RESUMO
OBJECTIVE: Because there are no studies available on the safety of venlafaxine during pregnancy, the authors' goal in this study was to determine whether venlafaxine increases the risk for major malformations. METHOD: Data on 150 women exposed to venlafaxine during pregnancy in seven pregnancy counseling centers were compared with data from studies of pregnant women who 1) received selective serotonin reuptake inhibitor antidepressants (SSRIs) (N=150) and 2) who received nonteratogenic drugs (N=150). RESULTS: Among the 150 women who were exposed to venlafaxine during pregnancy, 125 had live births, 18 had spontaneous abortions, and seven had therapeutic abortions; two of the babies had major malformations. There were no significant differences between these women and the two comparison groups on any of the measures analyzed. CONCLUSIONS: These results suggest that the use of venlafaxine during pregnancy does not increase the rates of major malformations above the baseline rate of 1%-3%.
Assuntos
Anormalidades Induzidas por Medicamentos/epidemiologia , Cicloexanóis/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Troca Materno-Fetal , Complicações na Gravidez/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Aborto Terapêutico/estatística & dados numéricos , Peso ao Nascer/efeitos dos fármacos , Cicloexanóis/uso terapêutico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Exposição Materna/efeitos adversos , Gravidez , Resultado da Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Fumar/efeitos adversos , Cloridrato de VenlafaxinaRESUMO
Endoscopic transurethral resection of the prostate (TURP) can be complicated by absorption of a large volume of irrigation fluid. The clinical features of this complication are referred as the TURP syndrome. We report a case where hyperglycaemia and lactic acidosis complicated the TURP syndrome caused by the massive absorption (approximately 15 litres) of a sorbitol- mannitol irrigation solution. The proposed mechanism is a type B lactic acidosis related to the metabolism of sorbitol.
Assuntos
Acidose Láctica/etiologia , Hiperglicemia/etiologia , Excipientes Farmacêuticos/efeitos adversos , Sorbitol/efeitos adversos , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Humanos , Cuidados Intraoperatórios/efeitos adversos , Masculino , Síndrome , Irrigação Terapêutica/efeitos adversosRESUMO
We prospectively compared pregnancy outcome after exposure to sumatriptan with that of disease-matched controls and nonteratogen controls. There were no differences in the rates of live births, spontaneous abortions, therapeutic abortions, or major birth defects among the three groups. This first prospective report suggests that the use of sumatriptan during organogenesis is not associated with an apparent increased risk of major birth defects.
Assuntos
Resultado da Gravidez , Agonistas do Receptor de Serotonina/efeitos adversos , Sumatriptana/efeitos adversos , Adulto , Desenvolvimento Embrionário e Fetal/efeitos dos fármacos , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Fatores de RiscoRESUMO
CONTEXT: Although a large number of women of reproductive age use new selective serotonin reuptake inhibitors (SSRIs) and half of all pregnancies are unplanned, no data exist on the safety of these agents for the human fetus. OBJECTIVE: To assess fetal safety and risk of fluvoxamine, paroxetine, and sertraline. DESIGN: A prospective, multicenter, controlled cohort study. SETTING: Nine Teratology Information Service centers in the United States and Canada. PATIENTS: All women who were counseled during pregnancy following exposure to a new SSRI and followed up by the participating centers. Controls were randomly selected from women counseled after exposure to nonteratogenic agents. MAIN OUTCOME MEASURES: Rates of major congenital malformations. RESULTS: A total of 267 women exposed to an SSRI and 267 controls were studied. Exposure to SSRIs was not associated with either increased risk for major malformations (9/222 live births [4.1%] vs 9/235 live births [3.8%] in the controls, relative risk, 1.06, 95% confidence interval, 0.43-2.62) or higher rates of miscarriage, stillbirth, or prematurity. Mean (SD) birth weights among SSRI users (3439 [505] g) were similar to the controls (3445 [610] g) as were the gestational ages (39.4 [1.7] weeks vs 39.4 [1.9] weeks). CONCLUSION: The new SSRIs, fluvoxamine, paroxetine, and sertraline, do not appear to increase the teratogenic risk when used in their recommended doses.
Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Antidepressivos/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , 1-Naftilamina/efeitos adversos , 1-Naftilamina/análogos & derivados , Adulto , Antidepressivos/uso terapêutico , Estudos de Coortes , Feminino , Fluvoxamina/efeitos adversos , Humanos , Recém-Nascido , Paroxetina/efeitos adversos , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , SertralinaAssuntos
Anestesia Geral , Intubação Intratraqueal , Brometo de Vecurônio/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Eletromiografia/efeitos dos fármacos , Humanos , Infusões Intravenosas , Junção Neuromuscular/efeitos dos fármacos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-CegoAssuntos
Anestesia por Inalação , Taxa de Filtração Glomerular/efeitos dos fármacos , Hipotensão Controlada/métodos , Isoflurano , Circulação Renal/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Fentanila , Humanos , Óxido Nitroso , Resistência Vascular/efeitos dos fármacosRESUMO
The rate of blood contamination of IV tubings used in anaesthesia practice was investigated. Only IV tubings started in the operating room were studied. First, 300 tubings of three different types were tested at the three distal injection sites. The contamination rate was 3.3 per cent at the injection site closest to the IV catheter and 0.3 per cent at the furthest. The presence of a check-valve did not affect the contamination rate. Second, 300 third injection sites fixed at a level equal to or above the IV catheter were tested. None of them was contaminated. Finally, in order to evaluate whether changing the needle alone could prevent the contamination of syringes, injections were made into a tubing where blood was flowing. Thirty-four per cent of the syringes tested positive for blood. We conclude that IV tubings have a significant contamination rate in usual practice. This rate decreases as the distance from the IV catheter increases. The use of the third site fixed at a level equal to or above the IV catheter carries a lower risk of contamination. Changing the needle alone is a useless procedure to prevent cross-contamination.
Assuntos
Infecção Hospitalar/etiologia , Equipamentos Descartáveis , Contaminação de Equipamentos , Infusões Intravenosas/instrumentação , Seringas , Síndrome da Imunodeficiência Adquirida/transmissão , Análise de Variância , Sangue/microbiologia , Hepatite Viral Humana/transmissão , Humanos , Agulhas , Salas Cirúrgicas , Fatores de RiscoRESUMO
The effect of isoflurane-induced hypotension on reduction of blood loss, improvement of surgical field, and postoperative edema was investigated in 52 patients undergoing combined maxillary and mandibular osteotomies. Anesthesia was maintained with fentanyl, N2O, O2, and isoflurane. Deliberate hypotension was induced by increasing isoflurane inspired concentration. Blood loss in the hypotensive group (MAP 55-65 mm Hg) was significantly less than that in the control group (MAP 75-85 mm Hg); 454.0 +/- 211.3 mL versus 755.3 +/- 334.6 mL (P less than 0.001). Fewer patients had to be transfused in the hypotensive group, 12.0% versus 44.4% (P less than 0.02). The surgical field was significantly improved by the hypotensive technique, but operative time was not shortened. Subjective and objective measurements of postoperative edema failed to show any effect of deliberate hypotension. Our data suggest that isoflurane-induced hypotension effectively reduces blood loss and the number of transfusions in orthognathic surgery.