ABSTRACT
A ansiedade desempenha um papel significativo na experiência de tratamentos odontológicos e pode resultar em evasão por parte dos pacientes. Isso é especialmente relevante para grupos como pacientes pediátricos e aqueles com necessidades especiais, que muitas vezes requerem técnicas de controle de comportamento ou sedação devido à ansiedade. No entanto, a ansiedade não deve ser negligenciada mesmo em pacientes sem odontofobia grave, pois está relacionada à percepção da dor durante os procedimentos odontológicos. A sedação consciente com óxido nitroso surge como uma alternativa valiosa para reduzir a ansiedade e melhorar o conforto do paciente. Ao contrário dos benzodiazepínicos e da anestesia geral, o óxido nitroso atua no sistema nervoso de uma forma que deprime levemente o córtex cerebral, sem afetar o centro respiratório. Isso permite o uso de concentrações subanestésicas do gás, administradas com oxigênio por meio de uma máscara nasal. O óxido nitroso é de rápida ação, pouco solúvel e tem um período de recuperação breve, permitindo que os pacientes retornem rapidamente às atividades normais. Este estudo, uma revisão de literatura, explora o mecanismo de ação do óxido nitroso, suas indicações na prática odontológica e examina possíveis riscos e contraindicações associados ao seu uso. Em resumo, a sedação consciente com óxido nitroso se mostra como uma opção promissora para aliviar a ansiedade e melhorar a experiência de tratamentos odontológicos, beneficiando uma ampla gama de pacientes, não apenas aqueles com fobias graves.
Anxiety, in an outpatient dental environment, plays a fundamental role in pain and discomfort expectation, resulting in increase of treatment evasion. The groups that present greater difficulty in cooperation are children and special needs patients, with behavioral control and sedation being often necessary. Nevertheless, literature emphasizes that anxiety must be evaluated as a critical stage and its management done not only in patients with elevated anxiety levels, but being crucial on pain control of every dental patient, since higher grades of restlessness equals higher pain perception. It is known that the use of nitrous oxide in conscious sedation proves to be an useful tool on reducing anxiety and enabling comfortable interventions, indicating that it is an alternative to the use of benzodiazepines and general anesthesia. The drug acts on the nervous system, promoting a slight depression of the cerebral cortex and, unlike benzodiazepines, which act at the medulla level, it does not depress the respiratory center. The technique uses sub-anesthetic concentrations of nitrous oxide delivered with oxygen through a nasal mask. Nitrous oxide is poorly soluble and has a rapid onset of action, being therefore associated with a rapid recovery period. The duration of sedation is controlled and the patient can quickly return to normal activities. This paper is a narrative review with the objective of exploring the mechanism of action of this gas, evaluating its indications for use in dental clinic and verifying possible risks and contraindications.
Subject(s)
Conscious Sedation , Dental Anxiety , Dental Clinics , Analgesia , Nitrous OxideABSTRACT
: La colecistectomía es una intervención quirúrgica que se realiza para extraer una vesícula biliar patológica. El postquirúrgico genera dolor en su periodo inmediato. La infiltración de la pared abdominal en los sitios de inserción de los trocares con anestésicos locales con aguja intramuscular al comienzo de la cirugía es una práctica que se realiza de manera rápida y segura. Lugar de Aplicación: Servicio de Cirugía General. Sala 3/5. Hospital Nacional de Clínicas. UNC. Córdoba. Material y Métodos: Se realizó un estudio entre julio del 2022 a julio 2023. Fueron operados 50 pacientes, entre 18 y 80 años de colecistectomías laparoscópicas. De ellos, 17 eran masculinos y 33 femeninos. El estudio fue comparar el dolor postquirúrgico en pacientes con infiltración y sin infiltración peritoneal. Determinar en cuantos pacientes se presentó dolor en el lugar del trocar umbilical y en zona de drenaje si se les coloco. Valorar en que tiempo del postquirúrgico inmediato es más efectiva la analgesia. Resultados: Los pacientes que sí fueron infiltrados corresponden al 44%. Estos con infiltración presentan menor proporción de dolor inmediato, y la relación entre las variables es estadísticamente significativa (p<0,05). Además, los pacientes con infiltración presentan menor proporción de dolor a la semana postquirúrgica, y menor proporción de consumo de AINES. Así mismo presentan menor proporción de dolor en trocar, como menor proporción de dolor en zona de drenaje. Conclusión: Podemos concluir que la infiltración de los orificios de trocares antes de la incisión de piel es una práctica útil que debería ser sistemática para mejorar el dolor postquirúrgico del paciente y en consecuencia su recuperación postquirúrgica más rápida
Cholecystectomy is a surgical procedure performed to remove a pathological gallbladder. The post-surgical period generates pain in its immediate period. Infiltration of the abdominal wall at trocar insertion sites with intramuscular needle local anesthetics at the beginning of surgery is a practice that is performed quickly and safely. Desing: General Surgery Service. Room 3/5. National Hospital of Clinics. UNC. Córdoba. Methods: A study was conducted between July 2022 and July 2023. 50 patients were operated on, between 18 and 80 years of laparoscopic cholecystectomies. Of these, 17 were male and 33 females. The study was to compare postoperative pain in patients with and without peritoneal infiltration. To determine how many patients had pain at the site of the umbilical trocar and in the drainage area if they were placed. To assess at what time of the immediate postoperative period analgesia is most effective. Results: The patients who were infiltrated correspond to 44%. Those with infiltration have a lower proportion of immediate pain, and the relationship between the variables is statistically significant (p<0.05). In addition, patients with infiltration have a lower proportion of pain at the postoperative week, and a lower proportion of NSAID consumption. They also have a lower proportion of pain in the trocar, as well as a lower proportion of pain in the drainage area. Conclusion: We can conclude that the infiltration of the trocar orifices before the skin incision is a useful practice that should be systematic to improve the patient's postoperative pain and consequently their faster postoperative recovery
