RESUMO
Objective: To study the clinical features and related factors of invasive pulmonary aspergillosis (IPA) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: This retrospective study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with IPA were included as case group, AECOPD patients without IPA were randomly selected as control group from the same hospitals and same hospitalization period as the patients with IPA using the random function in the software of Microsoft Excel 2003, at a ratio of 2â¶1. The clinical characteristics, treatment and outcome were compared between the two groups. Binary logistic regression model was used to analyze the factors associated with IPA in AECOPD patients. Results: A total of 14 007 inpatients with AECOPD were included in this study, and 300 patients were confirmed to have IPA, with an incidence rate of 2.14%. According to the above matching method, 600 AECOPD patients without aspergillus infection were enrolled as the control group. The age of the case group and the control group were (72.5±9.7) and (73.5±10.3) years old, with 78.0%(n=234) male and 76.8%(n=461) male, respectively. There were no significant differences in age and gender composition between the two groups (all P>0.05). The prognosis of case group was significantly worse than that of the control group, with longer hospital stay [M(Q1,Q3)], [14 (10-20) d vs 11 (8-15) d, P<0.001], higher ICU admission rate [16.3% (49 case) vs 10.0% (60 case), P=0.006], higher in-hospital mortality [4.0% (12 cases) vs 1.3% (8 cases), P=0.011], and higher hospitalization costs (28 000 ¥ vs 13 700 ¥, P<0.001). The smoking index of the case group and proportions of patients with diabetes mellitus, chronic pulmonary heart disease in the case group were significantly higher than those in control group (all P<0.05). In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, hemoptysis and fever in the case group were higher than those in the control group, the serum albumin was significantly lower than that in the control group, and the proportions of patients with bronchiectasis and pulmonary bullae on imaging were significantly higher than those in the control group (all P<0.05). Diabetes (OR=1.559, 95%CI: 1.084-2.243), chronic pulmonary heart disease (OR=1.476, 95%CI: 1.075-2.028), bronchiectasis (OR=1.506, 95%CI: 1.092-2.078), pulmonary bullae (OR=1.988, 95%CI: 1.475-2.678) and serum albumin<35 g/L (OR=1.786, 95%CI: 1.325-2.406) were the related factors of IPA in patients with AECOPD. Conclusions: The incidence of IPA in AECOPD patients is relatively high and the prognosis of these patients is worse. Diabetes, chronic pulmonary heart disease, bronchiectasis, pulmonary bulla, hypoproteinemia are the related factors of IPA in patients with AECOPD.
Assuntos
Bronquiectasia , Aspergilose Pulmonar Invasiva , Doença Pulmonar Obstrutiva Crônica , Doença Cardiopulmonar , Humanos , Masculino , Vesícula , Estudos RetrospectivosRESUMO
Objective: To investigate the risk factors associated with in-hospital mortality in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A total of 6 668 patients hospitalized for AECOPD in seven tertiary hospitals from September 2017 to January 2021 were consecutively included, and clinical data related to medical history, laboratory tests, treatment and prognosis were collected, and patients were divided into death group and survival group according to whether they died during hospitalization. After univariate analysis, multivariate logistic regression analysis was then performed to explore the independent risk factors related to in-hospital mortality. Results: Among 6 668 patients hospitalized for AECOPD, 128 patients experienced in-hospital death, with a mortality rate of 1.9%. The mean age of the death group was (81±9) years, which was significantly older than that of the survival group ((72±11) years P<0.001). The proportion of patients in the AECOPD in-hospital death group with a combination of prolonged bed rest, hypertension, myocardial infarction within 3 months, cardiac insufficiency, chronic pulmonary heart disease, pneumonia, type 2 diabetes, venous thromboembolism (VTE), and chronic renal insufficiency was also significantly higher than in the survival group (all P<0.05) The median length of stay in the in-hospital death group was 18 d, which was significantly longer than that in the survival group (9 d, P<0.001), and the proportion of patients admitted to the