ABSTRACT
OBJECTIVE: Talc pleurodesis is a widely used treatment option for malignant pleural effusion (MPE). However, the optimal form of administration remains controversial. Thus, we performed a systematic review and meta-analysis to assess the effectiveness of talc slurry (TS) in comparison with thoracoscopic talc insufflation/poudrage (TTI) for MPE treatment. METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for studies that compared TS with TTI in patients with MPE. We used a random-effects model with a 95% CI to pool the data. Heterogeneity was assessed with I2 statistics. RESULTS: We included eight studies involving 1,163 patients, 584 of whom (50.21%) underwent TS. Pleurodesis failure rates were similar between the procedures (OR = 1.07; 95% CI: 0.56-2.06; p = 0.83; I2 = 62%); and 68% of patients (95% CI: 0.31-1.47; p = 0.33; I2 = 58%) had postoperative complications, which were lower in patients in the TS group than in the TTI group. In a subgroup analysis considering only randomized clinical trials, the failure rate was significantly lower in the TS treatment group (OR = 0.62; 95% CI: 0.42-0.90; p = 0.01; I2 = 0%). Similarly, dyspnea was less common in the TS group (OR = 0.74; 95% CI: 0.41-1.34; p = 0.32; I2 = 55%). Adverse effects were reported in 86 patients, and no significant difference was seen between the TS and TTI groups: empyema (OR = 1.43; 95% CI: 0.36-5.64; p = 0.86; I2 = 0%), pain (OR = 1.22 (95% CI: 0.67-2.21; p = 0.51; I2 = 38%), and pneumonia (OR = 1.15; 95% CI: 0.30-4.46; p = 0.86; I2 = 27%). CONCLUSIONS: Our findings suggest that TS is an effective treatment for MPE, with no significant increase in adverse events. Results suggest equivalent efficacy and safety for both procedures.
Subject(s)
Insufflation , Pleural Effusion, Malignant , Pleurodesis , Talc , Thoracoscopy , Humans , Talc/administration & dosage , Pleural Effusion, Malignant/therapy , Pleurodesis/methods , Insufflation/methods , Insufflation/adverse effects , Thoracoscopy/methods , Thoracoscopy/adverse effects , Treatment Outcome , Reproducibility of ResultsABSTRACT
Ozone therapy acts in the body inducing controlled oxidative stress, thereby improving the antioxidant, immune and circulatory responses. However, very little is known about how this therapy affects oxidative stress indicators in dogs. We aimed to assess the clinical, hematological, biochemical and oxidative stress parameters of healthy dogs subjected to ozone therapy and oxygen therapy by rectal insufflation. Ten healthy dogs were allocated into three experimental groups in a cross-over design: control, without intervention; ozone, which received 100 µg of O3/kg through rectal insufflation; and oxygen, which received an ozone-equivalent volume of medicinal O2 through rectal insufflation. Dogs received four applications weekly and were followed up until the seventh week. Ozone therapy significantly increased the weight, mean corpuscular volume and mean platelet volume and decreased total cholesterol of treated dogs. Regarding oxidative stress, ozone therapy reduced total antioxidant capacity by ferric reduction (TAC-FRAP) in D7 compared with baseline and the control, significantly increased total antioxidant capacity by cupric reduction (TAC-CUPRAC) in D42 and D49 compared with the control group, caused an increase in uric acid compared with the oxygen group and decreased lipid peroxidation on D21 compared with the control group. In conclusion, ozone therapy through rectal insufflation causes transient oxidative stress followed by an antioxidant response and discreetly interferes with a few clinical, hematological and biochemical variables in healthy dogs, although variables still remained within the reference ranges for the species, thus proving the safety of the therapy. Furthermore, oxygen therapy causes oxidative stress without inducing a subsequent antioxidant response.
