RESUMO
Objetivos: Principales: evaluar la seguridad y la efectividad (mediante el análisis de la conducta del paciente) con el uso de óxido nitroso durante la realización de procedimientos dolorosos en los servicios de urgencias pediátricos (SUP); secundarios: evaluar su manejabilidad y su aceptación por el equipo médico y el paciente. Pacientes y métodos: Estudio post-autorización, prospectivo, observacional, multicéntrico, no aleatorizado y abierto (noviembre 2007-diciembre 2008), en el que participaron 7 SUP nacionales. Se incluyó a los pacientes de 2-18 años en los que se utilizó óxido nitroso para la realización de procedimientos dolorosos. Resultados: Se incluyó a 213 pacientes (27,2% < 5 años). La conducta del paciente fue considerada «buena/muy buena» en el 79,7%. El porcentaje de casos con conducta «mala/acepta con dificultad» fue mayor en < 5 años (33,3% vs. 15,1%; p=0,006), no detectándose diferencias significativas en función del procedimiento. Se registraron efectos adversos en 17 casos (7,9%), sin diferencias significativas en función de la edad, estar o no en ayunas ni la asociación de otros fármacos. Los más frecuentes fueron mareo y/o cefalea (10), seguido de vómitos (3). La administración fue considerada fácil por parte del equipo médico en el 96,6%. En el 92,7%, los padres aceptarían que volviera a ser utilizado en su hijo en una situación similar. Conclusiones: La administración de óxido nitroso logra una adecuada sedoanalgesia para la realización de procedimientos dolorosos, sobre todo en niños mayores de 5 años. Los efectos adversos registrados son escasos, leves y conocidos. La mayoría de los padres aceptaría nuevamente su uso en condiciones similares (AU)
Objectives: Primary objectives: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and the patient. Patients and methods: Post-marketing observational, prospective, multicentre, non-randomised and open (November 2007-December 2008) study, which involved seven national PED. We included patients between 2 and 18 years-old on whom a painful procedure was performed in the PED and nitrous oxide was used. Results: A total 213 patients were included (27,2% < 5years). Patient behaviour was considered «good/very good» in 79,7%, with no statistically significant difference in relation to the procedure performed. Patient behaviour was more often classified as «bad/accept with difficulty» among those < 5years (33.3% vs 15.1%, P=0.006). Adverse events occurred in 17 cases (7.9%), with no significant difference in the rate in relation to the age, fasting or not or in association with other drugs; the most frequent were dizziness and/or headache (10), followed by vomiting (3). The administration was considered easy by the medical team in the 96.6% of the cases. Parents would accept the use of nitrous oxide in their child in a similar situation in 92.7% of the cases. Conclusions: Administration of nitrous oxide achieves proper sedation and analgesia during painful procedures, especially in children older than 5years. Adverse events reported were few, mild and expected. Most parents would accept its use again in a similar situation (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Analgesia/métodos , Dor/tratamento farmacológico , Óxido Nitroso/uso terapêutico , Tratamento de Emergência/métodos , Satisfação do Paciente/estatística & dados numéricos , EfetividadeRESUMO
PRIMARY OBJECTIVES: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and the patient. PATIENTS AND METHODS: Post-marketing observational, prospective, multicentre, non-randomised and open (November 2007-December 2008) study, which involved seven national PED. We included patients between 2 and 18 years-old on whom a painful procedure was performed in the PED and nitrous oxide was used. RESULTS: A total 213 patients were included (27,2% < 5 years). Patient behaviour was considered «good/very good¼ in 79,7%, with no statistically significant difference in relation to the procedure performed. Patient behaviour was more often classified as «bad/accept with difficulty¼ among those < 5 years (33.3% vs 15.1%, P=.006). Adverse events occurred in 17 cases (7.9%), with no significant difference in the rate in relation to the age, fasting or not or in association with other drugs; the most frequent were dizziness and/or headache (10), followed by vomiting (3). The administration was considered easy by the medical team in the 96.6% of the cases. Parents would accept the use of nitrous oxide in their child in a similar situation in 92.7% of the cases. CONCLUSIONS: Administration of nitrous oxide achieves proper sedation and analgesia during painful procedures, especially in children older than 5 years. Adverse events reported were few, mild and expected. Most parents would accept its use again in a similar situation.
