Erector spinae plane block as a rescue therapy in following cholecystectomy: a historical cohort study.

OBJECTIVE: The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. MATERIALS AND METHODS: This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. RESULTS: One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. CONCLUSION: ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.

OBJETIVO: Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. MÉTODO: Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. RESULTADOS: En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. CONCLUSIONES: El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.

Vasectomy of golden-headed lion tamarins (Leontopithecus chrysomelas) using local anesthesia after sedation with dexmedetomidine-ketamine-meperidine.

The study evaluated the combination of ketamine, dexmedetomidine, and meperidine for vasectomy in golden-headed lion tamarins. Lidocaine infiltration was required for intraoperative analgesia and atipamezole was used at the end of the procedure. The protocol promoted satisfactory sedation and analgesia with a short recovery time in tamarins.

Bloqueio do plano transverso do abdômen guiado por ultrassom em felino submetido a mastectomia regional / Blocking of the abdomen transverse plan guided by ultrasound in feline submitted to regional mastectomy

Os bloqueios locorregionais vêm sendo cada vez mais utilizados na medicina veterinária. O bloqueio do plano transverso do abdômen (TAP Block) é uma técnica de anestesia locorregional, faz parte da estratégia de analgesia multimodal, capaz de promover anestesia e analgesia em regiões de pele, musculatura e peritônio parietal. O objetivo deste trabalho é relatar o bloqueio do plano transverso em um felino macho de dois anos de idade submetido a mastectomia regional. Foram feitos dois pontos de bloqueio do espaço TAP guiado por ultrassom, em cada lado do abdômen: um na parte caudal da região abdominal média, cranial a crista ilíaca, e o outro ponto, caudal a última costela, com 0,5mg/kg de bupivacaína a 0,25% em cada ponto, padronizando um volume injetado de 0,6mL. Foi utilizado acepromazina (0,05mg/kg), petidina (3mg/kg), cetamina (2mg/kg) e midazolam (0,3mg/kg) como medicação pré-anestésica, indução com propofol (3mg/kg) e manutenção por anestesia inalatória com isoflurano. Conclui-se que o TAP block foi eficaz para mastectomia regional abdominal, com alto índice de segurança e de fácil execução com treinamento adequado, mesmo com transdutores de baixa frequência.

Locoregional blocks have been increasingly used in veterinary medicine. Blocking the transverse plane of the abdomen (TAP Block) is a technique of locoregional anesthesia, it is part of the multimodal analgesia strategy, capable of promoting anesthesia and analgesia in regions of skin, musculature and parietal peritoneum. The aim of this study is to report the transverse plane block in a two-year-old male cat undergoing regional mastectomy. Two ultrasound-guided TAP space block points were made on each side of the abdomen: one in the caudal part of the middle abodminal region, cranial to the iliac crest, and the other point, caudal to the last rib, with 0.5mg/kg of 0.25% bupivacaine at each point, standardizing an injected volume of 0.6mL. Acepromazine (0.05mg/kg), pethidine (3mg/kg), ketamine (2mg/kg) and midazolam (0.3mg/kg) were used as pre-anesthetic medication, induction with propofol (3mg/kg) and maintenance by inhalation anesthesia with isoflurane. It is concluded that the TAP block was effective for regional abdominal mastectomy, with a high safety index and easy to perform with adequate training, even with less frequent transducers.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model.

PURPOSE: To evaluate the effects of meperidine on fascial healing. METHODS: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. RESULTS: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. CONCLUSION: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Anestesia espinal con meperidina en paciente con hipersensibilidad a anestésicos locales / Spinal cord anesthesia with meperidine in a patient with hypersensitivity to local anesthesia