Subject(s)
Cross-Over Studies , Insufflation , Oxidative Stress , Ozone , Rectum , Animals , Dogs , Ozone/administration & dosage , Oxidative Stress/drug effects , Rectum/drug effects , Male , Insufflation/veterinary , Female , AntioxidantsABSTRACT
La atrofia muscular espinal (AME) de presentación temprana representa la variante más severa, con una expectativa de vida generalmente no mayor a dos años sin soporte ventilatorio, debido a la insuficiencia respiratoria y la dificultad para toser. Tradicionalmente, el manejo respiratorio en muchos países ha incluido la traqueostomía para proporcionar asistencia ventilatoria invasiva de manera continua. No obstante, la introducción de medicamentos de precisión ha modificado la progresión natural de la enfermedad, evidenciando mejoras significativas en los hitos motores y beneficiando también la función respiratoria. A pesar de estas mejoras, en muchos casos sigue siendo necesaria la ventilación intermitente y/o continua, además de la facilitación de la tos. Estas necesidades pueden abordarse de forma no invasiva mediante el soporte ventilatorio no invasivo (SVN), la in-exsuflación mecánica (IEM) y el reclutamiento de volumen pulmonar (RVP), que son considerados pilares del tratamiento respiratorio en enfermedades neuromusculares. Estas estrategias promueven el desarrollo y mantenimiento de la función respiratoria, reduciendo el riesgo de exacerbaciones respiratorias que podrían llevar a intubaciones evitables. Comúnmente, los pacientes con AME experimentan intentos fallidos de extubación siguiendo protocolos tradicionales, siendo catalogados como no extubables y potenciales candidatos a traqueostomía. No obstante, existen protocolos de extubación específicos para AME que emplean SVN e IEM con un alto porcentaje de éxito, evitando traqueostomías innecesarias que pueden complicar la progresión de la enfermedad y afectar la calidad de vida. El enfoque respiratorio no invasivo es una opción de manejo segura tanto en el hospital como en el hogar, ofreciendo una mejor calidad de vida para los pacientes y sus familias.
Early-onset spinal muscular atrophy (SMA) is the most severe variant, with a life expectancy generally not exceeding two years without ventilatory support due to respiratory insufficiency and difficulty in coughing. Traditionally, respiratory management in many countries has included tracheostomy to provide continuous invasive ventilatory support. However, the introduction of precision medicine has altered the natural progression of the disease, showing significant improvements in motor milestones and also benefiting respiratory function. Despite these improvements, many cases still require intermittent and/or continuous ventilation, as well as cough facilitation. These needs can be addressed non-invasively through non-invasive ventilatory support (NIV), mechanical insufflation-exsufflation (MIE), and lung volume recruitment (LVR), which are considered the pillars of respiratory treatment in neuromuscular diseases. These strategies promote the development and maintenance of respiratory function, reducing the risk of respiratory exacerbations that could lead to avoidable intubations. Commonly, SMA patients experience failed extubation attempts following traditional protocols, being labeled as non-extubatable and potential candidates for tracheostomy. Nevertheless, there are specific extubation protocols for SMA that employ NIV and MIE with a high success rate, avoiding unnecessary tracheostomies that can complicate disease progression and impact quality of life. The non-invasive respiratory approach is a safe management option both in the hospital and at home, offering a better quality of life for patients and their families.
