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1.
Arch. pediatr. Urug ; 94(1): e801, 2023. ilus, tab
Artigo em Espanhol | UY-BNMED, LILACS, BNUY | ID: biblio-1439312

RESUMO

La hernia diafragmática congénita es un defecto en el diafragma que lleva a la herniación del contenido abdominal a la cavidad torácica durante el período intrauterino. La morbimortalidad está determinada por la asociación con otras malformaciones, el grado de hipoplasia pulmonar y la presencia de hipertensión pulmonar secundaria. Presenta una incidencia estimada de 1 cada 2.500-3.000 recién nacidos vivos, constituyendo en un 60% una malformación aislada. Es una patología evolutiva que puede ser diagnosticada a partir de la semana 20-24, la ubicación más habitual es la posterolateral izquierda. Se trata de una patología que requiere ingreso a cuidados intensivos al nacimiento y luego de lograda la estabilización del paciente es de sanción quirúrgica. Los objetivos de este trabajo son conocer las características generales de la patología para sistematizar el manejo logrando así un óptimo asesoramiento de los padres a nivel prenatal y seguimiento postnatal del recién nacido.


Congenital diaphragmatic hernia is a defect in the diaphragm that leads to herniation of theabdominal contents of the thoracic cavity during the intrauterine period. Morbidity and mortality are determined by the association with other malformations, the degree ofpulmonary hypoplasia and the presence of secondary pulmonary hypertension.It has an estimated incidence of 1 every 2,500-3,000 live newborns, and in 60% of the cases it is an isolated malformation. It is an evolutionary pathology that can be diagnosed from week 20-24; it is most commonly located in the left posterolateral. It is a pathology that requires intensive care at birth and after delivery and once the patient has been stabilized, surgical action is required. The objectives of this work are to understand the general characteristics of the pathology in order to refine its manipulation and achieve optimal counseling for parents at the newborn's prenatal and postnatal stages.


A hérnia diafragmática congênita é um defeito no diafragma que leva à herniação doconteúdo abdominal para a cavidade torácica durante o período intrauterino. A morbimortalidade é determinada pela associação com outras malformações, pelo grau de hipoplasia pulmonar e pela presença de hipertensão pulmonar secundária. Apresenta uma incidência estimada de 1 a cada 2.500-3.000 nascidos vivos, constituindo-se em 60% uma malformação isolada. É uma patologia evolutiva que pode ser diagnosticada a partir da semana 20-24 e a localização mais comum é o póstero-lateral esquerdo. É uma patologia que requer internação em terapia intensiva ao nascimento e após o parto. Uma vez que o paciente for estabilizado, é necessária ação cirúrgica. Os objetivos deste paper são conhecer as características gerais da patologia para melhorar o seu manejo, obtendo assim um aconselhamento ideal para os pais no nível pré-natal e no acompanhamento do crescimento pós-natal do recém-nascido.


Assuntos
Humanos , Recém-Nascido , Cuidado Pós-Natal/normas , Hérnias Diafragmáticas Congênitas/terapia , Período Pós-Operatório , Diagnóstico Pré-Natal/normas , Prognóstico , Índice de Gravidade de Doença , Transferência de Pacientes/normas , Cuidados Críticos/normas , Período Pré-Operatório , Hérnias Diafragmáticas Congênitas/cirurgia , Analgesia/normas , Hipertensão Pulmonar/terapia , Monitorização Fisiológica/normas
2.
Rev. bras. ter. intensiva ; 33(1): 48-67, jan.-mar. 2021. tab, graf
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1289052

RESUMO

RESUMEN Objetivo: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. Metodos: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. Resultados: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. Discusión: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.


ABSTRACT Objective: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. Methods: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. Results: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. Discussion: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


Assuntos
Humanos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Delírio/terapia , Consenso , Manejo da Dor/normas , COVID-19/complicações , Analgesia/normas , Agitação Psicomotora/terapia , Bloqueio Neuromuscular/métodos , Delírio/diagnóstico , Deambulação Precoce , Lista de Checagem , Manejo da Dor/métodos , COVID-19/tratamento farmacológico , Analgesia/métodos , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos
3.
Female Pelvic Med Reconstr Surg ; 26(12): e78-e82, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32947551

