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1.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
CMAJ ; 191(17): E462-E468, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036608

RESUMO

BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Usuários de Drogas/estatística & dados numéricos , Hepatite C/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Buprenorfina/administração & dosagem , Estudos de Coortes , Feminino , Hepatite C/etiologia , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/complicações
3.
Ren Fail ; 41(1): 341-353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31057054

RESUMO

OBJECTIVES: The aim of this study was to evaluate and compare the severity of acute kidney injury (AKI) induced by iodine contrast agent injection via the renal artery, ear vein, and femoral artery in a rabbit model. METHODS: Blood oxygenation level-dependent (BOLD) magnetic resonance (MR) scans were performed at 24 h prior to contrast injection and 1, 24, 48, and 72 h after injection. Iodixanol injection dose was 1.0, 1.5, 2.0, and 2.5 g iodine/kg, respectively. Hypoxia-inducible factor-1α (HIF-1α) expression was determined, and the BOLD-MRI parameter R2* was used to express tissue oxygenation. Increases in R2* levels reflect reductions in tissue oxygenation. Analyses including R2* value, dose response, histology, and HIF-1α were conducted. RESULT: Injection of 1.0 g iodine/kg into the left renal artery resulted in significant increases in renal R2* values after 24 h. This was equivalent to the change of R2* after 2.0 g iodine/kg femoral artery injection. Renal injury scores and HIF-1α expression scores were significantly increased at 24 h. The R2* values exhibited a positive linear correlation with histological injury scores. The maximum effects occurred 24 h after iodixanol injection and returned to baseline levels within 72 h. CONCLUSIONS: The renal injury induced by 1.0 g iodine/kg iodixanol through renal artery injection was more significant than that caused by the same dose of femoral artery and auricular vein injection, while similar to that caused by 2.0 g iodine/kg femoral artery injection.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Animais , Meios de Contraste/administração & dosagem , Modelos Animais de Doenças , Pavilhão Auricular/irrigação sanguínea , Artéria Femoral , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/análise , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Injeções Intra-Arteriais/efeitos adversos , Injeções Intra-Arteriais/métodos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/métodos , Rim/diagnóstico por imagem , Rim/efeitos dos fármacos , Rim/patologia , Imagem por Ressonância Magnética , Masculino , Oxigênio/sangue , Coelhos , Artéria Renal , Índice de Gravidade de Doença , Ácidos Tri-Iodobenzoicos/administração & dosagem , Ácidos Tri-Iodobenzoicos/efeitos adversos
4.
Curr Opin Anaesthesiol ; 32(3): 377-383, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30893121

RESUMO

PURPOSE OF REVIEW: This review summarizes the current evidence available to guide anaesthetists along the decision-making process between inhalational and intravenous anaesthesia when caring for paediatric patients. RECENT FINDINGS: A recent large randomized controlled trial in children with risk factors demonstrated a significant benefit of intravenous induction over inhalational induction with regards to respiratory adverse events. This difference is particularly pronounced in those with respiratory symptoms. SUMMARY: For children scheduled for elective surgery, intravenous induction has significant advantages with regards to reduced respiratory adverse events and for less postoperative behavioural disturbances, it may be associated with more anxiety at the time of induction. The anaesthetist in charge of the patient needs to weigh up the balance between the clinical risk of respiratory adverse events, the 'veins on offer', the level of anxiety and previous experiences of the child and his/her parents.


Assuntos
Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Dor/prevenção & controle , Sistema Respiratório/efeitos dos fármacos , Anestesia por Inalação/efeitos adversos , Anestesia Intravenosa/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Ansiedade/etiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Criança , Comportamento Infantil/efeitos dos fármacos , Comportamento Infantil/fisiologia , Tomada de Decisão Clínica , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/psicologia , Agulhas , Dor/etiologia , Satisfação do Paciente , Seleção de Pacientes , Período Pós-Operatório , Sistema Respiratório/fisiopatologia
5.
J Forensic Sci ; 64(4): 1245-1247, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30513554

RESUMO

A 32-year-old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe-patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.