Subject(s)
Humans , Muscular Atrophy, Spinal/therapy , Insufflation , Airway Extubation , Noninvasive Ventilation , Lung Volume MeasurementsABSTRACT
Introducción: Las infecciones intestinales se relacionan con trastornos del sistema inmune y de la microbiota intestinal. Pueden ser recurrentes y producir otras alteraciones intestinales y sistémicas, que empeoran con la terapia antimicrobiana. La ozonoterapia ha sido usada en el tratamiento de infecciones intestinales. Objetivos: Recopilar información sobre los efectos biológicos, terapéuticos y la seguridad de la administración del ozono por insuflación rectal en el tratamiento de las infecciones intestinales. Métodos: Para la búsqueda de información se empleó el motor de búsqueda Google Académico. Se consultaron artículos en las bases de datos PubMed y SciELO de la Biblioteca Virtual de Salud. Además, se realizó una búsqueda general en los idiomas español e inglés, a partir de los artículos más relevantes acerca del estudio. Se utilizaron como palabras clave: infecciones, insuflación, microbioma gastrointestinal, ozono como términos más concretos. En el estudio no se aplicó ninguna restricción acerca del ámbito geográfico ni de la edad. Conclusiones: La aplicación rectal de ozono es segura, tiene acciones biológicas y terapéuticas útiles para tratar las infecciones intestinales. Actúa como inmunomodulador y protector de la microbiota intestinal, lo que permite enfrentar esta problemática de salud desde el punto de vista preventivo, curativo y de rehabilitación de los daños causados, tanto por los gérmenes como por los efectos de los antibióticos(AU)
Introduction: Intestinal infections are related to disorders of the immune system and intestinal microbiota. They can be recurrent and produce other intestinal and systemic alterations, which worsen with antimicrobial therapy. Ozone therapy has been used in the treatment of intestinal infections. Objectives: To compile information on the biological, therapeutic effects and safety of the administration of ozone by rectal insufflation in the treatment of intestinal infections. Methods: Google Scholar search engine was used for searching information. Articles were consulted in PubMed and SciELO databases of the Virtual Health Library. In addition, a general search was carried out in Spanish and English, based on the most relevant articles about the study. The keywords used were infections, insufflation, gastrointestinal microbiome, ozone as more specific terms. No restrictions on geographic area or age were applied in the study. Conclusions: The rectal application of ozone is safe, it has useful biological and therapeutic actions to treat intestinal infections, acting as an immunomodulator and protector of the intestinal microbiota, which allows us to face this health problem from a preventive, curative and rehabilitation point of view of the damage caused, both by germs and by the effects of antibiotics(AU)
Subject(s)
Humans , Ozone/therapeutic use , Insufflation/methods , Gastrointestinal Microbiome/physiology , Infections/drug therapyABSTRACT
OBJECTIVE: We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients. METHODS: This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation. The incidence of acute respiratory failure within 48 hours of extubation was evaluated. Similarly, the reintubation rate, intensive care unit length of stay, mortality at 28 days, and survival probability at 90 days were assessed. The study was stopped after futility results in the interim analysis. RESULTS: We included 122 consecutive patients (n = 61 per group). There was no significant difference in the incidence of acute respiratory failure between treatments (11.5% control group versus 16.4%, intervention group; p = 0.60), the need for reintubation (3.6% versus 10.7%; p = 0.27), mean length of stay (3 versus 4 days; p = 0.33), mortality at Day 28 (9.8% versus 15.0%; p = 0.42), or survival probability at Day 90 (21.3% versus 28.3%; p = 0.41). CONCLUSION: Mechanical insufflation-exsufflation combined with chest physiotherapy seems to have no impact in preventing postextubation acute respiratory failure in intensive care unit-acquired weakness patients. Similarly, mortality and survival probability were similar in both groups. Nevertheless, given the early termination of the trial, further clinical investigation is strongly recommended. CLINICAL TRIALS REGISTER: NCT01931228.
Subject(s)
Insufflation , Respiratory Insufficiency , Humans , Prospective Studies , Insufflation/adverse effects , Respiration, Artificial/adverse effects , Critical Care , Respiratory Insufficiency/etiologyABSTRACT
We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.
