ABSTRACT
Abstract Background and objectives The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. Case report A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. Conclusion We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.
Resumo Justificativa e objetivo A decisão quanto ao manejo de paciente ambulatorial com via aérea difícil previamente diagnosticada com o uso de dispositivo supraglótico permanece controversa. Relatamos o caso de inserção de máscara laríngea ProSeal™ em paciente acordado, com via aérea difícil prevista, agendado para cirurgia ambulatorial. Relato de caso Paciente do sexo feminino, 46 anos, programada para cirurgia de ressecção de nódulo de mama com alta hospitalar no mesmo dia. A história anestésica incluía uma intubação impossível, com o cancelamento da cirurgia e posterior intubação com o uso de fibroscópio, com a paciente acordada. A paciente relatou que ficou emocionalmente abalada com a experiência anterior e recusou essa abordagem. Considerando essa experiência anterior, uma abordagem das vias aéreas com a paciente acordada e o uso de uma máscara laríngea ProSeal™ foi planejada, após se explicar o procedimento para a paciente e tranquilizá-la. Após topicalização adequada, uma máscara laríngea (LMA ProSeal™) de tamanho 4 foi inserida com sucesso depois de duas tentativas e a permeabilidade foi confirmada por capnografia. A anestesia foi induzida por via intravenosa e a cirurgia foi feita sem intercorrências. Conclusão Descrevemos uma estratégia opcional viável para a intubação em uma paciente acordada com via aérea difícil previamente diagnosticada submetida a cirurgia ambulatorial. Nessa situação clínica específica, quando a intubação traqueal é considerada desnecessária, a via aérea supraglótica em paciente acordado pode permitir uma ventilação adequada e seu uso deve ser considerado.
Subject(s)
Humans , Female , Laryngeal Masks , Airway Management/methods , Ambulatory Surgical Procedures/methods , Intubation, Intratracheal , Breast Neoplasms/surgery , Fiber Optic Technology , Middle AgedABSTRACT
Introduction: Tracheostomy is a procedure indicated for patients with extended mechanical ventilation. Objective: The objective of the study was to learn about the technical characteristics, the appropriate timing for the procedure and its evolution. Material and method: Observational, retrospective study of ICU admitted patients during 2012, with elective tracheostomy. The demographic variables, the Apache II, the pathologies, the number of days in MV, length of stay and mortality were analyzed, both globally and by groups, depending on the early or late use of the technique. The study was approved by the Ethics Committee for Clinical Research of the institution, in accordance with the institutional bioethical principles. Results: The mean age in the sample with 42 patients was 61.36, and the mean Apache II was 18. The most frequent pathology was neurological. The approach was percutaneous in 71.5%, with minor complications in 20% of the cases. In the early tracheostomy group, the number of days in MV and the length of stay were both considerably shorter. Conclusions:Elective tracheostomy is a commonly used technique in the ICU and the procedure is performed according to the protocol. The percutaneous approach is the most frequently used, with few complications. In neurological critical patients with extended weaning, an early approach reduces the number of days with ventilation and the length of stay, with no positive impact on mortality.
Introducción: La traqueostomía es un procedimiento indicado en los pacientes con ventilación mecánica prolongada. Objetivo: El objetivo del estudio fue conocer sus características, técnica, momento adecuado de realización y evolución. Material y método: Estudio observacional retrospectivo, de pacientes ingresados en UCI durante 2012, con traqueostomía electiva. Se analizaron variables demográficas, escala Apache II, patologías, días de VM, estancia y mortalidad; de forma global, y por grupos según técnica precoz o tardía. El estudio fue aprobado por el Comité Ético de Investigación Clínica del centro, cumpliendo con los principios bioéticos del mismo. Resultados: En la muestra de 42 pacientes la edad media fue 61.36, con mediana de Apache II de 18. La patología más frecuente fueron los pacientes neurológicos, se realizó la forma percutánea en el 71.5%, con complicaciones menores del 20%. En el grupo de traqueostomía precoz se observó menor número de días de VM y estancia de forma significativa. Conclusiones: La traqueostomía electiva es una técnica frecuente en UCI, realizado el procedimiento según protocolo; la modalidad percutánea es la más empleada, con escasas complicaciones. En los pacientes neurocríticos y con destete prolongado la técnica precoz reduce los días de ventilación y estancia, sin beneficio en la mortalidad.
Subject(s)
HumansABSTRACT
En este trabajo analizamos el concepto de erotomanía, centrándonos en la obra de De Clérambault, quien es el mayor exponente de la temática, realizando también un breve recorrido de la obra de quienes lo precedieron y focalizando la escuela francesa de psiquiatría. Asimismo, presentamos un caso clínico en el marco de dichos aportes. (AU)
In this paper we analyze the erotomanic concept, focusing on the studies of De Clerambault, who is the main reference in the issue, and a brief analysis of his predecessors. Then, we present a clinical case and analyze it in the light of such contributions. (AU)
Subject(s)
Humans , Female , Middle Aged , Psychotic Disorders/diagnosis , Sexual Behavior/psychology , Bipolar Disorder/diagnosis , Delirium/diagnosis , Psychiatry/history , Suicide, Attempted/psychologyABSTRACT
This study aimed to analyse the physical health effects of a community based 10-week physical activity programme with people living with HIV. It was developed; implemented and evaluated in a disadvantaged community in South Africa. A pre-post research design was chosen. Major recruitment and adherence challenges resulted in a small sample. Among the 23 participants who took part in both baseline and final testing; compliant participants (n = 12) were compared to non-compliant participants (n = 11). Immunological (CD4; viral load); anthropometric (height; weight; skinfolds and waist to hip ratio); muscular strength (h1RM) and cardiopulmonary fitness (time on treadmill) parameters were measured. The compliant and non-compliant groups were not different at baseline. Muscular strength was the parameter most influenced by compliance with the physical activity programme (F = 4.516; p = 0.047). Weight loss and improvement in cardiopulmonary fitness were restricted by the duration of the programme; compliance and influencing factors (e.g. nutrition; medication). The increase in strength is significant and meaningful in the context; as the participants' goals were to look healthy and strong to avoid HIV related stigma. The improvements in appearance were a motivational factor; especially since the changes were made visible in a short time. Practical implications for health promotion are described. More research contextualised in disadvantaged settings is needed
Subject(s)
Acquired Immunodeficiency Syndrome , Exercise , HIV Infections , Health Promotion , SportsABSTRACT
Se realizó un estudio de intervención educativa pre-experimental de tipo antes-después a adultos mayores con polifarmacia valorados por medicina interna, de abril del 2010 a junio del 2011, con el objetivo de elevar el nivel de conocimientos de éstos sobre el efecto nocivo de la polifarmacia en los adultos mayores, mediante la aplicación de una estrategia de intervención educativa. El universo estuvo constituido por 150 adultos mayores. Predominaron los adultos mayores de 60-69 años para un 40 por ciento, sexo femenino en un 68 por ciento; la enfermedad crónica que prevaleció fue la hipertensión arterial; los fármacos prescritos más consumidos fueron los hipotensores y diuréticos y de los autoprescritos los analgésicos; las reacciones adversas más frecuentes de los medicamentos prescritos resultaron ser la tos y la cefalea. Se evaluaron antes y después de la intervención los conocimientos sobre el efecto nocivo de la polifarmacia, los factores que modifican la respuesta farmacológica en el adulto mayor y reacciones adversas frecuentes de los medicamentos en este grupo etario. Al concluir la intervención se comprobó que los adultos mayores elevaron el nivel de conocimientos sobre el tema.
Subject(s)
Humans , Male , Female , Aged , Aged , PolypharmacyABSTRACT
Este estudio analiza la satisfacción con la Educación Física (EF) y la percepción del comportamiento instructivo del profesor (CIP). Participaron 2.536 estudiantes (edad 13,7 ± 2,0). Se aplicaron dos escalas: a) escala de satisfacción con la EF; y b) escala de comportamientos instructivos del profesorado. Los resultados muestran una elevada satisfacción con la EF y la percepción de una buena frecuencia del CIP. Existen algunas diferencias significativas en función del género de los alumnos y profesores. No se produce empatía de género descrita en otros estudios: chicos y chicas perciben mayor frecuencia de comportamientos instructivos deseables cuando el profesor es mujer
Este trabalho analisa a satisfação com a educação física (EF) e a percepção do comportamento no ensino do professor. Participaram 2.536 estudantes (idade 13,77 ± 2,0). Foram aplicadas duas escalas: a) escala de satisfação com a educação física; y b) escala de comportamento no ensino dos professores. Os resultados demonstram uma alta satisfação com a EF, bem como a percepção de uma boa freqüência do comportamento no ensino do professor. Existem algumas diferenças significativas em função do gênero dos alunos e professores. Não há relação direta de simpatia de gênero encontrada em outros estudos: meninos e meninas percebem com mais frequência um comportamento no ensino do professor de maneira desejável, quando ele é uma mulher
The purposes of this study were to analyze the satisfaction with PE and the perception of the students about of the Teacher´ Instructional Behaviours. Participants were 2,536 students (13.7 ± 2.0 years old). Two scales were applied: a) the satisfaction with PE scale; and b) the scale of perception of the Teacher´ Instructional Behaviours. The results illustrate a high level of satisfaction with PE. Students perceive instructional desirable behaviours of their teachers occur frequently. The findings show some significant differences in gender. There is not empathy of gender: both boys and girls perceive more frequent instructional desirable behaviour when the teacher is female