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Medicine (Baltimore) ; 100(22): e26199, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087890


ABSTRACT: Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs.This was a retrospective data analysis. The sedation medications and relevant covariates, including demographic parameters, disability levels, oral health conditions, dental procedures, treatment time, and side effects, of 718 patients with special needs were collected between April 2013 and September 2014. The unfavorable side effects by sedation types were reported. Factors associated with procedure time and the sedation medications were assessed with multiple logistic regression analyses.Of 718 patients, 8 patients experienced unfavorable side effects (vomiting, sleepiness, or emotional disturbance) after the dental procedures; the rate was 0.6% in the 509 patients who received propofol only. In 209 patients who received propofol and midazolam, 2.4% experienced the side effects. Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04-2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06-1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28-3.86), men (aOR = 2.05, 95% CI: 1.41-2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21-3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13-2.39).With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.

Sedação Consciente/estatística & dados numéricos , Assistência Odontológica/normas , Midazolam/administração & dosagem , Propofol/administração & dosagem , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Administração Intravenosa , Adolescente , Adulto , Sintomas Afetivos/induzido quimicamente , Criança , Disfunção Cognitiva/complicações , Sedação Consciente/efeitos adversos , Assistência Odontológica/estatística & dados numéricos , Raspagem Dentária/estatística & dados numéricos , Combinação de Medicamentos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Retrospectivos , Sonolência , Vômito/induzido quimicamente
Toxicol Appl Pharmacol ; 419: 115519, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33823148


The development of refractory status epilepticus (SE) induced by sarin intoxication presents a therapeutic challenge. In our current research we evaluate the efficacy of a delayed combined triple treatment in ending the abnormal epileptiform seizure activity (ESA) and the ensuing of long-term neuronal insult. SE was induced in male Sprague-Dawley rats by exposure to 1.2LD50 sarin insufficiently treated by atropine and TMB4 (TA) 1 min later. Triple treatment of ketamine, midazolam and valproic acid was administered 30 min or 1 h post exposure and was compared to a delayed single treatment with midazolam alone. Toxicity and electrocorticogram activity were monitored during the first week and behavioral evaluation performed 3 weeks post exposure followed by brain biochemical and immunohistopathological analyses. The addition of both single and triple treatments reduced mortality and enhanced weight recovery compared to the TA-only treated group. The triple treatment also significantly minimized the duration of the ESA, reduced the sarin-induced increase in the neuroinflammatory marker PGE2, the brain damage marker TSPO, decreased the gliosis, astrocytosis and neuronal damage compared to the TA+ midazolam or only TA treated groups. Finally, the triple treatment eliminated the sarin exposed increased open field activity, as well as impairing recognition memory as seen in the other experimental groups. The delayed triple treatment may serve as an efficient therapy, which prevents brain insult propagation following sarin-induced refractory SE, even if treatment is postponed for up to 1 h.

Anticonvulsivantes/administração & dosagem , Encéfalo/efeitos dos fármacos , Ketamina/administração & dosagem , Midazolam/administração & dosagem , Sarina , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/administração & dosagem , Animais , Comportamento Animal/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Proteínas de Transporte/metabolismo , Dinoprostona/metabolismo , Modelos Animais de Doenças , Esquema de Medicação , Quimioterapia Combinada , Injeções Intramusculares , Injeções Intraperitoneais , Masculino , Teste de Campo Aberto/efeitos dos fármacos , Ratos Sprague-Dawley , Receptores de GABA-A/metabolismo , Reconhecimento Psicológico/efeitos dos fármacos , Estado Epiléptico/induzido quimicamente , Estado Epiléptico/patologia , Estado Epiléptico/fisiopatologia , Fatores de Tempo
Anesthesiology ; 134(5): 734-747, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33684203