Subject(s)
Gastroschisis , Insufflation , Pregnancy , Infant, Newborn , Female , Humans , Fetoscopy/methods , Gastroschisis/diagnostic imaging , Gastroschisis/surgery , Carbon Dioxide , FetusSubject(s)
Insufflation , Pneumothorax , Humans , Insufflation/methods , Feasibility Studies , Carbon DioxideABSTRACT
BACKGROUND: Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. OBJECTIVE: This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. METHODS: In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. RESULTS: The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). CONCLUSION: In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
Subject(s)
Insufflation , Capnography , Carbon Dioxide , Colonoscopy/adverse effects , Colonoscopy/methods , Humans , Hypoxia/diagnosis , Insufflation/adverse effects , Insufflation/methods , Pain , Prospective StudiesSubject(s)
Bariatric Surgery , Insufflation , Obesity, Morbid , Anesthetics, Local , Humans , Intubation, Intratracheal , Lidocaine , Obesity, Morbid/surgeryABSTRACT
BACKGROUND: The use of low-pressure pneumoperitoneum seems to be capable of reducing complications such as post-operative pain. However, the quality of evidence supporting this conclusion is low. Both the lack of investigator blinding to both intra-abdominal pressure and to method of neuromuscular blockade represent key sources of bias. Hence, this prospective, randomised, and double-blind study aimed to compare the quality of recovery (Questionnaire QoR-40) of patients undergoing laparoscopic cholecystectomy under low-pressure and standard-pressure pneumoperitoneum. We tested the hypothesis that low pneumoperitoneum pressure enhances the quality of recovery following LC. METHODS: Eighty patients who underwent elective laparoscopic cholecystectomy were randomly divided into two groups, a low-pressure (10 mm Hg) pneumoperitoneum group and a standard-pressure (14 mm Hg) pneumoperitoneum group. For all participants, the value of the insufflation pressure was kept hidden and only the nurse responsible for the operating room was aware of it. Deep neuromuscular blockade was induced for all cases [train-of-four (TOF) = 0; post-tetanic count (PTC) > 0]. The quality of recovery was assessed on the morning of first post-operative day. RESULTS: No difference was found in either total score or in its different dimensions according to the QoR-40 questionnaire. The patients in the low-pressure pneumoperitoneum group experienced more pain during forced coughing measured at 4 hours (median difference [95% CI], 1 [0-2]; P = .030), 8 hours (1 [0-2]; P = .030) and 12 hours (0 [0-1] P = .025) after discharge from the post-anaesthesia care unit, when compared with those in the standard-pressure pneumoperitoneum group. CONCLUSION: We thus conclude that the use of low-pressure pneumoperitoneum during elective laparoscopic cholecystectomy does not improve the quality of recovery.
Subject(s)
Cholecystectomy, Laparoscopic , Insufflation , Pain, Postoperative , Pneumoperitoneum , Abdomen , Cholecystectomy, Laparoscopic/adverse effects , Humans , Pain, Postoperative/prevention & control , Pneumoperitoneum, Artificial , Prospective StudiesABSTRACT
Ozone (O3 ) therapy has been used to improve peripheral tissue oxygenation in humans and domestic animals. The goal of the present study was to characterize histological changes in the endometria of healthy equines following tissue exposure to gas mixtures enriched with different concentrations of O3 . Cycling mares without endometrial degeneration were divided into three groups according to treatment (n = 9 mares/group). The uteri from the O3 , ½O3 and control groups were insufflated for 3 min with gas containing 42, 21 and 0 µg O3 ml-1 , respectively. Treatments were performed every three days from D0 to D6. Endometrial samples were collected immediately before the first treatment and 24 hr after the last treatment. The following nine histological parameters were evaluated: (i) the number of endometrial blood vessels, (ii) endometrial vascular degree (EVD), (iii) increase rate of blood vessels, (iv) increase rate of EVD, (v) glandular total area, (vi) glandular lumen area, (vii) intraglandular secretion area, (viii) glandular epithelial height and (ix) luminal epithelial height. In the O3 group, a positive effect from treatment (p < .01) was detected for all vascular parameters (i, ii, iii and iv), glandular total area, intraglandular secretion area and glandular epithelial height. Compared to the control group, the ½O3 group had greater (p < .01) EVD (84.1 ± 12%) and a higher increase rate of blood vessels (151.9 ± 47.1%). Uterine insufflation with low or intermediate concentrations of the O2 -O3 gas mixture induced endometrial angiogenesis. Morphometry, but not morphology, of the endometrial glands was affected by local O3 therapy. These findings would be of great significance for the development of new therapies for infertility in mares.