Assuntos
Corpos Estranhos/patologia , Granuloma de Corpo Estranho/patologia , Injeções Intravenosas/efeitos adversos , Comprimidos , Adulto , Feminino , Forame Oval Patente/patologia , Humanos , Pulmão/patologia , Abuso de Substâncias por Via Intravenosa/complicações
6.
Lab Anim ; 53(2): 190-201, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30089439

RESUMO

Intravenous (IV) administration in mice is predominantly performed via the lateral tail veins. The technique requires adequate training before it can be used safely and routinely. A novel anaesthesia induction chamber has been developed to simplify the treatment and to facilitate IV injection in mice, particularly for untrained personnel. We have assessed the benefits of the chamber in refining IV injection in isoflurane-anaesthetized mice in direct comparison with the common restrainer method on conscious animals. The body weight, nesting behaviour and concentrations of faecal corticosterone metabolites were taken as indicative of distress induced by the various procedures. The results suggest that both methods of tail-vein injection induce similar levels of momentary stress in the animals, revealed by a short-term increase in the levels of stress hormone metabolites in faeces. A temporary reduction of body weight was observed after IV injection under isoflurane anaesthesia but not for conscious mice injected in the common restrainer. We conclude that the severity of tail-vein injection in mice is 'mild' for both methods. There was no evidence that refining the procedure by using isoflurane anaesthesia in the induction chamber was associated with any benefit.


Assuntos
Peso Corporal , Corticosterona/metabolismo , Injeções Intravenosas/métodos , Camundongos , Comportamento de Nidação , Manejo da Dor , Anestésicos Inalatórios/administração & dosagem , Animais , Fezes/química , Feminino , Injeções Intravenosas/efeitos adversos , Isoflurano/administração & dosagem , Masculino , Camundongos Endogâmicos C57BL , Distribuição Aleatória
7.
Am J Ther ; 25(6): e670-e674, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30169374

RESUMO

BACKGROUND: Unexpected serious adverse drug reactions (sADRs) affecting patients with chronic kidney disease (CKD) who received erythropoiesis-stimulating agents were identified by study co-authors. These included pure red cell aplasia (PRCA) after administration of the Eprex formulation of epoetin or the epoetin biosimilar HX575 and fatal anaphylaxis associated with peginesatide, an erythropoietin receptor agonist. We developed and applied a structured framework to describe these sADRs, including root cause analyses and eradication efforts. METHODS: A 10-step framework termed "ANTICIPATE," focusing on signal identification, incidence, causality, and eradication guided our evaluations. RESULTS: Initial cases were identified by a hematologist (Eprex), clinical study monitors (HX575), and 4 nurses (peginesatide). The number of persons with individual ADRs was 13 PRCA cases for epoetin, 2 antibody-mediated PRCA cases for HX575, and 5 fatal anaphylaxis cases for peginesatide. Initial incidence estimates per 1000 treated persons were 0.27 for Eprex-associated PRCA, 11 for HX575-associated PRCA, and 0.38 for peginesatide fatalities. Likely causes were subcutaneous administration of epoetin formulated with polysorbate 80 (Eprex), tungsten leaching from pins included in product syringes (HX575), and inclusion of a phenol stabilizer (peginesatide). Eradication strategies included restricting Eprex administration to the intravenous route, excluding tungsten from HX575 syringes, and for peginesatide, proposed eradication was to return to single-dose vials without preservatives. CONCLUSION: Although the number of cases of each sADR was small, eradication was successful for 2 sADRs, and a proposed eradication was developed for a third sADR. The structured framework used to describe the above 3 sADRs in patients with CKD can also be used in other clinical settings.


