Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.916
Filtrar
1.
Br J Anaesth ; 124(1): 92-100, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711605

RESUMO

BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block. METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).


Assuntos
Adjuvantes Anestésicos , Dexametasona , Bloqueio Nervoso/métodos , Nervos Periféricos , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Administração Intravenosa , Adulto , Estudos Cross-Over , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Força da Mão , Voluntários Saudáveis , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Limiar da Dor/efeitos dos fármacos , Sensação/efeitos dos fármacos , Sensação Térmica/efeitos dos fármacos , Adulto Jovem
2.
Br J Anaesth ; 124(1): 84-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31591018

RESUMO

BACKGROUND: Efforts to prolong interscalene block (ISB) analgesia include the use of local anaesthetic adjuvants such as dexamethasone. Previous work showing prolonged block duration suggests that both perineural and intravenous (i.v.) routes can both prolong analgesia. The superiority of either route is controversial given the design of previous studies. As perineural dexamethasone is an off-label use, anaesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to test whether perineural vs i.v. dexamethasone administration are equivalent. METHODS: We randomised 182 eligible patients scheduled for arthroscopic shoulder surgery to receive low-dose ISB (0.5% ropivacaine 5 ml) with perineural or i.v. dexamethasone 4 mg. Subjects, anaesthesiologists, and research personnel were blinded. All subjects also received a standardised general anaesthetic and multimodal analgesia. The primary outcome was duration of analgesia analysed as an equivalence outcome (2 h equivalency margin) using the two one-sided test (TOST) method. RESULTS: For the primary outcome, duration of analgesia, and perineural and i.v. administration of dexamethasone were not equivalent. The upper and lower bounds of the 90% confidence interval were 1 h (P=0.12) and -2.5 h (P=0.01), respectively. The observed difference in mean block duration was not clinically relevant (0.75 h longer for i.v. dexamethasone). There were no other clinically significant differences between groups. CONCLUSION: In the context of low-volume ISB with ropivacaine, perineural and i.v. dexamethasone were not equivalent in terms of their effects on block duration. However, there were no clinically significant differences in outcomes, and there is no advantage of perineural over intravenous dexamethasone. WWW.CLINICALTRIALS. GOV REGISTRATION: NCT02322242.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/farmacologia , Bloqueio do Plexo Braquial/métodos , Plexo Braquial , Dexametasona/administração & dosagem , Dexametasona/farmacologia , Bloqueio Nervoso/métodos , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/métodos , Método Duplo-Cego , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Ombro/cirurgia , Adulto Jovem
3.
Vet J ; 253: 105377, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685135

RESUMO

Management of urinary retention after spinal cord injury in dogs is often needed and can include use of medications to relax the urethral sphincter. This was a retrospective study evaluating two such medications, prazosin and diazepam, and whether dogs treated with these medications had different lengths of hospitalization, urinary continence levels, or development of bacteriuria compared to dogs not receiving these medications after thoracolumbar hemilaminectomy for intervertebral disc herniation (IVDH). Electronic medical records were searched for dogs that underwent CT or MRI followed by a hemilaminectomy between the 3rd thoracic and 3rd lumbar vertebra for treatment of IVDH. Dogs were grouped based on whether or not they received a medication to aid in urethral sphincter relaxation (either prazosin, diazepam, or both medications). The total length of hospitalization, urinary continence at the time of discharge, and presence of bacteriuria were recorded from the medical file. Medical records from 71 dogs were included in the analysis. There were no significant associations between administration of prazosin and/or diazepam and length of hospitalization or urinary continence scores at the time of discharge from the hospital (P > 0.05).


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Diazepam/uso terapêutico , Doenças do Cão/tratamento farmacológico , Deslocamento do Disco Intervertebral/veterinária , Prazosina/uso terapêutico , Traumatismos da Medula Espinal/veterinária , Retenção Urinária/veterinária , Adjuvantes Anestésicos/administração & dosagem , Animais , Diazepam/administração & dosagem , Cães , Feminino , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/veterinária , Vértebras Lombares , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Prazosina/administração & dosagem , Registros/veterinária , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas , Resultado do Tratamento , Retenção Urinária/tratamento farmacológico
5.
Arch. Soc. Esp. Oftalmol ; 94(9): 441-444, sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186223