Subject(s)
Pain, Postoperative/therapy , Peritoneum , Cholecystectomy, Laparoscopic , Analgesia , Anesthesia, Local/methodsABSTRACT
El dolor crónico posterior a cirugía torácica es una entidad frecuente, pudiendo llegar a afectar a un 60% de los pacientes sometidos a este tipo de cirugías, con el consiguiente deterioro en su calidad de vida. El principal factor de riesgo para la aparición de éste es la presencia y severidad del dolor agudo postquirúrgico; por lo cual, es de vital importancia la prevención y el tratamiento eficaz de este último. Es por esta razón que la implementación de estrategias para el manejo del dolor agudo, tales como la analgesia multimodal y la analgesia preventiva, juegan un rol importante en el manejo de estos pacientes. Dentro del manejo podemos destacar también el uso de técnicas de analgesia neuroaxial, como la analgesia epidural torácica y técnicas de analgesia regionales, como el bloqueo paravertebral, bloqueos intercostales y los bloqueos del plano o miofascial. La analgesia regional ha cobrado gran interés en los últimos años debido a una eficacia comparable a la anestesia epidural torácica, pero con menos efectos adversos y complicaciones. Finalmente, el uso adecuado y criterioso de las técnicas antes señaladas permitirán un manejo exitoso de nuestros pacientes.
Chronic pain after thoracic surgery is a frequent entity, affecting up to 60% of patients undergoing this type of surgery, with the consequent deterioration in their quality of life. The main risk factor for the appearance of this is the presence and severity of acute post-surgical pain; Therefore, the prevention and effective treatment of the latter is of vital importance. For this reason, the implementation of strategies for the management of acute pain, such as multimodal analgesia and preventive analgesia, play an important role in the management of these patients. Within management we can also highlight the use of neuraxial analgesia techniques, such as thoracic epidural analgesia and regional analgesia techniques such as paravertebral block, intercostal blocks and plane or myofascial blocks. Regional analgesia has gained great interest in recent years due to efficacy comparable to thoracic epidural anesthesia, but with fewer adverse effects and complications. Finally, the proper and judicious use of the techniques will allow a successful management of our patients.
Subject(s)
Humans , Pain, Postoperative/drug therapy , Pain, Postoperative/therapy , Chest Pain/drug therapy , Chest Pain/therapy , Analgesia , Thoracic SurgeryABSTRACT
OBJETIVO: Verificar qual o tratamento mais indicado para a prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes por meio de uma revisão sistemática da literatura mundial. MÉTODO: A revisão sistemática será conduzida conforme a metodologia PRISMA e Cochrane, com registro no PROSPERO, sob o número de ID CRD42021274670, nas respectivas bases de dados PubMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review e CENTRAL. As buscas serão realizadas por dois avaliadores independentes, um terceiro realizará o intermédio se necessário. Os dados serão inseridos no programa de software Zotero que irá excluir os artigos duplicados, após o material selecionado será transferido para planilha Excel em instrumento próprio. Os estudos serão classificados quanto ao seu nível de evidência, viés e fator de risco. Os resultados serão analisados e tabulados e discutidos a fim de melhor compreensão dos resultados. Se possível, serão realizadas meta-análises para os resultados agregados.
OBEJECTIVE: To verify the most appropriate treatment for the prevention and reduction of the signs and symptoms of abstinence in critically ill children through a systematic review of the world literature. METHOD: The systematic review will be conducted according to the PRISMA and Cochrane methodology, with registration at PROSPERO, under the ID number CRD42021274670, in the respective databases, PUBMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review, and CENTRAL, searches will be carried out by two independent evaluators, and a third party will perform the intermediate if necessary. The data will be entered into the Zotero software program that will delete duplicate articles after the selected material is transferred to an Excel spreadsheet on its instrument. The studies will be classified according to their level of evidence, bias, and risk factors. The results will be analyzed, tabulated, and discussed to understand the results better. If possible, meta-analyzes will be carried out for the aggregated results.
Subject(s)
Humans , Child , Substance Withdrawal Syndrome , Intensive Care Units, Pediatric , Child Health , Critical Illness , Systematic Reviews as Topic , AnalgesiaABSTRACT
INTRODUCTION@#The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA).@*METHODS@#A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured.@*RESULTS@#Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups.@*CONCLUSION@#Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.