Introducción: La meperidina (o petidina) es un opioide sintético que tiene propiedades anestésicas locales bien conocidas, y ha sido utilizada por vía intratecal en cirugía general, urológica y obstétrica de forma segura. Este puede ser usado en anestesia espinal en paciente con hipersensibilidad a los anestésicos locales. Objetivo: Describir el manejo anestésico en una paciente con hipersensibilidad a los anestésicos locales con uso de meperidina intratecal. Presentación del caso: Se presenta una paciente femenina de 54 años de edad con historia previa de hipersensibilidad a los anestésicos locales, programada para colporrafia anterior, a la cual se le realiza una técnica regional, administrando meperidina intratecal. Para la analgesia posoperatoria se suministró diclofenaco de sodio en dosis única de 75 mg, por vía IV previo a la incisión. Conclusiones: Con la técnica descrita se logra un bloqueo sensitivo y motor adecuado, estabilidad de los signos vitales intraoperatoria y recuperación óptima en el posoperatorio inmediato. Es una alternativa más en el manejo de los pacientes con hipersensibilidad a los anestésicos locales(AU)

Introduction: Meperidine (or pethidine) is a synthetic opioid with well-known local anesthetic properties. It has been safely used intrathecally in general, urological and obstetric surgery. This can be used in spinal anesthesia in patients with hypersensitivity to local anesthetics. Objective: To describe anesthetic management of a patient with hypersensitivity to local anesthetics with the use of intrathecal meperidine. Case presentation: The case is presented of a 54-year-old female patient with a previous history of hypersensitivity to local anesthetics, scheduled for anterior colporrhaphy, who is performed regional technique, administering intrathecal meperidine. For post-operative analgesia, diclofenac sodium was administered intravenously in a single dose of 75 mg before the incision. Conclusions: The described technique allowed to achieve adequate sensory and motor block, stability of intraoperative vital signs, and optimal recovery in the immediate postoperative period. It is another alternative in the management of patients with hypersensitivity to local anesthetics(AU)

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model

Purpose: To evaluate the effects of meperidine on fascial healing. Methods: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. Results: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. Conclusion: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.(AU)

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model

Abstract Purpose: To evaluate the effects of meperidine on fascial healing. Methods: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. Results: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. Conclusion: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Analgesia subaracnoidea en el trabajo de parto: bupivacaína/fentanilo vs. petidina / Subarachnoid analgesia in labor: bupivacaine/fentanyl vs pethidine

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)

Sphingolipid biosynthetic pathway is crucial for growth, biofilm formation and membrane integrity of Scedosporium boydii.

Aim: Glycosphingolipids are conserved lipids displaying a variety of functions in fungal cells, such as determination of cell polarity and virulence. They have been considered as potent targets for new antifungal drugs. The present work aimed to test two inhibitors, myriocin and DL-threo-1-Phenyl-2-palmitoylamino-3-morpholino-1-propanol, in Scedosporium boydii, a pathogenic fungus which causes a wide range of disease. Materials & methods: Mass spectrometry, microscopy and cell biology approaches showed that treatment with both inhibitors led to defects in fungal growth and membrane integrity, and caused an increased susceptibility to the current antifungal agents. Conclusion: These data demonstrate the antifungal potential of drugs inhibiting sphingolipid biosynthesis, as well as the usefulness of sphingolipids as promising targets for the development of new therapeutic options.

Pethidine in Low Doses versus Dipyrone for Pain Relief in Labor: A Randomized Controlled Trial.

OBJECTIVE: To compare low doses of pethidine with dipyrone in labor analgesia. METHODS: In a randomized prospective study conducted by Universidade de Fortaleza, in the state of Ceará, Brazil, between May and December 2016, 200 full-term parturients, with very painful uterine contractions and exhibiting uterine cervix dilatation ≥ 5 cm, were selected to receive a single intravenous dose of either 0.25 mg/kg of pethidine (n = 100) or of 25 mg/kg of dipyrone (n = 100). Pain was assessed using the visual analogue scale. The data were analyzed using the Student t-test, the chi-square test and the likelihood ratio. RESULTS: There was a significant improvement in pain in 35% of the parturients. Both drugs presented a similar analgesic effect 1 hour after the intervention (p = 0.692). There was no analgesic effect during the evaluation of the second hour after the intervention with pethidine or dipyrone. There were no adverse effects, such as maternal drowsiness, nausea or vomiting, related to the drugs used. CONCLUSION: Pethidine in low doses and dipyrone presented equivalent analgesia during labor. PUBLIC REGISTRY OF CLINICAL TRIALS: RBR-4hsyy4.