RESUMO

Una mujer de 58 años presentó quemosis intensa y oftalmoparesia en el ojo izquierdo 8 h después de cirugía de catarata no complicada bajo anestesia subtenoniana. Tras tratamiento corticoideo y antihistamínico, se observó recuperación de la motilidad extrínseca pero se apreciaron un edema de papila no hemorrágico y un defecto concéntrico de campo visual. El caso evolucionó a atrofia papilar con agudeza visual central preservada pero con una contracción significativa del campo visual. El estudio etiológico reveló una alergia a la hialuronidasa, usada como adyuvante a la anestesia. Esta complicación debe ser diagnosticada y tratada precozmente, puesto que el edema de los tejidos orbitarios puede dañar el nervio óptico


A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8 hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adjuvantes Anestésicos/efeitos adversos , Hipersensibilidade a Drogas/complicações , Hialuronoglucosaminidase/efeitos adversos , Síndromes de Compressão Nervosa/induzido quimicamente , Doenças do Nervo Óptico/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Adjuvantes Anestésicos/imunologia , Diagnóstico Tardio , Hipersensibilidade a Drogas/etiologia , Edema/etiologia , Doenças Palpebrais/etiologia , Hialuronoglucosaminidase/imunologia , Isquemia/etiologia , Oftalmoplegia/induzido quimicamente , Facoemulsificação , Distúrbios Pupilares/induzido quimicamente , Vasos Retinianos , Tomografia de Coerência Óptica , Campos Visuais
6.
Rev Bras Anestesiol ; 69(4): 369-376, 2019.
Artigo em Português | MEDLINE | ID: mdl-31362883

RESUMO

BACKGROUND AND OBJECTIVES: One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery. METHODS: In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1mL bupivacaine 0.5% (5mg). In groups BD, BF and BS, 5µg of dexmedetomidine, 25µg of fentanyl and 0.5mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90min. RESULTS: The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169min) and BD (92 and 166min) groups than the BS (84 and 157min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24h after surgery, than the BS (1.6) group. CONCLUSIONS: The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.


Assuntos
Raquianestesia/métodos , Bupivacaína/administração & dosagem , Dexmedetomidina/administração & dosagem , Fentanila/administração & dosagem , Adjuvantes Anestésicos/administração & dosagem , Adulto , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Adulto Jovem
7.
Crit Care Nurs Q ; 42(4): 376-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449148

RESUMO

In this article, we discuss the literature behind the use of paralytics, sedation, and steroids in acute respiratory distress syndrome. We explore the controversies and discuss the recommendations for the use of these agents.


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Corticosteroides/uso terapêutico , Atracúrio/análogos & derivados , Bloqueadores Neuromusculares/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Atracúrio/administração & dosagem , Enfermagem de Cuidados Críticos , Fidelidade a Diretrizes/normas , Humanos
8.
Drugs ; 79(13): 1455-1466, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31468315

RESUMO

Glycopyrronium/formoterol (Bevespi Aerosphere®) is a fixed-dose combination of the long-acting muscarinic antagonist glycopyrronium bromide and the long-acting ß2-agonist formoterol fumarate delivered via a pressurized metered dose inhaler (pMDI) and formulated using co-suspension delivery technology. It is approved in the USA and EU for use as maintenance treatment in patients with chronic obstructive pulmonary disease (COPD) and in Japan to relieve symptoms in patients with COPD. In the PINNACLE trials in patients with moderate to very severe COPD, glycopyrronium/formoterol was associated with significantly greater improvements in lung function than its monocomponents and placebo at 24 weeks and its monocomponents and open-label tiotropium over 52 weeks. In the AERISTO trial, glycopyrronium/formoterol was non-inferior to umeclidinium/vilanterol dry powder inhaler for peak change in forced expiratory volume in 1 s (FEV1) within 2 h postdose, but not for the change in morning predose trough FEV1, over 24 weeks. Glycopyrronium/formoterol was generally well tolerated in patients with moderate to very severe COPD, with most adverse events (AEs) being of mild or moderate severity. Thus, glycopyrronium/formoterol pMDI formulated using co-suspension delivery technology is a useful new addition that extends treatment options for patients with COPD.


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Broncodilatadores/uso terapêutico , Fumarato de Formoterol/uso terapêutico , Glicopirrolato/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Animais , Ensaios Clínicos como Assunto , Humanos
9.
Arch Soc Esp Oftalmol ; 94(9): 441-444, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31280939

RESUMO

A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve.