RESUMO

BACKGROUND: The opioid epidemic has been influenced in part by physician overprescribing. Several studies have evaluated opioid use after urogynecologic surgery, with limited data on postoperative guidelines. The objective of this study was to investigate the effect of implementing a multimodal, opioid-sparing analgesia regimen on opioid use, patient satisfaction, and refill rates. MATERIALS AND METHODS: This was a retrospective observational study of female patients undergoing urogynecologic surgery at an academic center from 2017 to 2019, before and after introduction of an opioid-sparing multimodal regimen protocol advocating for standing ibuprofen and acetaminophen. Demographic information, opioid prescription details (oral morphine equivalent [OME]), and refill rate data were collected from the chart. Postoperative opioid use and satisfaction score (for the after group using Likert scale) was obtained by telephone survey. t Test was used to compare continuous variables, and χ2/Fischer exact test was used to compare categorical variables. RESULTS: Two hundred ninety-two patients were eligible and contacted. One hundred one patients responded before protocol implementation and 102 responded after protocol implementation. The median number of tablets prescribed was 14.5 (108.5 OME; IQR, 10) and 10 (75 OME; IQR, 5; P < 0.01) preprotocol and postprotocol, whereas the mean number of tablets used was 10 (75 OME; IQR, 13) and 3 (22.5 OME; IQR, 10; P = 0.0009) preprotocol and postprotocol, respectively. Refill rate did not differ significantly (11% preprotocol vs 7% postprotocol P = 0.32) Mean satisfaction score was 4.3 (SD, 0.9). CONCLUSIONS: A multimodal analgesia regimen limiting postoperative opioids decreased postoperative opioid prescribing and consumption while maintaining similar patient satisfaction and refill rates.


Assuntos
Analgésicos Opioides/uso terapêutico , Protocolos Clínicos/normas , Prescrições de Medicamentos , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória , Procedimentos Cirúrgicos Urológicos , Acetaminofen/uso terapêutico , Analgesia/métodos , Analgesia/normas , Analgésicos/uso terapêutico , Terapia Combinada , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Ibuprofeno/uso terapêutico , Pessoa de Meia-Idade , New York/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
4.
Hawaii J Health Soc Welf ; 79(8): 246-248, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32789295

RESUMO

Human infection with Angiostrongyloides cantonensis, or rat lungworm disease, manifests most commonly with neurologic symptoms that often include severe diffuse pain. While pain is reported by the majority of patients with rat lungworm disease, there are presently no published guidelines on the approach to pain management for these patients. Here we report a case of rat lungworm disease where severe refractory pain was the most prominent symptom and an intravenous lidocaine infusion was used as a successful treatment modality. Intravenous lidocaine has been shown to be safe and effective in neuropathic pain, refractory cancer pain, and peri-operative pain management. To our knowledge, this is the first case report on the use of lidocaine infusion for the management of refractory pain from rat lungworm disease, and among the first reports of any approach, to pain management for rat lungworm disease. We suggest that a lidocaine infusion protocol be considered when pain from rat lungworm disease fails to respond to first-line analgesics.


Assuntos
Infusões Intravenosas/normas , Lidocaína/administração & dosagem , Dor Intratável/tratamento farmacológico , Infecções por Strongylida/complicações , Adulto , Analgesia/métodos , Analgesia/normas , Analgesia/estatística & dados numéricos , Angiostrongylus cantonensis/efeitos dos fármacos , Angiostrongylus cantonensis/patogenicidade , Animais , Havaí , Humanos , Infusões Intravenosas/métodos , Infusões Intravenosas/estatística & dados numéricos , Masculino , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Infecções por Strongylida/tratamento farmacológico
5.
Eur J Anaesthesiol ; 37(7): 521-610, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487963

RESUMO

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.


Assuntos
Analgesia/normas , Anestesia/normas , Anestesiologia/normas , Competência Clínica/normas , Erros Médicos/prevenção & controle , Segurança do Paciente/normas , Assistência Perioperatória/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Analgesia/efeitos adversos , Anestesia/efeitos adversos , Prova Pericial , Declaração de Helsinki , Humanos , Período Perioperatório , Guias de Prática Clínica como Assunto
6.
Ital J Pediatr ; 46(1): 57, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357893

RESUMO

BACKGROUND: In Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs. METHODS: The preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate. RESULTS: Overall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and discharge checklists, training, non-pharmacologic techniques, the adult ED setting, impact on hospitalizations) were developed, taking into account the Italian training system and healthcare organization characteristics. CONCLUSION: The results of the first multidisciplinary and multi-professional Consensus Conference in Italy are meant to provide up-to-date national guidance to improve the standard of care of children undergoing painful and stressful procedures in the ED. The recommendations will be periodically updated as new relevant evidence is published.


