RESUMO
INTRODUCTION: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. OBJECTIVES: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. MATERIALS AND METHODS: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 ± 2.35; Ci 11 ± 3.63: p=0.54) and APACHE II (He 28.60 ± 9.40; Ci 24 ± 8.46: p=0.93) scores. RESULTS: Nights in hospital (He 35.2 ± 16.3 nights; Ci 9 ± 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 ± 21.82; Ci 13.2 ± 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 ± 5.66; Ci 4 ± 1.72: p=0.004), and the predicted (55.39 ± 26.13%) versus real mortality in both groups (9.1%: p=0.004). CONCLUSIONS: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies.
Assuntos
Anticoagulantes/uso terapêutico , Citratos/uso terapêutico , Terapia de Substituição Renal Contínua/métodos , Inflamação/terapia , Membranas Artificiais , Complicações Pós-Operatórias/terapia , APACHE , Adulto , Estudos de Casos e Controles , Protocolos Clínicos , Terapia de Substituição Renal Contínua/instrumentação , Estado Terminal , Estudos de Viabilidade , Hidratação , Heparina/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Inflamação/etiologia , Escores de Disfunção Orgânica , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tamanho da Amostra , Procedimentos Cirúrgicos Operatórios/efeitos adversosRESUMO
Due to the its physical-chemical properties, alumina nanoparticles have potential applications in several areas, such as nanobiomaterials for medicinal or orthodontic implants, although the introduction of these devices poses a serious risk of microbial infection. One convenient strategy to circumvent this problem is to associate the nanomaterials to antimicrobial peptides with broad-spectrum of activities. In this study we present two novel synthesis approaches to obtain fibrous type alumina nanoparticles covalently bound to antimicrobial peptides. In the first strategy, thiol functionalized alumina nanoparticles were linked via disulfide bond formation to a cysteine residue of an analog of the peptide BP100 containing a four amino acid spacer (Cys-Ala-Ala-Ala). In the second strategy, alumina nanoparticles were functionalized with azide groups and then bound to alkyne-decorated analogs of the peptides BP100 and DD K through a triazole linkage obtained via a copper(I)-catalyzed cycloaddition reaction. The complete physical-chemical characterization of the intermediates and final materials is presented along with in vitro biological assays and membrane interaction studies, which confirmed the activity of the obtained nanobiostructures against both bacteria and fungi. To our knowledge, this is the first report of aluminum nanoparticles covalently bound to triazole-peptides and to a disulfide bound antimicrobial peptide with high potential for biotechnological applications.
Assuntos
Antibacterianos/síntese química , Antibacterianos/farmacologia , Antifúngicos/síntese química , Antifúngicos/farmacologia , Dissulfetos/farmacologia , Nanopartículas/química , Peptídeos/farmacologia , Triazóis/farmacologia , Óxido de Alumínio/química , Óxido de Alumínio/farmacologia , Antibacterianos/química , Antifúngicos/química , Candida/efeitos dos fármacos , Dissulfetos/química , Escherichia coli/efeitos dos fármacos , Fusarium/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Estrutura Molecular , Tamanho da Partícula , Peptídeos/síntese química , Peptídeos/química , Propriedades de Superfície , Triazóis/químicaRESUMO
Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the "Test Your Memory" (TYM) test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104), musculoskeletal pain (99) and fibromyalgia (51). The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADs), Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale) and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach's alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, p<0.001); HAD-anxiety (-0.50, p<0.001) and HAD-depression scales (-0.52, p<0.001); MOS-sleep Index-9 (-0.49, p<0.001); and the physical (0.49, p < .001) and mental components (0.55, p < .001) of SF-12. The exploratory structure of the TYM showed an 8-factor solution that explained 53% of the variance, and Cronbach's alpha was 0.66. The TYM is a valid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.
