Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Intubação Intratraqueal/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Aerossóis , COVID-19 , Tosse/virologia , Filtração , Pessoal de Saúde , Humanos , VentilaçãoAssuntos
Anemia Falciforme/tratamento farmacológico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Hemorragias Intracranianas/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico por imagem , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Transtornos da Coagulação Sanguínea/etiologia , Criança , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologiaRESUMO
Retrograde intubation is part of the difficult airway algorithm in the American Society of Anesthesiologists, but its usage is rare in small pediatric patients with the advent of new intubation techniques. We present our experience of retrograde intubation for a 4-month-old patient who presented for laryngeal cleft repair on cardiopulmonary bypass. This case highlights the unique place for retrograde intubation in small patients in the current era.
Assuntos
Ponte Cardiopulmonar/métodos , Anormalidades Congênitas/cirurgia , Intubação Intratraqueal/métodos , Humanos , Lactente , Laringe/anormalidades , Laringe/cirurgia , MasculinoAssuntos
Anestesia , Parada Cardíaca/etiologia , Transplante de Coração/métodos , Bloqueio Neuromuscular/métodos , Bloqueadores Neuromusculares/antagonistas & inibidores , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inibidores da Colinesterase/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Sistema Nervoso Parassimpático/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge. METHODS: Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study. The control group (n = 30) received intermittent doses of fentanyl, the esmolol group (n = 30) received a continuous infusion of esmolol (5-15 microg x kg(-1) x min(-1)) and no supplemental opioids during surgery, and the remifentanil group (n = 30) received a continuous infusion of remifentanil (0.1-0.5 mixrog x kg(-1) x min(-1)). General anesthesia was standardized, and adjuvant medications included acetaminophen, ketorolac, local anesthetics in the skin incisions, dexamethasone, and droperidol. Postoperative analgesia included fentanyl. RESULTS: The amount of fentanyl in the postanesthesia care unit was significantly less in the esmolol group, 91.5 +/- 42.7 microg, compared with the other two groups, remifentanil, 237.8 +/- 54.7 microg, control, 168.1 +/- 96.8 microg (P < 0.0001). The incidence of nausea was more frequent in the control (66.7%) and remifentanil (67.9%) groups compared with the esmolol group (30%) (P < 0.01). The esmolol group reached the White-Song score of 12 of 14 faster than the remifentanil group (P < 0.01), and left the hospital 45-60 min earlier (P < 0.004). CONCLUSIONS: Intraoperative IV infusion of esmolol contributes to a significant decrease in postoperative administration of fentanyl and ondansetron and facilitates earlier discharge.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos Opioides/administração & dosagem , Colecistectomia Laparoscópica , Fentanila/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Propanolaminas/administração & dosagem , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: To assess which measurements best predict improvement on ADHD symptomatology after medication is given. METHODS: 147 children aged 6 to 12 years, diagnosed with ADHD, participated in a double-blind placebo controlled twoweek crossover trial of methylphenidate. RESULTS: There were statistically significant differences on all measures between placebo and medication. Effect size for the overall group was 0.33 (CGI-P), 0.80 (CGI-T), 1.33 (CGI), 0.56 (CPT), 0.82 (RASS). CONCLUSIONS: Acute behavioural response measures, where children are observed by clinicians (RASS and CGI), were overall more reliable than parent reports in detecting improvement on ADHD symptomatology. Teacher reports were also very important, especially in the 9 to 12 year old group.