Assuntos
Anafilaxia/epidemiologia , Hematínicos/efeitos adversos , Aplasia Pura de Série Vermelha/epidemiologia , Insuficiência Renal Crônica/complicações , Análise de Causa Fundamental/estatística & dados numéricos , Anafilaxia/induzido quimicamente , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Epoetina alfa/efeitos adversos , Excipientes/efeitos adversos , Humanos , Incidência , Injeções Intravenosas/efeitos adversos , Injeções Subcutâneas/efeitos adversos , Peptídeos/efeitos adversos , Conservantes Farmacêuticos/efeitos adversos , Aplasia Pura de Série Vermelha/induzido quimicamente , Insuficiência Renal Crônica/sangue , Seringas/efeitos adversos , Tungstênio/efeitos adversos
8.
Eur Radiol ; 28(12): 5376-5383, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29948071

RESUMO

OBJECTIVES: Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol to current practice. METHODS: Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc. RESULTS: The incidence of large-volume CM extravasation was very low (0.04% [27/67,129] overall; 0.03% related to manual injection [age range, 59-92 years; mean, 75.4 years], and 0.045% related to auto-injection [age range, 36-86 years; mean, 65.8 years]). The CM extravasation volume in majority of patients was 20-40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention. CONCLUSIONS: Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective. KEY POINTS: • The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%. • No patient needed surgical intervention, and most recovered within 7 days. • Each element of our management protocol contributed to good outcome.


Assuntos
Tratamento Conservador/métodos , Meios de Contraste/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , China , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Feminino , Humanos , Incidência , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Korean J Anesthesiol ; 71(6): 453-458, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29843507

RESUMO

BACKGROUND: Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection. METHODS: Eighty American Society of Anesthesiologists class I adult patients undergoing general anesthesia were enrolled and divided into two groups of 40 each. Group I (Valsalva) patients blew into a sphygmomanometer tube raising the mercury column up to 30 mmHg for 20 seconds, while Group II (Control) patients did not. Anesthesia was induced with 1% propofol immediately afterwards. Pain was assessed on a 10-point visual analog scale (VAS), where 0 represented no pain, and 10, the worst imaginable pain, and a 4-point withdrawal response score, where 0 represented no pain, and 3, the worst imaginable pain. Scores were presented as median (interquartile range). RESULTS: We analyzed the data of 70 patients. The incidence of pain was significantly lower in the Valsalva than in the control group (53% vs. 78%, P = 0.029). The withdrawal response score was significantly lower in the Valsalva group (1.00 [0.00-1.00] vs. 2.00 [2.00-3.00], P < 0.001). The VAS score was significantly lower in the Valsalva group (1.00 [0.00-4.00] vs. 7.00 [6.25-8.00], P < 0.001). CONCLUSIONS: A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Dor/induzido quimicamente , Dor/prevenção & controle , Propofol/efeitos adversos , Manobra de Valsalva/fisiologia , Adolescente , Adulto , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
10.
Acad Emerg Med ; 25(9): 1048-1052, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29645317

RESUMO

OBJECTIVE: We compared the analgesic efficacy and incidence of side effects when low-dose (0.3 mg/kg) ketamine (LDK) is administered as a slow infusion (SI) over 15 minutes versus an intravenous push (IVP) over 1 minute. METHODS: This was a prospective, randomized, double-blind, double-dummy, placebo-controlled trial of adult ED patients presenting with moderate to severe pain (numerical rating scale [NRS] score ≥ 5). Patients received 0.3 mg/kg ketamine administered either as a SI or a IVP. Our primary outcome was the proportion of patients experiencing any psychoperceptual side effect over 60 minutes. A secondary outcome was incidence of moderate or greater psychoperceptual side effects. Additional outcomes included reduction in pain NRS scores at 60 minutes and percent maximum summed pain intensity difference (%SPID). RESULTS: Fifty-nine participants completed the study. A total of 86.2% of the IVP arm and 70.0% of the SI arm experienced any side effect (difference = 16.2%, 95% confidence interval [CI] = -5.4 to 37.8). We found a large reduction in moderate or greater psychoperceptual side effects with SI administration-75.9% reported moderate or greater side effects versus 43.4% in the SI arm (difference = 32.5%, 95% CI = 7.9 to 57.1). Additionally, the IVP arm experienced more hallucinations (n = 8, 27.6%) than the SI arm (SI n = 2, 6.7%, difference = 20.9%, 95% CI = 1.8 to 43.4). We found no significant differences in analgesic efficacy. At 60 minutes, the mean %SPID values in the IVP and SI arms were 39.9 and 33.5%, respectively, with a difference of 6.5% (95% CI = -5.8 to 18.7). CONCLUSION: Most patients who are administered LDK experience a psychoperceptual side effect regardless of administration via SI or IVP. However, patients receiving LDK as a SI reported significantly fewer moderate or greater psychoperceptual side effects and hallucinations with equivalent analgesia.