Subject(s)
Endometrium/drug effects , Neovascularization, Physiologic/drug effects , Ozone/pharmacology , Animals , Endometrium/blood supply , Female , Horses , Insufflation/veterinary , Oxygen/pharmacology , Uterus/surgeryABSTRACT
PURPOSE: The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS: Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS: During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION: The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.
Subject(s)
Hernia, Ventral , Insufflation , Pneumoperitoneum , Cohort Studies , Hernia, Ventral/surgery , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Humans , Middle Aged , Pneumoperitoneum/surgery , Pneumoperitoneum, Artificial/adverse effects , Pneumoperitoneum, Artificial/methods , Preoperative Care/methods , Retrospective StudiesABSTRACT
A endometrite infecciosa é considerada uma das principais causas de infertilidade em éguas. Por sua vez, alterações degenerativas endometriais interferem diretamente na hemodinâmica uterina, podendo comprometer a fertilização e a manutenção da gestação. Por serem poderosos agentes oxidantes nãoespecíficos, o gás ozônio (O3) e os óleos vegetais ozonizados tem sido utilizados como alternativas às terapias antimicrobianas convencionais. Além de apresentar ação germicida frente a forma livre de fungos e bactérias, a ozonioterapia possui marcante potencial antibiofilme. Adicionalmente, o preenchimento da cavidade uterina de éguas com gás O3 estimula a angiogênese local sem apresentar efeitos deletérios ao endométrio. Dessa forma, os potencias antimicrobianos e angiogênicos fazem da ozonioterapia uma promissora alterativa para o tratamento adjuvante de endometrites crônicas em éguas.
Infectious endometritis is considered one of the main causes of infertility in mares. Similarly, endometrial degenerative changes directly affect the uterine hemodynamics, compromising the fertilization and the maintenance of pregnancy. Based on their powerful non-specific oxidizing action, ozone (O3) and ozonized vegetable oils have been used as alternatives to conventional antimicrobial therapies. In addition to the germicidal effect against the free-living cells of fungi and bacteria, O3 therapy has showed unspecific anti-biofilm potential. Additionally, the insufflation of the uterine cavity of mares with O3 stimulates local angiogenesis without inducing deleterious effects on the endometrium. Therefore, the antimicrobial and angiogenic potentials make O3 therapy a promising alternative for the adjuvant treatment of persistent endometritis in mares.
Subject(s)
Female , Animals , Anti-Infective Agents , Horses/physiology , Endometritis , Angiogenesis Inducing Agents , Insufflation , OzonationABSTRACT
Secretion management in mechanically ventilated patients is a paramount task for clinicians. A better understanding of the mechanisms of flow bias and airway dynamic compression during airway clearance therapy may enable a more effective approach for this population. Ventilator hyperinflation, expiratory rib cage compression, a PEEP-ZEEP maneuver, and mechanical insufflation-exsufflation are examples of techniques that can be optimized according to such mechanisms. In addition, novel technologies, such as electric impedance tomography, may help improve airway clearance therapy by monitoring the consequences of regional secretion displacement on lung aeration and regional lung mechanics.
