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1.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 98(51): e18188, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860965

RESUMO

AIM: We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing. METHODS: In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6). RESULTS: The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%). CONCLUSION: N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Ansiolíticos/uso terapêutico , Queimaduras/terapia , Óxido Nitroso/uso terapêutico , Administração por Inalação , Adolescente , Adulto , Idoso , Analgésicos não Entorpecentes/administração & dosagem , Ansiolíticos/administração & dosagem , Ansiedade/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/administração & dosagem , Manejo da Dor , Método Simples-Cego , Adulto Jovem
3.
J Craniofac Surg ; 30(8): 2549-2550, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403507

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficiency of inhaled nitrous oxide (N2O) for manual reduction of acute nontraumatic temporomandibular joint (TMJ) dislocation in the supine position technique. METHODS: This clinical trial included a total of 51 patients presenting with acute nontraumatic TMJ dislocation. The patients were grouped randomly. The supine position technique was applied in both N2O group (experimental group) and control group (without N2O). The visual analogue scale scores (VAS scores) of the pain perception and the operation time were recorded. RESULTS: All patients with dislocated mandible were successfully managed. The VAS scores of pain perception were significantly reduced in N2O group. It was 1.63 compared to 4.00 in control group. The average operation time was also significantly reduced in N2O group (Supplemental Digital Content, Table 2, http://links.lww.com/SCS/A716). It was 129.92 seconds compared to 170.04 seconds in control group. CONCLUSION: Inhalation of N2O helps to reduce the pain perception and the operation time of manual reduction of acute nontraumatic TMJ dislocation using the supine position technique. It is beneficial to both patients and doctors.


Assuntos
Luxações Articulares/cirurgia , Óxido Nitroso/uso terapêutico , Articulação Temporomandibular/cirurgia , Administração por Inalação , Feminino , Humanos , Masculino , Percepção da Dor
4.
Br J Anaesth ; 122(5): 587-604, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30916011

RESUMO

Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.


Assuntos
Anestésicos Inalatórios/farmacologia , Óxido Nitroso/farmacologia , Analgesia Obstétrica/métodos , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/farmacologia , Analgésicos não Entorpecentes/uso terapêutico , Anestesia Dentária/métodos , Anestésicos Inalatórios/efeitos adversos , Antidepressivos/uso terapêutico , Dor Crônica/prevenção & controle , Sedação Consciente/métodos , Contraindicações de Medicamentos , Transtorno Depressivo Maior/tratamento farmacológico , Medicina Baseada em Evidências/métodos , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/uso terapêutico
5.
Curr Drug Res Rev ; 11(1): 12-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829177

RESUMO

BACKGROUND: Joseph Priestley's discovery of nitrous oxide (N2O) was recorded in 1772. In the late 1790's, Humphry Davy experimented with the psychotropic properties of N2O, describing his observations in a book, published in 1800. A dentist, Horace Wells discovered anaesthesia with N2O in 1844. Over a century after Davy, its potential usefulness in psychiatry was first recognised. The seminal researches in neuropsychiatry, between 1920 and 1950, mainly used anaesthetic concentrations of the gas. The psychotropic actions of N2O, at non-anaesthetic doses, were first used by dentists, mainly for its anxiolytic action. In modern dentistry, N2O is always mixed with at least 30% oxygen and titrated to doses rarely exceeding 40% of N2O. At these lower concentrations, untoward effects are almost always avoided, including over-sedation and/or anaesthesia. In the early 1980's, the low-dose dental titration technique was first used to investigate and treat psychiatric conditions, including substance abuse. Until then, most physicians regarded the gas only as an anaesthetic agent. An exception was obstetricians who used a fixed 50% concentration of N2O diluted with oxygen for analgesia during parturition. In 1994, to clearly distinguish between anaesthetic and non-anaesthetic concentrations (as used in dentistry), the term Psychotropic Analgesic Nitrous oxide (PAN) was introduced. OBJECTIVE: This paper will give a brief history of the use of the N2O in psychiatry since the psychotropic actions were first recognised in the 18th century until the present. CONCLUSION: The role of other non- opioid systems, and the extent to which they contribute to the psychotropic properties of N2O, still remains to be established.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Óxido Nitroso/uso terapêutico , Dor/tratamento farmacológico , Anestesia Dentária/métodos , Anestésicos Inalatórios , Ansiolíticos/administração & dosagem , Humanos , Óxido Nitroso/administração & dosagem
6.
Emerg Med J ; 36(3): 142-147, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30630844

RESUMO

OBJECTIVE: Nitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2O 70% with and without INF. METHODS: Patients aged 2-16 years who qualified for PAS with N2O 70% were randomly assigned to receive either INF or placebo prior to N2O inhalation in this randomised, double-blind study, which was performed in a tertiary children's hospital ED between September 2015 and October 2017. Behaviour during the procedure was evaluated using the Face, Leg, Activity, Cry and Consolability (FLACC) scale and the Modified Behavioural Pain Scale (MBPS); analgesic efficacy was assessed with a self-reported pain scale. Sedation depth using the validated University of Michigan Sedation Scale and adverse events in the ED and during the following 12 hours were documented. RESULTS: A total of 402 patients were included; 3 did not tolerate N2O and therefore had to be excluded. Overall, 399 patients were analysed, of whom 201 (50.4%) received INF. No significant group differences with regard to FLACC scale score, self-reported pain, MBPS score and sedation depth were found. In addition, the two groups did not differ with regard to all types of adverse events. CONCLUSION: Combining N2O 70% with INF resulted in no differences with regard to FLACC scale score, self-reported pain, MBPS score, patient and parental satisfaction rate, sedation depth, and adverse events. TRIAL REGISTRATION NUMBER: NCT02533908.


Assuntos
Combinação de Medicamentos , Fentanila/uso terapêutico , Óxido Nitroso/uso terapêutico , Administração Intranasal , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Óxido Nitroso/administração & dosagem , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Pediatria/métodos , Pediatria/normas , Placebos , Estudos Prospectivos
7.
Nurs Womens Health ; 23(1): 11-20, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30593767

RESUMO

OBJECTIVE: The aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women's satisfaction with that option. DESIGN: Evidence-based practice change guided by the model for evidence-based practice change. SETTING: Labor and delivery unit in a tertiary medical center in the southwestern United States. PARTICIPANTS: Laboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period. MEASUREMENTS: Process indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women's satisfaction with the choice to use nitrous oxide. RESULTS: Nitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor. CONCLUSION: Our experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor.


Assuntos
Dor do Parto/tratamento farmacológico , Trabalho de Parto/efeitos dos fármacos , Óxido Nitroso/uso terapêutico , Adulto , Analgésicos não Entorpecentes/economia , Analgésicos não Entorpecentes/uso terapêutico , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/tendências , Feminino , Humanos , Óxido Nitroso/economia , Manejo da Dor/economia , Manejo da Dor/métodos , Manejo da Dor/tendências , Gravidez
8.
Pediatr Dent ; 40(4): 265-272, 2018 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30345965

RESUMO

Purpose: The purpose of this study was to determine how ethnicity influences parental acceptability of behavior management techniques (BMTs) used during dental treatment of children. This is the first known study to compare ethnic differences in acceptance levels of the BMTs. Methods: Parental acceptance of 10 BMTs (tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, parental presence/absence, nitrous oxide, protective stabilization, sedation, and general anesthesia) was rated using a visual analogue scale (VAS) after watching vignettes of each technique. Parental preferences were stratified by ethnicity and analyzed. Results: Among the 104 parents (21 Caucasians, 29 Hispanics, 30 Asians, and 24 African Americans) who qualified and completed the study, we observed that, overall, non-invasive techniques (positive reinforcement and tell-show-do) were most accepted by parents, while invasive techniques (voice control and protective stabilization) were least accepted (P<0.001). Within each ethnicity, there were significant differences between the BMTs (P<0.001). Additionally, conscious sedation was the only BMT to show a significant difference between the ethnic groups (P=0.047), with Asian parents having a lower mean score than Caucasian and Hispanic parents. Conclusions: Our results suggest that considering the ethnic/cultural differences of patients and their parents is an instrumental component for pediatric dentists to provide quality care to children patients.


Assuntos
Controle Comportamental/métodos , Controle Comportamental/psicologia , Terapia Comportamental/métodos , Comportamento Infantil/psicologia , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Crianças/psicologia , Grupos Étnicos/psicologia , Pais/psicologia , Adolescente , Adulto , Afro-Americanos , Idoso , Anestesia Geral/métodos , Grupo com Ancestrais do Continente Asiático , Criança , Sedação Consciente/métodos , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/uso terapêutico , Comunicação não Verbal , Preferência do Paciente , Inquéritos e Questionários , Escala Visual Analógica , Adulto Jovem
9.
JAMA Otolaryngol Head Neck Surg ; 144(9): 781-787, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30073285

RESUMO

Importance: The tinnitus research literature suggests that N-methyl-d-aspartate (NMDA) receptor antagonists may be useful in reducing tinnitus. Nitrous oxide, a member of the NMDA receptor antagonist class, is a widely used general anesthetic and sedative with a proven safety record. Objective: To investigate whether nitrous oxide can reduce bothersome tinnitus. Design, Setting, and Participants: Randomized, placebo-controlled crossover trial conducted between October 15, 2016, and June 22, 2017. Participants attended 2 interventional sessions separated by at least 14 days and were randomized to receive either placebo first or nitrous oxide first. Participants were followed up through completion of the second arm of the study. The setting was a clinical research unit at an academic medical center. Adults aged 18 to 65 years with subjective, idiopathic, nonpulsatile bothersome tinnitus of 6 months' duration or longer were recruited from 2 clinical research databases. Seventy-one individuals were screened, of whom 40 were enrolled. Of those enrolled, 37 participants completed all components of the study. Interventions: The placebo session consisted of 50% nitrogen and 50% oxygen inhaled for 40 minutes, and the treatment session consisted of 50% nitrous oxide and 50% oxygen inhaled for 40 minutes. Main Outcomes and Measures: Tinnitus was assessed before and after intervention, with the change in the Tinnitus Functional Index (TFI) as the primary outcome measure. Secondary outcome measures included the Patients' Global Impression of Change score and the change in the Global Bothersome Scale score. Results: Among 40 participants in this intent-to-treat randomized clinical trial with 20 participants randomly assigned to each group, the mean (SD) age of participants was 52.9 (11.1) years, with equal numbers of male and female participants. The TFI after intervention was a mean (SD) of 1.8 (8.8) points lower than before intervention in the placebo arm and a mean (SD) of 2.5 (11.0) points lower than before intervention in the nitrous oxide arm. The within-participant mean difference in the change in the TFI of the placebo arm compared with the nitrous oxide arm was -1.1 points (95% CI, -5.6 to 3.4 points). The difference between the placebo and nitrous oxide arms was neither clinically meaningful nor statistically significant. Conclusions and Relevance: Nitrous oxide was no more effective than placebo for the treatment of subjective, idiopathic tinnitus. Trial Registration: ClinicalTrials.gov identifier: NCT03365011.


Assuntos
Óxido Nitroso/uso terapêutico , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Zumbido/tratamento farmacológico , Administração por Inalação , Adolescente , Adulto , Idoso , Estudos Cross-Over , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Zumbido/etiologia , Zumbido/psicologia , Resultado do Tratamento , Adulto Jovem
10.
Eur J Paediatr Dent ; 19(3): 205-212, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30063152

RESUMO

AIM: Pain experienced during dental treatment increases the risk of developing dental anxiety in children who will became anxious adults, avoiding dental care. It is therefore essential to provide pain-free dental treatment. The strongest fears are often associated with injections: being able to successfully complete painless restorative treatment without the need for local anesthesia injection is therefore an important goal. Nitrous oxide administration by means of Langa's Relative Analgesia (RA) technique has been demonstrated to have both sedative and bland analgesic properties: the mechanism by which N2O exerts its analgesic effects is now understood. The purpose of this study was to test the analgesic effectiveness of Nitrous Oxide used in the RA technique as the only analgesic agent for restorative treatment of primary molars presenting caries lesions without pulp involvement. MATERIALS AND METHODS: Ninety patients aged between 3.2 and 9.4 years, 38 males and 52 females, ASA I and II, were included in the study. One hundred and thirty-four restorations were completed on primary molars with caries lesions without pulp involvement (1/3 to 2/3 into dentin): 72 restorations were completed on 48 patients under RA in the Study Group and 62 restorations were performed on 42 patients under RA and local anaesthesia (LA) in the Control Group. At the end of each session, the perception of pain experienced during treatment was rated by each patient using the Wong-Baker FACES® Pain Rating Scale. RESULTS: No statistical difference on self-reported pain perception was seen in the Study Group (treatment under RA) and in the Control Group (treatment under RA plus LA administration). The results also showed no significant difference in pain sensation between males and females; age as well as gender did not affect the results between groups. CONCLUSIONS: Nitrous oxide as used in the Langa's RA technique is effective in providing a sufficient analgesic outcome during restorations of primary molars when there is no pulp involvement, with no need for LA supplement.


Assuntos
Ansiedade ao Tratamento Odontológico/prevenção & controle , Cárie Dentária/terapia , Restauração Dentária Permanente , Dente Molar , Óxido Nitroso/uso terapêutico , Manejo da Dor/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Medição da Dor , Estudos Prospectivos , Dente Decíduo , Resultado do Tratamento
11.
J Anesth Hist ; 4(2): 130-132, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29960677

RESUMO

During the latter half of the six-year long "Panic of 1873," nitrous-oxide pioneer G.Q. Colton developed, advertised, and sold his dentifrice, "Dr Colton's Vegetable Dentonic" to supplement his dental anesthetic enterprise.


Assuntos
Anestesia Dentária/história , Dentifrícios/história , Óxido Nitroso/história , Dentifrícios/química , Dentifrícios/uso terapêutico , História do Século XIX , Humanos , Óxido Nitroso/uso terapêutico , Estados Unidos
12.
Eur Neuropsychopharmacol ; 28(7): 828-840, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29887289

RESUMO

Weakening drinking-related reward memories by blocking their reconsolidation is a potential novel strategy for treating alcohol use disorders. However, few viable pharmacological options exist for reconsolidation interference in humans. We therefore examined whether the NMDA receptor antagonising gas, Nitrous Oxide (N2O) could reduce drinking by preventing the post-retrieval restabilisation of alcohol memories in a group of hazardous drinkers. Critically, we focussed on whether prediction error (PE; a key determinant of reconsolidation) was experienced at retrieval. Sixty hazardous drinkers were randomised to one of three groups that retrieved alcohol memories either with negative PE (Retrieval + PE), no PE (Retrieval no PE) or non-alcohol memory retrieval with PE (No-retrieval +PE). All participants then inhaled 50% N2O for 30 min. The primary outcome was change in beer consumption and alcohol cue-driven urge to drink from the week preceding manipulation (baseline) to the week following manipulation (test). The manipulation did not affect drinking following the intended retrieval+/- PE conditions However, a manipulation check, using a measure of subjective surprise, revealed that the group-level manipulation did not achieve the intended differences in PE at retrieval. Assessment of outcomes according to whether alcohol-relevant PE was actually experienced at retrieval, showed N2O produced reductions in drinking in a retrieval and PE-dependent fashion. These preliminary findings highlight the importance of directly testing assumptions about memory reactivation procedures in reconsolidation research and suggest that N2O should be further investigated as a potential reconsolidation-blocking agent.


Assuntos
Consumo de Bebidas Alcoólicas/tratamento farmacológico , Consumo de Bebidas Alcoólicas/psicologia , Consolidação da Memória/efeitos dos fármacos , Rememoração Mental/efeitos dos fármacos , Óxido Nitroso/uso terapêutico , Adulto , Idoso , Anestésicos Inalatórios/uso terapêutico , Fissura/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Curr Opin Anaesthesiol ; 31(4): 439-445, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29794854

RESUMO

PURPOSE OF REVIEW: After decades without substantial advances, multiple novel antidepressants show promise against treatment-resistant depression. Interestingly, many of these are anesthetics. The purpose of this review is to discuss the evidence for the antidepressant effects of ketamine, nitrous oxide, isoflurane and propofol and to consider potential clinical, administrative and research implications for anesthesiologists. RECENT FINDINGS: Ketamine has acute, transient antidepressant and antisuicidal effects. Nitrous oxide has also shown antidepressant efficacy. There are converging preclinical and clinical data that isoflurane (and perhaps propofol), dosed to burst suppression, has relatively rapid, robust and durable antidepressant effects and lacks the adverse effects associated with electroconvulsive therapy (ECT). SUMMARY: Several anesthetics show promise as novel antidepressants. Ketamine is the most well studied. Anesthetic-induced burst-suppression may provide an alternative to ECT that lacks adverse cognitive effects. Further study is necessary to better understand how these drugs work and how they might be used as effective antidepressant therapy.


Assuntos
Anestésicos/uso terapêutico , Antidepressivos/uso terapêutico , Córtex Cerebral/efeitos dos fármacos , Transtorno Depressivo Resistente a Tratamento/terapia , Anestesiologistas/organização & administração , Anestésicos/farmacologia , Antidepressivos/farmacologia , Córtex Cerebral/fisiopatologia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Depressivo Resistente a Tratamento/fisiopatologia , Eletroconvulsoterapia/efeitos adversos , Eletroconvulsoterapia/estatística & dados numéricos , Humanos , Isoflurano/farmacologia , Isoflurano/uso terapêutico , Ketamina/farmacologia , Ketamina/uso terapêutico , Óxido Nitroso/farmacologia , Óxido Nitroso/uso terapêutico , Seleção de Pacientes , Prevalência , Papel Profissional , Propofol/farmacologia , Propofol/uso terapêutico , Resultado do Tratamento
15.
PLoS One ; 13(4): e0195574, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29702684

RESUMO

INTRODUCTION: Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50-50% N2O-O2 gas mixture on pain intensity in these patients. MATERIAL AND METHODS: Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50-50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. RESULTS: Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0-10) vs 5.95 (0-10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. CONCLUSION: The 50-50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Biópsia Guiada por Imagem , Óxido Nitroso/uso terapêutico , Oxigênio/uso terapêutico , Dor Processual/tratamento farmacológico , Próstata/cirurgia , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Entorpecentes/efeitos adversos , Método Duplo-Cego , Gases/efeitos adversos , Gases/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Oxigênio/efeitos adversos , Medição da Dor , Satisfação do Paciente , Próstata/diagnóstico por imagem , Próstata/patologia , Reto/diagnóstico por imagem , Reto/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção
17.
J Anesth Hist ; 4(1): 9-10, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29559092

RESUMO

In 1847, British anesthesia pioneer John Snow (1813-1858) observed that patients did not manifest cyanosis during induction with hypoxic mixtures of ether vapor in air. He hypothesized a molecular mechanism that would be understood over a century later as the second gas effect.


Assuntos
Anestesia/história , Anestesiologia/história , Anestesia/métodos , Anestesiologia/métodos , Éter/história , Éter/uso terapêutico , História do Século XIX , Humanos , Óxido Nitroso/história , Óxido Nitroso/uso terapêutico , Reino Unido
19.
Eur J Pain ; 22(3): 492-500, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29226545

RESUMO

BACKGROUND: The aim of this study was to assess the efficacy of a fixed nitrous oxide/oxygen mixture for the management of breakthrough cancer pain. METHODS/DESIGN: A double-blind, placebo-controlled, randomized clinical trial was undertaken in the Medical ward of Tumor Hospital of General Hospital of Ningxia Medical University. 240 cancer patients with breakthrough pain were recruited and randomly received a standard pain treatment (morphine sulphate immediate release) plus a pre-prepared nitrous oxide/oxygen mixture, or the standard pain treatment plus oxygen. The primary endpoint measure was the numerical rating scale (NRS) score measured at baseline, 5 and 15 min after the beginning of treatment, and at 5 min post treatment. RESULT: In all, analysis of pain score (NRS) at 5 min after the beginning of treatment shown a significant decrease in nitrous oxide/oxygen mixture treated patients with 2.8 ± 1.3 versus 5.5 ± 1.2 in controls (p < 0.01). At 15 min during the intervention, the mean pain score for nitrous oxide/oxygen was 2.0 ± 1.1 compared with 5.6 ± 1.3 for oxygen (p < 0.01). CONCLUSION: This study shows that self-administered nitrous oxide/oxygen mixture was effective in reducing moderate to severe breakthrough pain among patients with cancer. SIGNIFICANCE: The management of breakthrough cancer pain is always a challenge due to its temporal characteristics of rapid onset, moderate to severe in intensity, short duration (median 30-60 min). Our study find that self-administered nitrous oxide/oxygen mixture was effective in reducing moderate to severe breakthrough cancer pain.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Óxido Nitroso/uso terapêutico , Oxigenoterapia/métodos , Adulto , Idoso , Analgesia , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hipestesia , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Manejo da Dor , Medição da Dor , Autoadministração , Fatores de Tempo
20.
Artigo em Inglês | MEDLINE | ID: mdl-29204316

RESUMO

Background: A 36-year-old Thai female who underwent a thymectomy under general anesthesia developed acute abnormal movements in the craniofacial region immediately after awakening with preserved consciousness. Phenomenology: Intermittent abnormal movements included oculogyric crisis; tongue protrusion; blepharospasm; and oro-mandibular dystonia consisting of risus sardonicus, jaw opening, and right torticollis. Educational value: An acute dystonic reaction can be a complication of either single or combined general anesthetic agents.


Assuntos
Anestésicos Gerais/efeitos adversos , Distonia/etiologia , Doença Aguda , Adulto , Anestesia Geral/efeitos adversos , Anestésicos Gerais/uso terapêutico , Distonia/tratamento farmacológico , Distonia/fisiopatologia , Feminino , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Éteres Metílicos/efeitos adversos , Éteres Metílicos/uso terapêutico , Óxido Nitroso/efeitos adversos , Óxido Nitroso/uso terapêutico , Sevoflurano , Timectomia
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