Assuntos
Analgésicos/administração & dosagem , Ketamina/administração & dosagem , Manejo da Dor/métodos , Dor/tratamento farmacológico , Adulto , Analgésicos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas/efeitos adversos , Injeções Intravenosas/efeitos adversos , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
11.
Niger J Clin Pract ; 21(1): 43-48, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29411722

RESUMO

AIM: This prospectively-planned, randomized, double-blind and placebo-controlled study aims to evaluate the effect of 1200 mg gabapentin premedication on the incidence and severity of propofol and rocuronium injection pain. METHOD: One hundred patients, between 18-60 years of age and ASA I-II for elective surgery planned under general anaesthetic, were randomized and divided into two groups. Two hours before the operation, the patients were given either a placebo tablet (Group P, n = 50) or 1200 mg gabapentin tablet (Group G, n = 50). On the back of the non-dominant hand, a vein was opened using a 20 G cannula , 0.9% NaCl was begun and preoxygenation was provided. For anaesthesia induction, 1% propofol at 800 ml/hr infusion rate was administered for 20 s. Propofol injection pain was evaluated up to the 20th second and recorded using a scale between 0 and 3 developed by McCrirrick and HunteR The remaining propofol dose (2.5 mg/kg), 5 ml saline and 0.6 mg/kg rocuronium were injected in that order over 10 seconds and rocuronium injection pain response was evaluated with a four point scale. RESULTS: Pain after propofol infusion average score (degree ≥ 1) (Group G = 0.5; Group P = 1.0) and incidence (Group G = 46%; Group P = 68%); and average withdrawal movements response score linked to rocuronium injection pain (≥ 1 response) (Group G = 0.3; Group P = 1.2) and incidence (Group G = 20%; Group P = 80%) were detected to be significantly lower in the gabapentin group compared to the placebo group (p < 0.001). CONCLUSION: Premedication with 1200 mg gabapentin 2 hours before propofol and rocuronium injection reduced the incidence and severity of injection pain.


Assuntos
Aminas/uso terapêutico , Analgésicos/uso terapêutico , Androstanóis/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Ácidos Cicloexanocarboxílicos/uso terapêutico , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Dor Processual/prevenção & controle , Propofol/efeitos adversos , Ácido gama-Aminobutírico/uso terapêutico , Adulto , Androstanóis/administração & dosagem , Anestesia Geral , Anestésicos Intravenosos/administração & dosagem , Método Duplo-Cego , Feminino , Gabapentina , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Medição da Dor , Propofol/administração & dosagem , Estudos Prospectivos , Rocurônio , Adulto Jovem
13.
Pain Med ; 19(3): 598-607, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28525614