Subject(s)
Humans , Male , Female , Tranexamic Acid/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Antifibrinolytic Agents/adverse effects , Retrospective Studies , Postoperative Hemorrhage , Blood Loss, Surgical/prevention & control , Administration, Intravenous , Analgesia , Analgesics/therapeutic use , Pain, Postoperative/drug therapy , Injections, Intra-ArticularABSTRACT
Abstract Objective To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI). Materials and Methods A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use. Results There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group (p = 0.04 and p = 0.02 respectively). Conclusion We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.
Resumo Objetivo Avaliar pacientes submetidos a artroplastia total do joelho (ATJ) sob raquianestesia e bloqueio do nervo femoral (BNF) único e comparar com pacientes que submetidos a ATJ sob raquianestesia e infiltração periarticular (IPA). Materiais e Métodos Um total de 100 pacientes submetidos a ATJ foram randomizados em dois grupos. O grupo 1 incluiu pacientes submetidos a ATJ sob BNF associado à raquianestesia, ao passo que o grupo 2 incluiu pacientes submetidos a ATJ sob IPA associada à raquianestesia. Os indivíduos foram avaliados no pós-operatório precoce quanto à dor, à flexão e extensão ativas, à elevação do membro estendido e ao uso de morfina. Resultados Não se observou diferença significativa associada ao tipo de analgesia em relação à dor, à elevação do membro em extensão e ao consumo de morfina. Houve melhor flexão e extensão ativas no grupo que recebeu IPA (p = 0,04 e p = 0,02, respectivamente). Conclusão Concluímos que as técnicas utilizadas são semelhantes quanto ao controle da dor, à elevação de membro e ao uso de morfina. O uso de IPA proporcionou uma melhor flexão e extensão ativas durante o período de internação hospitalar comparado ao uso de BNF único em pacientes submetidos a ATJ.
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Femoral Nerve , Analgesia , Anesthesia, Local , Nerve BlockABSTRACT
Abstract Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p< 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p< 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.
Resumo Objetivos Este estudo avaliou a intensidade da dor em idosos acometidos por fratura do quadril internados no setor de emergência e submetidos ao Pericapsular Nerve Group (PENG) block no pré-operatório. Ademais, o grau de flexão tolerável do quadril foi avaliado. Métodos Ensaio clínico, prospectivo, aleatorizado e controlado em grupos paralelos. O grupo controle consiste em idosos com fratura do quadril, submetidos à analgesia sistêmica endovenosa padronizada. O grupo intervenção consiste em idosos com fratura do quadril submetidos ao PENG block e analgesia sistêmica padronizada. Os grupos foram avaliados em repouso e durante o movimento pela escala de dor Pain Assessment in Advance Dementia (PAINAD). Aferiram-se intensidade da dor e redução álgica, assim como o grau de flexão tolerável do quadril fraturado. Todos os pacientes foram avaliados previamente à administração de medicação ou bloqueio e aos 45 minutos, 12, 24 e 36 horas pós-medicação ou bloqueio. Resultados No pré-operatório e 24 horas após o PENG block, idosos com fratura do quadril apresentaram redução significativa da dor em repouso ou movimento em comparação com o controle (p< 0,05), com 60% dos pacientes avaliados em repouso, demonstrando a redução álgica desejável de ≥ 50% e apenas 13,3% do grupo controle com redução álgica desejável. Durante o movimento, após o PENG block, 40% demonstraram redução álgica desejada e nenhum paciente do grupo controle apresentou a redução desejada. Verificou-se, também, no grupo intervenção a melhora significativa da flexão tolerável do quadril (p < 0,05). Conclusão O PENG block no pré-operatório de idosos com fratura do quadril, internados no setor de emergência, proporcionou redução significativa da dor em comparação ao grupo controle.
Subject(s)
Humans , Aged , Aged, 80 and over , Pain , Hip Fractures/surgery , Hip Fractures/diagnostic imaging , Analgesia , Anesthesia, Conduction , Nerve BlockSubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Breast Feeding , Pain Management , AnalgesiaABSTRACT
La estenosis laríngea es una de las causas más habituales de obstrucción de la vía aérea superior en pediatría. La estenosis laríngea congénita es la tercera anormalidad congénita laríngea más frecuente, luego de la laringomalacia y la parálisis cordal. El diagnóstico se sustenta en la clínica del paciente, la evaluación radiológica, la laringoscopía flexible y la endoscopía rígida de la vía aérea bajo anestesia general. Describimos un caso de estenosis laríngea congénita de presentación atípica con un pólipo en línea media, predominando la disfonía en lugar de la obstrucción respiratoria.
Laryngeal stenosis is one of the most frequent causes of airway obstruction in pediatrics. Congenital laryngeal stenosis is the third most common laryngeal congenital abnormality, after laryngomalacia and cord paralysis. The diagnosis is based on the patient's symptoms, radiological evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. We describe a case of congenital laryngeal stenosis with atypical presentation with a midline polyp, predominating dysphonia instead of respiratory obstruction.