Assuntos
Analgesia , Analgésicos não Narcóticos/uso terapêutico , Sedação Consciente , Tratamento de Emergência , Óxido Nitroso/uso terapêutico , Adolescente , Analgésicos não Narcóticos/efeitos adversos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Óxido Nitroso/efeitos adversos , Estudos ProspectivosRESUMO
PURPOSE: Assess the efficacy of corneal anterior stromal punctures as treatment for Recurrent Corneal Erosion (RCE) and relapse prevention. Two other treatments are compared: simple occlusion with antibiotic ointment, not manipulating the lesion and debridement of erosion previous to occlusion. MATERIAL AND METHOD: A retrospective study was performed on a total of 36 patients diagnosed with RCE where cases underwent different treatments and results were compared. Other general factors influencing the evolution of the illness are evaluated as well. RESULTS: No statistically significant differences were found comparing the effectiveness of these three treatments to decrease the risk of relapses in erosion. Presence of signs of map-dot-fingerprint dystrophy is common in RCE patients, however not associated with higher risk of relapse. The most frequent associated alteration is meibomitis. CONCLUSIONS: Treatment of RCE with erosion debridement previous to occlusion results in a high rate of healing and this treatment seems better than stromal punctures since it implies less potential risks. Pathogenesis of RCE still remains obscure. Association with certain dystrophys of the epithelial basal membrane could not be demonstrated in this study. However, it is possible that the presence of meibomitis, associated with lids contamination by certain strains of staphylococcus aureus, may play an important role in RCE pathogenesis (Arch Soc Esp Oftalmol 2002; 77: 257-262).
Assuntos
Doenças da Córnea/terapia , Punções , Adulto , Idoso , Substância Própria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Recidiva , Estudos RetrospectivosRESUMO
Objetivo: Evaluar qué factores influyen en la persistencia de la lesión de cérvix tras la exéresis.Diseño: Estudio retrospectivo.Sujetos de estudio: 140 pacientes a las que se les realizaron técnicas de exéresis de lesiones del cérvix uterino con asa de diatermia.Resultados: La edad media de las pacientes fue de 37,5 (19-74). El 72,5 por ciento eran fumadoras. Con márgenes afectados, la persistencia de la lesión a los 6 meses fue del 31,3, frente al 17,2 por ciento si los márgenes estaban libres (15 de 87) (odds ratio [OR]: 2,18; intervalo de confianza [IC]: 0,6-7,2) (p = 0,2). A los 18 meses, persistían dos lesiones (curación en el 96,1 por ciento); ambos casos tenían márgenes libres. En las fumadoras, persiste en el 26,5 por ciento a los 6 meses, frente al 13,3 por ciento en las no fumadoras (OR: 2,34; IC: 0,5-11,8) (p = 0,3). Las dos pacientes con persistencia a los 18 meses eran fumadoras. Las lesiones de alto grado persistieron en un 19,3 por ciento a los 6 meses y en un 3,9 por ciento a los 18 meses; las de bajo grado persistieron en un 29,4 por ciento a los 6 meses y en ningún caso a los 18 meses (p = 0,8).Conclusiones: La persistencia de la lesión a los 18 meses no dependió de la afectación de los márgenes de resección, de la histología ni del hábito tabáquico. No es necesaria la cirugía posterior en las pacientes que tienen resección incompleta de una lesión del cérvix uterino, y sólo la evolución tras el seguimiento con citología y colposcopia puede justificar la reintervención. (AU)