OBJETIVO: Comparar doses baixas de petidina com dipirona na analgesia de parto. MéTODOS: Em um estudo prospectivo randomizado realizado pela Universidade de Fortaleza, Ceará, Brasil, entre maio e dezembro de 2016, 200 parturientes a termo, com contrações uterinas muito dolorosas e apresentando dilatação do colo uterino ≥ 5 cm, foram selecionadas para receber dose única intravenosa de 0,25 mg/kg de petidina (n = 100) ou 25 mg/kg de dipirona (n = 100). A dor foi avaliada pela escala visual analógica. Os dados foram analisados por meio dos testes t de Student, qui-quadrado e razão de verossimilhança. RESULTADOS: Houve melhora significativa da dor em 35% das parturientes. Ambas as drogas apresentaram efeito analgésico semelhante 1 hora após a intervenção (p = 0.692). Inexistiu efeito analgésico durante a avaliação da segunda hora após a intervenção com a petidina ou com a dipirona. Não houve efeitos adversos, como sonolência, náuseas ou vômitos maternos, relacionados aos medicamentos utilizados. CONCLUSãO: A petidina em doses baixas e a dipirona apresentaram analgesia equivalente durante o trabalho de parto. REGISTRO PúBLICO DE TESTES CLíNICOS: RBR-4hsyy4.

Pethidine in low doses versus dipyrone for pain relief in labor: a randomized controlled trial / Petidina em doses baixas versus dipirona para alívio da dor no trabalho de parto: um ensaio clínico randomizado

Abstract Objective To compare low doses of pethidine with dipyrone in labor analgesia. Methods In a randomized prospective study conducted by Universidade de Fortaleza, in the state of Ceará, Brazil, between May and December 2016, 200 full-term parturients, with very painful uterine contractions and exhibiting uterine cervix dilatation ≥ 5 cm, were selected to receive a single intravenous dose of either 0.25 mg/kg of pethidine (n = 100) or of 25 mg/kg of dipyrone (n = 100). Pain was assessed using the visual analogue scale. The data were analyzed using the Student t-test, the chi-square test and the likelihood ratio. Results There was a significant improvement in pain in 35% of the parturients. Both drugs presented a similar analgesic effect 1 hour after the intervention (p = 0.692). There was no analgesic effect during the evaluation of the second hour after the intervention with pethidine or dipyrone. There were no adverse effects, such as maternal drowsiness, nausea or vomiting, related to the drugs used. Conclusion Pethidine in low doses and dipyrone presented equivalent analgesia during labor. Public Registry of Clinical TrialsRBR-4hsyy4.

Resumo Objetivo Comparar doses baixas de petidina com dipirona na analgesia de parto. Métodos Em um estudo prospectivo randomizado realizado pela Universidade de Fortaleza, Ceará, Brasil, entre maio e dezembro de 2016, 200 parturientes a termo, com contrações uterinas muito dolorosas e apresentando dilatação do colo uterino ≥ 5 cm, foram selecionadas para receber dose única intravenosa de 0,25 mg/kg de petidina (n = 100) ou 25 mg/kg de dipirona (n = 100). A dor foi avaliada pela escala visual analógica. Os dados foram analisados por meio dos testes t de Student, qui-quadrado e razão de verossimilhança. Resultados Houve melhora significativa da dor em 35% das parturientes. Ambas as drogas apresentaram efeito analgésico semelhante 1 hora após a intervenção (p = 0.692). Inexistiu efeito analgésico durante a avaliação da segunda hora após a intervenção com a petidina ou com a dipirona. Não houve efeitos adversos, como sonolência, náuseas ou vômitos maternos, relacionados aos medicamentos utilizados. Conclusão A petidina em doses baixas e a dipirona apresentaram analgesia equivalente durante o trabalho de parto. Registro público de testes clínicosRBR-4hsyy4.

[Safety of gastroenterologist-directed propofol administration for endoscopic procedures: 10-year experience in a private clinic in Lima, Peru]. / Seguridad en la administración de propofol dirigido por gastroenterólogo entrenado en procedimientos endocópicos: experiencia de 10 años en clínica privada en Lima, Perú.