A estenose laríngea é uma das causas mais comuns de obstrução das vias aéreas superiores em pediatria. A estenose laríngea congênita é a terceira anomalia laríngea congênita mais comum, depois da laringomalácia e da paralisia cordal. O diagnóstico é baseado nos sintomas clínicos do paciente, avaliação radiológica, laringoscopia flexível e endoscopia rígida das vias aéreas sob anestesia geral. Descrevemos um caso de estenose laríngea congênita de apresentação atípica com pólipo mediano, predominando disfonia e não obstrução respiratória.
Subject(s)
Humans , Infant, Newborn , Laryngostenosis/diagnostic imaging , Laryngostenosis/complications , Laryngostenosis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Dysphonia/etiology , Dysphonia/drug therapy , AnalgesiaABSTRACT
Apesar dos α-2 agonistas serem utilizados para sedação e analgesia de ruminantes, particularmente em ovinos, alguns efeitos adversos graves podem limitar o uso destes fármacos na espécie. Considerando as particularidades da espécie e a necessidade de analgesia e sedação tanto para procedimentos veterinários como para experimentos em biomedicina, faz-se necessário compreender os diferentes efeitos adversos que esta classe pode gerar em ovinos. Desta forma, o presente estudo objetivou realizar uma revisão bibliográfica sobre os efeitos adversos dos α-2 agonistas em ovinos, bem como estratégias que podem ser adotadas para uma sedação mais segura. Os principais α-2 agonistas utilizado em ovinos nos estudos científicos foram xilazina, romifidina, detomidina, medetomidina e dexmedetomidina. Foram abordadas alterações cardiovasculares, respiratórias, gastrointestinais, geniturinárias e hematológicas, e seus mecanismos adjacentes foram discutidos. Os principais efeitos adversos desta classe de fármacos em ovinos incluem: 1) Bradicardia com hipertensão transitória (um a cinco minutos), seguida de hipotensão; 2) Redução das trocas gasosas pulmonares; 3) Hipomotilidade de pré-estômagos e acúmulo excessivo de gás no rúmen; 4) Redução do fluxo uterino e contração uterina nos períodos estrogênicos, além de diurese de baixa densidade; 5) Redução da contagem de plaquetas e redução transitória do hematócrito. Conclui-se que os efeitos hemodinâmicos e respiratórios específicos dos agonistas alfa-2 adrenérgicos em ovinos devem ser cuidadosamente considerados para garantir uma sedação segura. O uso de antagonistas alfa-2 adrenérgicos periféricos atenua os efeitos adversos associados, enquanto a coadministração de opioides pode reduzir a dose sedativa necessária, minimizando assim os potenciais efeitos adversos.(AU)
Although the frequent use of α-2 agonists for sedation and analgesia in ruminants, particularly in sheep some serious side effects may limit the use of these drugs in this species. Considering the particularities of the species and the need for analgesia and sedation for both veterinary procedures and biomedical experiments, it is necessary to understand the different side effects of α-2 agonists in sheep. Thus, this study aimed to review the side effects of α-2 agonists in sheep, as well as strategies that can be adopted for safer sedation. The main α-2 agonists used in sheep in scientific studies were xylazine, romifidine, detomidine, medetomidine and dexmedetomidine. Cardiovascular, respiratory, gastrointestinal, genitourinary and hematologic alterations were addressed, and their underlying mechanisms were discussed. The main adverse effects of this class of drugs in sheep include: 1) Bradycardia with transient hypertension (one to five minutes), followed by hypotension; 2) Impaired pulmonary gas exchange; 3) Hypomotility of forestomachs and excessive gas accumulation in the rumen; 4) Reduction of uterine flow and uterine contraction in estrogenic periods, in addition to low-density diuresis; 5) Reduction of platelet count and transient reduction of packed cell volume. In conclusion, the specific hemodynamic and respiratory effects of alpha-2 agonists in sheep must be carefully considered to ensure safe sedation. The use of peripheral alpha-2 adrenergic antagonists effectively mitigates associated side effects, while co-administration of opioids can reduce the required sedative dose, thereby further minimizing potential adverse effects.(AU)