Assuntos
Adjuvantes Anestésicos/efeitos adversos , Hipersensibilidade a Drogas/complicações , Hialuronoglucosaminidase/efeitos adversos , Síndromes de Compressão Nervosa/induzido quimicamente , Doenças do Nervo Óptico/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Adjuvantes Anestésicos/imunologia , Diagnóstico Tardio , Hipersensibilidade a Drogas/etiologia , Edema/etiologia , Doenças Palpebrais/etiologia , Feminino , Humanos , Hialuronoglucosaminidase/imunologia , Isquemia/etiologia , Pessoa de Meia-Idade , Oftalmoplegia/induzido quimicamente , Facoemulsificação , Distúrbios Pupilares/induzido quimicamente , Vasos Retinianos , Tomografia de Coerência Óptica , Campos Visuais
10.
Medicine (Baltimore) ; 98(29): e16262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335674

RESUMO

RATIONALE: The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. PATIENT CONCERNS: Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. DIAGNOSES: They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. INTERVENTIONS: The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. OUTCOMES: The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. LESSONS: Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.


Assuntos
Adenocarcinoma de Pulmão , Adjuvantes Anestésicos , Neoplasias Pulmonares , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Músculos Paraespinais/fisiopatologia , Pneumonectomia , Ropivacaina/administração & dosagem , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/classificação , Idoso , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/administração & dosagem , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
11.
Medicine (Baltimore) ; 98(9): e14666, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817591

RESUMO

BACKGROUND: Dexmedetomidine (Dex), as an adjuvant, has been reported to prolong the duration of spinal analgesia when adding to local anesthetic. We hypothesized that Dex could enhance the efficiency of intrathecal bupivacaine for spinal anesthesia in cesarean section. The aim of his study is to test our hypothesis that 5 µg Dex could enhance the efficiency of intrathecal bupivacaine and reduce the dose requirement of spinal bupivacaine for patients undergoing cesarean section. METHODS: Ninety patients with ASA I or II, who underwent cesarean section, were randomized into 2 groups: group D (bupivacaine + 5 µg Dex) and group C (bupivacaine + the same volume of saline). The subsequent dose of spinal bupivacaine was determined by the improved up-down allocation method. The initial dose of bupivacaine in the 2 groups was 4 mg, and the subsequent dose for the following patient was depended on the probability of the current dose. ED95 of spinal bupivacaine was calculated using logistic regression model. RESULTS: The ED95 and 95% confidence intervals (95% CI) of spinal hyperbaric bupivacaine in group D and group C were 7.4 mg (95% CI, 5.6-12.4 mg) and 11.0 mg (95% CI, 4.4-56.8 mg), respectively. The duration of sensory block was 120.5 ±â€Š37.0 minutes in Dex group and 70.5 ±â€Š34.5 minutes in Control group, respectively (P < .05). The duration of analgesia was 230.5 ±â€Š40.5 minutes in Dex group and 145.1 ±â€Š28.5 minutes in Control group, respectively (P < .001). The consumption of postoperative rescued sufentanil was significantly lower in Dex group than in the Control group (56.3 ±â€Š9.4 vs 65.9 ±â€Š10.7 µg). There was not significantly different in the patient satisfaction of analgesia, incidence of side effects, neonatal outcomes and neurological deficit between the 2 groups. CONCLUSION: Intrathecal 5 µg Dex enhances the efficacy of spinal bupivacaine by 24% in patients undergoing cesarean section with spinal anesthesia. No additional side effect was observed by adding spinal Dex.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Cesárea/métodos , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Adjuvantes Anestésicos/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Injeções Espinhais , Gravidez , Estudos Prospectivos , Sufentanil/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
12.
Br J Anaesth ; 122(4): 525-531, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30857609

