RESUMO
PURPOSE: Purpose of this study was to retrospectively review our experience of multidisciplinary clinic providing a joint approach by radiation oncologist and anesthetist for patients with cancer pain to evaluate the adequacy and the IMprovement in MAnagement (IM-MA study) of this symptom. METHODS: A Team for Pain Management (TPM) represented by radiation oncologist and anesthetist weekly provided consultations to patient presenting cancer pain. TPM prospectively reported epidemiologic, symptomatic, and pharmacological data. TPM modified pain therapy and indicated antalgic radiotherapy. Patients were evaluated at baseline and after 4 weeks after intervention. RESULTS: From November 2015 to April 2016, 65 patients were evaluated by TPM. At the baseline, 18 patients (27.7%) were undertreated (i.e., receiving inadequate pain management); furthermore, 27 patients (41.5%) despite receiving strong opioids had uncontrolled pain. After 4 weeks from intervention, undertreated patients were reduced to 1.53%. For those patients undergone to radiotherapy, response at 34 weeks was scored as follows: complete response 28.8%, partial response 46.7%, pain progression 0.95%, indeterminate response 23.8%. CONCLUSIONS: A multidisciplinary Team for Pain Management improved the clinical management, optimizing pain control and increasing adequacy of pharmacological management. The TPM intervention seems particularly worth for patients presenting specific features including BTcP, neuropathic pain, severe pain due to bone metastases, and any potential candidate to radiotherapy. Larger series and QoL questionnaires are required to confirm these results.
Assuntos
Anestesistas/tendências , Dor do Câncer/tratamento farmacológico , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Radioterapia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Infections occurring at the end of pregnancy, during birth or by breastfeeding are responsible for the high toll of death among first-week infants. In-utero DNA immunization has demonstrated the effectiveness in inducing specific immunity in newborns. A major contribution to infant immunization would be achieved if a vaccine proved able to be protective as early as at the birth, preventing the typical 'first-week infections'. To establish its potential for use in humans, in-utero DNA vaccination efficiency has to be evaluated for short- and long-term safety, protection at delivery, efficacy of boosts in adults and effective window/s for modulation of immune response during pregnancy, in an animal model suitable with human development. Here we show that a single intramuscular in-utero anti-HBV DNA immunization at two-thirds of pig gestation produces, at birth, antibody titers considered protective in humans. The boost of antibody titers in every animal following recall at 4 and 10 months demonstrates the establishment of immune memory. The safety of in-utero fetus manipulation is guaranteed by short-term (no fetus loss, lack of local alterations, at-term spontaneous delivery, breastfeeding) and long-term (2 years) monitoring. Treatment of fetuses closer to delivery results in immune ignorance without induction of tolerance. This result highlights the repercussion of selecting the appropriate time point when this approach is used to deliver therapeutic genes. All these findings illustrate the relevance of naked DNA-based vaccination technology in therapeutic efforts aimed to prevent the high toll of death among first-week infants.
Assuntos
Feto/imunologia , Terapia Genética/métodos , Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Imunização/métodos , Vacinas de DNA/administração & dosagem , Animais , Animais Recém-Nascidos/imunologia , Feminino , Idade Gestacional , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Injeções Intramusculares , Modelos Animais , Gravidez , Efeitos Tardios da Exposição Pré-Natal , SuínosRESUMO
Postoperative emesis is a common daily problem in anesthetic practice. Authors report their experience about prevention of PONV (postoperative nausea and vomiting) with the association of different drugs in premedication, and suggest Promethazine as an effective and inexpensive medication to prevent PONV in orthopedic surgery.
Assuntos
Antieméticos/economia , Antieméticos/uso terapêutico , Náusea/economia , Náusea/prevenção & controle , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/prevenção & controle , Medicação Pré-Anestésica/economia , Prometazina/economia , Prometazina/uso terapêutico , Vômito/economia , Vômito/prevenção & controle , Adolescente , Adulto , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Humanos , MasculinoRESUMO
In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation. The patients were divided in six different groups, and in each of them intubation was performed at different times from injection of inducing agents (2-2, 30-3-4-5-6 minutes). Overall results show a lack of satisfying intubating conditions on the extreme of selected times (2 and 5-6 minutes), with no significant difference between Thiopental and Propofol, except for a minimal unlike behaviour in hemodynamics. Therefore, on the basis of our data, as far as intubating conditions are considered, we can conclude that there is no reason to prefer one of the two inducing agents.
Assuntos
Anestesia , Propofol , Tiopental , Brometo de Vecurônio , Adolescente , Adulto , Feminino , Humanos , Intubação Intratraqueal , Masculino , Medicação Pré-Anestésica , Propofol/administração & dosagemAssuntos
Anestesia , Consentimento Livre e Esclarecido , Pediatria/legislação & jurisprudência , Criança , Humanos , Itália , RiscoRESUMO
The authors report two cases of postanesthetic delirium in patients receiving intravenous atropine sulphate before surgery. In the first case the diagnosis of atropinic syndrome has been suggested by a cause effect relationship; in the second case the diagnosis has been supported by the prompt resolution after intravenous physostigmine salycilate administration. Since such syndrome was never observed in patients receiving atropine sulphate as i.m. premedicant, authors are prone to consider the i.m. route a safer approach to premedication with this drug.