A pesar del uso de agonistas α-2 para sedación y analgesia en rumiantes, particularmente en ovejas, algunos efectos adversos graves pueden limitar el uso de estos fármacos en la especie. Considerando las particularidades de la especie y la necesidad de analgesia y sedación tanto para procedimientos veterinarios como para experimentos en biomedicina, es necesario comprender los diferentes efectos adversos que esta clase puede generar en los ovinos. Así, el presente estudio tuvo como objetivo realizar una revisión de la literatura sobre los efectos adversos de los agonistas α-2 en ovejas, así como las estrategias que pueden adoptarse para una sedación más segura. Los principales agonistas α-2 utilizados en ovejas en estudios científicos fueron xilazina, romifidina, detomidina, medetomidina y dexmedetomidina. Se abordaron los efectos adversos cardiovasculares, respiratorios, gastrointestinales, genitourinarios y hematológicos y se discutieron sus mecanismos subyacentes. Los principales efectos adversos de esta clase de fármacos en ovejas incluyen: 1) bradicardia con hipertensión transitoria (de uno a cinco minutos), seguida de hipotensión; 2) Reducción del intercambio gaseoso pulmonar; 3) Hipomotilidad de los preestómagos y acumulación excesiva de gases en el rumen; 4) Reducción del flujo uterino y de la contracción uterina durante los períodos estrogénicos, además de la diuresis de baja densidad; 5) Reducción del recuento de plaquetas y reducción transitoria del hematocrito. En conclusión, se deben considerar cuidadosamente los efectos hemodinámicos y respiratorios específicos de los agonistas alfa-2 en ovejas para garantizar una sedación segura. El uso de antagonistas adrenérgicos alfa-2 periféricos mitiga eficazmente los efectos secundarios asociados, mientras que la administración conjunta de opioides puede reducir la dosis sedante necesaria, minimizando así los posibles efectos adversos.(AU)
Subject(s)
Animals , Sheep/physiology , Adrenergic alpha-Agonists/adverse effects , Analgesia/veterinary , Medication ReviewABSTRACT
Introducción: La cefalea postpunción meníngea (CPPM) posterior a la anestesia raquídea es una de las complicaciones más frecuentes asociadas a factores intrínsecos del paciente y de la técnica anestésica. Objetivo: Describir la frecuencia y los factores asociados con el desarrollo de la cefalea postpunción meníngea. Materiales y métodos: Serie retrospectiva de pacientes que ingresaron a un hospital de segundo nivel y se les confirmó el diagnóstico de cefalea secundaria a la anestesia raquídea. Resultados: Serie de 49 casos, 88 % de sexo femenino y 12 % de sexo masculino, con una edad media de 27,7 años. Los procedimientos quirúrgicos con desenlace de CPPM fueron: cirugías de ginecología y obstetricia (63 %), cirugías de urgencias de otras especialidades (28 %) y cirugías electivas (8 %). La técnica anestésica se realizó con agujas biseladas tipo Quincke calibre 25 gauge (G) en 14%, calibre 26 G 33 % y 27 G 53 %. El 51 % se realizó en posición de sedestación y el 49 % en decúbito lateral izquierdo. El 10% de los casos se manejó con parche hemático, en tanto que el antecedente de migraña se presentó en el 8 %. Discusión: En la actualidad, el uso de agujas con diseño de punta cónica es el estándar de oro, ya que permite obtener resultados confiables y disminuye complicaciones como la CPPM. Conclusión: La CPPM luego de una anestesia espinal se relacionó con factores como la edad (joven), el sexo (femenino) y el uso de agujas biseladas. Los otros factores de riesgo identificados fueron poco concluyentes, aunque no se pueden descartar, debido a la naturaleza de este estudio.
Introduction: Post dural puncture headache (PDPH) following spinal anesthesia is one of the most frequent complications associated with intrinsic patient and anesthetic technique factors. Objective: To describe the frequency and associated factors related to the development of PDPH. Materials and methods: Retrospective series of patients admitted to a second level hospital with a confirmed diagnosis of headache secondary to spinal anesthesia. Results: Series of 49 cases, 88 % female and 12 % male, mean age 27.7 years. The surgical procedures resulting in CPPM were gynecology and obstetrics surgeries 63 %, emergency surgeries of other specialties 28 % and elective surgeries 8 %. The anesthetic technique was performed with beveled needles Quincke type 25 gauge (G) in 14 %, 26 G gauge 33% and 27 G 53 %. In the seated position 51 % and in the left lateral decubitus position 49% were performed. A blood patch was used in 10 % of the cases and a history of migraine was present in 8 %. Discussion: The use of needles with conical tip design is currently the gold standard, they give reliable results and reduce complications such as PDPH. Conclusion: PDPH after spinal anesthesia was related to factors such as age (young), sex (female) and the use of traumatic needles. The other risk factors identified were inconclusive, although they cannot be ruled out due to the nature of this study.
