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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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
12.
Curr Drug Saf ; 14(1): 57-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30394214

RESUMO

BACKGROUND: Adverse cardiorespiratory events are associated with midazolam continuous IV infusion, used for sedation. HISTORY: Here we are reporting a case of 5 year old male child suffering from diphtheria induced airway obstruction, and myocarditis, who received midazolam in the form of IV infusion for sedation while undergoing mechanical ventilation for respiratory failure. Adverse Event: Six hours after starting midazolam infusion he started developing pulsus bigeminus and bradycardia and eventual death after two hours. CONCLUSION: Midazolam, although considered one of the safest drugs, need to be used cautiously in a child with myocarditis, because of the possible cardiotoxic effect in an already affected heart.


Assuntos
Adjuvantes Anestésicos/efeitos adversos , Cardiotoxicidade/diagnóstico , Difteria/diagnóstico , Difteria/tratamento farmacológico , Midazolam/efeitos adversos , Adjuvantes Anestésicos/administração & dosagem , Cardiotoxicidade/complicações , Pré-Escolar , Difteria/complicações , Humanos , Infusões Intravenosas , Masculino , Midazolam/administração & dosagem
13.
J Pediatr Surg ; 54(1): 189-193, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30355460

RESUMO

BACKGROUND/PURPOSE: We initiated a pediatric surgical program including a caregiver for the induction of anesthesia. We measured preoperative midazolam administration, preoperative time, induction time, and program satisfaction. METHODS: Families with children undergoing surgery during the study period were included. Preoperative midazolam administration, preoperative time, and induction time were compared between participants and controls. Satisfaction surveys were given to participating caregivers and staff. RESULTS: The rate of preoperative midazolam use decreased from 41% (392/964) to 13% (16/118) among participants vs controls (p < 0.0001). After linear regression analysis, this difference persisted as an adjusted odds ratio of 0.29 (95% CI = 0.16-0.52). Preoperative and induction times (minutes) were similar between groups (76.2 vs 82.2, 13.8 vs 16.2, p = nonsignificant). Based on 5-point Likert surveys, the program was rated as "beneficial" or "very beneficial" to the patient by caregivers (99.2%) and staff (77.5%). Caregivers stated it "reduced" or "greatly reduced" anxiety for them (87.1%) and their child (93.2%). CONCLUSIONS: Opponents of similar programs suggest familial presence slows care and is disruptive. Our program decreased utilization of preoperative anxiolytics with no effect on operating room efficiency. Both hospital staff and participants felt the program was beneficial to the patient. Perceived caregiver and child anxiety was reduced. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Anestesia/métodos , Midazolam/administração & dosagem , Assistência Centrada no Paciente/métodos , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Família , Feminino , Humanos , Lactente , Masculino , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
14.
Sleep Med Rev ; 43: 23-36, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30503715

RESUMO

Excessive daytime sleepiness (EDS) and cataplexy are common symptoms of narcolepsy, a sleep disorder associated with the loss of hypocretin/orexin (Hcrt) neurons. Although only a few drugs have received regulatory approval for narcolepsy to date, treatment involves diverse medications that affect multiple biochemical targets and neural circuits. Clinical trials have demonstrated efficacy for the following classes of drugs as narcolepsy treatments: alerting medications (amphetamine, methylphenidate, modafinil/armodafinil, solriamfetol [JZP-110]), antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors), sodium oxybate, and the H3-receptor inverse agonist/antagonist pitolisant. Enhanced catecholamine availability and regulation of locus coeruleus (LC) norepinephrine (NE) neuron activity is likely central to the therapeutic activity of most of these compounds. LC NE neurons are integral to sleep/wake regulation and muscle tone; reduced excitatory input to the LC due to compromise of Hcrt/orexin neurons (likely due to autoimmune factors) results in LC NE dysregulation and contributes to narcolepsy/cataplexy symptoms. Agents that increase catecholamines and/or LC activity may mitigate EDS and cataplexy by elevating NE regulation of GABAergic inputs from the amygdala. Consequently, novel medications and treatment strategies aimed at preserving and/or modulating Hcrt/orexin-LC circuit integrity are warranted in narcolepsy/cataplexy.


Assuntos
Cataplexia/tratamento farmacológico , Tratamento Farmacológico/métodos , Imunogenética , Narcolepsia/tratamento farmacológico , Neurobiologia , Adjuvantes Anestésicos/administração & dosagem , Antidepressivos/administração & dosagem , Antidepressivos Tricíclicos/administração & dosagem , Cataplexia/metabolismo , Estimulantes do Sistema Nervoso Central/administração & dosagem , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Modafinila/administração & dosagem , Narcolepsia/metabolismo , Oxibato de Sódio/administração & dosagem
15.
Medicine (Baltimore) ; 97(50): e13727, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558092

RESUMO

BACKGROUND: Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. METHODS: A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 µg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis. RESULTS: The ED95 of intrathecal ropivacaine with 5 µg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5-18.8 mg), when receiving prophylactic infusion of phenylephrine. CONCLUSION: Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.