BACKGROUND: Anesthetics aim to prevent memory of unpleasant experiences. The amygdala and dorsal anterior cingulate cortex participate in forging emotional and valence-driven memory formation. It was hypothesized that this circuitry maintains its role under sedation. METHODS: Two nonhuman primates underwent aversive tone-odor conditioning under sedative states induced by ketamine or midazolam (1 to 8 and 0.1 to 0.8 mg/kg, respectively). The primary outcome was behavioral and neural evidence suggesting memory formation. This study simultaneously measured conditioned inspiratory changes and changes in firing rate of single neurons in the amygdala and the dorsal anterior cingulate cortex in response to an expected aversive olfactory stimulus appearing during acquisition and tested their retention after recovery. RESULTS: Aversive memory formation occurred in 26 of 59 sessions under anesthetics (16 of 29 and 10 of 30, 5 of 30 and 21 of 29 for midazolam and ketamine at low and high doses, respectively). Single-neuron responses in the amygdala and dorsal anterior cingulate cortex were positively correlated between acquisition and retention (amygdala, n = 101, r = 0.51, P < 0.001; dorsal anterior cingulate cortex, n = 121, r = 0.32, P < 0.001). Neural responses during acquisition under anesthetics were stronger in sessions exhibiting memory formation than those that did not (amygdala median response ratio, 0.52 versus 0.33, n = 101, P = 0.021; dorsal anterior cingulate cortex median response ratio, 0.48 versus 0.32, n = 121, P = 0.012). The change in firing rate of amygdala neurons during acquisition was correlated with the size of stimuli-conditioned inspiratory response during retention (n = 101, r = 0.22 P = 0.026). Thus, amygdala and dorsal anterior cingulate cortex responses during acquisition under anesthetics predicted retention. Respiratory unconditioned responses to the aversive odor anesthetics did not differ from saline controls. CONCLUSIONS: These results suggest that the amygdala-dorsal anterior cingulate cortex circuit maintains its role in acquisition and maintenance of aversive memories in nonhuman primates under sedation with ketamine and midazolam and that the stimulus valence is sufficient to drive memory formation.

Tonsila do Cerebelo/fisiologia , Giro do Cíngulo/fisiologia , Ketamina/administração & dosagem , Memória/fisiologia , Midazolam/administração & dosagem , Neurônios/fisiologia , Anestésicos Dissociativos/administração & dosagem , Animais , Aprendizagem da Esquiva/fisiologia , Relação Dose-Resposta a Droga , Hipnóticos e Sedativos/administração & dosagem , Macaca fascicularis , Masculino , Modelos Animais
Heart Surg Forum ; 24(1): E019-E021, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33635242


Pneumonia caused by coronavirus disease 2019 (COVID-19) is a highly contagious disease. Unfortunately, research on extracorporeal membrane oxygenation (ECMO) assisted treatments for patients with COVID-19 infection is limited. In this case study, a patient who was in late pregnancy (35+2 weeks of pregnancy) and suffering from severe COVID-19 was extremely irritable during ECMO-assisted treatment after she underwent a cesarean section. Her Richmond Agitation Sedation Scale (RASS) score reached +3. Nevertheless, the patient successfully was treated with a continuous single/combined application of propofol, midazolam, dexmedetomidine, hibernation mixture, and other drugs for several days (maintaining RASS -2 to -4) and provided with anti-infection, mechanical ventilation, nutritional support, fluid balance under hemodynamic monitoring, liver support, and other organ function support treatments. ECMO-assisted sedation strategy for patients was introduced and discussed in this case to provide a certain reference for the clinical diagnosis and treatment of such patients.

COVID-19/terapia , Cesárea , Dexmedetomidina/administração & dosagem , Oxigenação por Membrana Extracorpórea , Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Propofol/administração & dosagem , Terapia Combinada , Feminino , Hidratação , Humanos , Monitorização Fisiológica , Apoio Nutricional , Gravidez , Respiração Artificial , SARS-CoV-2
An. pediatr. (2003. Ed. impr.) ; 94(1): 36-45, ene. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200275


