RESUMO
STUDY OBJECTIVE: To evaluate the efficacy of dexmedetomidine with midazolam (DEX-MDZ) versus midazolam only (MDZ) for sedation during awake fiberoptic intubation (AFOI). DESIGN: Randomized, double-blinded study. SETTING: Academic medical center. SUBJECTS: 55 ASA physical status I, II, III, and IV patients, aged 18-85 years, scheduled for non-emergency surgery with AFOI. INTERVENTIONS: All patients received intravenous (IV) glycopyrrolate 0.2 mg premedication, oxygen by nasal cannula, and topical local anesthetics to the airway. MDZ subjects received IV midazolam 0.05 mg/kg with additional doses to achieve a Ramsay Sedation Scale (RSS) score of >or= 2. DEX-MDZ patients received midazolam 0.02 mg/kg followed by dexmedetomidine one microg/kg, then an infusion of dexmedetomidine 0.1 microg/kg/hr and titrated to 0.7 microg/kg/hr to achieve RSS>or=2. MEASUREMENTS: Observers' Assessment of Alertness/Sedation (OAA/S) and RSS were evaluated. The anesthesiologist rated AFOI ease of placement. Two observers rated patients' comfort and reaction to placement at three time points: preoxygenation, at introduction of the fiberoptic laryngoscope, and at introduction of the endotracheal tube (ET) before surgery. Following surgery, patients were asked if they recalled the AFOI and also to rate their satisfaction with the intubation. RESULTS: DEX-MDZ patients were significantly calmer and more cooperative during AFOI and had fewer adverse reactions to AFOI than did the MDZ patients. They also were more satisfied with the AFOI (P < 0.001) than were the midazolam-only patients. There were no significant hemodynamic differences between the two subject groups. CONCLUSIONS: Dexmedetomidine in combination with low doses of midazolam is more effective than midazolam alone for sedation in AFOI.
Assuntos
Sedação Consciente , Dexmedetomidina , Hipnóticos e Sedativos , Intubação Intratraqueal , Midazolam , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
The purpose of this study is to evaluate the effect of California's bicycle helmet law on bicycle-related head injuries in San Diego County with a year 2000 population of approximately 3 million people. The study design is an ecological trend design based on observational data from a Trauma Registry. Outcome measures include helmet use compliance, site/severity of injury and abbreviated injury scale (AIS). There were 1116 bicycle trauma patients recorded in the San Diego County Trauma Registry between 1992 and 1996. The percentages of pre-law and post-law helmet use were 13.2 and 31.7%, respectively. Over the whole study period, the overall helmet use increased by an average of 43% per year with an averaged 84% rate increase in helmet use among children. Only 16.1% of patients with serious head injury used helmets, compared to 28.2% in those who did not have serious head injury. The odds ratio of helmet use against serious head injuries is 0.43 (95% CI 0.28-0.66) after adjusting for age, ethnicity and time. The p-values for comparing pre- and post-legislation serious head injury rates are p=0.764, 0.4 and 0.194 for the overall, adult and child populations, respectively. Helmet legislation increased helmet use in the targeted child population and the effect was carried over to the adult population. Helmet use has a protective effect against serious head injury. Probably due to several of its limitations, the current study did not confirm that helmet legislation alone significantly reduced head injury rates in San Diego County during the study period.
Assuntos
Ciclismo/lesões , Ciclismo/legislação & jurisprudência , Traumatismos Craniocerebrais/epidemiologia , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Política Pública , Adolescente , Adulto , California/epidemiologia , Criança , Traumatismos Craniocerebrais/prevenção & controle , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Avaliação de Programas e Projetos de Saúde , Sistema de Registros/estatística & dados numéricos , Índices de Gravidade do TraumaRESUMO
R.7/S
Conferencia Internacional sobre Mitigacion de Desastres en Instalaciones de Salud. Organización Panamericana de la Salud; 26-28 feb, 1996
. Mexico. Gobierno
. Banco Mundial
. CEPAL
. OEA
. Secretaria del Decenio Internacional para la Reduccion de los Desastres Naturales
Assuntos
Cooperação Econômica , Infraestrutura Sanitária , Centros de Saúde , Desastres NaturaisRESUMO
El concepto de "desarrollo sostenible", tan aceptado por la comunidad internacional es analizado en este ensayo y sometido a una revisión crítica. La reducción de la vulnerabilidad debe jugar un rol preponderante en la definición del "desarrollo sostenible", sin olvidar a los propios agentes sociales, los cuales muchas veces son puestos de lado en nombre de la "verdad" técnica o científica (AU)