RESUMO

BACKGROUND: The efficacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine. METHODS: Ultrasound-guided ulnar nerve blocks (ropivacaine 0.75% wt/vol, 3 ml, with saline 1 ml with or without dexamethasone 4 mg) were performed on three occasions in 24 male volunteers along with an i.v. injection of saline 1 ml with or without dexamethasone 4 mg. The combinations of saline and dexamethasone were as follows: control group, perineural and i.v. saline; perineural group, perineural dexamethasone and i.v. saline; i.v. group, perineural saline and i.v. dexamethasone. Sensory block was measured using a VAS in response to pinprick testing. The duration of sensory block was the primary outcome and time to onset of sensory block the secondary outcome. RESULTS: All 24 subjects completed the trial. The median [inter-quartile range (IQR)] duration of sensory block was 6.87 (5.85-7.62) h in the control group, 7.37 (5.78-7.93) h in the perineural group and 7.37 (6.10-7.97) h in the i.v. group (P=0.61). There was also no significant difference in block onset time between the three groups. CONCLUSION: Dexamethasone 4 mg has no clinically relevant effect on the duration of sensory block provided by ropivacaine applied to the ulnar nerve. CLINICAL TRIAL REGISTRATION: DRKS, 00014604; EudraCT, 2018-001221-98.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Bloqueio Nervoso/métodos , Adolescente , Adulto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Ropivacaina/administração & dosagem , Fatores de Tempo , Nervo Ulnar/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto Jovem
13.
Pesqui. vet. bras ; 39(3): 214-220, Mar. 2019. tab, ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1002798

RESUMO

The objective of this study was to evaluate the quality and recovery from anesthesia promoted by the tiletamine-zolazepam (TZ) combination administered intravenously (IV) continuously in bitches pre-medicated with acepromazine. Eight cross-bred, clinically healthy bitches weighing 13.7 ±1.9kg on average were used in this study. After a food fast of 12 h and a water fast of four hours, the animals were treated with acepromazine (0.1mg/kg, intramuscular) and, after 15 minutes, anesthesia was induced with a combination of tiletamine-zolazepam (2mg/kg, IV) immediately followed by continuous IV infusion thereof at a dose of 2mg/kg/h for 60 min. The following parameters were measured in all animals immediately before administration of acepromazine (M15), immediately before anesthetic induction (M0), and at 5, 10, 20, 30, 40, 50, and 60 min after initiation of continuous infusion (M5, M10, M20, M30, M40, M50, and M60): electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), body temperature (BT), and arterial hemogasometry, with the last performed only at experimental times M15, M0, M30, and M60. A subcutaneous electrical stimulator was used to evaluate the degree of analgesia. Myorelaxation and quality of anesthetic recovery were also assessed, classifying these parameters as excellent, good, and poor. Anesthetic recovery time was recorded in minutes. HR increased significantly at time M10 in relation to that at M-15, and at times M5, M10, M40, and M50 in relation to that at M0. MAP decreased significantly at M20 and M30 compared with the baseline. BT decreased significantly at M50 compared with that at M0, but no hypothermia was observed. RR showed significant reduction at M5, M10, and M20 in relation to that at M-15, and at M5 and M10 in relation to that at M0, and bradypnoea was observed during the first 20 min after anesthetic induction. Significant decreases in the PR interval at times M10, M40, and M50 were observed in relation to that at M15. Amplitude of the R wave showed significant decrease at M20 compared with that at M-15. In the other ECG parameters, no significant difference was observed between the times evaluated. Hemogasometric parameters and analgesia did not show significant alterations. Myorelaxation and quality of anesthetic recovery were considered excellent. Recovery time was 15.1±7.7 min for positioning of sternal decubitus and 45.5±23.1 minutes for return of ambulation. Continuous IV administration of TZ combination does not produce satisfactory analgesia and does not cause severe cardiorespiratory and hemogasometric effects in bitches pre-medicated with acepromazine.(AU)


