A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and type 2 leprosy reactions.

BACKGROUND: Steroids regimens in leprosy neuropathies are still controversial in botth types of reactions. METHOD: For this trial, 21 patients with ulnar neuropathy were selected from 163 leprosy patients, 12 with type 1 reaction (T1R) and nine with type 2 (T2R). One experimental group started with prednisone 2 mg/kg/day and the control group with 1 mg/kg/day. A clinical score based on tests for spontaneous pain, nerve palpation, sensory and muscle function was used. Neurophysiological evaluation consisted on the motor nerve conduction of the ulnar nerve in three segments. Student "t" test for statistical analysis was applied on the results: before treatment, first week, first month and sixth month, between each regimen and types of reaction. CONCLUSION: In both reactions during the first month higher doses of steroids produced better results but, earlier treatment with lower dose was as effective. Short periods of steroid, 1 mg/Kg/day at the beginning and,tapering to 0,5 mg/Kg/day or less in one month turned out to be efficient in T2R.

A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and type 2 leprosy reactions / Ensaio clínico sobre o tratamento com esteróides via oral da neuropatia ulnar em reação tipo 1 e tipo 2 da hanseníase

BACKGROUND: Steroids regimens in leprosy neuropathies are still controversial in botth types of reactions. METHOD: For this trial, 21 patients with ulnar neuropathy were selected from 163 leprosy patients, 12 with type 1 reaction (T1R) and nine with type 2 (T2R). One experimental group started with prednisone 2 mg/kg/day and the control group with 1 mg/kg/day. A clinical score based on tests for spontaneous pain, nerve palpation, sensory and muscle function was used. Neurophysiological evaluation consisted on the motor nerve conduction of the ulnar nerve in three segments. Student "t" test for statistical analysis was applied on the results: before treatment, first week, first month and sixth month, between each regimen and types of reaction. CONCLUSION: In both reactions during the first month higher doses of steroids produced better results but, earlier treatment with lower dose was as effective. Short periods of steroid, 1 mg/Kg/day at the beginning and,tapering to 0,5 mg/Kg/day or less in one month turned out to be efficient in T2R.

INTRODUÇÃO: O tratamento da neuropatia da hanseníase com esteróides é ainda controverso nos dois tipos de reações. MÉTODO: Neste ensaio, de 163 pacientes foram selecionados 21 com neuropatia ulnar, 12 com reação tipo 1 e 9 com tipo 2. Um grupo experimental iniciou com 2 mg/kg/dia e o grupo controle com 1 mg/kg/dia. Foi composto um escore clínico pela avaliação da sensação dolorosa espontânea, palpação de nervos e funções sensitiva e motora. Realizou-se a condução nervosa motora do nervo ulnar em três segmentos. Aplicaram-se os estudos estatísticos com o teste t de Student nos resultados: antes do tratamento, primeira semana, primeiro mês e sexto mês. CONCLUSÃO: Em ambas as reações dosagens mais elevadas iniciais produziram melhores resultados, mas a dose menor quando administrada precocemente foi igualmente efetiva. Períodos curtos com doses efetivas, 1 mg/Kg/dia no início e reduzindo-se para 0,5 mg/Kg/dia ou menos em um mês foram eficientes na reação tipo 2.

Avaliaçäo das respostas dos músculos orbicular ocular, adutor do polegar e flexor do hálux à estimulaçäo com a seqüência de quatro estímulos / Evaluation of orbicularis oculi, adductor pollicis and flexor hallux muscles responses to train of four stimulation