Subject(s)
Blood Patch, Epidural , Anesthesia, Obstetrical , Anesthesia, Spinal , AnalgesiaABSTRACT
Introducción: el dolor es "una experiencia sensitiva y emocional desagradable que se asocia a una lesión tisular real o potencial".1 La Organización Mundial de la Salud establece una clasificación del dolor de acuerdo a sus múltiples características. Asimismo, existen distintas escalas validadas a nivel internacional para establecer niveles de dolor. Objetivo: evaluar mediante tres escalas el nivel de dolor de pacientes en estado crítico con ventilación mecánica y protocolo de sedoanalgesia durante la realización de cuatro procedimientos, con el fin de conocer si las medidas analgésicas empleadas son eficientes para mitigarlo o suprimirlo. Material y métodos: se evaluó el nivel de dolor en procedimientos como aspiración de secreciones, movilización, instalación de sondas y catéteres, y curación de heridas. La valoración incluyó la analgesia farmacológica de base y la administrada en bolos, además, se midieron las variables fisiológicas 5 minutos antes, durante y 10 minutos después de la realización de los procedimientos. Las puntuaciones obtenidas se clasificaron conforme tres escalas indicadoras de dolor (BPS, CPOT y ESCID). Resultados: Antes del procedimiento la mayoría de los pacientes tenían una expresión facial relajada (48.4%, n=14), durante, predominó una expresión facial parcialmente contraída (48.3%, n=14), y además se presentaron seis casos en que se observaron muecas de dolor (20.7%). Después del procedimiento la expresión facial de los pacientes volvió a estar en su mayoría relajada (75.9%, n=22). Se observó que los picos de dolor se presentan principalmente durante los procedimientos pese a la administración de medidas farmacológicas; se encontró un comportamiento similar según las escalas ESCID y CPOT. Conclusión: Los procedimientos que con más frecuencia causan dolor son la movilización y aspiración de secreciones; el que produce menos dolor es la instalación de sondas. Las escalas CPOT y ESCID suelen ser más precisas, pues cuentan con una mayor cantidad de categorías de clasificación. La escala BPS contabilizó al total de la muestra como sin dolor, mientras que la CPOT sólo colocó en esta categoría a 18 personas.
Introduction: pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage".1 The World Health Organization has established a classification of pain based on various characteristics. In the same way, there are multiple internationally validated scales to assess and evaluate levels of pain. Objective: to measure the levels of pain in critically ill patients on mechanical ventilation and a sedoanalgesia protocol during four procedures, through the use of three scales to determine the effectiveness of analgesic measures employed to eliminate or alleviate the pain. Material and Methods: the levels of pain were evaluated in procedures such as secretion aspiration, mobilization, installation of tubes and catheters, and wound healing. The assessment included low levels of pharmacological analgesia administered in boluses. Additionally, physiological variables were measured 5 minutes before, throughout, and 10 minutes after the procedures were performed. The obtained scores were classified according to three pain indicator scales (BPS, CPOT, and ESCID). Results: before the procedure, most patients had a relaxed facial expression (48.4%, n=14), throughout it, a partially contracted facial expression predominated (48.3%, n=14), additionally, pain grimaces were observed in six cases (20.7%). After the procedure, the patients' facial expressions returned to being mostly relaxed (75.9%, n=22). It was observed that pain spikes mainly occur during procedures despite pharmacological measures being administered; similar behaviors were found according to ESCID and CPOT scales. Conclusions: the procedures that most frequently cause pain are mobilization and aspiration of secretions; the procedure that produces the lesser levels of pain is the installation of probes. The CPOT and ESCID scales are usually more precise, as they have a greater number of classification categories. The BPS scale evaluated the entire sample as pain-free, while the CPOT only placed 18 people within this category.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pain , Analgesia , Intensive Care UnitsSubject(s)
Humans , Male , Female , Rectal Neoplasms/surgery , Digestive System Surgical Procedures/methods , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/therapy , Patient Care Team , Radiotherapy/methods , Diagnostic Imaging , Colostomy/methods , Biomarkers, Tumor , Survival Analysis , Pelvic Floor/surgery , Disease-Free Survival , Minimally Invasive Surgical Procedures/methods , Drug Therapy/methods , Surgical Clearance , Analgesia/methods , Intraoperative Care , Neoplasm Recurrence, Local/classification , Antineoplastic Agents/therapeutic useABSTRACT
O objetivo do estudo foi determinar dose segura de acepromazina e avaliar sua ação anestésica em conjunto com morfina e/ou butorfanol para a espécie Meriones unguiculatus. Foram utilizados 12 gerbilos machos, que receberam em um estudo piloto doses de acepromazina de 0,5 a 8 mg/kg. Os animais foram avaliados em escala de sedação, em diferentes tempos. O estudo foi delineado como duplo cego, sem que avaliador e aplicador soubessem as doses. Com base na primeira etapa, verificou-se que doses de 5 a 8 mg/kg não se diferenciaram estatisticamente quanto aos efeitos sedativos, entretanto, a partir de 5 mg/kg o tempo de recuperação total aumentou. Na segunda etapa, foi realizada a testagem de 2 ou 4 mg/kg de acepromazina, na qual foram utilizados 10 animais em modo cross-over, que tiveram o grau de sedação e recuperação avaliados. Por fim, na última parte do estudo foi realizado o procedimento de orquiectomia eletiva em 12 animais, que receberam como medicação pré-anestésica acepromazina (2 mg/kg), metade do grupo associado a morfina (n = 6, 2 mg/kg) e a outra a butorfanol (n = 6, 1 mg/kg). Segundo análises estatísticas houve diferença significativa na frequência cardíaca do grupo submetido à morfina, que se mostrou elevada. Não houve diferença no tempo de indução anestésica nem nos demais parâmetros vitais e cirúrgicos entre os grupos. Nenhum dos animais submetidos a qualquer dose utilizada durante o estudo demonstrou quadros de convulsão ou óbito. Definiu-se a partir disso que doses de acepromazina de 2 mg/kg e 4 mg/kg são seguras, atingem um bom grau de sedação e demonstram uma recuperação adequada.
The purpose of the study is to determine a safe dose of acepromazine and evaluate its anesthetic action in conjunction with morphine and butorphanol for the species Meriones unguiculatus. In a pilot study, 12 male gerbils were given doses of acepromazine ranging from 0.5 to 8mg/kg. The animals were evaluated on a sedation scale at different times. The medication was administered in a double-blind manner, without the evaluator and the applicator knowing the doses. Based on this first part of the study, it was found that doses of 5 to 8mg/kg did not differ in terms of sedation, however, with 5mg/kg or above the recovery time increased. After that, acepromazine doses of 2mg/kg and 4mg/kg were tested. 10 animals were used in cross-over mode, and their degree of sedation and recovery were evaluated. The last part of the study consisted of the orchiectomy of 12 animals, which received acepromazine (2mg/kg) as pre-anesthetic medication, half of the group associated with morphine (2mg/kg) and the other with butorphanol (1mg/kg). According to statistical analysis, there was a significant difference in the heart rate of the morphine group, which was high. There was no difference in the anesthetic induction time or the other vital and surgical parameters between groups. None of the animals submitted to any dose used during the study showed convulsionor death. As a conclusion, it was defined that acepromazine doses of 2mg/kg and 4mg/kg are safe, achieve a good degree of sedation and demonstrate adequate recovery.
Subject(s)
Animals , Orchiectomy/veterinary , Gerbillinae/surgery , Analgesia/veterinary , Analgesics, Opioid/administration & dosage , Anesthesiology/methods , Acepromazine/administration & dosageABSTRACT
Una deficiente calidad del manejo del dolor post operatorio agudo genera aumento en la morbilidad perioperatoria, disminuye la calidad de vida del paciente, aumenta los reingresos hospitalarios y, finalmente, los costes en salud. La analgesia preventiva y multimodal son dos estrategias que han sido implementadas para tratar de optimizar el manejo del dolor. Si bien en la primera, la evidencia es favorable a su empleo, aún no existe un total consenso en esto. A su vez, la analgesia multimodal, al emplear diferentes fármacos y/o técnicas, ha logrado evidenciar de mejor manera su utilidad y los beneficios al implementarla como terapia. En este artículo, revisamos la evidencia que certifica y avala el uso de éstas. Finalmente, a nuestro parecer, lo más importante en el quehacer del clínico, es lograr individualizar la estrategia que usaremos en el manejo del dolor postoperatorio, adaptándonos a las necesidades y el contexto propio de cada uno de nuestros pacientes.
A poor quality of acute postoperative pain management generates an increase in perioperative morbidity, decreases the quality of life of the patient, increases hospital readmissions and finally, increases health costs. Preventive and multimodal analgesia are two strategies that are implemented to try to optimize pain management. Although in the first, the evidence is favorable to its use, there is still no total consensus. At the same time, multimodal analgesia, by using different drugs and/or techniques, has demonstrated, in a better way, its usefulness and benefits when implemented as a therapy. In this article, we review the evidence that certifies and supports the use of these techniques. Finally, in our opinion, the most important thing in the clinician's task is to be able to individualize the strategy that we will use in postoperative pain management, adapting to the needs and context of each one of our patients.
Subject(s)
Humans , Pain, Postoperative/drug therapy , Analgesia/methods , Quality of LifeABSTRACT
Introducción. La adecuada sedación y analgesia es fundamental en el tratamiento de pacientes que requieren asistencia ventilatoria mecánica (AVM). Se recomienda la utilización de protocolos y su monitoreo; son dispares los resultados reportados sobre adhesión e impacto. Objetivos. Evaluar el impacto de la implementación de un protocolo de sedoanalgesia sobre el uso de benzodiacepinas, opioides y evolución en la unidad de cuidados intensivos pediátricos (UCIP), en pacientes que requieren AVM mayor a 72 horas. Métodos. Estudio tipo antes-después, no controlado, en la UCIP de un hospital pediátrico. Se desarrolló en 3 etapas: preintervención de diagnóstico situacional (de abril a septiembre de 2019), intervención y posintervención de implementación del protocolo de sedoanalgesia, educación sobre uso y monitorización de adherencia y su impacto (de octubre de 2019 a octubre de 2021). Resultados. Ingresaron al estudio 99 y 92 pacientes en las etapas pre- y posintervención, respectivamente. Presentaron mayor gravedad, menor edad y peso en el período preintervención. En la comparación de grupos, luego de ajustar por gravedad y edad, en la etapa posintervención se reportó una reducción en los días de uso de opioides en infusión continua (6 ± 5,2 vs. 7,6 ± 5,8; p = 0,018) y los días de uso de benzodiacepinas en infusión continua (3,3 ± 3,5 vs. 7,6 ± 6,8; p = 0,001). No se observaron diferencias significativas en los días de AVM y en los días totales de uso de benzodiacepinas. Conclusión. La implementación de un protocolo de sedoanalgesia permitió reducir el uso de fármacos en infusión continua.