OBJECTIVE: To evaluate safety of propofol combined with Meperidine and Midazolam in colonoscopies, upper endoscopies (EGD) and Endoscopic Ultrasound (EUS) administered by a nurse supervised by a trained gastroenterologist. To compare the required doses of propofol among older and younger than 75 years old. MATERIALS AND METHODS: Retrospective descriptive study including patients 18 years of age and older who received propofol for EGD, colonoscopy (or EGD + colonoscopy) and EUS. The patients were given a baseline dose of Meperidine (25 mg) and Midazolam (1-3 mg) intravenously (IV). After 2-3 minutes, they received an IV bolus of propofol between 10-30 mg. Repeat boluses of 10-20 mg were administered at intervals no lesser than 60 seconds during the procedure, as needed according to patient`s tolerance to the procedure. RESULTS: Between September 2006 and September 2016, 9,704 procedures were performed, of which 1,598 were EGD, 3,065 colonoscopies, 2,492 EGD + colonoscopies and 57 EUS. There were 3,912 women (59.1%), and the average age was 57.1 ± 14.6 years. Eight hundred eighty (12.5%) were older than 75 years. The average dose of propofol for all the procedures was 83.2 ± 48.1 mg, for EGD and colonoscopy was 59.7 ± 36.2 mg and 77.2 ± 41 mg respectively. The average dose used in patients >75 years for EGD was 47.5 ± 37.8 mg, for colonoscopies 58.3 ± 33.4 mg and for EGD + colonoscopies was 78.7 ± 42.7 mg compared to patients <75 years in whom the average dose for EGD was 61.1 ± 35.8 mg (p<0.05), in colonoscopies was 80.5 ± 41.3 mg (p<0.05) and in EGD + colonoscopies 105.9 ± 50.2 mg (p<0.05). There were no sedation-related complications. CONCLUSIONS: Propofol combined with meperidine and midazolam in endoscopic procedures directed by a trained gastroenterologist is safe. Elderly patients (>75 years old) required significantly less doses of propofol for EGD, colonoscopy, EGD/colonoscopy and EUS.

The use of local anesthesia and sedation in transanal hemorrhoidal dearterialization with Doppler / O uso da anestesia local e sedação na desarterialização hemorroidária transanal com Doppler

ABSTRACT The treatment of hemorrhoidal disease has never been as innovated as in recent decades. The transanal hemorrhoidal dearterialization with Doppler (THD) was described under general anesthesia or spinal blockage and there is no use of local anesthesia reports. This study aims to evaluate the safety of the use of local anesthesia with sedation in THD. For this purpose, two cases are reported describing the technical and safety analysis and results. Both patients were women with grade II and III hemorrhoidal disease. These patients underwent pre-anesthetic sedation with intravenous diazepam, then were positioned in lithotomy and sedated with midazolam and pethidine. The intersphincteric blockage was followed by THD with mucopexy. One patient made a small submucosal hematoma without expansion. The patients were stable and comfortable throughout the procedure. Both were discharged the next day, with regular analgesia. In the seventh postoperative day, both had mild annoyance at constant tenesmus, which was reduced gradually. The cases illustrate that THD is feasible when performed with local anesthesia and sedation, as it is safe and effective. This new technology can be incorporated into services that have a local anesthesia protocol as their standard.

RESUMO O tratamento da doença hemorroidária nunca foi tão inovado como nas últimas décadas. A desarterialização hemorroidária transanal é uma dessas inovações. Foi originalmente descrita sob anestesia geral ou bloqueio espinal e não há relatos de utilização de anestesia local. Assim, este estudo visa avaliar a segurança do uso da anestesia local com sedação na desarterialização hemorroidária transanal. Para tal, dois casos são relatados com descrição da técnica e análise da segurança e resultados. Ambas pacientes eram mulheres com doença hemorroidária grau II e III. Foram submetidas à indução anestésica, posicionadas em litotomia e sedadas com midazolan e petidina. Realizou-se bloqueio interesfincteriano seguido de desarterialização hemorroidária transanal com doppler associado a mucopexia. Uma das pacientes fez um hematoma submucoso pequeno, sem expansão. As pacientes ficaram estáveis e confortáveis durante todo o procedimento. Ambas receberam alta no dia seguinte, com analgesia habitual. No sétimo dia do pós-operatório, ambas apresentavam incômodo leve pelo tenesmo constante, que foi reduzindo gradualmente. Os casos ilustram que a desarterialização hemorroidária transanal é factível quando realizada com anestesia local e sedação, visto que é segura e eficaz. Esta nova tecnologia pode também ser incorporada aos serviços cujo protocolo de anestesia local seja padrão.