Assuntos
Analgesia/normas , Sedação Consciente/normas , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/normas , Pediatria/normas , Humanos , Itália
7.
Intensive Crit Care Nurs ; 60: 102879, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32448630

RESUMO

INTRODUCTION: Enhanced clinical outcomes in the Paediatric Intensive Care Unit following standardisation of analgesia and sedation practice are reported. Little is known about the impact of standardisation of analgesia and sedation practice including incorporation of a validated distress assessment instrument on infants post cardiac surgery, a subset of whom have Trisomy 21. This study investigated whether the parallel introduction of nurse-led analgesia and sedation guidelines including regular distress assessment would impact on morphine administered to infants post cardiac surgery, and whether any differences observed would be amplified within the Trisomy 21 population. METHODOLOGY: A retrospective single centre before/after study design was used. Patients aged between 44 weeks postconceptual age and one year old who had open cardiothoracic surgery were included. RESULTS: 61 patients before and 64 patients after the intervention were included. After the intervention, a reduction in the amount of morphine administered was not evident, while greater use of adjuvant sedatives and analgesics was observed. Patients with Trisomy 21 had a shorter duration of mechanical ventilation after the change in practice. CONCLUSION: The findings from this study affirm the importance of the nurses' role in managing prescribed analgesia and sedation supported by best available evidence. A continued education and awareness focus on analgesia and sedation management in the pursuit of best patient care is imperative.


Assuntos
Analgesia/enfermagem , Sedação Profunda/métodos , Papel do Profissional de Enfermagem , Analgesia/normas , Analgesia/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/fisiopatologia , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Estudos Retrospectivos
8.
Medicina (Kaunas) ; 56(4)2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32230895

RESUMO

Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0-890.0) µg; FO: 482.8 (305.8-635.0) µg; p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8-803.0) µg). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.


Assuntos
Analgesia/normas , Artroscopia/instrumentação , Adulto , Analgesia/instrumentação , Analgesia/métodos , Análise de Variância , Artroscopia/métodos , Artroscopia/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/normas , Nervo Obturador/efeitos dos fármacos , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Estudos Retrospectivos
9.
J Spec Pediatr Nurs ; 25(3): e12291, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32243076

RESUMO

PURPOSE: Analgesia and sedation protocols are reported to reduce the requirement of sedative and analgesic agents, duration of mechanical ventilation, and length of pediatric intensive care unit (PICU) stay. However, these studies often were conducted based on inhomogeneous cohorts. The aim of this study was the evaluation of a nurse-driven analgesia and sedation protocol in a homogenous population of infants following corrective surgery for tetralogy of Fallot (TOF). DESIGN AND METHODS: This retrospective analysis was conducted in a cardiac PICU of a tertiary referral center. Two cohorts of patients who underwent corrective surgery for TOF below the age of 7 months, were retrospectively evaluated before and after implementation of a nurse-driven analgesia and sedation protocol. We compared peak and cumulative doses of midazolam, morphine, and clonidine, length of PICU stay and time on mechanical ventilation. RESULTS: A total of 33 patients were included in the preimplementation period and 32 during the postimplementation period. Implementation of the nurse-driven analgesia and sedation protocol had no effect on time on mechanical ventilation (72 hr [24-141] vs. 49 hr [24-98]), but significantly on length of PICU stay (7 days [5-14] vs. 5 days [4-7]). Cumulative doses of midazolam (7.37 mg/kg [4.70-17.65] vs. 5.0 mg/kg [2.70-9.12]) as well as peak doses of midazolam (0.22 mg·kg-1 ·hr-1 [0.20-0.33] vs. 0.15 mg·kg-1 ·hr-1 [0.13-0.20]) and morphine (50.0 µg·kg-1 ·hr-1 [39.7-79.9] vs. 42.5 µg·kg-1 ·hr-1 [29.7-51.8]) were significantly reduced. The postimplemantation group showed no increase in postoperative complications and adverse events. PRACTICE IMPLICATIONS: The implementation of a nurse-driven analgesia and sedation protocol is safe in infants following corrective surgery for TOF. It reduces significantly the length of PICU stay, cumulative and peak doses of midazolam and peak doses of morphine.