Assuntos
Cesárea/métodos , Parto/efeitos dos fármacos , Fenilefrina/uso terapêutico , Ropivacaina/farmacologia , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/uso terapêutico , Agonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipotensão Controlada , Infusões Intravenosas , Injeções Espinhais , Fenilefrina/administração & dosagem , Gravidez , Estudos Prospectivos , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Sufentanil/administração & dosagem , Sufentanil/uso terapêutico
16.
Sci Rep ; 8(1): 17124, 2018 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-30459408

RESUMO

Inhalant anesthesia is challenging in chelonians due to a great capacity for breath-holding and an incomplete separation of the cardiac ventricle. Deoxygenated blood can recirculate back into systemic circulation by bypassing the lung in a process referred to as intracardiac right to left (R-L) shunting. Via electrocardiogram gated magnetic resonance imaging, a novel modality to investigate arterial flows in reptiles, intracardiac shunting and its elimination via atropine during gas anesthesia in tortoises (Chelonoidis carbonaria) was demonstrated. The great vessels of the heart were visualized confirming that after shunt-elimination, the flow (mean ± sd) in the pulmonary arteries increased significantly (54.6 ± 9.5 mL min-1 kg-1 vs 10.8 ± 3.4 mL min-1 kg-1; P < 0.008). Consequently, animals required significantly lower concentrations of inhaled anesthetics to maintain a stable anesthesia. To that end, the minimum anesthetic concentration (MAC) of isoflurane needed to maintain surgical anesthesia was measured. A significantly lower MAC was found after administration of atropine (mean MAC ± sd 2.2 ± 0.3% vs 3.2 ± 0.4%; P < 0.002). Previously, MAC has been indeterminable in chelonians likely due to intracardiac shunting, so this report constitutes the first MAC study performed in a tortoise.


Assuntos
Anestesia por Inalação/veterinária , Anestésicos Inalatórios/administração & dosagem , Coração/fisiologia , Isoflurano/administração & dosagem , Tartarugas , Adjuvantes Anestésicos/administração & dosagem , Anestésicos Inalatórios/sangue , Animais , Atropina/administração & dosagem , Estudos Cross-Over , Eletrocardiografia , Feminino , Isoflurano/sangue , Imagem por Ressonância Magnética , Artéria Pulmonar/fisiologia , Circulação Pulmonar/fisiologia , Distribuição Aleatória
17.
Cardiovasc Drugs Ther ; 32(6): 625-632, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30357518

RESUMO

Over the last years, fentanyl, a potent synthetic µ receptor-stimulating opioid, has become one of the most used drugs for both procedural analgesia and sedation in patients undergoing coronary angiography (CA) and/or percutaneous coronary intervention (PCI). However, few studies have been performed to evaluate the efficacy and the impact of this drug in patients with coronary artery disease (CAD) treated with PCI. Most of the previous studies have investigated the self-reported discomfort pain, demonstrating that patients premedicated with fentanyl generally reported a lower pain/discomfort when compared to placebo, benzodiazepines, or local anesthesia at the site of the artery cannulation, without significant variation in the hemodynamic response. The biochemical properties of fentanyl have been used to prevent the radial arterial spasm, which represents one of the major causes of the access site cross-over during PCI, experienced when radial artery cannulation has failed and successful access can be obtained only switching to an alternative arterial route, as the ulnar or the femoral artery. However, some unresolved problems, as fentanyl-induced hypothermia and delayed absorption of P2Y12 inhibitors required further investigations.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Fentanila/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Intervenção Coronária Percutânea , Adjuvantes Anestésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Interações de Medicamentos , Fentanila/efeitos adversos , Humanos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco , Resultado do Tratamento
18.
Oral Maxillofac Surg ; 22(4): 457-461, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30327982

RESUMO

PURPOSE: To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase. OBJECTIVE: A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations. BACKGROUND: Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix). METHODS: Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)-(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS). RESULTS: The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41 ± 48.67 ng/ml and for IS group it was 209.67 ± 88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P = 0.605). CONCLUSION: Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Lidocaína/administração & dosagem , Nervo Mandibular , Bloqueio Nervoso/métodos , Adjuvantes Anestésicos/sangue , Adjuvantes Anestésicos/farmacocinética , Adulto , Anestésicos Locais/sangue , Anestésicos Locais/farmacocinética , Dexametasona/sangue , Dexametasona/farmacocinética , Método Duplo-Cego , Feminino , Humanos , Injeções , Lidocaína/sangue , Lidocaína/farmacocinética , Masculino , Mandíbula , Músculos Pterigoides
19.
Int J Pediatr Otorhinolaryngol ; 113: 248-251, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173995

