RESUMO
No disponible
Assuntos
Humanos , Pesquisas sobre Atenção à Saúde , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Necessidades e Demandas de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Anestesia/provisão & distribuição , EspanhaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Educação Baseada em Competências/organização & administração , Educação Baseada em Competências/tendências , Dor/terapia , Anestesia , Educação Baseada em Competências/estatística & dados numéricos , Educação Baseada em Competências/normas , Anestesiologia/educação , 35176 , Docentes , Docentes de Medicina/organização & administraçãoRESUMO
Provision of adequate analgesia and sedation is an essential element in the overall management of critically ill patients who require mechanical ventilation. Familiarity with the regimens used for the different sedatives and analgesic drugs and awareness of their pharmacodynamics and pharmacokinetics in the context of each patient are essential for provision of the most appropriate treatment. In this article, we review assessment methods, the most recent therapeutic recommendations, and a range of analgesic and sedative drugs.
Assuntos
Analgesia/métodos , Sedação Consciente/métodos , Respiração Artificial , Analgésicos/administração & dosagem , Estado Terminal , Humanos , Hipnóticos e Sedativos/administração & dosagemRESUMO
Proporcionar una adecuada analgesia y sedación enpacientes críticos que requieren ventilación mecánicaconstituye una parte importante en el manejo global deestos pacientes. El conocimiento de las estrategias deadministración y del comportamiento farmacocinético yfarmacodinámico de los agentes sedantes y analgésicos,en el contexto de cada paciente, son imprescindiblespara la terapia más apropiada. En este artículo revisamoslos métodos de evaluación, las recomendacionesterapéuticas más recientes y una serie de fármacos analgésicos y sedantes (AU)
Provision of adequate analgesia and sedation is an essential element in the overall management of critically ill patients who require mechanical ventilation. Familiarity with the regimens used for the different sedatives and analgesic drugs and awareness of their pharmacodynamics and pharmacokinetics in the context of each patient are essential for provision of the most appropriate treatment. In this article, we review assessment methods, the most recent therapeutic recommendations, and a range of analgesic and sedative drugs (AU)
Assuntos
Humanos , Analgesia/métodos , Respiração Artificial/métodos , Hipnóticos e Sedativos/farmacocinética , Analgésicos/farmacocinética , Cuidados Críticos/métodos , Hipnóticos e Sedativos/administração & dosagem , Analgésicos/administração & dosagem , Agitação Psicomotora/complicações , Delírio/complicaçõesRESUMO
Paraplegia is a fearful and not uncommon complication of aortic clamping in surgical procedures involving thoracic and abdominal aorta. We report a case of transient spinal cord ischemia during the early postoperative period of aortobifemoral bypass in a 69-year-old male with arteriosclerosis obliterans, hypertension, type II diabetes mellitus and COLD. The anesthetic procedure was combined (peridural + intubation and mechanical ventilation + isofluorane). Two hypotensive episodes of about 80 mmHg developed, one after induction and another in the Reanimation area. The first one had a short duration, whereas the second one required the administration of colloids, crystalloids and blood. The infrarenal aortic clamping time was 35 minutes. In the early postoperative period the patient had clinical features consistent with spinal ischemia, which progressively recovered. To prevent spinal ischemia during surgery a shorter duration than 30 minutes of aortic clamping, a higher distal perfusion pressures higher than 60 mmHg during clamping, and the attempt to exclude the least possible number of intercostal and/or lumbar vessels are recommended. Drugs (corticosteroids, naloxone) and hypothermia can be useful.