RESUMO

Objective: Lidocaine alleviates propofol injection pain. However, whether lidocaine works through a local anesthetic effect at the site of intravenous injection or through a systemic effect on the central nervous system remains unknown. This study aimed to determine the pain-alleviating mechanism of lidocaine. Design: A randomized controlled study. Setting: A gastroscopy facility. Methods: The study was divided into two parts. Part 1 involved 717 patients who were randomly assigned into five groups. Groups PR, RL20, and RL40 received normal saline or saline containing 20 or 40 mg of lidocaine, injected via the vein on the right hand. Groups LL20 and LL40 received 20 or 40 mg of lidocaine, injected via the vein on the left hand. Part 2 involved 378 patients who were randomly assigned into five groups. Groups RL40, RL1.2, and RL1.5 received 40 mg, 1.2 mg/kg, and 1.5 mg/kg of lidocaine, injected via the vein on the right hand. Groups LL1.2 and LL1.5 received 1.2 or 1.5 mg/kg of lidocaine, injected via the vein on the left hand. All received 2 mg/kg of propofol via the vein on the right hand two minutes later. Injection pain and patient satisfaction were recorded. Results: The incidence of pain of group RL40 was lower than that of group PR. The incidence of pain of group LL1.2 was higher than that of other groups. Conclusions: A dosage of 40 mg lidocaine is an appropriate dosage to alleviate propofol injection pain within the same vein. Lidocaine reduces propofol injection pain through both a local anesthetic effect and a central analgesic effect when the dosage reaches 1.5 mg/kg.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Dor/prevenção & controle , Propofol/efeitos adversos , Adulto , Sistema Nervoso Central/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/induzido quimicamente
14.
Agri ; 29(4): 162-166, 2017 Oct.
Artigo em Turco | MEDLINE | ID: mdl-29171646

RESUMO

OBJECTIVES: In this study, we aimed to determine the effect of remifentanil administration prior to slow and fast rocuronium infusion on hemodynamic changes and rocuronium injection pain in pediatric patients. METHODS: In total, 120 5-15-year-old ASA score I/II pediatric patients were included in the study. Group A: slow rocuronium injection-saline; group B: slow rocuronium injection (0.6 mg/kg IV)-remifentanyl; group C: fast rocuronium injection-saline; and group D: fast rocuronium injection-remifentanyl. Withdrawal movement after rocuronium injection was recorded based on a 3-point response to withdrawal score. Hemodynamic parameters were recorded. RESULTS: One minute after rocuronium injection, HR values were found to be lower in remifentanil groups (p: 0.0001; 101.4±22.1, p: 0.003; 99.8±18.3 in group B and D, respectively) compared with those in placebo groups (p: 0.025; 107.4±21.7, p: 0.012; 114.0±16.4 in group A and C, respectively). With respect to the response to withdrawal scores, unresponsiveness rates were the highest in group B (66.7%) and group D (70%). The number of non-responder patients was 9 in saline-administered groups (group A and C), whereas it was 20 and 21 in remifentanil-administered groups (group B and D, respectively). Generalized responses were observed predominantly in groups A (20%) and C (20%). Generalized responses were highest in groups A (20%, n=6) and C (20%, n=6). CONCLUSION: There was no impact of infusion speed on rocuronium injection pain in pediatric cases, whereas it is concluded that remifentanil administration prior to rocuronium injection considerably reduced rocuronium injection pain regardless of injection speed and without serious hemodynamic changes.


Assuntos
Analgésicos Opioides/administração & dosagem , Androstanóis/administração & dosagem , Anestesia Geral , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Piperidinas/administração & dosagem , Adolescente , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Medição da Dor , Remifentanil , Rocurônio , Resultado do Tratamento
16.
Compr Child Adolesc Nurs ; 40(sup1): 8-13, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29166185

RESUMO

Intravenous injection is the most feared medical procedure and gives rise to an experience of mild to severe pain in children. Unrestrained pain has a negative effect on the child. Pain management in the form of a convenient sitting position is needed by children who undergo intravenous injection procedures. This study aims to determine the effect of parental holding and an upright position on children's pain during intravenous injection procedures. The study used the Randomized Clinical Trial method involving 34 respondents, aged 1-4 years, who were included in the intervention and control group. The result of a Mann-Whitney U test analysis showed a significant difference in the pain score between the intervention and control groups (p value = .000; α = .05). The parental holding and upright position can be applied as a nonpharmacological pain management strategy for children who undergo intravenous injection procedures.


Assuntos
Injeções Intravenosas/efeitos adversos , Manejo da Dor/métodos , Postura , Adulto , Pré-Escolar , Feminino , Humanos , Indonésia , Lactente , Masculino , Dor/psicologia , Manejo da Dor/psicologia , Medição da Dor/métodos , Pais/psicologia , Estatísticas não Paramétricas
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