Seguridad en la administración de propofol dirigido por gastroenterólogo entrenado en procedimientos endocópicos: experiencia de 10 años en clínica privada en Lima, Perú / Safety of gastroenterologist-directed propofol administration for endoscopic procedures: 10-year experience in a private clinic in Lima, Peru

Objetivo: Evaluar la seguridad de propofol combinado con meperidina y midazolam en colonoscopías, endoscopías y ecoendoscopía administrado por una enfermera supervisada por un gastroenterólogo entrenado y comparar su requerimiento en pacientes menores y mayores de 75 años. Material y métodos: Estudio descriptivo retrospectivo, que incluyó a pacientes mayores de 18 años de edad que recibieron propofol durante la endoscopía, colonoscopía (o endoscopía+colonoscopía) y ecoendoscopía. A los pacientes se les administró una dosis inicial de Meperidina (25 mg) y Midazolam (1-3 mg) por vía intravenosa (IV). Después de 2-3 minutos recibieron un bolo IV de propofol entre 10-30 mg. Se administraron bolos repetidos de 10-20 mg a intervalos no menores a 60 segundos durante cada procedimiento, titulado según necesidad y tolerancia del paciente. Resultados: Entre septiembre del 2006 y septiembre del 2016, se realizaron 9 704 procedimientos endoscópicos: 1 598 endoscopías, 3 065 colonoscopías, 2 492 endoscopía + colonoscopía y 57 eco-endoscopías. Hubo 3 912 mujeres (59,1%), la edad promedio fue de 57,1 ± 14,6 años, 880 pacientes (12,5%) mayores de 75 años. La dosis media de propofol para todos los procedimientos fue de 83,2 ± 48,1 mg, para la endoscopía y colonoscopía fue de 59,7 ± 36,2 mg y 77,2 ± 41 mg respectivamente. La dosis media utilizada en pacientes mayores de 75 años en endoscopía fue de 47,5 ± 37,8 mg, colonoscopías de 58,3 ± 33,4 mg y endoscopía + colonoscopía de 78,7 ± 42,7 mg en comparación con pacientes < 75 años en los que la dosis promedio de endoscopía fue de 61,1±35,8 mg (p <0,05), en colonoscopías de 80,5±41,3 mg (p<0,05) y en endoscopías+colonoscopías 105,9 ± 50,2 mg (p<0,05). No hubo complicaciones relacionadas con la sedación. Conclusiones: Propofol combinado con meperidina y midazolam en procedimientos endoscópicos, administrado por enfermera y dirigidos por un gastroenterólogo entrenado, es seguro. Los pacientes mayores de 75 años, necesitaron dosis significativamente menores de propofol para endoscopía, colonoscopia, endoscopía + colonoscopia y ecoendoscopía.