ICU, receiving invasive mechanical ventilation and non-invasive mechanical ventilation was also significantly higher than that in the survival group (all P<0.05). The white blood cell count, glutamic transaminase, blood creatinine, calcitoninogen, C-reactive protein, D-dimer, N-terminal B-type natriuretic and Pseudomonas aeruginosa infection rates were significantly higher than those in the survival group (all P<0.05). Multifactorial analysis showed that age>80 years (OR=3.82, 95%CI 2.36 to 6.18, P<0.001), prolonged bed rest (OR=2.95, 95%CI: 1.79 to 4.86, P<0.001), chronic pulmonary heart disease (OR=1.85, 95%CI: 1.14 to 3.00, P=0.012), and pneumonia (OR=2.75, 95%CI: 1.65 to 4.60, P<0.001), invasive mechanical ventilation (OR=7.33, 95%CI: 4.40 to 12.21, P<0.001), noninvasive mechanical ventilation (OR=3.73, 95%CI: 2.30 to 6.04, P<0.001), anemia (OR=2.03. 95%CI: 1.21 to 3.42, P=0.008), and calcitoninogen>0.5 ng/ml (OR=2.38, 95%CI: 1.41 to 4.02, P=0.001) were independent risk factors for in-hospital mortality in patients with AECOPD. Conclusion: Advanced age (>80 years), prolonged bed rest, chronic pulmonary heart disease, pneumonia, invasive mechanical ventilation, noninvasive mechanical ventilation, anemia, and calcitoninogen>0.5 ng/ml were independent risk factors for in-hospital mortality in patients hospitalized with AECOPD.
Assuntos
Diabetes Mellitus Tipo 2 , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Microbial transglutaminase (MTGase)-induced polymerization of individual milk proteins during incubation was investigated using a proteomics-based approach. The addition of MTGase (0.25-2.0 units/mL) caused the milk proteins to polymerize after a 3-h incubation period. Sodium dodecyl sulfate-PAGE analysis showed that the total intensities of the protein bands that corresponded to α(S)-casein, ß-casein, and κ-casein decreased from 8,245.6, 6,677.2, and 586.6 arbitrary units to 1,911.7, 0.0, and 66.2 arbitrary units, respectively. Components with higher molecular weights were observed, and the intensity of these proteins increased after 3h of incubation. These results support that inter- or intramolecular crosslinking occurred in the casein proteins of MTGase-treated milk. Two-dimensional electrophoresis analysis indicated that isomers of ß-casein, κ-casein, a fraction of serum albumin, α(S1)-casein, α(S2)-casein, ß-lactoglobulin, and α-lactalbumin in the milk were polymerized following incubation with MTGase. In addition, MTGase-induced polymerization occurred earlier for ß-casein and κ-casein isomers than for other milk proteins.
Assuntos
Proteínas do Leite/genética , Transglutaminases/metabolismo , Animais , Caseínas/genética , Bovinos , Eletroforese em Gel Bidimensional , Eletroforese em Gel de Poliacrilamida , Mescalina/genética , Peso Molecular , PolimerizaçãoRESUMO
The incidence of persistent pain after cesarean deliveries (CD) varies but is much lower than after comparable surgeries. However, with over four million deliveries annually and a rising CD rate, even a low prevalence of persistent pain after CD impacts many otherwise healthy young women. Consideration of the pathophysiology of persistent pain after surgery and the risk factors predisposing women to persistent and chronic pain after CD provides insights into the prevention and treatment of persistent pain; and improves the quality of care and recovery after CD. The findings that the peripartum state and oxytocin confer protection against persistent pain may provide new and interesting perspectives for the prevention and treatment of chronic pain caused by trauma or surgery. Predictive tools available to identify and target patients at high risk of acute and chronic pain have mostly weak to modest predictive correlations and many are either not clinically feasible or too time-consuming to apply. Persistent pain has been linked to the severity of acute postoperative pain and opioid exposure. Modified surgical techniques, neuraxial anesthesia and opioid-sparing analgesia may help limit the development of persistent and chronic pain. The goal of this narrative review is to examine the incidence of persistent pain after CD; review briefly the underlying pathophysiology of persistent pain and the transition from acute to chronic pain (with particular emphasis on the uniqueness after CD); and to review modifiable risk factors and prevention strategies that identify at-risk patients and allow tailored treatment.