Assuntos
Dor Crônica/complicações , Disfunção Cognitiva/diagnóstico , Fibromialgia/complicações , Dor Musculoesquelética/complicações , Neuralgia/complicações , Psicometria/métodos , Adulto , Cognição , Disfunção Cognitiva/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Casearia sylvestris S.w (Salicaceae) is catalogued by the Brazilian Unified Health System as a plant of interest for the Brazilian population with the purpose of treating inflammatory disorders, such as pain and gastrointestinal disorders based on the folk use and some literature about efficacy; however, no toxicological studies concerned the safety of extract fluid of this plant have been reported. AIM OF THE STUDY: The present study was carried out to evaluate the acute and subchronic toxicity of the hydroethanolic extract fluid (FE) obtained from leaves of C. sylvestris in Wistar rats. MATERIALS AND METHODS: In the acute toxicity test three female Wistar rats were treated with a single dose of FE (2000 mg/kg) administered by oral gavage and observed for 14 days in order to identify signs of toxicity or death. In subchronic toxicity study animals received, by daily gavage three doses 60, 120 and 240 mg/kg of the FE of the plant for 28 and 90 days. The animals were observed daily for clinical signs and mortality. Body weight and food consumption were measured weekly and at the end of treatment were analysed hematological, biochemical and histopathological parameters. Also was analysed the cellularity of bone marrow and spleen. Moreover, phytochemical analysis by HPLC-PDA-ESI(+)/MS and CG/MS/EI was carried out to qualify the constituents of the extract. RESULTS: The results of acute study indicated that the LD50 is higher than 2000 mg/kg and at 28 and 90 day oral toxicity showed that there were no toxic effects detected in any of the parameters evaluated: body weight and relative organ weight, general behavioral changes, haematological and biochemical parameters and histopathological examination. The analysis by HPLC-PDA-ESI(+)/MS and CG/MS/EI identified the flavonoids rutin, quercetin and luteolin and also chlorogenic on the extract. CONCLUSION: Based on this study the hydroethanolic fluid extract of C. sylvestris could be safe even when used over a long period for therapeutic uses proposed by the Brazilian Unified Health System.
Assuntos
Casearia , Extratos Vegetais/toxicidade , Animais , Brasil , Feminino , Dose Letal Mediana , Masculino , Programas Nacionais de Saúde , Folhas de Planta , Plantas Medicinais , Ratos Wistar , Testes de Toxicidade Aguda , Testes de Toxicidade SubcrônicaRESUMO
There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.
Assuntos
Antitrombinas/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Hemorragia/prevenção & controle , Assistência Perioperatória/métodos , Administração Oral , Antitrombinas/administração & dosagem , Fatores de Coagulação Sanguínea/uso terapêutico , Testes de Coagulação Sanguínea , Perda Sanguínea Cirúrgica , Monitoramento de Medicamentos , Emergências , Fator VIIa/uso terapêutico , Inibidores do Fator Xa/administração & dosagem , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Técnicas Hemostáticas , Humanos , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/prevenção & controle , Guias de Prática Clínica como Assunto , Proteínas Recombinantes/uso terapêuticoRESUMO
La primera aplicación del laser en un diente fue realizada en 1965. Desde entonces ha presentado una constante evolución y desarrollo. La tecnología laser permite realizar procedimientos en tejidos duros y blandos, pudiendo ser utilizado con las siguientes finalidades: como prevención de la desmineralización, en la adhesión y remoción de brackets, en la reducción del dolor producto del movimiento dental, en la reparación ósea después de la expansión, en diversas cirugías y otras aplicaciones más. El objetivo de este artículo es realizar una revisión bibliográfica sobre algunos de los usos, ventajas y características del laser en Ortodoncia.
The first application of laser in a tooth was made in 1965. Since then this tecnology had a constant evolution and development. Laser technology allows procedures in hard and soft tissues, it can be used for the following purposes: prevention of demineralization, bonding and debonding of brackets, to reduce pain resulting from tooth movement, bone repair after expansion, surgeries and other applications. The aim of this article is to review the literature on some of the uses, advantages and features of the laser in orthodontics.
Assuntos
Humanos , Analgesia , Odontologia , Ortodontia , Lasers , Terapia a LaserRESUMO
New direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for long-term prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1-5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed.
Assuntos
Anticoagulantes/administração & dosagem , Hemorragia/prevenção & controle , Tromboembolia/prevenção & controle , Administração Oral , Idoso , Anestesiologia , Anticoagulantes/química , Artroplastia de Quadril , Artroplastia do Joelho , Benzimidazóis/administração & dosagem , Dabigatrana , Feminino , Hemostasia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Morfolinas/uso terapêutico , Segurança do Paciente , Período Perioperatório , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana , Tiofenos/uso terapêutico , beta-Alanina/administração & dosagem , beta-Alanina/análogos & derivadosRESUMO
The new direct-acting oral anticoagulants (ACOD) in patients on prolonged treatment require the need to balance the risk of haemorrhage by administering them against the risk of thrombosis on withdrawing them. Recommendations for their management are proposed in the present article: A) Thromboprophylaxis and general anaesthesia: the performing of regional anaesthesia if administered with an ACOD as thromboprophylaxis requires some safety intervals based on their pharmacokinetic parameters; B) Management of ACOD in elective surgery: in patients with normal renal function and a low haemorrhage/thrombosis risk, stop the ACOD two days before the surgery; it the haemorrhage/thrombosis risk is high and/or renal function is impaired, therapy with a low molecular weight heparin is proposed from 5 days prior to the surgery, and C) Management of ACOD in urgent surgery and associated haemorrhage: the systematic prophylactic administration of haemostatics is recommended. In the event of acute bleeding that may place the life of the patient at risk (due to volume or location), the administration of concentrated prothrombin complex, fresh plasma, or factor VIIa, must be assessed, together with general control measures of acute haemorrhage. These recommendations should be considered in the context of the use drugs that do have a specific antidote, where their monitoring by the usual coagulation tests is not routine, and with those in which there is limited experience. We believe they need to be reviewed in the future, depending on further studies and clinical experience obtained.
Assuntos
Anticoagulantes/uso terapêutico , Benzimidazóis/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Morfolinas/uso terapêutico , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tiofenos/uso terapêutico , Trombose/prevenção & controle , beta-Alanina/análogos & derivados , Administração Oral , Anestesia por Condução , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacocinética , Antídotos , Benzimidazóis/administração & dosagem , Benzimidazóis/efeitos adversos , Benzimidazóis/farmacocinética , Fatores de Coagulação Sanguínea/uso terapêutico , Dabigatrana , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos , Emergências , Fator VIIa/uso terapêutico , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/farmacocinética , Hemostáticos/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Morfolinas/farmacocinética , Assistência Perioperatória/normas , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/terapia , Guias de Prática Clínica como Assunto , Pré-Medicação , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Pirazóis/farmacocinética , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Piridonas/farmacocinética , Fatores de Risco , Rivaroxabana , Tiofenos/administração & dosagem , Tiofenos/efeitos adversos , Tiofenos/farmacocinética , beta-Alanina/administração & dosagem , beta-Alanina/efeitos adversos , beta-Alanina/farmacocinética , beta-Alanina/uso terapêuticoRESUMO
Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.
Assuntos
Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Analgésicos Opioides/efeitos adversos , Quimioprevenção/efeitos adversos , Quimioprevenção/economia , Criança , Análise Custo-Benefício , Interações Medicamentosas , Humanos , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Náusea e Vômito Pós-Operatórios/fisiopatologia , Fatores de RiscoRESUMO
OBJECTIVES: The Postoperative Analgesic Therapy Observational Survey (PATHOS) was designed to identify the current state of postoperative pain in specific areas and the needs and opportunities for improving treatment. We compared the results obtained in Spain with those obtained in the rest of Europe between August 2004 and June 2005. MATERIAL AND METHODS: A prospective observational multicenter, multinational study in 7 European countries. The data on postoperative pain management were obtained anonymously by means of a standardized multiple-choice questionnaire. RESULTS: Participation was higher among surgeons (68%) in Spain and among anesthesiologists (69%) in other European countries. Systematic presurgical information on the treatment of postoperative pain was provided to 22.2% of patients undergoing surgery in Spain. Organized structures for the treatment of postoperative pain are less common in Spanish hospitals (47%) than in other European hospitals (69%). Anesthesiologists are less often those who inform patients about postoperative pain in Spain than in other European countries. Only 25.9% of Spanish hospitals have written protocols for treating postoperative pain. Pain was not evaluated in 39% of patients who underwent surgery in Spain. CONCLUSIONS: There is inadequate treatment of postoperative pain, and the problem is greater in Spain than in the other European countries participating in PATHOS. The results should help to identify opportunities for improvement.
Assuntos
Analgesia , Dor Pós-Operatória/terapia , Europa (Continente) , Humanos , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Relief of postoperative pain is a major topic of public health and has been repeatedly shown to be inadequate. STUDY DESIGN: A questionnaire survey performed in seven European countries (postoperative analgesic therapy observational survey) in 746 health structures--which perform more than 80% of the total number of surgical procedures of each country--has demonstrated significant improvement when compared with previous surveys, particularly regarding increased use of multimodal analgesia and regular administration of analgesic drugs. The present study describes specific results for the 178 French health care institutions surveyed and 345 questionnaires collected. Preoperative patient information is given on a regular basis for 84% of respondents. RESULTS: Multimodal analgesia is used after major surgery in 87% of cases and prescribed on a regular basis for 84% of respondents. Written protocols are available in 36% of responding institutions. Pain scores are measured several times a day in 65% of institutions. An acute pain service (or any other structure with a similar aim) is found in 52% of institutions. Regular on-site training courses on pain control are delivered to 30% of anaesthesiologists, to 6% of surgeons, to 57% of recovery-room nurses and to 63% of ward nurses. Overall, the study suggests an improvement of current practices but also highlights remaining insufficiencies. CONCLUSION: Important efforts remain to be done, particularly in the field of initial and continuous education of all healthcare categories as this is believed to be the only real way to obtain long-term results.
Assuntos
Analgesia , Dor Pós-Operatória/terapia , Europa (Continente) , França , Humanos , Inquéritos e QuestionáriosAssuntos
Cicatriz/complicações , Sarcoidose/diagnóstico , Dermatopatias/diagnóstico , Idoso , Queimaduras/complicações , Diagnóstico Diferencial , Feminino , Granuloma de Corpo Estranho/diagnóstico , Humanos , Sarcoidose/etiologia , Sarcoidose/patologia , Dermatopatias/etiologia , Dermatopatias/patologiaRESUMO
The wide use of anticlotting drugs by patients scheduled for surgery is a challenge for the anaesthesiologist when considering a regional anaesthesia technique. This practice seems safe if there is an appropriate management based on safety intervals established according to the pharmacology of the drug and the regional technique. Some anaesthesiology societies have published recommendations for the safe practice of regional anaesthesia with the simultaneous use of anticoagulants (heparin, low molecular weight heparins, oral anticoagulants (OA), fondaparinux and others) and antiplatelet agents (aspirin, clopidogrel, ticlopidine, argatroban and others). One of the most recent guidelines has been published by the Spanish Society of Anaesthesia and Critical Care. This article reviews these recommendations and compares them with others published in the last years. The recommendations are similar, but some interesting differences can be observed and need to be considered. A European consensus in this setting would probably be necessary.
Assuntos
Analgesia/efeitos adversos , Anestesia por Condução/efeitos adversos , Anticoagulantes/efeitos adversos , Interações Medicamentosas , Guias de Prática Clínica como Assunto , Humanos , Sociedades Médicas , EspanhaAssuntos
Síndrome Antifosfolipídica/complicações , Perda Sanguínea Cirúrgica , Desamino Arginina Vasopressina/uso terapêutico , Hemorragia/tratamento farmacológico , Hemostáticos/uso terapêutico , Adulto , Ácido Aminocaproico , Aprotinina , Testes de Coagulação Sanguínea , Terapia Combinada , Contraindicações , Soluções Cristaloides , Coagulação Intravascular Disseminada/prevenção & controle , Transfusão de Eritrócitos , Fator VII , Fator VIIa , Feminino , Hidratação , Humanos , Soluções Isotônicas/uso terapêutico , Inibidor de Coagulação do Lúpus/análise , Plasma , Transfusão de Plaquetas , Pressão , Proteínas Recombinantes , Neoplasias Retroperitoneais/cirurgia , Choque/etiologia , Tromboflebite/etiologia , Ácido TranexâmicoRESUMO
OBJECTIVE: Our objective was to evaluate efficacy, side effects, and hemodynamic alterations during anesthetic induction with sevoflurane in patients undergoing coronary artery bypass surgery, comparing the techniques of administration with tidal volume breathing and with vital capacity breaths. MATERIAL AND METHODS: This was a randomized controlled trial enrolling 30 patients scheduled for myocardial revascularization. Anesthetic induction with inhaled sevoflurane was performed with 2 techniques: sevoflurane administered with tidal volume breathing (n=15) and with vital capacity breaths (n=15). We assessed time until a bispectral index (BIS) of 50 or less was reached. We also recorded adverse effects and alterations in hemodynamic variables during induction. RESULTS: The time to induction was significantly shorter in the tidal volume group. The time until reaching a BIS of 50 or less was significantly shorter in the vital capacity group. Hemodynamics were similar in both groups (no significant differences). In both groups mean arterial pressure decreased significantly from baseline (P<0.05) and systolic and diastolic blood pressures both decreased slightly, with no significant heart rate or ST segment changes. Adverse effects were few and not serious. CONCLUSIONS: Mean arterial pressure decreased in both groups, with no significant differences. The results indicate that hemodynamic stability seems to be similar with both techniques for providing inhaled anesthetic induction with sevoflurane.
Assuntos
Anestesia por Inalação/métodos , Anestésicos Inalatórios/administração & dosagem , Ponte de Artéria Coronária , Éteres Metílicos/administração & dosagem , Volume de Ventilação Pulmonar , Capacidade Vital , Adulto , Idoso , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacocinética , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipotensão/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Masculino , Éteres Metílicos/efeitos adversos , Éteres Metílicos/farmacocinética , Pessoa de Meia-Idade , Estudos Prospectivos , SevofluranoRESUMO
Prophylactic treatment with low molecular weight heparins (LMWH) is currently widely used to prevent thromboembolic events. However, such treatment is not free of risk. Among the possible complications described is rectus sheath hematoma. We report the case of a patient undergoing surgery for a hypophysial adenoma approached by the transsphenoidal route. He received LMWH prophylaxis for thromboembolism and showed a tendency to hypotension during surgery. The patient's condition deteriorated to hypovolemic shock accompanied by episodes of atrial fibrillation with rapid ventricular response. With the transfusion of medications, blood products and plasma volume expanders, the patient was stabilized and surgery was completed. A computed tomography scan then revealed a hematoma occupying the greater part of the left anterior rectus muscle. With conservative wait-and-see treatment the abdominal symptoms disappeared and the hematoma gradually receded until fully resolved. Spontaneous rectus sheath hematoma is a rare condition. Presentation is quite nonspecific and computed tomography is needed for reaching a firm diagnosis. When a hematoma is large, the initial clinical picture may include hypovolemic shock, which may develop during surgery if the hematoma is not diagnosed early. Intraoperative management will be much more difficult than it would have been if diagnosis and treatment had taken place before the operation.
Assuntos
Anticoagulantes/efeitos adversos , Hematoma/complicações , Complicações Intraoperatórias/etiologia , Nadroparina/efeitos adversos , Pré-Medicação , Reto do Abdome/irrigação sanguínea , Choque/etiologia , Adenoma/cirurgia , Anticoagulantes/administração & dosagem , Fibrilação Atrial/etiologia , Hematoma/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Nadroparina/administração & dosagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Reto do Abdome/diagnóstico por imagem , Ruptura Espontânea , Tromboembolia/prevenção & controle , Tomografia Computadorizada por Raios XRESUMO
Epidural abscess as a complication of spinal analgesia is rare, but because of its potential clinical implications it must always be watched for in patients who have undergone epidural procedures. The case we report is of interest because of the long latency period between removal of the catheter and the onset of clinical signs and because of the rarity of the pathogen implicated in forming the abscess (Candida albicans).
Assuntos
Analgesia Epidural/efeitos adversos , Candidíase/complicações , Discite/complicações , Abscesso Epidural/etiologia , Fungemia/complicações , Meningite Fúngica/complicações , Complicações Pós-Operatórias , Infecções Urinárias/complicações , Ampola Hepatopancreática/cirurgia , Carcinoma Ductal/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Diabetes Mellitus Tipo 2/complicações , Contaminação de Equipamentos , Humanos , Hidrocefalia/complicações , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Fístula Pancreática/complicações , Vértebras TorácicasRESUMO
OBJECTIVE: To compare 3 oral analgesic doses--valdecoxib 20 mg, valdecoxib 40 mg and controlled-release diclofenac 75 mg--to placebo in the treatment of pain after inguinal herniorrhaphy. METHOD: An international multicenter double-blind placebo-controlled trial comparing parallel groups receiving oral valdecoxib 20 or 40 mg, controlled-release diclofenac 75 mg, or placebo every 12 hours over a period of 36 hours. The study enrolled 269 patients undergoing inguinal herniorrhaphy with spinal anesthesia. Pain intensity difference, the sum pain intensity difference, need for rescue medication, and overall patient satisfaction were compared. RESULTS: Valdecoxib 40 mg and controlled-release diclofenac 75 mg take every 12 hours provided similar analgesia that was significantly more efficacious than placebo as shown by the sum pain intensity difference at 12 hours. Both treatments decreased pain intensity in comparison with baseline throughout the study. Differences were significant in comparison with placebo at 8-10 hours through 24 hours of administration of the first dose. No significant differences between valdecoxib 20 mg and placebo were observed. The percentage of patients needing rescue medication was significantly lower in the valdecoxib 40 mg group (30% in that group vs. 52% for placebo), and that difference was not seen for any of the other groups. All treatments were well tolerated. CONCLUSIONS: Valdecoxib 40 mg and diclofenac 75 mg provided similar quality of analgesia for treating pain after inguinal herniorrhaphy.