Assuntos
Analgesia/normas , Anestesia/normas , Benzodiazepinas/normas , Unidades de Terapia Intensiva Pediátrica/normas , Midazolam/normas , Morfina/normas , Dor Pós-Operatória/tratamento farmacológico , Tetralogia de Fallot/cirurgia , Benzodiazepinas/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Midazolam/uso terapêutico , Morfina/uso terapêutico , Manejo da Dor/métodos , Enfermagem Pediátrica/normas , Guias de Prática Clínica como Assunto , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Tetralogia de Fallot/complicações
10.
Orthop Nurs ; 39(1): 37-46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977740

RESUMO

BACKGROUND: Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management. PURPOSE: Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff. METHODS: Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys. RESULTS: Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN. CONCLUSION: Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.


Assuntos
Administração Oral , Analgesia Controlada pelo Paciente/normas , Analgesia/normas , Idoso , Analgesia/métodos , Analgesia Controlada pelo Paciente/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Estudos Prospectivos
11.
Anesthesiology ; 131(6): 1316-1326, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31490292

RESUMO

BACKGROUND: Interscalene brachial plexus block of the C5-C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. METHODS: Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 µg · ml epinephrine around either (1) the C5-C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. RESULTS: Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, -0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. CONCLUSIONS: The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.


Assuntos
Analgesia/métodos , Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Ombro/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Analgesia/normas , Artroscopia/normas , Bloqueio do Plexo Braquial/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Ombro/diagnóstico por imagem , Ultrassonografia de Intervenção/normas
12.
Curr Opin Anaesthesiol ; 32(5): 683-689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389804

RESUMO

PURPOSE OF REVIEW: In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA. RECENT FINDINGS: A number of studies found favorable effects of regional anesthesia used in patients with OSA, including reduced incidence of major perioperative complications such as the need for mechanical ventilation, reintubation and pulmonary/cardiac complications. No negative effects of regional anesthesia specific to patients with OSA were found. Regional anesthesia was most effective when used as a sole technique, but also carried benefits when added to general anesthesia. The majority of available literature focuses on orthopedic surgery and neuraxial anesthesia. SUMMARY: Regional anesthesia can be recommended as a good strategy to treat patients with OSA whenever feasible, as it reduces the incidence of potentially catastrophic perioperative complications. However, the breadth of both surgical and regional anesthetic techniques analyzed is limited; further research should focus on extending the knowledge base beyond neuraxial anesthesia and orthopedics.


Assuntos
Anestesia por Condução/métodos , Manejo da Dor/métodos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Apneia Obstrutiva do Sono/complicações , Analgesia/métodos , Analgesia/normas , Anestesia por Condução/normas , Anestesia Geral/efeitos adversos , Anestesia Geral/normas , Anestesiologia/normas , Humanos , Incidência , Manejo da Dor/efeitos adversos , Manejo da Dor/normas , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
13.
Curr Opin Anaesthesiol ; 32(3): 285-290, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045635

RESUMO

PURPOSE OF REVIEW: The objective of this review is to analyze and summarize the current anesthetic methods used to alleviate pain and discomfort during transvaginal oocyte retrieval procedures (TORP), to try to reach practical recommendations, based on the evidence, which will translate into daily practice, the knowledge on the anesthetic management of patients scheduled for TORP. RECENT FINDINGS: There is no strong evidence to recommend the avoidance of any technique or drug for TORP, including nitrous oxide or halogenated agents. Women should be offered any available technique. The evidence available up to date is not convincing enough to recommend avoiding any anesthetic technique in terms of pregnancy and birth rates. SUMMARY: TORP is painful for women and different techniques may be used for pain relief in day case surgery. The other important outcome to consider is the pregnancy rate, and any anesthetic technique or drug which would improve this pregnancy rate should be recommended. Conscious sedation and general anesthesia proved to be well tolerated for woman and the oocytes, despite the use of propofol, opioids, benzodiacepines, nitrous oxide, or other drugs. Spinal anesthesia and paracervical block are also acceptable options, and can be combined with conscious sedation. Nevertheless, more studies are needed to find out the ideal drug or technique combination for the woman and the oocyte.


Assuntos
Analgesia/normas , Anestesia/normas , Sedação Consciente/normas , Recuperação de Oócitos/efeitos adversos , Dor/prevenção & controle , Analgesia/efeitos adversos , Analgesia/métodos , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anestesia/efeitos adversos , Anestesia/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Feminino , Humanos , Recuperação de Oócitos/métodos , Dor/etiologia , Guias de Prática Clínica como Assunto , Resultado do Tratamento
14.
Rev. bras. enferm ; 72(supl.3): 170-177, 2019. tab
Artigo em Inglês | BDENF - Enfermagem, LILACS | ID: biblio-1057700

RESUMO

ABSTRACT Objective: To identify the procedures considered painful and stressful by health professionals from a neonatal intensive care unit and check the measures of analgesia. Method: Descriptive exploratory quantitative study with 65 health professionals, from November 2016 to February 2017. Results: The procedures considered painful were removal of adhesives, vein, arterial and lumbar puncture, phlebotomy, and thoracic drainage. Oral suctioning, intravenous catheter removal and tracheal extubation were considered stressful. Fentanyl was the most cited pharmacological measure, and restraint and nonnutritive suction were the most used nonpharmacological measures. Conclusion: Professionals were able to classify the painful and stressful procedures; however, low use of measures for analgesia was evidenced.


