amounted to 50%. Early or late respiratory depression was not found in the fentanyl group. During operation, all patients were wakeful and alert. Neonatal condition as determined by 1-min and 5-min Apgar score was satisfactory and showed no significant difference in both groups. Examination on neurobehavior and reflexes done at the baby room showed no abnormality in both groups.