RESUMO

INTRODUCTION: The objective of this study was to determine if pre-operative oral midazolam administration decreased postoperative oral fluid intake after tonsillectomy with or without adenoidectomy. METHODS: A retrospective chart review identified 104 patients who were undergoing tonsillectomy with and without adenoidectomy who were not given midazolam preoperatively and 182 who were given midazolam preoperatively. Indications for tonsillectomy with or without adenoidectomy included obstructive sleep apnea, recurrent acute streptococcal pharyngotonsillitis, and, in selected cases, periodic fever with aphthous stomatitis, pharyngitis and adenopathy. All patients were evaluated in the pre-operative area by the attending anesthesiologist, who then determined whether or not he/she felt the patient would benefit from premedication with oral midazolam prior to surgery. Patients whom the attending anesthesiologist judged would benefit from midazolam were then given a 0.12-1.06 mg/kg dose (mean 0.35 mg/kg, STD 0.12), at the discretion of the anesthesiologist. Various methods were used to perform tonsillectomy, such as coblation and electrocautery, at the discretion of the otolaryngologist. Results were not stratified by surgical technique. Oral fluid intake was calculated by establishing the time of return to the floor from surgery and determining the documented oral fluid intake for the next 12 h. Oral fluid intake per kg per hour was then calculated. The amount of midazolam given was documented. RESULTS: There was no significant difference in oral fluid intake by group when adjusting for age and weight, F(1, 282) = 0.383, p = 0.537. Also, there was no significant difference in ml/kg/hr by group when adjusting for age and weight, F(1, 282) = 2.813, p = 0.095. CONCLUSIONS: There was no significant difference in oral fluid intake between the no midazolam and midazolam groups, indicating that clinicians can continue to use their judgement in administering midazolam to select anxious patients prior to tonsillectomy with or without adenoidectomy. Future work could include multi-center retrospective reviews or a randomized placebo-controlled trial to examine more carefully the effects of midazolam on postoperative oral fluid intake. LEVEL OF EVIDENCE: Level IV.


Assuntos
Adenoidectomia/efeitos adversos , Adjuvantes Anestésicos/administração & dosagem , Ingestão de Líquidos/efeitos dos fármacos , Midazolam/administração & dosagem , Tonsilectomia/efeitos adversos , Adenoidectomia/métodos , Adjuvantes Anestésicos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Midazolam/efeitos adversos , Estado de Hidratação do Organismo/efeitos dos fármacos , Complicações Pós-Operatórias/tratamento farmacológico , Período Pós-Operatório , Pré-Medicação/métodos , Estudos Retrospectivos , Tonsilectomia/métodos
20.
Psychopharmacology (Berl) ; 235(11): 3223-3232, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232528

RESUMO

RATIONALE: Gamma-hydroxybutyrate acid (GHB), a GABAB receptor agonist approved for treatment of narcolepsy, impairs driving ability, but little is known about doses and plasma concentrations associated with impairment and time course of recovery. OBJECTIVE: To assess effects of oral GHB (Xyrem®) upon driving as measured by a driving simulator, and to determine plasma concentrations associated with impairment and the time course of recovery. METHODS: Randomized, double-blind, two-arm crossover study, during which 16 participants received GHB 50 mg/kg orally or placebo. GHB blood samples were collected prior to and at 1, 3, and 6 h post dosing. Driving simulator sessions occurred immediately after blood sampling. RESULTS: Plasma GHB was not detectable at baseline or 6 h post dosing. Median GHB concentrations at 1 and 3 h were 83.1 mg/L (range 54-110) and 24.4 mg/L (range 7.2-49.7), respectively. Compared to placebo, at 1 h post GHB dosing, significant differences were seen for the life-threatening outcome collisions (p < 0.001) and off-road accidents (p = 0.018). Although driving was not faster, there was significantly more weaving and erratic driving with GHB as measured by speed deviation (p = 0.002) and lane position deviation (p = 0.004). No significant impairment regarding driving outcomes was found in the GHB group at 3 and 6 h post dose. CONCLUSION: GHB in doses used to treat narcolepsy resulted in severe driving impairment at 1 h post dosing. After 3 to 6 h, there was full recovery indicating that safe driving is expected the next morning after bedtime therapeutic GHB use in the absence of other substances.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Condução de Veículo/psicologia , Simulação por Computador , Dirigir sob a Influência/psicologia , Oxibato de Sódio/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Adjuvantes Anestésicos/sangue , Administração Oral , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Narcolepsia/sangue , Narcolepsia/tratamento farmacológico , Oxibato de Sódio/efeitos adversos , Oxibato de Sódio/sangue
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