Assuntos
Cesárea , Dor Crônica/fisiopatologia , Dor Pós-Operatória/fisiopatologia , Adulto , Dor Crônica/terapia , Feminino , Humanos , Dor Pós-Operatória/terapia , GravidezRESUMO
The rare congenital heart defect of Ebstein's anomaly is characterized by downward displacement and elongation of the septal cusp of tricuspid valve. As a result, it is often associated with a thin-walled and poorly contractile right ventricle, an enlarged atrium, tricuspid regurgitation, atrial septal defect with intracardiac shunt, pulmonary hypertension and tachyarrhythmia. Published reports or studies on analgesic and/or anesthetic management of laboring parturients with Ebstein's anomaly are limited. We present an evidence-based case report of the successful management of an obese laboring parturient with Ebstein's anomaly and Wolff-Parkinson-White syndrome under epidural analgesia. We reviewed the literature and present the best evidence available or its lack of, and the reasoning in supporting the choice of the analgesic and anesthetic management.
Assuntos
Analgesia Obstétrica/métodos , Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Anomalia de Ebstein , Complicações Cardiovasculares na Gravidez , Síndrome de Wolff-Parkinson-White/congênito , Adulto , Anestesia Epidural/instrumentação , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Medicina Baseada em Evidências , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Monitorização Fisiológica , Obesidade/complicações , Gravidez , Cuidados Pré-OperatóriosRESUMO
BACKGROUND: The optimal volume of blood required to treat post-dural puncture headache remains in question. In our institution a target volume of 30mL is used for an epidural blood patch unless the patient experiences pain during injection. METHODS: The institutional database was retrospectively reviewed for epidural blood patch and delivery statistics over a 15-year period to determine if the volume of blood administered during the procedure directly correlated with the number of epidural blood patches administered. The primary endpoint was defined as the need for a repeat epidural blood patch. RESULTS: There were 466 epidural blood patches performed on 394 patients, associated with 84 804 obstetric neuraxial procedures. Thirty-two percent (95% CI 28.3 to 34.9%) of patients who had an inadvertent dural puncture with an epidural needle received an epidural blood patch versus 0.19% (0.16% to 0.22%) of patients who received neuraxial anesthesia with no documented dural puncture with an epidural needle. All patients experienced relief of post-dural puncture headache, although 17% required two and 1.5% required three epidural blood patches. The mean±SD volume of blood administered was 20.5±5.4mL and only 35 patients (8.9%) received 30mL. CONCLUSION: Increasing blood volumes up to 30mL did not reduce the need for repeat epidural blood patch. Although the optimal volume of blood to administer during epidural blood patch placement remains unknown, our institution will continue to administer up to 30mL or until the patient experiences pain during epidural injection.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Placa de Sangue Epidural/estatística & dados numéricos , Volume Sanguíneo/fisiologia , Bases de Dados Factuais/estatística & dados numéricos , Cefaleia Pós-Punção Dural/terapia , Adulto , Feminino , Humanos , Incidência , Cefaleia Pós-Punção Dural/epidemiologia , Cefaleia Pós-Punção Dural/fisiopatologia , Gravidez , Estudos Retrospectivos , Resultado do TratamentoRESUMO
To our knowledge, based on a literature search, this is the first case report of successful cesarean section requiring a very low total dose of 5 mg hyperbaric spinal bupivacaine without any spinal or intravenous supplements in a morbidly obese (BMI=66 kg/m(2)) preeclamptic parturient. This parturient appeared to be more sensitive than the average to spinal anesthesia for cesarean section. Titrating the neuraxial drugs to effect with a combined spinal-epidural or epidural technique instead of a single-shot spinal may be useful in cases such as this. This report does not suggest the routine use of low-dose spinal anesthesia without supplements, but illustrates the wide variability in dosage and sensitivity to spinal anesthetics, and suggests that further research is needed in this area, particularly in morbidly obese parturients. Furthermore, it emphasizes the importance of vigilance and frequent blood pressure and respiration monitoring even in cases of low-dose spinal analgesia, such as that used in the combined spinal-epidural technique for labor analgesia.