Justificativa e Objetivos: O advento de drogas bloqueadorea neuromusculares foi um grande marco na Anestesiologia. Entretanto, um dos problemas do uso desses fármacos é a possibilidade de curarizaçäo residual no pós-operatório. O objetivo deste estudo foi avaliar as respostas de três músculos à estimulaçäo e a regressäo do relaxamento muscular induzido pelo rocurônio. Método: Participaram do estudo 30 pacientes do sexo feminino, com idades entre 20 e 40 anos, estado físico ASA I, submetidos à anestesia geral. Na sala de operaçäo, todas receberam alfentanil 10 µg.Kg-û i.v. e, em seguida, foram determinadas as respostas supramaximais dos músculos orbicular, adutor do polegar e flexor do hálux com acelerometria. A induçäo constou de propofol 3,5 mg.hg-û i.v. e alfentanil 50 µg.kg-û i.v. Todas receberam rocurônio 0,6 mg.kg-û i.v. e sevoflurano para a manutençäo da anestesia. Foram avaliadas as respostas musculares à estimulaçäo com a seqüência de quatro estímulos a cada 14 segundos, durante instalaçäo e na recuperaçäo T4/T1 de 0,25, 0,50, 0,75 e 0,90. A intubaçäo foi realizada no momento de relaxamento mais rápido nos músculos estudados e avaliada por escala proposta. Resultados: O início de açäo nos músculos orbicular ocular, adutor do polegar e flexor do hálux foi respectivamente 64,8, 131,3 e 196,1 segundos (média). A recuperaçäo até T4/T1 0,9 foi de 59,1, 96,4, 65,4 minutos (média) para os mesmos músculos respectivamente. As condiçöes de intubaçäo traqueal foram considerados como clinicamente excelentes. Conclusöes: Os resultados mostram que se pode conseguir condiçöes satisfatórias de intubaçäo traqueal com início de açäo baseado na resposta à neuroestimulaçäo do músculo orbicular ocular. Entretanto, durante a recuperaçäo do bloqueio, o que proporciona maior margem de segurança é a monitorizaçäo do músculo adutor do polegar

Rocuronium administration in children during isoflurane anesthesia: neuromuscular effects.

BACKGROUND: The time-course of the effect of rocuronium during isoflurane anesthesia in children has rarely been evaluated. Forty-five children, aged 2-14 years, ASA 1, undergoing elective surgery and receiving isoflurane anesthesia, were studied. METHODS: Patients randomly received a dose of 400, 600, or 800 micrograms/kg of rocuronium. The first response to the control height (T1:T0) was fitted to time in order to obtain times to onset of action (TOA) including time to 90 (B90) and 99.9% (B100) of relaxation and to spontaneous recovery of 10 (T10), 25 (T25), 50 (T50), 75 (T75), and 90% (T90) of neuromuscular function (NMF). Each time was compared among groups. Linear regression analysis between the TOA or the times to spontaneous recovery of NMF (TSRNMF) and age or weight were also performed. RESULTS: The TOA were similar among the three groups while TSRNF in children receiving 600 or 800 micrograms/kg were longer (p < 0.05) than children receiving 400 micrograms/kg. The T10 and T25 were related to age (p = 0.05), whereas T10, T50, T75, and T90 were related to weight (p < 0.01). These relationships were stronger in males than females. CONCLUSIONS: Maximal relaxation was reached in all children receiving 600 or 800 micrograms/kg of rocuronium. The TSRNMF were mainly related to the weight of the children, and gender affected each relationship. Widely variable responses were observed with all three doses.

Rocuronium administration in children during isoflurane anesthesia: neuromuscular effects

Brockground. The time-course of the effect of rocuronium during isoflurane anesthesia in children rarely evaluated. Forty-five children, aged 2-14 years, ASA 1, undergoing elective surgery and receiving isoflurane anesthesia, were studied. Methods. Patients randomly received a dose of 400, 600, or 800 µg/kg of rocuronium. The first response to control height (T1:TO) was fitted to time in order to obtain times to onset of action (TOA) including time to 90 (b10) and 99.9 percent (B100) of relaxation and to spontaneous reconver of 10 (T10), 25 (t25), 50 (t75), and 90 percent (T90) of neuromuscular function (NMF). Each time was compared among group. Linear regression analysis between the TOA or the times to spontaneous recovery of NMF (TSRNMF) and age or weight were also performed. Results. The TOA were similar among the three groups while TSRNF in children receiving 600 or 800 µg/kg were longer (p< 0.05) than children receiving 400 µg/kg. The T10 and T25 were related to age (p= 0.05), whereas T10, T50, T75, and T90 were related to weight (p< 0.01). These relationships were stringer in males than females. Conclusions. Maximal relaxation was reached in all children receiving 600 or 800 µg/kg of rocuronium. The TSRNMF were mainly related to the weight of the children, and gender affected each relationship. Widely variable response were observed with all three doses