Objetivou-se avaliar a qualidade e a recuperação da anestesia promovida pela associação tiletamina-zolazepam, administrada por via intravenosa (IV) contínua, em cadelas pré-medicadas com acepromazina. Foram utilizadas oito cadelas, sem raças definidas, clinicamente sadias, pesando em média 13,7±1,9kg. Após jejum alimentar de 12 horas e hídrico de quatro horas, os animais foram medicados com acepromazina (0,1mg/kg, via intramuscular) e, após 15 minutos, a anestesia foi induzida com a associação tiletamina-zolazepam (2mg/kg, IV) seguida imediatamente pela infusão IV contínua da mesma, na dose de 2mg/kg/h, durante 60 minutos. Os parâmetros que foram mensurados em todos os animais, imediatamente antes da administração da acepromazina (M-15), imediatamente antes da indução anestésica (M0) e, aos 5, 10, 20, 30, 40, 50 e 60 minutos após o início da infusão contínua (M5, M10, M20, M30, M40, M50 e M60) foram os seguintes: eletrocardiografia (ECG), frequência cardíaca (FC), pressão arterial média (PAM), frequência respiratória (f), temperatura corpórea (TC) e hemogasometria arterial, esta sendo realizada apenas nos momentos M-15, M0, M30 e M60. Para avaliação do grau de analgesia foi empregado um estimulador elétrico subcutâneo. Também se avaliou o miorrelaxamento e a qualidade da recuperação anestésica, classificando estes parâmetros em: excelente, bom e ruim. O tempo de recuperação anestésica foi registrado em minutos. A FC aumentou significativamente no momento M10 em relação ao M-15, e nos momentos M5, M10, M40 e M50 em relação ao M0. A PAM diminuiu significativamente em M20 e M30 em comparação ao valor basal. A TC diminuiu significativamente em M50 em comparação ao M0, mas não foi observada hipotermia. A f apresentou uma redução significativa nos momentos M5, M10 e M20 em relação ao M-15, e em M5 e M10 em relação ao M0, sendo observado bradipneia durante os primeiros 20 minutos após a indução anestésica. Foram observadas diminuições significativas do intervalo PR nos momentos M10, M40 e M50, em relação ao M-15. A amplitude da onda R apresentou diminuição significativa em M20 em comparação ao M-15. Nos demais parâmetros da ECG não houve diferença significativa entre os momentos avaliados. Os parâmetros hemogasométricos e a analgesia não apresentaram alterações significativas. O miorrelaxamento e a qualidade da recuperação anestésica foram considerados excelentes. O período de recuperação foi de 15,1±7,7 minutos para posicionamento do decúbito esternal e 45,5±23,1 minutos para retorno da deambulação. A administração intravenosa contínua de tiletamina-zolazepam não produz analgesia satisfatória e não causa efeitos cardiorrespiratórios e hemogasométricos severos, em cadelas pré-tratadas com acepromazina.(AU)


Assuntos
Animais , Feminino , Cães , Tiletamina/farmacologia , Zolazepam/farmacologia , Período de Recuperação da Anestesia , Taxa Respiratória/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Adjuvantes Anestésicos , Anestesia Intravenosa/veterinária , Acepromazina/farmacologia
14.
Vet Anaesth Analg ; 46(3): 360-364, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30772260

RESUMO

OBJECTIVE: To evaluate the effect of two doses of fentanyl upon chest wall rigidity of dogs anesthetized at equipotent doses of isoflurane [1.3 minimum alveolar concentration (MACISO) of each dose of fentanyl]. STUDY DESIGN: Prospective crossover randomized study. ANIMALS: A group of eight male Beagle dogs, approximately 1 year old and weighing 12.1 ± 1.6 kg (mean ± standard deviation). METHODS: The dogs were anesthetized with isoflurane and instrumented for the measurement of esophageal pressure (PESO), flow (V˙) and volume (V). Chest wall elastance (ECW) was estimated by multiple linear regression of the model. PESO(t) = V˙(t) × RCW + V(t) × ECW + EEPESO where t is time, RCW is chest wall resistance and EEPESO is end-expiratory PESO. Chest wall compliance (CCW) was calculated as 1/ECW and normalized to the body weight of each dog (mL cmH2O-1 kg-1). Anesthesia was maintained at 1.3 MACISO for at least 15 minutes and CCW recorded (CCW-ISO). The dogs were randomly assigned to the lower fentanyl dose [loading dose (33 µg kg-1) and infusion (0.2 µg kg-1 minute-1)] or the higher fentanyl dose [loading dose (102 µg kg-1) and infusion (0.8 µg kg-1 minute-1)]. After 60 minutes of fentanyl infusion, CCW was recorded for each dose (CCW-FENT). During fentanyl infusion, the dogs were maintained at equipotent doses of isoflurane (1.3 MACISO for each fentanyl dose). A two-way analysis of variance followed by a Bonferroni test was used to compare CCW-ISO and CCW-FENT in both treatments and CCW-FENT between treatments. A p value <0.05 was considered significant. RESULTS: Neither of the fentanyl doses decreased CCW and there was no difference in CCW-FENT between doses. CONCLUSIONS AND CLINICAL RELEVANCE: Fentanyl at the studied doses did not result in chest wall rigidity in dogs anesthetized with equipotent doses of isoflurane (1.3 MACISO).