INTRODUCCIÓN: La escala de sedación para procedimientos del Hospital Niño Jesús (ESPHNJ) no ha sido validada. PACIENTES Y MÉTODOS: Estudio analítico prospectivo bihospitalario. Se reclutaron prospectivamente pacientes ≥ 6 meses sometidos a procedimientos invasivos bajo sedoanalgesia con propofol o midazolam y fentanilo. Todos fueron monitorizados con el índice biespectral (IB). Se realizaron videos de cada procedimiento, que fueron editados y aleatorizados. Ciento cincuenta videos fueron puntuados por cuatro observadores con la ESPHNJ, la escala de sedación de la Universidad de Michigan (ESUM) y la Escala de Ramsay (ER). Dichos observadores estaban cegados al IB y al momento de administración de fármacos. Para evaluar la fiabilidad test-retest, 50 videos de los 150 iniciales seleccionados aleatorizadamente fueron reevaluados. RESULTADOS: Fueron incluidos 65 pacientes. La concordancia intraobservadores fue alta (ρ = 0,793). La ESPHNJ presentó una fiabilidad interobservador buena al comparar con la ESUM (CCI = 0,88) y con la ER (CCI = 0,86), y no hubo con el IB. La consistencia interna fue moderada (α = 0,68). La validez de constructo fue demostrada por los cambios en las puntuaciones tras administrar sedantes (p < 0,0001). La ESPHNJ tuvo muy baja correlación con el IB (r = -0,166), y correlación moderada con la ESUM (r = 0,497) y la ER (r = 0,405). En relación a la aplicabilidad, nuestro trabajo se ha empleado en dos hospitales en cinco ámbitos distintos por cuatro profesionales de diferentes categorías. CONCLUSIONES: La ESPHNJ es válida, fiable y aplicable para la monitorización de la sedación en procedimientos invasivos bajo sedoanalgesia profunda en pediatría. La ESPHNJ presenta peores propiedades que la ESUM y que la ER

INTRODUCTION: The procedural sedation scale of the Niño Jesús Hospital (Madrid) (SSPNJH) has not been validated. PATIENTS AND METHODS: A prospective analytical study was conducted in 2 hospitals on patients ≥ 6 months undergoing invasive procedures using sedation-analgesia with propofol or midazolam and fentanyl. All were monitored using the bispectral index (BIS). Videos were made of each procedure, which were then edited and randomised. A total of 150 videos were rated by four observers using the SSPNJH, the sedation scale of the University of Michigan (UMSS), and the Ramsay Scale (SR). These observers were blinded to the BIS, and at the time of drug administration. To assess test-retest reliability, 50 of the initial 150 randomly selected videos were re-assessed. RESULTS: The study included a total of 65 patients. The within-observer agreement was high (ρ = 0.793). The SSPNJH gave a good interobserver reliability when compared with the UMSS (ICC = 0.88) and the SR (ICC = 0.86), and there was none with the BIS. Internal consistency was moderate (α = 0.68). Construct validity was demonstrated by changes in scores after administering sedatives (p < 0.0001). The SSPNJH had a very low correlation with the BIS (r = -0.166), and a moderate correlation with the UMSS (r = 0.497) and the SR (r = 0.405). As regards the applicability, this scale has been used in two hospitals in five different areas by four professionals of different categories. CONCLUSIONS: The SSPNJH is valid, reliable and applicable for sedation monitoring in invasive procedures under deep sedation-analgesia in paediatric patients. The SSPNJH has worse properties than the UMSS and the SR

Humanos , Masculino , Criança , Reprodutibilidade dos Testes , Sedação Profunda/métodos , Hipnóticos e Sedativos/administração & dosagem , Monitorização Fisiológica/métodos , Estudos Prospectivos , Gravação em Vídeo , Fentanila/administração & dosagem , Propofol/administração & dosagem , Psicometria , Midazolam/administração & dosagem
Biomed Chromatogr ; 35(3): e4999, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33460183


Midazolam (MDZ) is routinely employed as a marker compound of cytochrome P450 3A (CYP3A) activity. Despite the many HPLC-UV methods described to quantify MDZ in plasma, all of them use acetonitrile (ACN) or a mixture of methanol-isopropanol as organic solvent of the mobile phase. Since the ACN shortage in 2008, efforts have been made to replace this solvent during HPLC analysis. A simple, sensitive, accurate and repeatable HPLC-UV method (220 nm) was developed and validated to quantify MDZ in rat plasma using methanol instead. The method was applied during a herb-drug interaction study involving Maytenus ilicifolia, a Brazilian folk medicine used to treat gastric disorders. Plasma samples were alkalinized and MDZ plus alprazolam (internal standard) were extracted with diethyl ether. After solvent removal, the residue was reconstituted with methanol-water (1:1). The analyte was eluted throughout a C18 column using sodium acetate buffer (10 mm, pH 7.4)-methanol (40:60, v/v). The precision at the lower limit of quantification never exceeded 19.40%, and 13.86% at the higher levels of quality control standards, whereas the accuracy ranged from -19.81 to 14.33%. The analytical curve was linear from 50 to 2,000 ng/ml. The activity of the hepatic CYP3A enzymes was not affected by the extract.