Subject(s)
Respiration, Artificial , Humans , Insufflation , Lung , Respiratory Physiological Phenomena , Ventilators, MechanicalSubject(s)
Carbon Dioxide , Insufflation , Child , Clinical Competence , Colonoscopy , Education, Medical, Graduate , HumansABSTRACT
PURPOSE: Preoperative progressive pneumoperitoneum (PPP) is mostly used for giant abdominal incisional hernias, and only a few isolated or paired cases that used PPP in the treatment of giant inguinal hernias (GIH) have been reported. The main objective of this study is to describe our technique in the use of PPP in the treatment of GIH in a series of patients who presented with this challenging condition. METHODS: We retrospectively reviewed the medical records of a series of patients treated with PPP for GIH during a 6-year period (2012-2018) at a single institution. The demographics, preoperative, and surgical characteristics were analyzed. RESULTS: In total, 7 patients were treated for GIH with PPP. The median age was 64 (range 30-89) years. The median history time with the inguinal hernia was 8 (range 2-20) years. The median time of PPP was 22 (range 15-30) days. All patients underwent the Lichtenstein technique. The median follow-up time was 12 (range 3-84) months. Three (42.8%) of the patients had preoperative complications. Two patients developed mild dyspnea during PPP, and another patient had subcutaneous emphysema during the insertion of the catheter. Two (28.5%) patients had postoperative complications. One of them developed a right scrotal abscess, and another patient developed bilateral grade III hydrocele. CONCLUSION: With our limited experience, it is too early to tell if this should be the gold standard for the treatment of GIH. To see if there is superiority among different procedures, more studies that compare the morbidity of PPP with that of other trans operative techniques are needed. Nevertheless, the procedure we propose has provided satisfactory results.
Subject(s)
Hernia, Inguinal/surgery , Herniorrhaphy/methods , Pneumoperitoneum, Artificial/methods , Abdomen/surgery , Adult , Aged , Aged, 80 and over , Hernia, Inguinal/pathology , Humans , Insufflation/adverse effects , Male , Middle Aged , Postoperative Complications , Preoperative Care/adverse effects , Retrospective Studies , Scrotum/pathologyABSTRACT
Objetivo Generar una aproximación a las terapias no farmacológicas que disminuyan el dolor durante la realización de la cistoscopia. Métodos Se realizó una búsqueda de la literatura para identificar artículos relevantes con respecto al tópico, utilizando como palabras clave: cistoscopia, dolor, terapia no farmacológica en cistoscopia y terapias alternativas. La búsqueda se hizo a través de Medline y Embase. Se realizó una revisión narrativa. Resultados Aunque la cistoscopia flexible aumenta la tolerancia, especialmente en pacientes masculinos, el dolor sigue siendo inevitable durante la misma. Se han estudiado diferentes intervenciones no farmacológicas orientadas a disminuir el dolor y la ansiedad durante la cistoscopia, entre las que se encuentran: escuchar música, tomar la mano del paciente, ver el procedimiento en tiempo real, el aumento de la presión hidrostática, insuflación con aire y la hipnosis. Conclusión Esas intervenciones podrían ser usadas como adyuvantes en la disminución del dolor y la ansiedad durante la cistoscopia, principalmente la masculina. Sin embargo, se requieren más estudios que comprueben su uso clínico apropiado.
Objective To generate an approach to non-pharmacological therapies that reduce pain during cystoscopy. Methods We searched the literature to identify relevant articles regarding the topic, using as keywords: cystoscopy, pain, non-pharmacological therapy in cystoscopy and alternative therapies. The search was made through Medline and Embase. A narrative review was made. Results Although flexible cystoscopy increases tolerance, especially in male patients, pain remains unavoidable during it. Different non-pharmacological interventions aimed at reducing pain and anxiety during cystoscopy have been studied, among which are: listening to music, taking the patient's hand, seeing the procedure in real time, increasing hydrostatic pressure, insufflation with air and hypnosis. Conclusion These interventions could be used as adjuvants in the reduction of pain and anxiety during cystoscopy, mainly male. However, more studies are required to prove their appropriate clinical use.
Subject(s)
Humans , Complementary Therapies , Cystoscopy , Pain , Insufflation , Hydrostatic Pressure , HypnosisABSTRACT
INTRODUCTION: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). MATERIALS AND METHODS: Children with functional constipation, aged 4 to 17years, that underwent ARM were included in the study. RESULTS: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135ml of air as the maximum tolerance sensation for distinguishing children with RFI. CONCLUSIONS: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation.