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2.
Br J Anaesth ; 120(4): 705-711, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29576111

RESUMO

BACKGROUND: Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus process that included up to 89 clinician researchers was then used to refine a recommended list of outcome measures. RESULTS: We identified 122 studies in a literature search, which were the basis for a preliminary list of 24 outcome measures and their definitions. The response rates for Delphi Rounds 1, 2, and 3 were 100% (n=22), 90% (n=79), and 100% (n=13), respectively. A final list of six defined endpoints was identified: pain intensity (at rest and during movement) at 24 h postoperatively, nausea and vomiting (0-6 h, 6-24 h, and overall), one of two quality-of-recovery (QoR) scales (QoR score or QoR-15), time to gastrointestinal recovery, time to mobilisation, and sleep quality. CONCLUSIONS: As standardised outcomes will support benchmarking and pooling (meta-analysis) of trials, one or more of these recommended endpoints should be considered for inclusion in clinical trials assessing patient comfort and pain after surgery.


Assuntos
Conforto do Paciente/métodos , Assistência Perioperatória/métodos , Consenso , Técnica Delfos , Humanos , Guias de Prática Clínica como Assunto , Projetos de Pesquisa
3.
Br J Anaesth ; 120(2): 317-322, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29406181

RESUMO

BACKGROUND: The knowledge regarding appropriate dosage of local anaesthetics for peripheral nerve blocks in children is very scarce. The main objective of the current investigation was to evaluate dosing patterns of local anaesthetics in children receiving peripheral nerve blocks across multiple paediatric hospitals in the USA. We also sought to estimate the incidence of local anaesthetic systemic toxicity. METHODS: This is an observational study using the Pediatric Regional Anesthesia Network (PRAN) database. Data on every peripheral nerve block in patients aged <18 years placed from April 1, 2007 to May 31, 2015 were examined as a subset of the PRAN protocol. Data were examined for the type and dose of local anaesthetic and for the presence of local anaesthetic systemic toxicity. RESULTS: In total, 40 121 peripheral nerve blocks in children were analysed. Individual analyses of block type demonstrated large local anaesthetic dose variability with a five- to 10-fold spread depending on the block type. Two patients developed local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) per blocks performed of 0.005% (0.001-0.015%). None of the patients had any short- or long-term complications or sequelae. CONCLUSIONS: We detected a large variability in the local anaesthetic dosing practices for peripheral nerve blocks in children across multiple hospitals in the USA. Nonetheless, the risk of local anaesthetic systemic toxicity was very low. Due to the lack of dose findings studies, our results suggest the need to develop practice guidelines to minimize variability of regional anaesthesia practices in children.


Assuntos
Anestesia por Condução/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Nervos Periféricos , Adolescente , Anestésicos Locais/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Pediatria , Ultrassonografia de Intervenção , Estados Unidos/epidemiologia
4.
Br J Anaesth ; 118(6): 932-937, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28549081

RESUMO

Background.: We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age. Methods.: Two hundred children were randomly assigned to tracheal intubation using DL or KVL. The primary outcome was the median difference in the total time for successful tracheal intubation. Secondary outcomes assessed were tracheal intubation attempts, time to best glottic view, time for tracheal tube entry, percentage of glottic opening score, airway manoeuvres needed, and complications. Results.: The median difference between the groups was 5.7 s, with an upper 95% confidence interval of 7.5 s, which was less than our defined equivalence time difference of 10 s. There were no differences in the number of tracheal intubation attempts and the time to best glottic view [DL median 5.3 (4.1-7.6) s vs KVL 5.0 (4.0-6.3) s; P =0.19]. The percentage of glottic opening score was better when using the KVL [median 100 (100-100) vs DL median 100 (90-100); P <0.0001]. Use of DL was associated with greater need for airway manoeuvres during tracheal intubation (33 vs 7%; P <0.001). Complications did not differ between devices. Conclusions.: In children <2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade. Clinical trial registration: NCT02590237.


Assuntos
Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/instrumentação , Laringoscopia/métodos , Manuseio das Vias Aéreas/efeitos adversos , Manuseio das Vias Aéreas/métodos , Anestesia Geral , Feminino , Glote/anatomia & histologia , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Masculino , Resultado do Tratamento
5.
Anaesthesia ; 71(2): 205-12, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26648173

RESUMO

We conducted a randomised trial in 100 children in order to compare the clinical performance of the Ambu(®) AuraGain(™) and the LMA(®) Supreme(*) for airway maintenance during mechanical ventilation. The primary outcomes were initial and 10-min airway leak pressures. Ease, time and success rates for device and gastric tube insertion, fibreoptic grades of view, airway quality during anaesthetic maintenance, and complications were also assessed. There were no differences in the initial and ten min airway leak pressures between the Ambu AuraGain and LMA Supreme, median (IQR [range]) initial: 19 (16-22 [10-34]) vs 18 (14-24 [8-40]) cmH2 O, p = 0.4; and ten min: 22 (18-26 [11-40]) vs 20 (16-26 [12-40]) cmH2 O, p = 0.08, respectively. Ease, time and success rates for device placement, gastric tube insertion and complications were also not significantly different. Children receiving the LMA Supreme required more airway manouevers (7 vs 1 patient, p = 0.06) to maintain a patent airway. Our results suggest that the Ambu AuraGain may be a useful alternative to the LMA Supreme, as demonstrated by comparable overall clinical performance in children.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Tecnologia de Fibra Óptica , Máscaras Laríngeas/estatística & dados numéricos , Manuseio das Vias Aéreas/estatística & dados numéricos , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Lactente , Masculino
6.
Br J Anaesth ; 115(3): 457-62, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26205902

RESUMO

BACKGROUND: Peripheral nerve catheters (PNCs) are used with increasing frequency in children. Although adult studies have demonstrated safety with this technique, there have been few safety studies in children. The main objective of the current investigation was to examine the incidence of PNC complications in children undergoing surgery. METHODS: This is an observational, multi-institutional study using the Pediatric Regional Anesthesia Network (PRAN) database. Data pertaining to PNCs were entered prospectively into a secure, online database by each participating centre. Patient characteristics, anatomic location, localization techniques, medications used, and complications were recorded for each catheter. All complications and any sequelae were followed until resolution. RESULTS: There were 2074 PNCs included in the study. 251 adverse events and complications were recorded, resulting in an overall incidence (95% CI) of complications of 12.1% (10.7-13.5%). The most common complications were catheter malfunction, block failure, infection, and vascular puncture. There were no reports of persistent neurologic problems, serious infection, or local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) of 0.04% (0.001-0.2%). Patients who developed an infection had used the catheters for a greater number of days, median (IQR) of 4.5 (3-7) days compared with 3 (1-3) days in the patients who did not develop an infection, P<0.0001. CONCLUSIONS: Our data support the safety of placing PNCs in children, with adverse event rates similar to adult studies. Catheter problems are common, yet minor, in severity.


Assuntos
Anestesia por Condução/efeitos adversos , Anestesia por Condução/estatística & dados numéricos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/estatística & dados numéricos , Nervos Periféricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Infecções Bacterianas/epidemiologia , Cateteres/efeitos adversos , Criança , Bases de Dados Factuais , Falha de Equipamento , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
8.
Br J Anaesth ; 114(2): 290-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25377166

RESUMO

BACKGROUND: We hypothesized that the time to successful fibreoptic tracheal intubation through the nasal route would be faster than the oral route for both experts and trainees in children <2 yr of age. METHODS: One hundred children, 24 months and under in age, were randomized to an operator (expert or trainee), and route (nasal or oral) for fibreoptic tracheal intubation. Three separate times were then measured: (i) time to first glottic view, (ii) time to carinal view, and (iii) total time to successful tracheal intubation. The number of attempts made, manoeuvres needed to obtain an adequate laryngeal view, and manoeuvres for tracheal tube passage were also recorded. RESULTS: Time to successful tracheal intubation was significantly faster for experts than trainees. There was no difference in the time to tracheal intubation between the nasal and oral routes for experts. In trainees, intubation times were shorter for the nasal route-median (inter-quartile range) time (s) to carinal view was 35 (27-63) for the nasal route vs 59 (38-94) for the oral route (P=0.03), and the median time to successful tracheal intubation were 62 (49-122) vs 117 (61-224), P=0.05, for the nasal and oral routes, respectively. For trainees, the oral route required a greater number of airway manoeuvres for adequate laryngeal views and passage of the tracheal tube compared with the nasal route. CONCLUSIONS: For clinicians with less experience in using paediatric bronchoscopes, fibreoptic tracheal intubation through the nasal route may be a more straightforward process than the oral route in children <2 yr of age. CLINICAL TRIAL REGISTRATION: NCT02029300 (www.clinicaltrials.gov).


Assuntos
Intubação Intratraqueal/métodos , Anestesia Geral , Competência Clínica , Feminino , Tecnologia de Fibra Óptica , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Erros Médicos/estatística & dados numéricos , Boca , Cavidade Nasal
9.
Br J Anaesth ; 113(3): 375-90, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24907283

RESUMO

Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population.


Assuntos
Anestesia por Condução/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Pediatria/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Criança , Estudos de Avaliação como Assunto , Humanos
10.
Anaesthesia ; 69(7): 723-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24797607

RESUMO

We prospectively compared free-handed and air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age. Eighty healthy children were enrolled and randomly assigned to a technique (free-handed or air-Q assisted) and operator (trainee or attending). Time, number of attempts and manoeuvres required were assessed. There was no difference in median (IQR [range]) time to successful tracheal intubation between the free-handed (52.2 (34.8-67.7 [19.7-108.0]) s), and the air-Q assisted (60.3 (45.5-75.1 [28.1-129.0]) s; p = 0.13) groups, or the number of attempts needed. The air-Q assisted group required fewer manoeuvres to optimise the laryngeal view (median (IQR [range]) 0 (0-1 [0-2])) than the free-handed group (1 (1-1 [0-3]); p < 0.001). In conclusion, fibreoptic-guided tracheal intubation times were similar with and without the use of the air-Q, but supraglottic airway devices may be a consideration for their other practical advantages.


Assuntos
Tecnologia de Fibra Óptica , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Desenho de Equipamento , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de Tempo
11.
Anaesthesia ; 68(10): 1053-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23952805

RESUMO

We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.


Assuntos
Anestesiologia/educação , Simulação por Computador , Tecnologia de Fibra Óptica , Intubação Intratraqueal/métodos , Interface Usuário-Computador , Manuseio das Vias Aéreas , Análise de Variância , Competência Clínica , Endoscopia , Humanos , Laringe/anatomia & histologia , Desempenho Psicomotor , Método Simples-Cego , Software , Estudantes de Medicina
12.
Aust Dent J ; 58(3): 326-32, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23981214

RESUMO

BACKGROUND: Orthodontic procedures are often limited by the presence of bone defects caused by trauma, periodontal diseases or surgeries, thus requiring the development of materials capable to compensate such deficiencies. Since bone morphogenetic proteins (BMPs) are indicative of bone reconstitution, this study aimed to evaluate histological and immunohistochemically the temporal location of BMP-2 and BMP-4 in osteoblasts of rat alveolar wounds filled with demineralized human dentine matrix (DHDM), used as a graft material. METHODS: After extraction of the upper second molars, the left side alveoli were filled with DHDM and the right side served as the control. The animals were euthanized after 3, 5, 10 and 14 days of surgery. After fixation, demineralization and paraffin embedding, representative samples of each group were stained with H&E and immunohistochemically evaluated. RESULTS: The data showed a statistically significant (p < 0.05) increased number of osteoblasts positively immunostained for BMP-2 and BMP-4 on the experimental side (left) at 10 days. Our results also showed that even when not degraded, dentine matrix was incorporated to new bone formation after 14 days of surgery. CONCLUSIONS: The results suggest that DHDM acts as a scaffold for osteoblast differentiation, actively yielding new bone formation, and it may represent an effective bone implant material.


Assuntos
Proteína Morfogenética Óssea 2/metabolismo , Proteína Morfogenética Óssea 4/metabolismo , Dentina , Osteoblastos/metabolismo , Osteogênese/fisiologia , Alvéolo Dental/fisiopatologia , Cicatrização/fisiologia , Animais , Proteína Morfogenética Óssea 2/análise , Proteína Morfogenética Óssea 4/análise , Dentina/metabolismo , Humanos , Ratos
13.
Br J Anaesth ; 109(5): 688-97, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23015617

RESUMO

Previous evidence suggested that 10 mg systemic metoclopramide is not effective to prevent postoperative nausea and/or vomiting (PONV) in patients receiving general anaesthesia. However, the evidence included data with questioned validity by the author Yoshitaka Fujii. The objective of the current study was to examine the effect of a systemic dose of 10 mg metoclopramide to prevent PONV. This quantitative systematic review was performed according to the PRISMA guidelines. A wide search was performed to identify randomized clinical trials that evaluated systemic 10 mg metoclopramide as a prophylactic agent to reduce PONV. Meta-analysis was performed using a random-effect model. Thirty trials evaluating the effect of 10 mg systemic metoclopramide in 3328 subjects on PONV outcomes were included. Metoclopramide reduced the incidence of 24 h PONV compared with control, odds ratio (OR) [95% confidence interval (CI)] of 0.58 (0.43-0.78), number needed to treat (NNT)=7.8. When evaluated as separate outcomes, metoclopramide also decreased the incidence of nausea over 24 h, OR (95% CI) of 0.51 (0.38-0.68), NNT=7.1, and vomiting over 24 h, OR (95% CI) of 0.51 (0.40-0.66), NNT=8.3. A post hoc analysis examining three studies with questioned validity performed by the author Yoshitaka Fujii that would meet criteria for inclusion in the current study did not demonstrate a significant benefit of metoclopramide compared with control on the incidence of 24 h PONV. Our findings suggest that metoclopramide 10 mg i.v. is effective to prevent PONV in patients having surgical procedures under general anaesthesia. Metoclopramide seems to be a reasonable agent to prevent PONV.


Assuntos
Antieméticos/uso terapêutico , Metoclopramida/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Transfus Med ; 22(2): 97-103, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22151920

RESUMO

OBJECTIVE: To evaluate the association between perioperative blood transfusion on the recurrence and survival of patient with advanced ovarian cancer. BACKGROUND: Cytoreductive surgery for ovarian cancer can be an extensive procedure often requiring allogeneic blood transfusions. Blood transfusions can have detrimental effects on immune function which can lead to a decrease in the organism ability to detect and destroy metastasis. METHODS: The study was a retrospective cohort investigation. Patients with advanced ovarian cancer (stage III) undergoing cytoreductive surgery were stratified by the need for perioperative blood transfusion. Allogeneic transfusions were non-leucodepleted. Primary outcome included time to recurrence and survival. Data were extracted from the gynaecology oncology database at Northwestern University. Times to event outcomes were evaluated by constructing Kaplan-Meyer curves and Cox regression. RESULTS: The charts of 136 subjects were evaluated. Seventy-six received blood transfusion. Median [95% confidence interval (CI)] time to recurrence for the non-transfusion group was longer, i.e. 17 (6-27) months, compared to 11 (8-14) months for the transfused group (P = 0.03). Median (95% CI) survival following surgery was longer in the non-transfused group, i.e. 58 (43-73) months, compared to 36 (28-44) months for the transfused group (P = 0.04). Cox regression showed that transfused subjects had shorter median times to recurrence and mortality after adjusting for age and tumour grade. CONCLUSIONS: There is an association between ovarian cancer recurrence and allogeneic perioperative blood transfusion in patients with advanced ovarian cancer undergoing cytoreductive surgery. These findings may have important implications in the perioperative management of those patients.


Assuntos
Transfusão de Sangue , Neoplasias Ovarianas/mortalidade , Assistência Perioperatória , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida
15.
Br J Anaesth ; 107(3): 362-71, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21669954

RESUMO

BACKGROUND: Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery. METHODS: This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg(-1) or dexamethasone 0.1 mg kg(-1) before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated. RESULTS: Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg(-1) 193 (192-195) was greater than dexamethasone 0.05 mg kg(-1) 179 (175-185) (P=0.004) or saline, 171 (160-182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (0-6.3) mg after dexamethasone 0.1 mg kg(-1) compared with 5.3 (2.4-8.8) mg and 5.3 (2.7-7.8) mg after dexamethasone 0.05 mg kg(-1) and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg(-1) compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg(-1) had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg(-1) and saline. CONCLUSIONS: Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg(-1) reduced opioid consumption compared with dexamethasone 0.05 mg kg(-1), which may be beneficial for improving recovery after ambulatory gynaecological surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos Opioides/administração & dosagem , Dexametasona/administração & dosagem , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória/tratamento farmacológico , Adulto , Período de Recuperação da Anestesia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Inquéritos e Questionários
16.
Br J Anaesth ; 104(6): 774-8, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20418266

RESUMO

BACKGROUND: Transcutaneous measurement of carbon dioxide (Tc(co(2))) provides a non-invasive estimation of arterial carbon dioxide (Pa(co(2))). Nasal capnography (Pe'(co(2))) is used to assess ventilation during monitored anaesthesia care (MAC) with sedation since it can readily detect apnoea. We compared the agreement between Tc(co(2)) and Pe'(co(2)) with Pa(co(2)) and the ability to detect hypercarbia in patients under deep sedation. METHODS: Forty healthy female subjects receiving deep sedation for hysteroscopy were studied. A Tc(co(2)) (TOSCA 500, Radiometer, Inc., Westlake, OH, USA) electrode was applied to the earlobe and Pe'(co(2)) capnography was monitored using nasal side-stream sampling. All subjects received oxygen (3 litre min(-1)). Subjects were evaluated at intervals using a modified Ramsay sedation score until they reached a score >or=5. Arterial blood gas values were compared with Tc(co(2)) and Pe'(co(2)) values. Bland-Altman, linear regression, and receiver operator characteristics analysis were performed. RESULTS: The mean (sd) absolute difference between the Tc(co(2)), Pe'(co(2)), and the Pa(co(2)) were 0.43 (0.35) and 1.06 (0.8) kPa, respectively (P=0.002). Tc(co(2)) demonstrated a mean bias (2 sd) of 0.23 (0.07-0.4) kPa with Pa(co(2)) compared with -0.93 (-1.24 to -0.63) kPa for Pe'(co(2)). One minute before blood sampling, the sensitivity of the Tc(co(2)) monitor for detecting Pa(co(2)) >6.65 kPa was greater than for Pe'(co(2)) (66.7% vs 33.3%, P<0.01). CONCLUSIONS: Tc(co(2)) demonstrated better agreement with Pa(co(2)) than Pe'(co(2)) for patients under MAC with deep sedation. Tc(co(2)) monitoring was more sensitive for detection of Pa(co(2)) >6.65 kPa than Pe'(co(2)).


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Sedação Profunda , Hipoventilação/diagnóstico , Histeroscopia/métodos , Complicações Intraoperatórias/diagnóstico , Adulto , Idoso , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Capnografia/métodos , Dióxido de Carbono/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Pressão Parcial , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Rev Hosp Clin Fac Med Sao Paulo ; 53(1): 16-20, 1998.
Artigo em Português | MEDLINE | ID: mdl-9659738

RESUMO

The present work intended to test the validity of the quantitative datas provided by computerized baropodometry based in three comparisons: between static vertical force on the three regions of the foot and weight, between vertical force on the three regions of the foot during gait and weight, and between peak plantar pressure on the three regions of the foot and weight. It was used body weight because the calibration of the equipment is done in relation to the body weight of the patient. It was selected ten volunteers without foot pain complaints, age between 27-54 years old, 6 women and 4 men. The equipment used was the FSCAN version 1.821 (Teckscan, Boston MA), with new insoles. At the static assessment, the correlation between vertical force and weight was statistically significant only to the midfoot. At the assessment during gait the correlation between vertical force and weight was statistically significant for all regions of the foot and the correlation between peak plantar pressure and weight was statistically significant only to the midfoot. The clinical interpretation of the quantitative data provided by this exam must be done with caution due to uncount variables that are involved.


Assuntos
Peso Corporal , Pé/fisiologia , Marcha/fisiologia , Manometria/métodos , Processamento de Sinais Assistido por Computador , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade
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