RESUMEN Objetivo: Identificar los procedimientos considerados dolorosos y estresantes por los profesionales de salud en una unidad de cuidados intensivos neonatal y verificar las medidas de analgesia utilizadas. Método: Estudio descriptivo, exploratorio, de abordaje cuantitativo, con una muestra de 65 profesionales de salud, realizado en el período de noviembre de 2016 a febrero de 2017. Resultados: Los procedimientos considerados dolorosos fueron la retirada de adhesivos, la punción venosa, arterial y lumbar, la flebotomía y el drenaje torácico. Ya los considerados estresantes fueron la aspiración oral, la retirada del catéter intravenoso y la extubación traqueal. La medida farmacológica más citada fue el fentanilo; y las medidas no farmacológicas más utilizadas fueron la contención y la succión no nutritiva. Conclusión: Los profesionales pudieron clasificar los procedimientos en dolorosos y estresantes, sin embargo, se evidenció la baja utilización de medidas para analgesia.


RESUMO Objetivo: Identificar os procedimentos considerados dolorosos e estressantes pelos profissionais de saúde de uma unidade de terapia intensiva neonatal e verificar as medidas de analgesia. Método: Estudo descritivo, exploratório, com abordagem quantitativa, com amostra de 65 profissionais de saúde, no período de novembro de 2016 a fevereiro de 2017. Resultados: Os procedimentos considerados dolorosos foram a retirada de adesivos, a punção venosa, arterial e lombar, a flebotomia e a drenagem torácica. A aspiração oral, a retirada de cateter intravenoso e a extubação traqueal foram consideradas estressantes. O fentanil foi a medida farmacológica mais citada e a contenção e sucção não nutritiva as medidas não farmacológicas mais utilizadas. Conclusão: Os profissionais souberam classificar os procedimentos em dolorosos e estressantes, entretanto, foi evidenciada a baixa utilização de medidas para analgesia.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Adulto , Dor/etiologia , Percepção , Estresse Psicológico/etiologia , Pessoal de Saúde/psicologia , Analgesia/normas , Dor/tratamento farmacológico , Estresse Psicológico/tratamento farmacológico , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Analgesia/métodos , Analgesia/psicologia , Pessoa de Meia-Idade
15.
Medicine (Baltimore) ; 97(50): e13583, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558026

RESUMO

INTRODUCTION: The aim of this systematic review is to investigate the effects of perioperative intravenous administration of MgSO4 on postoperative pain, analgesic consumption and adverse effects in patients undergoing orthopedic surgery. METHODS: Two investigators independently searched for articles on randomized controlled trials (RCTs) from 1998 to 2016 in Pubmed, Web of science and Google scholar. We evaluated clinical outcomes, comparing postoperative pain scores, cumulative analgesic consumption, time to first analgesia, and adverse effects between orthopedic surgery patients with and without the administration of MgSO4. RESULTS: After screening 2350 articles, 11 RCTs (with a total sample size of 535 subjects) were included in this systematic review. Perioperative intravenous administered MgSO4 could reduce postoperative pain intensity compared with control in 6 trials (55%), but without significant difference in 5 trials (45%). With MgSO4 treatments, postoperative analgesic consumption was significantly reduced in 8 trials (73%), and without significant difference in 2 trials (18%). Two trials evaluated the time to first request of analgesic after surgery and showed prolong of 2.3 hours and 93 minutes respectively. MgSO4 group had less postoperative nausea (relative risk [RR] = 0.32, 95% confidence interval [CI] = 0.12-0.82, number needed to harm [NNH] = 8.8), vomiting (RR = 0.38, 95% CI = 0.15-0.92, NNH = 9.7), and shivering (RR = 0.31, 95% CI = 0.11-0.88, NNH = 5.2). CONCLUSION: Perioperative intravenous administration of MgSO4 in orthopedic surgery could reduce postoperative analgesic consumption and adverse effects such as vomiting, nausea, and shivering. These trials do not provide convincing evidence of beneficial effects on postoperative pain intensity and the time to first analgesic request. More trials should be conducted for the roles of MgSO4 in pain management for orthopedic surgery. However, intravenous MgSO4 administration should be considered as a strategy to relieve postoperative pain in orthopedic surgery patients.


Assuntos
Analgesia/normas , Sulfato de Magnésio/efeitos adversos , Procedimentos Ortopédicos/normas , Administração Intravenosa , Analgesia/métodos , Humanos , Sulfato de Magnésio/uso terapêutico , Procedimentos Ortopédicos/métodos , Medição da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Theor Med Bioeth ; 39(3): 211-220, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30078061

RESUMO

This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (a) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (b) whether unconsciousness can ever be a good for a human being; and (c) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases.


Assuntos
Sedação Profunda/ética , Cuidados Paliativos/ética , Conforto do Paciente/métodos , Analgesia/normas , Sedação Profunda/métodos , Humanos , Cuidados Paliativos/métodos , Conforto do Paciente/ética
17.
J Surg Res ; 228: 160-169, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29907207

RESUMO

BACKGROUND: Although evidence-based guidelines recommend a multimodal approach to pain management, limited information exists on adherence to these guidelines and its association with outcomes in a generalized population. We sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. METHODS: We evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). Multimodal analgesia at discharge was characterized as opioids in combination with acetaminophen (O + A) and nonsteroidal antiinflammatory (O + A + N) drugs. Hierarchical models estimated associations of analgesia with 45-d follow-up pain scores and 30-d readmissions. RESULTS: We identified 7893 patients at AH and 34,581 at VHA. In both settings, most patients were discharged with O + A (60.6% and 54.8%, respectively), yet a significant proportion received opioids alone (AH: 24.3% and VHA: 18.8%). Combining acetaminophen with opioids was associated with decreased follow-up pain in VHA (Odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.79, 0.93) and readmissions (AH OR: 0.74, CI: 0.60, 0.90; VHA OR: 0.89, CI: 0.82, 0.96). Further addition of nonsteroidal antiinflammatory drugs was associated with further decreased follow-up pain (AH OR: 0.71, CI: 0.53, 0.96; VHA OR: 0.77, CI: 0.69, 0.86) and readmissions (AH OR: 0.46, CI: 0.31, 0.69; VHA OR: 0.84, CI: 0.76, 0.93). In both systems, patients receiving multimodal analgesia received 10%-40% less opioids per day compared to opioids only. CONCLUSIONS: A majority of surgical patients receive a multimodal pain approach at discharge yet many receive only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.


Assuntos
Analgesia/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Analgesia/normas , Analgesia/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento
18.
Eur J Anaesthesiol ; 35(1): 6-24, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28877145

RESUMO

: Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts.These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication.


Assuntos
Analgesia/normas , Anestesiologia/normas , Sedação Consciente/normas , Manejo da Dor/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Adulto , Analgesia/métodos , Anestesiologia/métodos , Sedação Consciente/métodos , Europa (Continente) , Humanos , Manejo da Dor/métodos
19.
Pain Manag ; 7(6): 513-522, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28793825

RESUMO

Improvement in postoperative pain management remains a global concern with a significant unmet need for patients. This was the focus of a 'Change Pain' session at the 35th European Society of Regional Anesthesia meeting (Maastricht, September 2016). Awareness of the size and nature of the problem is important to improve postoperative pain management strategies. Optimal treatment of acute pain should aim to avoid long-term sequelae such as the development of chronic pain disorders (e.g., phantom limb pain). Cases highlighting unsuccessful and successful strategies to manage individuals undergoing surgery were presented. The benefits of personalized care, encouraging patients to be more involved in decisions regarding their treatment and their preferred clinical outcomes were discussed and considered to be a step forward in acute pain management.


Assuntos
Dor Aguda/terapia , Manejo da Dor/normas , Dor Pós-Operatória/terapia , Analgesia/normas , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Manejo da Dor/métodos , Medicina de Precisão , Sociedades Médicas
20.
Anesthesiol Clin ; 35(2): e115-e143, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28526156

RESUMO

Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.


Assuntos
Analgesia/métodos , Anestesia por Condução/métodos , Anestesia Geral/métodos , Manejo da Dor/métodos , Guias de Prática Clínica como Assunto , Analgesia/normas , Período de Recuperação da Anestesia , Humanos , Dor Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Sociedades Médicas , Estresse Fisiológico
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