ABSTRACT
There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).
Subject(s)
Muscle Relaxants, Central , Spinal Cord Injuries , Tolperisone , Baclofen/adverse effects , China , Humans , Muscle Relaxants, Central/adverse effects , Retrospective Studies , Spinal Cord Injuries/complicationsABSTRACT
There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).
Subject(s)
Humans , Spinal Cord Injuries/complications , Tolperisone , Muscle Relaxants, Central/adverse effects , Baclofen/adverse effects , China , Retrospective StudiesABSTRACT
The anesthesiologist is the specialist who most often faces allergic reactions due to the number of drugs and substances that are exposed to the patient during the course of an intervention. Although they are rare, they have a mortality rate between 3% and 10%. We present a clinical case of a 42-year-old woman with a history of anaphylactic reaction grade 2 that is coordinated for a Werthein-Meigs surgery, for which it is decided to test her with skin tests. The results were positive for morphine, fentanil, remifentanil and atracurium, which directly affected the perioperative management.
El anestesiólogo es el especialista que con mayor frecuencia se enfrenta a reacciones alérgicas por el número de fármacos y sustancias a las que se expone al paciente en el transcurso de una intervención. Si bien son poco frecuentes presentan una mortalidad entre 3 a 10%. Presentamos un caso clínico de una mujer de 42 años con un antecedente de reaccion anafiláctica grado 2 que se coordina para una cirugía de Werthein- Meigs, por lo cual se decide testearla con pruebas cutáneas. Los rsultados fueron positivos para morfina, fentani, remifentanil y atracurio, lo cual incidió directamente en el manejo perioperatorio.
Subject(s)
Humans , Female , Adult , Preoperative Care , Anaphylaxis/diagnosis , Anaphylaxis/prevention & control , Anesthesia, Conduction/methods , Skin Tests , Opiate Alkaloids/adverse effects , Anaphylaxis/chemically induced , Anesthetics, Local , Muscle Relaxants, Central/adverse effectsABSTRACT
OBJECTIVE: To analyze the incidence and factors associated with constipation in critically ill children. STUDY DESIGN: We performed a prospective observational study that included children admitted to the pediatric intensive care unit for more than 3 days. Constipation was defined as more than 3 days without a bowel movement. Relationships between constipation and demographic data; clinical severity score; use of mechanical ventilation, use of vasoconstrictors, sedatives, and muscle relaxants; nutritional data; electrolyte disturbances; and clinical course were analyzed. RESULTS: Constipation developed in 46.7% of the 150 patients studied (mean age, 34.3 ± 7.1 months). It was most common in postoperative, older, and higher-body-weight patients, and in those with fecal continence (P < .01). Compared with patients without constipation, patients with constipation had higher severity scores and more frequently received midazolam, fentanyl, muscle relaxants, and inotropic support (P < .05). Patients with constipation also started nutrition later and with a lower volume of nutrition (P < .01). There were no between-group differences in mortality or length of pediatric intensive care unit stay. In multivariate analysis, independent factors associated with constipation were body weight (OR, 1.08; 95% CI, 1.03-1.13), Pediatric Index of Mortality 2 score (OR, 1.05; 95% CI, 1.02-1.09), admission after surgery (OR, 7.64; 95% CI, 2.56-22.81), and treatment with vasoconstrictors (OR, 10.28; 95% CI, 3.53-29.93). CONCLUSION: Constipation is common in critically ill children. Body weight, Pediatric Index of Mortality 2 clinical severity score, admission after surgery, and the need for vasoconstrictor therapy are major independent risk factors associated with constipation.
Subject(s)
Constipation/etiology , Body Weight , Child , Child, Preschool , Critical Illness , Electrolytes , Female , Hospitalization , Humans , Hypnotics and Sedatives/adverse effects , Infant , Intensive Care Units, Pediatric , Male , Muscle Relaxants, Central/adverse effects , Prospective Studies , Regression Analysis , Respiration, Artificial/adverse effects , Risk Factors , Vasoconstrictor Agents/adverse effectsSubject(s)
Baclofen/poisoning , Coma/chemically induced , Electroencephalography/drug effects , Muscle Relaxants, Central/adverse effects , Tetanus/drug therapy , Baclofen/administration & dosage , Baclofen/therapeutic use , Coma/diagnostic imaging , Coma/physiopathology , Drug Overdose , Emergencies , Fatal Outcome , Female , Humans , Immunization, Passive , Injections, Intramuscular/adverse effects , Metronidazole/therapeutic use , Middle Aged , Multiple Organ Failure , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/therapeutic use , Tetanus Antitoxin/therapeutic use , Ultrasonography, Doppler, TranscranialABSTRACT
Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin) when compared with 20 mg piroxicam alone (Feldene) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Molar, Third/surgery , Muscle Relaxants, Central/administration & dosage , Tooth Extraction , Vitamin B Complex/administration & dosage , Adolescent , Adult , Anti-Inflammatory Agents/adverse effects , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Double-Blind Method , Drug Therapy, Combination , Edema/prevention & control , Female , Humans , Male , Middle Aged , Muscle Relaxants, Central/adverse effects , Orphenadrine/administration & dosage , Orphenadrine/adverse effects , Pain Measurement , Pain, Postoperative/drug therapy , Piroxicam/administration & dosage , Piroxicam/adverse effects , Prospective Studies , Severity of Illness Index , Vitamin B 12/administration & dosage , Vitamin B 12/adverse effects , Vitamin B Complex/adverse effectsABSTRACT
Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin®) when compared with 20 mg piroxicam alone (Feldene®) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Dexamethasone/administration & dosage , Molar, Third/surgery , Orphenadrine/administration & dosage , Piroxicam/administration & dosage , Tooth Extraction , /administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Double-Blind Method , Drug Combinations , Dexamethasone/adverse effects , Edema/prevention & control , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/adverse effects , Orphenadrine/adverse effects , Pain Measurement , Prospective Studies , Pain, Postoperative/drug therapy , Piroxicam/adverse effects , Severity of Illness Index , /adverse effects , Vitamin B Complex/administration & dosage , Vitamin B Complex/adverse effectsSubject(s)
Humans , Anesthesia , Muscle Relaxants, Central/pharmacokinetics , Muscle Relaxants, Central/adverse effects , Muscle Relaxants, Central/immunology , Muscle Relaxants, Central/toxicity , Drug Interactions , Product Surveillance, Postmarketing , Clinical Trials as Topic/methods , Bronchial Spasm/mortalityABSTRACT
La comprensión de la farmacocinética y la farmacodinamia de los relajantes musculares y el empleo del monitoreo de la transmisión neuromuscular, son elementos esenciales en la reversión del bloqueo neuromuscular. Esa reversión es adecuada cuando el registro de las respuestas musculares al Tren de Cuatro es superior al 70-80 por ciento, mientras que los demás métodos tienen menor especificidad. Entre los medios con registro disponible (fuerza, electromiograma, aceleración), el más práctico para el monitoreo es la acelerometría isotónica. Frente a la ausencia de métodos de registro, se impone la Estimulación de Doble Ráfaga, aunque su especificidad es del 96 por ciento. Antes de intentar la reversión farmacológica, el raciocinio clínico pronóstico de la función neuromuscular debe incluir los siguientes items: profundidad previa del bloqueo, posibilidad de interacciones farmacológicas, duración de la administración del relajante, mecanismo de finalización del efecto relajante según sea el agente usado, método empleado en el mantenimiento de la relajación, balance térmico y ácido-base del paciente, y su condición física. Si el nivel plasmático del relajante es alto, se puede obtener una reversión transitoria inyectando neostigmina, pero deben tomarse los cuidados necesarios en la sala de recuperación para reconocer y tratar adecuadamente una recurrencia del bloqueo neuromuscular.
Subject(s)
Humans , Anesthesia, General , Electric Stimulation/methods , Monitoring, Physiologic/methods , Muscle Relaxants, Central/adverse effects , Muscle Relaxants, Central/pharmacokinetics , Muscle Relaxants, Central/pharmacology , Anesthesia Recovery Period , Neostigmine/administration & dosage , Postoperative Complications , Respiratory ParalysisABSTRACT
La comprensión de la farmacocinética y la farmacodinamia de los relajantes musculares y el empleo del monitoreo de la transmisión neuromuscular, son elementos esenciales en la reversión del bloqueo neuromuscular. Esa reversión es adecuada cuando el registro de las respuestas musculares al Tren de Cuatro es superior al 70-80 por ciento, mientras que los demás métodos tienen menor especificidad. Entre los medios con registro disponible (fuerza, electromiograma, aceleración), el más práctico para el monitoreo es la acelerometría isotónica. Frente a la ausencia de métodos de registro, se impone la Estimulación de Doble Ráfaga, aunque su especificidad es del 96 por ciento. Antes de intentar la reversión farmacológica, el raciocinio clínico pronóstico de la función neuromuscular debe incluir los siguientes items: profundidad previa del bloqueo, posibilidad de interacciones farmacológicas, duración de la administración del relajante, mecanismo de finalización del efecto relajante según sea el agente usado, método empleado en el mantenimiento de la relajación, balance térmico y ácido-base del paciente, y su condición física. Si el nivel plasmático del relajante es alto, se puede obtener una reversión transitoria inyectando neostigmina, pero deben tomarse los cuidados necesarios en la sala de recuperación para reconocer y tratar adecuadamente una recurrencia del bloqueo neuromuscular. (AU)
Subject(s)
Humans , Monitoring, Physiologic/methods , Muscle Relaxants, Central/pharmacokinetics , Muscle Relaxants, Central/pharmacology , Muscle Relaxants, Central/adverse effects , Electric Stimulation/methods , Anesthesia, General , Postoperative Complications , Respiratory Paralysis , Anesthesia Recovery Period , Neostigmine/administration & dosageSubject(s)
Humans , Anaphylaxis , Anesthesia/mortality , Drug Hypersensitivity/physiopathology , Histamine/adverse effects , Histamine/pharmacokinetics , Histamine/pharmacology , Histamine Release , IgA Vasculitis , Adrenal Cortex Hormones/administration & dosage , Colloids/adverse effects , Epinephrine/administration & dosage , Hypotension/complications , Hypersensitivity/therapy , Muscle Relaxants, Central/adverse effects , Risk Factors , Tachycardia/complicationsSubject(s)
Humans , Anaphylaxis , IgA Vasculitis , Anesthesia/mortality , Drug Hypersensitivity/physiopathology , Histamine Release/drug effects , Histamine/pharmacology , Histamine/pharmacokinetics , Histamine/adverse effects , Tachycardia/complications , Hypotension/complications , Muscle Relaxants, Central/adverse effects , Colloids/adverse effects , Risk Factors , Hypersensitivity/therapy , Epinephrine/administration & dosage , Adrenal Cortex Hormones/administration & dosageABSTRACT
En el presente artículo se hace una revisión de la técnica de dosificación de los relajantes musculares por medio de los estimuladores de nervios periféricos; de las características de la estimulación; de la manera como se efectúa la reversión del bloqueo neuromuscular y algunas indicaciones importantes de la técnica. También se describe la utilización de la contracción única (Single twitch) ó "SI"; de la serie de cuatro (Train of four) ó "S4"; de la serie de dos (Double burst) ó "S2" del estímulo tetánico; y de algunas pautas para aprovechar al máximo esta ayuda diagnóstica