Introduction. Adequate sedation and analgesia is essential in the management of patients requiring mechanical ventilation (MV). The implementation of protocols and their monitoring is recommended; mixed results on adherence and impact have been reported. Objectives. To assess the impact of the implementation of a sedation and analgesia protocol on the use of benzodiazepines, opioids, and evolution in the pediatric intensive care unit (PICU) in patients requiring MV for more than 72 hours. Methods. Before-and-after, uncontrolled study in the PICU of a children's hospital. The study was developed in 3 stages: pre-intervention for situational diagnosis (from April to September 2019), intervention, and post-intervention for implementation of a sedation and analgesia protocol, education on use, and monitoring of adherence and impact (from October 2019 to October 2021). Results. A total of 99 and 92 patients were included in the study in the pre- and post-intervention stages, respectively. Patients had a more severe condition, were younger, and had a lower weight in the preintervention period. After adjusting for severity and age, the group comparison in the post-intervention stage showed a reduction in days of continuous infusion of opioids (6 ± 5.2 versus 7.65.8, p = 0.018) and days of continuous infusion of benzodiazepines (3.3 ± 3.5 versus 7.6 ± 6.8, p = 0.001). No significant differences were observed in days of MV and total days of benzodiazepine use. Conclusion. The implementation of a sedation and analgesia protocol resulted in a reduction in the use of continuous infusion of drugs.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Analgesia , Analgesics, Opioid , Pain , Respiration, Artificial/methods , Benzodiazepines/therapeutic use , Intensive Care Units, Pediatric , Hypnotics and SedativesABSTRACT
La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.
Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.
Subject(s)
Humans , Male , Adult , Middle Aged , Anal Canal , Anus Diseases , Pruritus Ani , Colorectal Surgery , Fissure in Ano/surgery , Quality of Life , Proctoscopy , Diet , Ecuador , Lateral Internal Sphincterotomy , Hemorrhage , AnalgesiaABSTRACT
Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.
Subject(s)
Humans , Brachial Plexus Block/methods , Analgesia , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Shoulder/surgery , Ultrasonography, Interventional/methods , Catheters , Ropivacaine , Anesthetics, LocalABSTRACT
Objetivo: descrever a percepção dos cuidadores frente a dor pós-operatória pediátrica e cuidados de enfermagem. Método: estudo descritivo, realizado na Unidade de Pediatria de um Hospital Universitário no Paraná com dados coletados mediante formulário sociodemográfico e questionário de Dor de MCGill-Melzack adaptado e análise a partir de estatística descritiva. Resultados: participaram do estudo 24 cuidadores de crianças submetidas a intervenções cirúrgicas, predominantemente, mulheres (22), preponderando as crianças do sexo masculino. Os resultados apresentaram maior utilização de dipirona como analgesia (50%), tendo a maioria dos cuidadores descrito a dor como breve (33,3%). O principal comportamento de dor relatado foi choro (35%). De forma geral, os cuidadores classificaram a assistência de enfermagem como muito boa ou excelente. Conclusão: o profissional de enfermagem, reconhece a dor como um evento importante e presta assistência. O estudo incita a necessidade de padronização de instrumentos de avaliação e manejo da dor pediátrica pós-operatória.
Objective: to describe the perception of caregivers regarding pediatric postoperative pain and nursing care.Method:descriptive study, carried out at the Pediatrics Unit of a University Hospital in Paraná with data collected using a sociodemographic form and an adapted MCGill-Melzack Pain questionnaire and analysis based on descriptive statistics. Results: 24 caregivers of children undergoing surgical interventions participated in the study, predominantly women (22), with a predominance of male children. The results showed a greater use of dipyrone as analgesia (50%), with most caregivers describing the pain as brief (33.3%). The main reported pain behavior was crying (35%). In general, caregivers rated nursing care as very good or excellent.Conclusions: the nursing professional recognizes pain as an important event and provides assistance. The study highlights the need for standardization of postoperative pediatric pain assessment and management instruments.
Objetivo: describir la percepción de los cuidadores sobre el dolor posoperatorio pediátrico y el cuidado de enfermería. Método: estudio descriptivo, realizado en la Unidad de Pediatría de un Hospital Universitario de Paraná con datos recolectados mediante formulario sociodemográfico y cuestionario MCGill-Melzack Pain adaptado y análisis con base en estadística descriptiva. Resultados: participaron del estudio 24 cuidadores de niños sometidos a intervenciones quirúrgicas, predominantemente mujeres (22), con predominio de niños varones. Los resultados mostraron un mayor uso de dipirona como analgesia (50%), con la mayoría de los cuidadores describiendo el dolor como breve (33,3%). La principal conducta de dolor reportada fue el llanto (35%). En general, los cuidadores calificaron la atención de enfermería como muy buena o excelente. Conclusiones: el profesional de enfermería reconoce el dolor como un evento importante y brinda asistencia. El estudio destaca la necesidad de estandarizar los instrumentos de evaluación ymanejo del dolor pediátrico posoperatorio.