Assuntos
Adjuvantes Anestésicos/farmacologia , Analgésicos Opioides/farmacologia , Anestesia/veterinária , Cães , Fentanila/farmacologia , Isoflurano/farmacologia , Parede Torácica/efeitos dos fármacos , Anestésicos Inalatórios/farmacologia , Animais , Estudos Cross-Over , Relação Dose-Resposta a Droga , Fentanila/administração & dosagem , Isoflurano/administração & dosagem , Masculino , Estudos Prospectivos , Ventilação Pulmonar/efeitos dos fármacos , Distribuição Aleatória
15.
J Korean Med Sci ; 34(3): e21, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30662387

RESUMO

Background: To evaluate the efficacy and safety of fentanyl for sedation therapy in mechanically ventilated children. Methods: This was a double-blind, randomized controlled trial of mechanically ventilated patients between 2 months and 18 years of age. Patients were randomly divided into two groups; the control group with midazolam alone, and the combination group with both fentanyl and midazolam. The sedation level was evaluated using the Comfort Behavior Scale (CBS), and the infusion rates were adjusted according to the difference between the measured and the target CBS score. Results: Forty-four patients were recruited and randomly allocated, with 22 patients in both groups. The time ratio of cumulative hours with a difference in CBS score (measured CBS-target CBS) of ≥ 4 points (i.e., under-sedation) was lower in the combination group (median, 0.06; interquartile range [IQR], 0-0.2) than in the control group (median, 0.15; IQR, 0.04-0.29) (P < 0.001). The time ratio of cumulative hours with a difference in CBS score of ≥ 8 points (serious under-sedation) was also lower in the combination group (P < 0.001). The cumulative amount of midazolam used in the control group (0.11 mg/kg/hr; 0.07-0.14 mg/kg/hr) was greater than in the combination group (0.07 mg/kg/hr; 0.06-0.11 mg/kg/hr) (P < 0.001). Two cases of hypotension in each group were detected but coma and ileus, the major known adverse reactions to fentanyl, did not occur. Conclusion: Fentanyl combined with midazolam is safe and more effective than midazolam alone for sedation therapy in mechanically ventilated children. Trial Registration: ClinicalTrials.gov Identifier: NCT02172014.


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Ansiedade/prevenção & controle , Fentanila/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Adjuvantes Anestésicos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Fentanila/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/etiologia , Lactente , Unidades de Terapia Intensiva , Masculino , Midazolam/efeitos adversos , Respiração Artificial , Resultado do Tratamento
16.
Anaesthesia ; 74(5): 602-608, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30663045

RESUMO

We retrospectively compared patients receiving remifentanil with patients receiving sufentanil undergoing fast-track cardiac surgery. After 1:1 propensity score matching there were 609 patients in each group. The sufentanil group had a significantly longer mean (SD) ventilation time compared with the remifentanil group; 122 (59) vs. 80 (44) min, p < 0.001 and longer mean (SD) length of stay in the recovery area; 277 (77) vs. 263 (78) min, p = 0.002. The sufentanil group had a lower mean (SD) visual analogue pain score than the remifentanil group; 1.5 (1.2) vs. 2.4 (1.5), p < 0.001 and consumed less mean (SD) piritramide (an opioid analgesic used in our hospital); 2.6 (4.7) vs. 18.9 (7.3) mg, p < 0.001. The results of our study show that although remifentanil was more effective in reducing time to tracheal extubation and length of stay in the recovery area, there was an increased requirement for postoperative analgesia when remifentanil was used.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Remifentanil/administração & dosagem , Sufentanil/administração & dosagem , Idoso , Extubação , Período de Recuperação da Anestesia , Esquema de Medicação , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Pirinitramida/administração & dosagem , Fatores de Tempo
17.
Pulmonology ; 25(1): 9-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29898873

RESUMO

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.


Assuntos
Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Derrame Pleural/diagnóstico por imagem , Toracoscopia/instrumentação , Adjuvantes Anestésicos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Pleura/patologia , Derrame Pleural/etiologia , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Enfisema Subcutâneo/etiologia , Toracoscópios/tendências , Toracoscopia/efeitos adversos , Toracoscopia/métodos
18.
Anesth Analg ; 129(1): 84-91, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29787410

RESUMO

BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS. METHODS: After ethics committee approval and written informed consent, 80 patients undergoing elective major laparoscopic/robotic surgery were randomly allocated to receive GA with propofol CLADS with or without the addition of dexmedetomidine. Quantitative reduction of propofol and quality of depth-of-anesthesia (primary objectives), intraoperative hemodynamics, incidence of postoperative adverse events (sedation, analgesia, nausea, and vomiting), and intraoperative awareness recall (secondary objectives) were analyzed. RESULTS: There was a statistically significant lowering of propofol requirement (by 15%) in the dexmedetomidine group for induction of anesthesia (dexmedetomidine group: mean ± standard deviation 0.91 ± 0.26 mg/kg; nondexmedetomidine group: 1.07 ± 0.23 mg/kg, mean difference: 0.163, 95% CI, 0.04-0.28; P = .01) and maintenance of GA (dexmedetomidine group: 3.25 ± 0.97 mg/kg/h; nondexmedetomidine group: 4.57 ± 1.21 mg/kg/h, mean difference: 1.32, 95% CI, 0.78-1.85; P < .001). The median performance error of BIS control, a measure of bias, was significantly lower in dexmedetomidine group (1% [-5.8%, 8%]) versus nondexmedetomidine group (8% [2%, 12%]; P = .002). No difference was found for anesthesia depth consistency parameters, including percentage of time BIS within ±10 of target (dexmedetomidine group: 79.5 [72.5, 85.3]; nondexmedetomidine group: 81 [68, 88]; P = .534), median absolute performance error (dexmedetomidine group: 12% [10%, 14%]; nondexmedetomidine group: 12% [10%, 14%]; P = .777), wobble (dexmedetomidine group: 10% [8%, 10%]; nondexmedetomidine group: 8% [6%, 10%]; P = .080), and global score (dexmedetomidine group: 25.2 [23.1, 35.8]; nondexmedetomidine group: 24.7 [20, 38.1]; P = .387). Similarly, there was no difference between the groups for percentage of time intraoperative heart rate and mean arterial pressure remained within 20% of baseline. However, addition of dexmedetomidine to CLADS propofol increased the incidence of significant bradycardia (dexmedetomidine group: 14 [41.1%]; nondexmedetomidine group: 3 [9.1%]; P = .004), hypotension (dexmedetomidine group: 9 [26.5%]; nondexmedetomidine group: 2 [6.1%]; P = .045), and early postoperative sedation. CONCLUSIONS: The addition of dexmedetomidine to propofol administered by CLADS was associated with a consistent depth of anesthesia along with a significant decrease in propofol requirements, albeit with an incidence of hemodynamic depression and early postoperative sedation.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Anestesia com Circuito Fechado/instrumentação , Anestesia Intravenosa/instrumentação , Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência , Dexmedetomidina/administração & dosagem , Monitorização Neurofisiológica Intraoperatória/instrumentação , Propofol/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Adulto , Idoso , Anestesia com Circuito Fechado/efeitos adversos , Anestesia Intravenosa/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Dexmedetomidina/efeitos adversos , Método Duplo-Cego , Interações de Medicamentos , Desenho de Equipamento , Feminino , Humanos , Índia , Infusões Intravenosas , Laparoscopia , Masculino , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos , Resultado do Tratamento , Adulto Jovem
19.
Spectrochim Acta A Mol Biomol Spectrosc ; 207: 143-149, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30223248

RESUMO

Currently, trace detection of drugs, medicinal products, psychoactive substances, poisons and other natural or synthetic compounds in the human body has become one of the most important areas of interest in medicine, toxicology and forensic research. Due to the rapid development of nanotechnology, applications in forensic and biological sciences, food industry and art preservation there is an increasing interest in surface-enhanced Raman scattering (SERS) spectroscopy as a technique capable of low detection limits in the analysis of small amounts of studied analytes. In this study, different excitation wavelengths (785 nm and 1064 nm) were used to find the appropriate experimental conditions for the detection and identification of medically significant alkaloids - atropine and pergolide - by means of surface-enhanced Raman scattering spectroscopy. SERS spectra of selected alkaloids were measured in the concentration range 10-3-10-9 mol∙L-1 using large-scaled platinum substrates coated with electrochemically prepared gold or silver SERS-active layers. Identification was based on the assignment of surface-enhanced characteristic vibrational bands using theoretical (DFT) calculations and comparing them with normal (non-enhanced) Raman spectra of pure compounds. All sets of spectral data were subjected to multivariate statistical approach (partial least squares regression) aiming at prediction of alkaloids concentration in developed models and its comparison with experimental results.


Assuntos
Adjuvantes Anestésicos/análise , Atropina/análise , Agonistas de Dopamina/análise , Pergolida/análise , Análise Espectral Raman/métodos , Ouro/química , Análise dos Mínimos Quadrados , Prata/química
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA