RESUMO
Post-operative nausea and vomiting (PONV) is an event of multifactorial origin with an incidence of 30% in the general population. Opioids such as fentanyl are being used as adjuvant to local anesthetic for its antiemetic effect. In this context, with this study we aimed to evaluate the impact of spinal fentanyl as an adjuvant on the incidence of PONV compared with a placebo, and shivering. A systematic search of randomized controlled trials that evaluated the use of spinal fentanyl in the prevention of PONV and shivering was conducted in different databases, of which 32 studies met the inclusion criteria. A total of 2116 patients scheduled for various surgeries, including cesarean section, orthopedic surgery in the lower limb, hysterectomy, and transurethral resection of the prostate, were included in the final analysis. The meta-analysis estimated the relative risk of incidence of PONV in the first 24 hours after surgery and secondary outcomes included the shivering symptom. The use of intrathecal fentanyl was associated with lower incidence of PONV, but not statistically significant when compared to the placebo (RR: 0.74 CI95%: 0.55-1.01 P = 0.06). Subgroup analysis showed a statistically significant reduction in PONV incidences with lower doses between 10 and 15 µg (RR: 0.44 CI95%: 0.35-0.55 P < 0.00001, I2 = 0%) but not with higher doses 20-25 µg. Secondary outcomes showed a decrease in incidence with the use of fentanyl vs the placebo (RR: 0.49, CI95% 0.33-0.72 P = 0.0003). Current evidence shows that the use of spinal fentanyl decreases the incidence of PONV, an effect favored using low doses.
RESUMO
Post-operative nausea and vomiting (PONV) is an event of multifactorial origin with an incidence of 30% in the general population. Opioids such as fentanyl are being used as adjuvant to local anesthetic for its antiemetic effect. In this context, with this study we aimed to evaluate the impact of spinal fentanyl as an adjuvant on the incidence of PONV compared with a placebo, and shivering. A systematic search of randomized controlled trials that evaluated the use of spinal fentanyl in the prevention of PONV and shivering was conducted in different databases, of which 32 studies met the inclusion criteria. A total of 2116 patients scheduled for various surgeries, including cesarean section, orthopedic surgery in the lower limb, hysterectomy, and transurethral resection of the prostate, were included in the final analysis. The meta-analysis estimated the relative risk of incidence of PONV in the first 24 hours after surgery and secondary outcomes included the shivering symptom. The use of intrathecal fentanyl was associated with lower incidence of PONV, but not statistically significant when compared to the placebo (RR: 0.74 CI95%: 0.55-1.01 P = 0.06). Subgroup analysis showed a statistically significant reduction in PONV incidences with lower doses between 10 and 15 µg (RR: 0.44 CI95%: 0.35-0.55 P < 0.00001, I2 = 0%) but not with higher doses 20-25 µg. Secondary outcomes showed a decrease in incidence with the use of fentanyl vs the placebo (RR: 0.49, CI95% 0.33-0.72 P = 0.0003). Current evidence shows that the use of spinal fentanyl decreases the incidence of PONV, an effect favored using low doses.
RESUMO
Objetivo: Describir las características clínicas y microbiológicas de recién nacidos con sepsis admitidos a UCI neonatal de la Fundación Valle del Lili. Materiales y métodos: estudio retrospectivo descriptivo entre los años 2012 y 2015. Se seleccionaron neonatos con diagnóstico de sepsis con más de tres días de manejo antibiótico. Resultados: Se analizaron datos de las historias de 569 pacientes. El 37.9% (216) de los neonatos tenían peso al nacimiento <1500 g, 29.2% (166) entre 1500-2500 g, y 33.9% (187) >2500 g. Para un total de 396 (69.6%) pacientes con sepsis temprana, 308 (54.1%) con sepsis tardía. Las características clínicas más comunes fueron las respiratorias. El principal diagnóstico de infección en sepsis tardía fue la bacteremia (46.4%), seguido de la infección asociada al catéter (17.8%). El aislamiento más común para sepsis temprana fue Streptococcus agalactiae en el 21.9%, mientras que en sepsis tardía fue Staphylococcus epidermidis en el 22.6%. La mortalidad encontrada en sepsis temprana fue de 8.8% y en tardía de 8.5%. Conclusiones: La sepsis neonatal, a pesar de la mejoría en los controles prenatales, continúa siendo una patología frecuente con un importante porcentaje de morbimortalidad. El Streptococcus agalactiae fue la principal causa de sepsis temprana en nuestros pacientes.
Objective: To describe the clinical and microbiological characteristics of newborns with sepsis admitted to the Neonatal Intensive Care Unit of Fundación Valle del Lili in Cali, Colombia. Methods: Descriptive, observational, retrospective study between 2012 and 2015. We included newborns with diagnosis of sepsis with more than three days of antibiotic management. Results: A total of 569 patients were included, 37.9% (216) of the newborns had a birth weight <1500g, 29.2% (166) between 1500 and 2500g , and 32.9% (187) >2500g. 396 (69.6%) patients with early-onset sepsus, 308 (54.1%) had late-onset sepsis. The most common clinical characteristics were respiratory symptoms. The main diagnosis of infection in late-onset sepsis was bacteremia (46.4%) followed by catheter associated infection (17.8%). The most common blood culture isolation for early-onset sepsis was Streptococcus agalactiae (21.9%) and Staphylococcus epidermidis in late onset sepsis (22.6%). The mortality found in early-onset sepsis was 8.8% and in late-onset sepsis was 8.5%. Conclusions: Neonatal sepsis continue to be a frequent diagnosis with significant morbidity and mortality. Better strategies for the prevention of this entity are required including the prenatal period.