Objective: To evaluate safety of propofol combined with Meperidine and Midazolam in colonoscopies, upper endoscopies (EGD) and Endoscopic Ultrasound (EUS) administered by a nurse supervised by a trained gastroenterologist. To compare the required doses of propofol among older and younger than 75 years old. Materials and methods: Retrospective descriptive study including patients 18 years of age and older who received propofol for EGD, colonoscopy (or EGD + colonoscopy) and EUS. The patients were given a baseline dose of Meperidine (25 mg) and Midazolam (1-3 mg) intravenously (IV). After 2-3 minutes, they received an IV bolus of propofol between 10-30 mg. Repeat boluses of 10-20 mg were administered at intervals no lesser than 60 seconds during the procedure, as needed according to patient`s tolerance to the procedure. Results: Between September 2006 and September 2016, 9,704 procedures were performed, of which 1,598 were EGD, 3,065 colonoscopies, 2,492 EGD + colonoscopies and 57 EUS. There were 3,912 women (59.1%), and the average age was 57.1 ± 14.6 years. Eight hundred eighty (12.5%) were older than 75 years. The average dose of propofol for all the procedures was 83.2 ± 48.1 mg, for EGD and colonoscopy was 59.7 ± 36.2 mg and 77.2 ± 41 mg respectively. The average dose used in patients >75 years for EGD was 47.5 ± 37.8 mg, for colonoscopies 58.3 ± 33.4 mg and for EGD + colonoscopies was 78.7 ± 42.7 mg compared to patients <75 years in whom the average dose for EGD was 61.1 ± 35.8 mg (p<0.05), in colonoscopies was 80.5 ± 41.3 mg (p<0.05) and in EGD + colonoscopies 105.9 ± 50.2 mg (p<0.05). There were no sedation-related complications. Conclusions: Propofol combined with meperidine and midazolam in endoscopic procedures directed by a trained gastroenterologist is safe. Elderly patients (>75 years old) required significantly less doses of propofol for EGD, colonoscopy, EGD/colonoscopy and EUS.

Parâmetros ecocardiográficos em cães saudáveis tratados com acepromazina, meperidina e sua associação / Echocardiographic parameters in healthy dogs treated with acepromazine, meperidine and their association

Objetivou-se avaliar os efeitos da tranquilização com meperidina, acepromazina e de sua associação sobre os parâmetros ecocardiográficos em cães. Foram utilizados 12 cães adultos, da raça Rottweiler, submetidos ao exame ecocardiográfico sem utilização de sedação (controle - TC) e a três protocolos de tratamento, utilizando-se meperidina (TM), acepromazina (TA) e a associação dos medicamentos (TMA). As variáveis foram analisadas pelo teste de Tukey (P<0,05). Observou-se que as médias obtidas na onda A do fluxo mitral em TA e TMA diminuíram significativamente com relação ao TM, que não diferiu do TC. Houve uma diminuição significativa no valor de movimento anular mitral (MAM) e excursão sistólica do plano anular tricúspide (ESPAT) no TA. Não houve diferença significativa para os valores de fração de encurtamento (FE) entre TA e os demais tratamentos. Entretanto, observou-se que 57,3% dos cães apresentaram valores de FE abaixo da normalidade. As alterações encontradas podem ser decorrentes dos efeitos hipotensores da acepromazina utilizada de forma isolada. Conclui-se que a meperidina ou sua associação com acepromazina não alteram os parâmetros ecocardiográficos em cães saudáveis e que a acepromazina, utilizada isoladamente, causa alteração nos parâmetros de função sistólica dos cães, não sendo recomendada para a contenção química dos cães submetidos ao ecocardiograma, o que poderia levar à má interpretação do exame.(AU)

The aim of this study was to evaluate the effects of sedation with meperidine, acepromazine and its association on the echocardiographic parameters in dogs. Twelve adult Rottweilers were used and subjected to the echocardiography examination without the use of sedation (control - CT) and subjected to three treatment protocols using meperidine (MT), acepromazine (AT), and the combination of drugs (MAT). Variables were analyzed by Tukey test (p<0,05). The averages obtained in A-wave of mitral inflow in AT and MAT decreased significantly compared to MT, which did not differ from CT. There was a significant decrease in the measurement of mitral annulus motion (MAM) and tricuspid annular plane systolic excursion (TAPSE) at TA. There was no significant difference in shortening fraction (SF) values between TA and other treatments. However, it was observed that 57.3% of the dogs showed SF values below the normal range for the species. All changes found may be due to the hypotensive effects of acepromazine used in isolation. In conclusion, meperidine or its association with acepromazine does not alter echocardiographic parameters in healthy dogs and acepromazine, used alone, causes changes in the parameters of systolic function and is not recommended for sedation of dogs submitted to echocardiogram, since it could cause a misinterpretation of the exam.(AU)

Parâmetros ecocardiográficos em cães saudáveis tratados com acepromazina, meperidina e sua associação / Echocardiographic parameters in healthy dogs treated with acepromazine, meperidine and their association

Objetivou-se avaliar os efeitos da tranquilização com meperidina, acepromazina e de sua associação sobre os parâmetros ecocardiográficos em cães. Foram utilizados 12 cães adultos, da raça Rottweiler, submetidos ao exame ecocardiográfico sem utilização de sedação (controle - TC) e a três protocolos de tratamento, utilizando-se meperidina (TM), acepromazina (TA) e a associação dos medicamentos (TMA). As variáveis foram analisadas pelo teste de Tukey (P<0,05). Observou-se que as médias obtidas na onda A do fluxo mitral em TA e TMA diminuíram significativamente com relação ao TM, que não diferiu do TC. Houve uma diminuição significativa no valor de movimento anular mitral (MAM) e excursão sistólica do plano anular tricúspide (ESPAT) no TA. Não houve diferença significativa para os valores de fração de encurtamento (FE) entre TA e os demais tratamentos. Entretanto, observou-se que 57,3% dos cães apresentaram valores de FE abaixo da normalidade. As alterações encontradas podem ser decorrentes dos efeitos hipotensores da acepromazina utilizada de forma isolada. Conclui-se que a meperidina ou sua associação com acepromazina não alteram os parâmetros ecocardiográficos em cães saudáveis e que a acepromazina, utilizada isoladamente, causa alteração nos parâmetros de função sistólica dos cães, não sendo recomendada para a contenção química dos cães submetidos ao ecocardiograma, o que poderia levar à má interpretação do exame.(AU)

The aim of this study was to evaluate the effects of sedation with meperidine, acepromazine and its association on the echocardiographic parameters in dogs. Twelve adult Rottweilers were used and subjected to the echocardiography examination without the use of sedation (control - CT) and subjected to three treatment protocols using meperidine (MT), acepromazine (AT), and the combination of drugs (MAT). Variables were analyzed by Tukey test (p<0,05). The averages obtained in A-wave of mitral inflow in AT and MAT decreased significantly compared to MT, which did not differ from CT. There was a significant decrease in the measurement of mitral annulus motion (MAM) and tricuspid annular plane systolic excursion (TAPSE) at TA. There was no significant difference in shortening fraction (SF) values between TA and other treatments. However, it was observed that 57.3% of the dogs showed SF values below the normal range for the species. All changes found may be due to the hypotensive effects of acepromazine used in isolation. In conclusion, meperidine or its association with acepromazine does not alter echocardiographic parameters in healthy dogs and acepromazine, used alone, causes changes in the parameters of systolic function and is not recommended for sedation of dogs submitted to echocardiogram, since it could cause a misinterpretation of the exam.(AU)

Is pethidine safe during labor? Systematic review / A petidina é segura durante o trabalho de parto? Revisão sistemática

Abstract Purpose To verify if pethidine is safe for the conceptus when used during labor. Methods Systematic review in the Capes Periodicals/PubMed and MEDLINE/Virtual Health Library (BVS, in the Portuguese acronym) databases. Results A total of 17 studies published from January 1st, 2000, to September 2nd, 2016, with a total of 1,688 participants involved were included in the present review. There was no record of conceptus vitality decrease associated with low doses of pethidine being administered to mothers during labor. Conclusions Intramuscular (IM) or intravenous (IV) pethidine at low doses, of up to 50 mg, is safe to administer during labor.

Resumo Objetivo Verificar se a petidina é segura para o concepto quando utilizada durante o trabalho de parto. Método Revisão sistemática nas bases de dados dos Periódicos Capes/PubMed e MEDLINE/Biblioteca Virtual em Saúde (BVS). Resultados Um total de 17 estudos, publicados de 1° de janeiro de 2000 a 2 de setembro de 2016, totalizando 1.688 participantes envolvidos, foram incluídos nesta revisão. Não houve registro de depressão na vitalidade dos conceptos comdoses baixas de petidina administradas às mães durante o trabalho de parto. Conclusão Petidina intramuscular (IM) ou intravenosa (IV) em baixas doses, de até 50 mg, é segura durante o trabalho de parto.