Assuntos
Anestesia Obstétrica , Raquianestesia , Anestésicos Locais/administração & dosagem , Cesárea , Obesidade Mórbida/complicações , Pré-Eclâmpsia/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Bupivacaína/administração & dosagem , Feminino , Hemodinâmica , Humanos , Labetalol/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Monitorização Intraoperatória , GravidezRESUMO
A retrospective analysis was performed on 19,259 deliveries that occurred in our institution from January 2000 to December 2002. Anesthesia records and quality assurance data sheets were reviewed for the characteristics and failure rates of neuraxial blocks performed for labor analgesia and anesthesia. The neuraxial labor analgesia rate was 75% and the overall failure rate was 12%. After adequate analgesia from initial placement, 6.8% of patients had subsequent inadequate analgesia during labor that required epidural catheter replacement. Ultimately 98.8% of all patients received adequate analgesia even though 1.5% of patients had multiple replacements. Six percent of epidural catheters had initial intravenous placement but 46% were made functional by simple manipulations without higher subsequent failure. Unintended dural puncture occurred in 1.2% of labor neuraxial analgesia. The incidences of overall failure, intravenous epidural catheter, wet tap, inadequate epidural analgesia and catheter replacement were lower in patients receiving combined spinal-epidural versus epidural analgesia. For cesarean section, 7.1% of pre-existing labor epidural catheters failed and 4.3% of patients required conversion to general anesthesia. Spinal anesthesia for cesarean section had a lower failure rate of 2.7%, with 1.2% of the patients requiring general anesthesia. The overall use of general anesthesia decreased from 8% to 4.3% over the three-year period. Furthermore, regional anesthesia was used in 93.5% of cesarean deliveries with no anesthetic-related mortalities. Future investigations should identify acceptable international standards, risk factors associated with failure and methods to reduce failure before cesarean section.
Assuntos
Analgesia Obstétrica , Anestesia Obstétrica , Bloqueio Nervoso , Adulto , Analgesia Obstétrica/efeitos adversos , Anestesia Epidural , Anestesia Geral , Anestesia Obstétrica/efeitos adversos , Raquianestesia , Cesárea , Bases de Dados Factuais , Parto Obstétrico , Feminino , Humanos , Bloqueio Nervoso/efeitos adversos , Gravidez , Estudos Retrospectivos , Gestão da Qualidade Total , Falha de TratamentoRESUMO
Subcutaneous emphysema is not an uncommon anesthetic complication, but it often occurs unexpectedly. It is usually self-limited, but mediastinitis can occur with mortality as high as 50%. A case of subcutaneous emphysema occurring during dental surgery is reported here. The diagnosis, management, complications, and pathogenesis are discussed.
Assuntos
Anestesia/efeitos adversos , Enfisema/etiologia , Enfisema Subcutâneo/etiologia , Anestesia Dentária/efeitos adversos , Criança , Diagnóstico Diferencial , Humanos , Masculino , Enfisema Subcutâneo/complicações , Enfisema Subcutâneo/terapiaRESUMO
STUDY OBJECTIVES: To evaluate the success rate of the spinal needle exiting through the spinal needle orifice in two commonly available single-lumen, dual-orifice combined spinal-epidural (CSE) needle kits, and to study the effects of the epidural needle bevel orientation and the modified insertion technique on its success rate. DESIGN: Prospective, randomized study. SETTING: Laboratory. EQUIPMENT: Two types of single-lumen, dual-orifice CSE needle kits: CSE-Q kit and CSE-S kit. INTERVENTION: 20 anesthesiologists and nurse-anesthetists were assigned to select randomly from the two types of CSE kits (CSE-Q and CSE-S). The epidural needle was then placed into a foam device simulating a patient's back and the associated spinal needle was inserted through the epidural needle with the epidural needle bevel oriented randomly upward, downward, left, and right, respectively. The procedures were performed before and after the modified technique was used. The modified technique consisted of (1) aligning the orifice/bevel of the spinal needle in the same direction as the epidural needle bevel, and (2) gently bending the hub of the spinal needle in the direction of the epidural needle bevel while advancing the spinal needle. MEASUREMENTS AND MAIN RESULTS: Success rate of the spinal needle exiting through the spinal needle orifice was measured. Data were collected from 1600 attempts. The modified technique improved the success rate of spinal needle exiting through the spinal needle orifice from 67% to 94 % for the CSE-Q kit and 50% to 81% for the CSE-S kit. Upward orientation of the epidural needle bevel further improved the success rate to 96% and 91% for CSE-Q and CSE-S kits, respectively. CONCLUSIONS: The spinal needle did not always exit through the spinal needle orifice in the CSE kits tested. CSE-Q kits performed better than CSE-S kits. Under the study conditions, the modified technique and the upward orientation of epidural needle bevel significantly improved the success rate of the spinal needle exiting through the appropriate spinal needle orifice.
Assuntos
Anestesia Epidural/instrumentação , Raquianestesia/instrumentação , Técnicas de Laboratório Clínico , Agulhas/normas , Estudos de Avaliação como Assunto , Humanos , Estudos ProspectivosRESUMO
STUDY OBJECTIVE: To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration. DESIGN: Prospective study. SETTING: University medical center. PATIENTS: 46 consecutive ASA physical status I-III patients undergoing general anesthesia for elective surgical operations. MEASUREMENTS AND MAIN RESULTS: With an integrated computer algorithm on the pulse oximeter and another computer linked to it, data were screened and the frequency and distribution of the following oximeter signals recorded: absent; low quality or interrupted, as detected by the pulse oximeter algorithm; nonphysiologic, identified by the personal computer as a heart rate change greater than 10 beats per minute within 2 consecutive 2-second samples, with no similar abrupt change reported simultaneously on ECG. The number of episodes per hour of discrepant oximeter data and the duration of the episodes were recorded by phase of anesthesia: induction, maintenance, and emergence. Discrepant data occurred most frequently and lasted longest during emergence (p < 0.05); the majority of episodes of discrepant data during emergence lasted less than 12 seconds. Excluding discrepant data that lasted less than 12 seconds decreased the frequency of discrepant data by 63% and excluding those that lasted less than 30 seconds decreased the frequency of discrepant data by 93%. CONCLUSIONS: Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.
Assuntos
Monitorização Intraoperatória , Oximetria , Algoritmos , Período de Recuperação da Anestesia , Anestesia Geral , Artefatos , Procedimentos Cirúrgicos Eletivos , Eletrocardiografia , Falha de Equipamento , Frequência Cardíaca/fisiologia , Humanos , Microcomputadores , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/estatística & dados numéricos , Oximetria/instrumentação , Oximetria/estatística & dados numéricos , Estudos Prospectivos , Processamento de Sinais Assistido por ComputadorRESUMO
STUDY OBJECTIVES: To evaluate and compare cisatracurium-induced neuromuscular blockade and intubating conditions between immediate postpartum (PP) and nonpregnant (NP) patients. DESIGN: Prospective control study. SETTINGS: University Hospital Center. PATIENTS: 44 ASA physical status I and II patients: 22 immediate postpartum (PP) patients (<48 hours after delivery) scheduled for elective postpartum tubal ligation and 22 nonpregnant (NP) patients (>40 weeks from prior pregnancy) scheduled for elective gynecological procedures. INTERVENTIONS: General anesthesia was induced intravenously (IV) with thiopental sodium 5 mg/kg, fentanyl 2.0 to 3.0 ug/kg, midazolam 0.015 to 0.025 mg/kg, and cisatracurium 0.2 mg/kg. Evoked electromyographic responses of the adductor pollicis muscle were obtained by supra-maximal train-of-four stimulation of the ulnar nerve every ten seconds via surface electrodes at the wrist. Intubation was attempted at 90 s after completion of cisatracurium administration and again at 120 seconds if the first attempt was unsuccessful. The intubating anesthesiologist assessed the intubating conditions with four variables: jaw relaxation, vocal cord immobility and exposure, patient/diaphragmatic movement, and overall intubating impression. Intraoperative anesthetic was maintained with 30% oxygen, 70% nitrous oxide, and 1% end-tidal isoflurane, as tolerated. Patient temperature was maintained at 35.5 degrees to 37.5 degrees Celsius (C), and end-tidal carbon dioxide at 30 to 36 mmHg. MEASUREMENTS AND MAIN RESULTS: The mean onset times to 50%, 90%, and maximal T(1) depression and mean time to 25% T(1) recovery in the PP group (68 +/- 19 sec, 110 +/- 26 sec, 147 +/- 32 sec, 60 +/- 6 min) were significantly less than those in the NP group (80 +/- 17 sec, 131 +/- 28 sec, 181 +/- 44 sec, 69 +/- 12 min), respectively (p < 0.05). All patients were successfully intubated on the first attempt at 90 seconds. 91% of the NP group and 81% of the PP group had excellent overall intubating conditions. CONCLUSIONS: This is the first published control study to compare the effects of cisatracurium between NP and PP patients. The results suggest that the mean onset time and clinical duration of cisatracurium are significantly shorter in immediate postpartum patients than those in nonpregnant female patients.
Assuntos
Atracúrio , Bloqueio Nervoso , Fármacos Neuromusculares não Despolarizantes , Período Pós-Parto/fisiologia , Adulto , Anestesia Geral , Atracúrio/análogos & derivados , Temperatura Corporal , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Intubação Intratraqueal , Gravidez , Estudos Prospectivos , Esterilização TubáriaRESUMO
STUDY OBJECTIVE: To compare the relative efficacy of prophylactic metoclopramide, ondansetron, and placebo in nonemergent cesarean section patients given epidural anesthesia intraoperatively and for the first 24-hour period after delivery. DESIGN: Randomized, double blind, placebo-controlled study. SETTING: Inpatient obstetric unit at a university hospital center. PATIENTS: 164 nonemergent cesarean section patients given epidural anesthesia. INTERVENTION: At time of umbilical cord clamp, patients received intravenously (IV) either 4 mg ondansetron (Group O) or 10 mg metoclopramide (Group M) or 10 mL normal saline (Group P). MEASUREMENTS AND MAIN RESULTS: Episodes and severity of nausea and vomiting, rescue antiemetic requirement, patient satisfaction, and side effects were recorded. The frequency of intraoperative nausea were 24%, 43%, and 57% for Group O, Group M, and Group P, respectively (p < 0.03). The frequency of nausea for the 24-hour study period were 26%, 51% and 71% for Groups O, M, and P respectively (p < 0.03). The frequency of intraoperative and postoperative vomiting were similar between Group O and Group M, but significantly higher in Group P (p < 0.05). Overall patient satisfaction was highest in Group O compared with Groups P and M (p < 0.05). Maximum analog sedation score was higher in Group M compared to Groups O and P (p < 0.05). CONCLUSIONS: In cesarean section patients given epidural anesthesia, prophylactic ondansetron, 4 mg IV, is more efficacious and has a higher patient satisfaction than that with metoclopramide, 10 mg IV, or placebo in preventing nausea and achieving complete responses during intraoperative period and the first 24-hour postdelivery period. However, there is no difference between ondansetron and metoclopramide in reducing frequency of vomiting. Prophylactic ondansetron 4 mg IV is more effective in preventing nausea than vomiting.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Antieméticos/uso terapêutico , Metoclopramida/uso terapêutico , Ondansetron/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Cesárea , Método Duplo-Cego , Feminino , Humanos , Metoclopramida/efeitos adversos , Ondansetron/efeitos adversos , GravidezRESUMO
STUDY OBJECTIVE: To document the effects of compromised respiratory function on oxygen saturation (SpO2) after cesarean section via the telemetric pulse oximetry network (TPON) for 24 continuous hours. DESIGN: Prospective study. SETTING: Postpartum ward of a university hospital. PATIENTS: ASA physical status I or II parturients undergoing cesarean section. INTERVENTIONS: Healthy parturients were assigned to 1 of 3 anesthetic-postoperative morphine regimens as follows: general anesthesia-parenteral morphine as needed (GA/PM; n = 11); epidural anesthesia-parenteral morphine as needed (EA/PM; n = 15); epidural anesthesia-epidural morphine 4 to 5 mg (EA/EM; n = 10). MEASUREMENTS AND MAIN RESULTS: For 24 continuous hours after cesarean section, SpO2, heart rate, and plethysmogram every 10 seconds were recorded by the TPON computer. In addition, pain, somnolence, respiratory rate (RR), and side effects were recorded every 30 minutes to 2 hours. SpO2 less than 94% and less than 92% occurred least with GA/PM. The highest mean cumulative time of SpO2 between 95% and 90% occurred with EA/EM. The longest episode of SpO2 less than 92% and the lowest SpO2 for more than 1 minute also occurred with EA/EM. With all 3 regimens, SpO2 decreased to less than 80% for 20 to 30 seconds at a time, but the lowest SpO2 (less than 85%) for more than 1 minute occurred with EA/EM in 1 patient and was associated with somnolence that required treatment. With all 3 regimens, average RR was within normal limits, but mean RR was significantly lower with EA/EM than with GA/PM or EA/PM from the 8th to the 14th postoperative hours. Somnolence did not differ significantly among the 3 regimens. Pain score was significantly lower with EA/EM than with GA/PM or EA/PM for the first 20 hours. CONCLUSIONS: All 3 regimens risked low SpO2, with the EA/EM regimen having the highest risk but the best analgesia. Neither general nor epidural anesthesia combined with postoperative parenteral morphine influenced SpO2 postoperatively. In this study, the TPON provided a feasible method of detecting hypoxemia early on in the general ward setting.
Assuntos
Analgesia Obstétrica , Anestesia Obstétrica , Cesárea , Morfina , Oximetria , Oxigênio/sangue , Respiração/fisiologia , Telemetria , Adulto , Analgesia Epidural , Anestesia Epidural , Anestesia Geral , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Injeções Intramusculares , Injeções Intravenosas , Morfina/administração & dosagem , Morfina/farmacologia , Gravidez , Estudos Prospectivos , Respiração/efeitos dos fármacos , Fases do Sono/efeitos dos fármacos , Fases do Sono/fisiologiaAssuntos
Anestesia com Circuito Fechado , Respiração com Pressão Positiva , Volume de Ventilação Pulmonar , Anestesia com Circuito Fechado/instrumentação , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/química , Desenho de Equipamento , Humanos , Complacência Pulmonar , Modelos Estruturais , Respiração com Pressão Positiva/instrumentação , PressãoRESUMO
No adequate criteria were established to distinguish between Nitrobacter agilis and N. winogradskyi. However, very gentle preparative techniques permitted demonstration of flagella in N. agilis.
Assuntos
Nitrobacter/citologia , Acetatos/metabolismo , Meios de Cultura , Flagelos , Microscopia Eletrônica , Nitritos/metabolismo , Nitrobacter/crescimento & desenvolvimento , Nitrobacter/metabolismo , Ácido Fosfotúngstico , Especificidade da Espécie , Coloração e RotulagemRESUMO
The efficacy of ondansetron and droperidol were evaluated for prophylactic treatment of nausea and vomiting in cesarean section patients under epidural anesthesia. Forty-eight ASA physical status I-II parturients requiring nonemergent cesarean section gave their consent and were randomly assigned into one of three treatment groups (n = 16 each) according to a double-blind, placebo-controlled protocol. When the fetal umbilical cord was clamped, patients received intravenously 8 mg of ondansetron or 0.625 mg of droperidol or saline depending on their treatment group. Ninety-four percent of the ondansetron group, 88% of the droperidol group, and 56% of the placebo group were emesis free. Sixty-nine percent of the ondansetron group, 75% of the droperidol group, and 31% of the placebo group were nausea free. This study showed a significantly lower incidence of nausea and vomiting and a tendency toward less severe emetic symptoms in the ondansetron and the droperidol groups than in the placebo group, but the ondansetron group was not statistically different from the droperidol group. This study is the first to report the antiemetic efficacy of prophylactic ondansetron in cesarean section patients or in patients under epidural anesthesia for abdominal surgery. Both prophylactic ondansetron and droperidol were similarly effective, and significantly better than placebo, in reducing the incidence and severity of intraoperative emetic symptoms in cesarean section patients under epidural anesthesia.