Serum oxytocin concentrations in elective caesarean delivery: a randomized comparison of three infusion regimens.

BACKGROUND: The aim of this study was to determine serum oxytocin concentrations following different regimens of prophylactic oxytocin administration in women undergoing elective caesarean delivery. METHODS: Thirty healthy pregnant patients were randomized, after clamping of the umbilical cord, to receive intravenous oxytocin in one of the following groups: G1 (n=9), 10 IU of oxytocin infused over 30 min (0.33 IU/min); G2 (n=11), 10 IU of oxytocin infused over 3 min and 45 s (2.67 IU/min); and G3 (n=10), 80 IU of oxytocin infused over 30 min (2.67 IU/min). Both patient and surgeon were blinded to allocation. Uterine tone was assessed by surgical palpation. Serum oxytocin concentration was determined by enzyme immunoassay before anaesthesia (T0) and at 5 (T5), 30 (T30) and 60 (T60) min after the start of oxytocin infusion. RESULTS: Serum oxytocin concentrations (mean±standard error, ng/mL) were not significantly different in the groups at T0 (0.06±0.02, 0.04±0.02 and 0.07±0.04, respectively, P=0.76), and T60 (0.65±0.26, 0.36±0.26 and 0.69±0.26, respectively, P=0.58). G3 showed higher concentrations than G1 at T5 (3.65±0.74 versus 0.71±0.27, P=0.01) and at T30 (6.19±1.19 versus 1.17±0.37, P<0.01), and were higher than G2 at T30 (6.19±1.19 versus 0.41±0.2, P<0.01). Haemodynamic data and uterine tone were considered satisfactory and similar in all groups. No additional uterotonic agents were needed. CONCLUSION: Serum oxytocin measurements made using enzyme immunoassay in healthy pregnant women undergoing elective caesarean delivery showed that administration of 80 IU oxytocin over 30 min resulted in higher serum oxytocin levels after 5 and 30 min than the two other regimens. The concentrations did not differ between groups at 60 min.

[Anna Justina Ferreira Nery: framework in the history of Brazilian nursing]. / Anna Justina Ferreira Nery: um marco na história da enfermagem brasileira.

The object of this study is Anna Neri (1814-1880), an anonymous woman who participated in the Paraguay War (1865-1870). This is a social-historical biographical study guided by the principles of the New History. The objective of this research is to characterize and raise relevant aspects of Anna Neri's life. It is known that this woman left her domestic life to play an important role in the public space. Her motivation was genuinely affectionate, and she didn't expect to be called a nurse. Anna Neri met the requirements that would raise the social and moral status of the XXth century nursing workers, and became a symbol of Brazilian nursing.

[Utility of gas chromatography for the identification of mycobacterial species]. / Utilidad de la cromatografia gaseosa para la identificación de micobacterias.

The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other than Mycobacterium tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods for diagnosis. In the present study, we investigated and assessed the suitability of a gas-liquid chromatography technique for diagnosis of clinically important mycobacteria in Argentina. An identification scheme was developed from the results obtained in a previous study where we characterized the cellular fatty acids and the mycolic acid cleavage products from most frequent species in Argentina. Of 183 isolates tested, 69% were correctly identified to species level and 5% were incorrectly classified. If we only take into account the isolates that could be identified, 93% were correctly identified. Although all of the isolates of M. tuberculosis were correctly identified, four isolates of MAC incorrectly matched by M. tuberculosis. Gas chromatography provides a rapid technique of highly predictive value for mycobacteria identification; it could be used in reference laboratories as a rapid presumptive identification until the biochemical tests are completed.

Epidural pressures and spread of 2% lidocaine in the epidural space: influence of volume and speed of injection of the local anesthetic solution.

BACKGROUND AND OBJECTIVES: The impact of epidural pressures on the spread of epidural block is controversial. This study examined the effect of volume and speed of injection of local anesthetics on epidural pressures and the spread of anesthesia. METHODS: Twenty women undergoing epidural anesthesia received a test dose of 3 mL of 2% lidocaine with epinephrine 1:200,000 over 6 seconds and subsequently the main dose of 15 mL of the solution over 30 seconds (group I) or 3 minutes (group II). Variables studied included epidural pressures and the extent and duration of thermal and sensory block. RESULTS: Peak epidural pressure following the main dose was significantly higher in group I as compared to group II. All other epidural pressures and the extent and duration of sensory and thermal block were similar in both groups. The peak epidural pressure in group II and the pressures obtained at 3 minutes after the main dose in both groups were inversely correlated with the extent of the thermal block and directly correlated with its regression time. CONCLUSIONS: The peak epidural pressures correlated with the speed of injection of the lidocaine solution and not with its volume, whereas the remaining epidural pressures correlated with its volume and not with the speed of injection. The extent and duration of the thermal block exhibited a more consistent correlation (inverse and direct, respectively) with the epidural pressures than those of the sensory block.

Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery.

UNLABELLED: Postoperative pain control after cesarean delivery under spinal anesthesia is effectively obtained with morphine 0.1-0.3 mg intrathecally, although there may be dose-dependent side effects. We evaluated the quality of analgesia and the incidence of side effects with smaller doses of intrathecal morphine combined with intramuscular (i.m.) diclofenac. One hundred-twenty pregnant patients were allocated into six groups, which received the following treatments: Groups 1, 3, and 5 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus 75 mg of i.m. diclofenac every 8 h; Groups 2, 4, and 6 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus i.m. diclofenac on demand. Spinal anesthesia was performed with 15 mg of 0.5% hyperbaric bupivacaine. Pain scores and side effects were evaluated hourly for the first 24 h. Groups 1 and 2 had lower pain scores than Groups 3, 4, 5, and 6. However, only patients in Groups 2, 4, and 6 requested additional analgesics. Severe pruritus was more frequent in Groups 1 and 2. No patient experienced respiratory depression. We conclude that there is no advantage in using doses larger than 0.025 mg of intrathecal morphine if they are combined with systemic diclofenac. IMPLICATIONS: A multimodal approach to pain control may provide good quality analgesia while reducing drug-related side effects. In this study, a very small dose of intrathecal morphine, in association with intramuscular diclofenac, proved effective for controlling pain after cesarean delivery, with a low incidence of morphine-induced pruritus.

Traumas oculares causados por agressoes em 70 pacientes. / Ocular traumas caused by personal attack in 70 patients

Num estudo realizado em 307 pacientes com traumatismos oculares, internados no servico de oftalmologia do Hospital Municipal Souza Aguiar no periodo de 15 meses, foram registrados 70 casos de agressoes. O agente causal mais frequente do trauma ocular foi a pedrada seguida do projetil da arma de fogo (PAF), ocasionando graves ferimentos perfurantes de globo ocular. O estudo das causas que levam a agressao implica numa profunda analise do comportamento humano e social, nao sendo esse o nosso proposito. Consideracoes sobre alguns aspectos estatisticos sao aqui abordados visando possiveis medidas preventivas, que possam contribuir para diminuir as agressoes ou os seus efeitos