Cromatografia Líquida de Alta Pressão/métodos , Interações Ervas-Drogas , Maytenus/química , Midazolam/sangue , Animais , Citocromo P-450 CYP3A/metabolismo , Modelos Lineares , Masculino , Metanol , Midazolam/administração & dosagem , Midazolam/farmacocinética , Preparações de Plantas/administração & dosagem , Preparações de Plantas/sangue , Preparações de Plantas/farmacocinética , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
J Zoo Wildl Med ; 51(4): 994-998, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480580


Ketamine-free, midazolam-based protocols have successfully immobilized cervids in the past but their impact on physiological function has not yet been thoroughly investigated. Six deer received IM dexmedetomidine (30.96 ± 3.06 µg/kg) and midazolam (0.31 ± 0.03 mg/kg). Heart rates (HR), respiratory rates (f ), rectal temperature, mean arterial blood pressure (MAP), and oxygen saturation (SpO2) were recorded 25 min after drug delivery (T25) and every 5 min until T55. An arterial blood sample was collected at T40. Mean HR and temperature significantly decreased throughout sedation, but were maintained above critical values (> 60 beats/ min and 37°C, respectively). Although not statistically different, f clinically decreased during sedation. MAP remained within acceptable ranges (60-80 mmHg) and SpO2 above 95%. Mean PaO2 was normal (>80 mmHg), but a mild hypoxemia was observed on two occasions. Recovery was smooth yet prolonged, as the first head movement, attempt to stand, sternal recumbency, and standing position were recorded within 9.36 ± 3.47, 10.32 ± 1.37, 13.13 ± 2.70, and 15.34 ± 2.57 min after IM atipamezole, respectively. This protocol was effective for short-term procedures in captive brown brocket deer, and appeared to be safe on the basis of arterial blood gases and cardiorespiratory variables.

Cervos , Dexmedetomidina/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Imidazóis/farmacologia , Midazolam/farmacologia , Fenômenos Fisiológicos Respiratórios/efeitos dos fármacos , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Dióxido de Carbono/sangue , Dexmedetomidina/administração & dosagem , Eletrólitos/sangue , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Imidazóis/administração & dosagem , Midazolam/administração & dosagem , Oxigênio/sangue
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419751


Prolonged exposure to benzodiazepines (BDZ) may contribute towards physical dependence, which is manifested by iatrogenic Benzodiazepine Withdrawal Syndrome (BWS), a condition often underdiagnosed. Current evidence recommends precluding BDZ infusion as sedation in the intensive care unit to avoid possible withdrawal and delirium issues. Administration of dexmedetomidine should be considered to facilitate weaning in patients with BWS.

Lesões Encefálicas Traumáticas/terapia , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/etiologia , Adolescente , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem , Síndrome de Abstinência a Substâncias/terapia
Eur J Pharmacol ; 896: 173886, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33493482


As a new and ultra fast-acting IV benzodiazepine, pharmacological tolerance may be anticipated during long-term treatment with remimazolam e.g. in intensive care. In this context, tolerance is particularly relevant for withdrawal syndrome. However, apart from primates, existing models of sedative tolerance are unsuitable for remimazolam due to its excessive metabolic clearance (i.e. in rodents) or paradoxical responses (in dogs). Pigs are a well-established model species, especially for in-vivo drug safety studies, and appear a well suited as model for evaluation of remimazolam. In a series of experiments from dose-range-finding bolus and infusion studies through to 28-day continuous level sedation, we established a viable model of intravenous benzodiazepine sedation in NIBS micropigs to compare tolerance development during 28 days sedation with either midazolam or remimazolam. Dose increases after 28 days were lower for remimazolam (0 to 3-fold) than for midazolam (2 to 4-fold) and recovery times were approximately 40% faster for remimazolam vs midazolam. Tolerance to remimazolam is therefore likely in long-term human sedation and may be less than that seen for midazolam.

Benzodiazepinas/administração & dosagem , Estado de Consciência/efeitos dos fármacos , Tolerância a Medicamentos , Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Administração Intravenosa , Animais , Relação Dose-Resposta a Droga , Masculino , Modelos Animais , Recuperação de Função Fisiológica , Suínos , Porco Miniatura , Fatores de Tempo
J Zoo Wildl Med ; 51(4): 834-840, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480563


Captured free-ranging North American river otters (Lontra canadensis) were immobilized for the placement of intra-abdominal radio transmitters in cooperation with the Iowa Department of Natural Resources. Twenty-four otters were induced with dexmedetomidine (0.03 mg/kg, IM), butorphanol (0.2 mg/kg, IM), and midazolam (0.15 mg/kg, IM) combined in one syringe. The otters were maintained on isoflurane during the surgical procedure. Heart rate and rhythm, respiratory rate, rectal temperature, and peripheral capillary oxygen saturation were recorded every 5 min for the duration of the procedures. The otters were reversed with atipamezole (0.3-2 mg/kg, IM), naltrexone (0.6 mg/kg, IM), and flumazenil (0.05 mg/kg, IM). Rapid and smooth induction was seen, with lateral recumbency reached within 6.2 ± 5.6 min. Episodes of resedation were seen in four otters that received 0.3 mg/kg atipamezole so the dose was increased to 1 mg/kg, and no further resedation events were noted. Two fatal complications occurred secondary to suspected respiratory arrest during recovery. This drug protocol provided a smooth and rapid induction in free-ranging river otters, but further research is required to determine the safety of this protocol for river otters in both zoo and free-ranging situations.

Analgésicos Opioides/farmacologia , Butorfanol/farmacologia , Dexmedetomidina/farmacologia , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Lontras/fisiologia , Analgésicos Opioides/administração & dosagem , Anestesia/veterinária , Animais , Animais Selvagens , Butorfanol/administração & dosagem , Dexmedetomidina/administração & dosagem , Feminino , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem
Arq. bras. med. vet. zootec. (Online) ; 72(5): 1727-1730, Sept.-Oct. 2020. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1131576


There is a need for various anesthetic agents to obtain sperm in the field of human and veterinary medicine. Propofol and midazolam are among the most preferred among these agents. The aim of this study was to determine how sperm paramaters are affected according to the anesthetic agent used. Propofol (2mg/kg) and midazolam (3,5-7,5mg/kg) were administered twice a day (morning-evening) for one week. As a result of this study, there was no statistical difference in sperm density and abnormal sperm rates (respectively P=0,673, P=0,479). Sperm motility rates are similar in the control and propofol groups, while the motility rate in the midazolam group is statistically lower. (Control group %85 - Midazolam group %68.75 - Propofol group %83.75), (P<0.05). As a result of this study, the confidence interval of propofol was higher than the other anesthetic agents used for sperm retrieval.(AU)

São necessários vários agentes anestésicos para obter espermatozoides no campo da medicina humana e veterinária. Propofol e midazolam estão entre os agentes preferidos. O objetivo deste estudo foi determinar como os parâmetros de esperma são afetados de acordo com o agente anestésico utilizado. Propofol (2mg / kg) e midazolam (3,5-7,5mg / kg) foram administrados duas vezes ao dia (manhã e noite) durante uma semana. Neste estudo, não houve diferença estatística na densidade espermática e nas taxas anormais de espermatozoides (respectivamente P = 0,673, P = 0,479). As taxas de motilidade espermática são semelhantes nos grupos controle e propofol, enquanto a taxa de motilidade no grupo midazolam é estatisticamente menor. (Grupo controle % 85 - grupo midazolam % 68,75 - grupo propofol % 83,75), (P <0,05). Neste estudo, o intervalo de confiança do propofol foi maior do que os outros agentes anestésicos utilizados na recuperação espermática.(AU)

Animais , Masculino , Ratos , Sêmen/química , Espermatozoides/fisiologia , Midazolam/administração & dosagem , Propofol/administração & dosagem
Rev. Soc. Esp. Dolor ; 27(3): 221-226, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196769


INTRODUCCIÓN: La neuralgia occipital es una entidad con componentes bien definidos, pero ocasionalmente subdiagnosticada, que tiende a mantener un comportamiento insidioso y generar cierta resistencia al tratamiento médico, manteniendo una buena respuesta al manejo intervencionista con un mínimo índice de complicaciones asociadas y un alivio del dolor satisfactorio y prolongado. DESCRIPCIÓN DEL CASO: Presentamos 5 casos de pacientes con criterios definidos para neuralgia occipital por la (IHS), los cuales fueron manejados mediante descompresión suboccipital percutánea, evaluados por la escala numérica análoga y escala verbal análoga durante un periodo de 90 días. Los procedimientos se realizaron sin complicaciones ni eventos adversos. El resultado fue un alivio satisfactorio para el paciente del dolor crónico, con una adecuada especificidad del sitio del padecimiento, así como mejoría en la calidad de vida, el estado de ánimo, el consumo de medicamentos y la satisfacción de la paciente. CONCLUSIONES: Consideramos que el uso de la descompresión percutánea del nervio occipital mayor vía suboccipital puede ser tomada como una alternativa en pacientes con neuralgia occipital, con una alta probabilidad de obtener un beneficio analgésico y una baja probabilidad de presentar algún efecto adverso o complicación

INTRODUCTION: Occipital neuralgia is an entity with welldefined components, but occasionally underdiagnosed that tends to maintain insidious behavior and generate some resistance to medical treatment, maintaining a good response to interventional management with a minimum rate of associated complications and pain relief. Satisfactory and prolonged. CASE DESCRIPTION: We present 5 cases of patients with defined criteria for occipital neuralgia by (IHS) which were managed by suboccipital decompression, evaluated by the analog numerical scale and analogous verbal scale over a period of 90 days. The procedures were performed without complications or adverse events. The result was a satisfactory relief for the patient of chronic pain, with adequate specificity of the site of the condition; as well as improvement in the quality of life, mood, medication consumption and patient satisfaction. CONCLUSIONS: We consider that the use of decompression of the major occipital nerve via suboccipital route can be taken as an alternative in patients with occipital neuralgia, with a high probability of obtaining an analgesic benefit and a low probability of presenting some adverse effect or complication

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neuralgia/terapia , Descompressão/métodos , Bupivacaína/administração & dosagem , Midazolam/administração & dosagem , Fentanila/administração & dosagem , Síndrome Pós-Laminectomia/complicações , Nervos Cranianos , Manejo da Dor/métodos , Anestesia Local/métodos , Resultado do Tratamento
West J Emerg Med ; 21(3): 677-683, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32421519


INTRODUCTION: Agitated patients in the prehospital setting pose challenges for both patient care and emergency medical services (EMS) provider safety. Midazolam is frequently used to control agitation in the emergency department setting; however, limited data exist in the prehospital setting. We describe our experience treating patients with midazolam for behavioral emergencies in a large urban EMS system. We hypothesized that using midazolam for acute agitation leads to improved clinical conditions without causing significant clinical deterioration. METHODS: We performed a retrospective review of EMS patient care reports following implementation of a behavioral emergencies protocol in a large urban EMS system from February 2014-June 2016. For acute agitation, paramedics administered midazolam 1 milligram (mg) intravenous (IV), 5 mg intramuscular (IM), or 5 mg intranasal (IN). Results were analyzed using descriptive statistics, Levene's test for assessing variance among study groups, and t-test to evaluate effectiveness based on route. RESULTS: In total, midazolam was administered 294 times to 257 patients. Median age was 30 (interquartile range 24-42) years, and 66.5% were male. Doses administered were 1 mg (7.1%) and 5 mg (92.9%). Routes were IM (52.0%), IN (40.8%), and IV (7.1%). A second dose was administered to 37 patients. In the majority of administrations, midazolam improved the patient's condition (73.5%) with infrequent adverse events (3.4%). There was no significant difference between the effectiveness of IM and IN midazolam (71.0% vs 75.4%; p = 0.24). CONCLUSION: A midazolam protocol for prehospital agitation was associated with reduced agitation and a low rate of adverse events.

Serviços Médicos de Emergência/métodos , Hipnóticos e Sedativos/administração & dosagem , Transtornos Mentais/tratamento farmacológico , Midazolam/administração & dosagem , Administração Intranasal , Administração Intravenosa , Adulto , Pessoal Técnico de Saúde , Protocolos Clínicos , Relação Dose-Resposta a Droga , Esquema de Medicação , Emergências , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Injeções Intramusculares , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
Zoolog Sci ; 37(2): 159-167, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282147


Kawai et al. (2011) recently introduced a mixture of three anesthetic agents (here called MMB) that has an effect similar to ketamine/xylazine in mice, which might allow more effective reaction to changes in the animal condition, as an antagonist is available, and which can be used without license for handling narcotic drugs. Using Kawai's study as a baseline, we tested whether this anesthesia and its antagonist can also be used in avian studies. In the present study, we used two species, the zebra finch and the Bengalese finch, of the avian family Estrildidae. In zebra finches, anesthesia effects similar to the use of ketamine/xylazine and to those obtained in mice can be reached by the use of MMB if a higher dose is applied. MMB leads to more variable anesthesia, but has the advantage of a longer time window of deep anesthesia. An antagonist to one component of MMB reduced the awaking time, but was not as effective as in mice. For Bengalese finches, MMB cannot be generally recommended because of difficult handling and high mortality rate when used without antagonist, but could be used for perfusions instead of pentobarbital.

Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Anestésicos Combinados/administração & dosagem , Butorfanol/administração & dosagem , Imidazóis/farmacologia , Medetomidina/administração & dosagem , Midazolam/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Analgésicos Opioides/administração & dosagem , Animais , Feminino , Tentilhões , Hipnóticos e Sedativos/administração & dosagem , Imidazóis/administração & dosagem , Injeções Intramusculares , Ketamina/administração & dosagem , Masculino , Medetomidina/antagonistas & inibidores , Xilazina/administração & dosagem
Arq. bras. med. vet. zootec. (Online) ; 72(2): 452-460, Mar./Apr. 2020. tab
Artigo em Português | LILACS, VETINDEX | ID: biblio-1128369


A presente pesquisa comparou os efeitos cardiorrespiratórios, hemogasométricos e sedativos da associação midazolam (0,41mg/kg) e butorfanol (0,31mg/kg) acrescida de detomidina (157µg/kg) (DTMB) ou dexmedetomidina (36µg/kg) (DXMB) em catetos. Catetos adultos (n=20) foram distribuídos em dois grupos, DTMB ou DXMB. As variáveis (FC, f, PAM, SpO2, EtCO2 e TR) foram avaliadas após aplicação dos fármacos. A sedação foi avaliada por meio de escala analógica visual, relaxamento muscular, postura e resposta auditiva. Foi realizada ANOVA, seguida de teste t pareado (paramétricos) e teste de Mann-Whitney rank-sum test (não paramétricos), com P<0,05. Não foi observada diferença estatística entre os grupos para o período de latência. Observou-se diferença significativa entre grupos para as variáveis f, PAM e SpO2, com maiores valores para DTMB, e EtCO2, com maiores valores para DXMB. Os dois grupos apresentaram redução da FC e da concentração de lactato, bem como aumento da concentração de bicarbonato. A SpO2 permaneceu abaixo de 90%, durante todo o período experimental, nos dois grupos estudados. Os animais dos dois grupos apresentaram sedação profunda e relaxamento muscular máximo. Conclui-se que os dois protocolos testados proporcionaram adequada sedação, podendo ser indicados para contenção química de catetos adultos.(AU)

The study compared the cardiorespiratory, hemogasometric and sedative effects of the combination of midazolam (0.41mg/kg) and butorphanol (0.31mg/kg) plus detomidine (157µg/kg) (DTMB) or dexmedetomidine (36µg/kg) (DXMB) in collared peccaries. Collared peccaries (n= 20) were divided into two groups, either DTMB or DXMB. The variables (FC, f, PAM, SpO2, EtCO2 and TR) were evaluated after application of the drugs. Sedation was assessed by visual analogue scale, muscle relaxation, posture and auditory response. ANOVA followed by paired t-test (parametric) and Mann Whitney Rank Sum Test (non-parametric) with P< 0.05 were performed. No statistical difference was observed for the latency period. A significant increase was observed between groups for the variables f, PAM and SpO2 with higher values for DTMB and EtCO2 with higher values for DXMB. The two groups presented a reduction in HR and lactate concentration, and an increase in bicarbonate concentration. SpO2 remained below 90% throughout the experiment in both groups. The animals of the two groups presented deep sedation and maximum muscle relaxation. It is concluded that the two protocols tested provided adequate sedation and could be indicated for chemical containment of collared peccaries.(AU)

Animais , Artiodáctilos/fisiologia , Midazolam/administração & dosagem , Butorfanol/administração & dosagem , Dexmedetomidina/administração & dosagem , Aptidão Cardiorrespiratória , Anestésicos Combinados/análise , Agonistas de Receptores Adrenérgicos alfa 2