RESUMEN
Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia procedures from January 1994 through August 1995 were randomly chosen for descriptive retrospective review and analysis. Four minor complications from the procedures were identified, and recovery was complete in all cases. One medication combination (fentanyl 1 microg/kg with propofol 1.5 to 2 mg/kg, followed by an infusion of 150 microg/kg/min) provided the shortest mean time to dismissal (17.8 minutes v 38 minutes) when compared with other combinations used. No episodes of respiratory depression, hypotension, or nausea and vomiting occurred in the fentanyl/propofol group. These results show that fentanyl/propofol was superior to other medications used during this study period for pediatric sedation with analgesia. Prospective comparison of this medication combination with other short-acting agents in patients undergoing both elective and emergency procedures is necessary.
Asunto(s)
Analgesia/métodos , Sedación Consciente/métodos , Adolescente , Analgesia/efectos adversos , Analgésicos Opioides/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Niño , Preescolar , Protocolos Clínicos , Sedación Consciente/efectos adversos , Quimioterapia Combinada , Fentanilo/uso terapéutico , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Propofol/uso terapéutico , Estudios Retrospectivos , Factores de TiempoRESUMEN
1. To evaluate the mechanism of action of imipramine in enuresis nocturna, we compared the effects of imipramine with those of scopolamine butylbromide in fourteen children suffering from this condition. A double-blind, cross-over design was used. 2. Imipramine, 10--20 mg, was superior to scopolamine butylbromide (10--20 mg), in eleven of the fourteen subjects (P less than 0.01), and the latter drug was no better than the placebo. 3. As scopolamine butylbromide does not cross the blood-brain barrier, it is concluded that peripheral antimuscarinic effects are not important in the beneficial effects of imipramine in enuresis nocturna. 4. The therapeutic effects of imipramine in depression frequently take 3 to 4 weeks to develop. Such a delay was not seen in our enuretic patients. Thus the mechanism of the drug in the two conditions is probably different.
Asunto(s)
Enuresis/tratamiento farmacológico , Imipramina/uso terapéutico , Bromuro de Butilescopolamonio/uso terapéutico , Niño , Preescolar , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Humanos , Imipramina/administración & dosificación , Placebos , Factores de TiempoRESUMEN
To reveal the differences in the nucleus ventralis postero-lateralis (VPL) of the thalamus of the corticofugal fibers originating from the first (S1) and the second (S2) somatosensory areas a combined morphological study was undertaken using autoradiography and electron microscopy of the degenerating terminals. Within the range of VPL distribution of the cortico-fugal fibers of the corresponding zones of two cortical somatosensory regions differed from one another. The terminals of both types of the fibers established synaptic contacts, chiefly with the distal dendrites of the relay VPL cells, and much more rarely with the dendrites of the interneurons of the Golgi II type. No direct convergence of the fibers originating from two somatosensory regions on single VPL elements was observed.