Tempo de latência do rocurônio e da succinilcolina e condiçöes de intubaçäo traqueal / Onset timr and intubating conditions of rocuronium and succinylcholine

Nas cirurgias de urgência - paciente com o estômago cheio - é importante a rápida intubaçäo traqueal e a manutençäo das vias aéreas. Dentre os bloqueadores neuromusculares (BNM), a succinilcolina possui o menor tempo de latência. Contudo, também apresenta vários efeitos colaterais. Recentemente, surgiu o rocurônio, que é um BNM adespolarizante com baixo tempo de latência da succinilcolina com o do rocurônio. Método - quarenta e cinco pacientes adultos foram divididos em três grupos de 15: GL=succinilcolina 1 mg.kg elevado a menos um; GII=rocurônio 0,6 mg.kg elevado a menos um; GIII=rocurônio 0,9 mg.kg elevado a amenos um. Todos os pacientes receberam 15 mg de midazolam, por via oral, como medicaçäo pré-anestesica, e fentanil (10 µg.kg elevado a menos um) e etomidato (0,3 mg.kg elevado a menos um) para induçäo anestésica. A monitorizaçäo do bloqueio neuromuscular foi realizada com o método da aceleromiografia (TOF-Guard) no trajeto do nervo ulnar. Considerou-se o tempo de latência como o tempo decorrido entre o final da injeçäo do BNM e a reduçäo de 10 por cento da contraçäo muscular do primeiro estímulo (T1) supramáximo. A pressäo arterial sistólica (PAS), diastólica (PAD) e freqüência cardíaca (FC) foram registradas em seis momentos antes e depois da induçäo da anestesia. Resultados - A mediana do tempo de latência GI = 71s, do G II = 70s, dando um F=8,862, p<0,01, ou seja, (GI = G III) < GII. As condiçöes de intubaçäo traqueal (IOT) foram excelentes na maioria dos pacientes de ambos os grupos. Conclusöes - Neste estudo obtiveram-se resultados similares entre o tempo de latência da succinilcolina e do rocurônio (GIII). Desse modo, abre-se a possibilidade de o rocurônio a 0,9 mg.kg elevado a menos um ser o substituto da succinilcolina, quando se necessita tempo de latência curto; este BNM estará também indicado em queimados, portadores de doenças neuromusculares e nos pacientes com aumento da pressäo intra-ocular e intracraniana pois, nestas condiçöes, a succinilcolina é contra-indicada. O rocurônio na dose de 0,9 mg.kg elevado a menos um é também o BNM alternativo na técnica seqüencial de intubaçäo rápida

Carbaryl poisoning and edrophonium: electrophysiologic changes.

A case of poisoning with the insecticide carbaryl, a cholinesterase inhibitor, was studied using repetitive stimulation and edrophonium administration. Without edrophonium, repetitive stimulation studies were normal. After 5mg of edrophonium was administered intravenously, a 40% decrement was recorded using 3Hz stimulation and an 80% decrement was seen with 30Hz stimulation. It is concluded that edrophonium is useful in testing for poisoning with cholinesterase inhibitors when other electrophysiologic studies are normal. These changes are most likely due to a recently described fast desensitization of the acetylcholine (ACh) receptor induced by high ACh concentrations.

[Polyneuropathy caused by tuberculostatics. Study of motor nerve conduction in 29 patients]. / Polineuropathisa determinadas por tuberculostaticos. Estudo da conducão nervosa motora em 29 pacientes

The electroneurographic study in 29 patients, during treatment with isoniazid for pulmonary tuberculosis in 12 months period is reported. The patients age were between 16 and 70 years. During the study period motor nerve conduction velocity was done every two months in the median, ulnar and peroneal nerves. The statistical analysis in a 6 months period, revealed p greater than 0.05 (nonsignificant) at the median and peroneal nerves, in spite of the lowering of the motor nerve conduction in a 12 months period. The same findings were observed with the ulnar nerve, but p less than 0.01 (significant). It was impossible to establish a correlation between the motor nerve conduction velocities and the clinical findings observed in the patients. This paper, in the author's opinion, shows that the nerve motor conduction technique is worthless in the follow up of isoniazid patients.