Oral preanesthetic medication in children - comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis

Abstract Background Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. Methods The study protocol was registered in PROSPERO as CRD42020172920. A systematic literature search was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing oral combinations of midazolam and ketamine with midazolam alone as preanesthetic medication in elective surgical pediatric patients. Meta-analyses included the following outcomes: anxiety and sedation levels, child's behavior during separation from parents, face mask acceptance, and venipuncture. The quality of evidence was assessed using GRADE criteria. Results Twenty studies were included. The following effects (RR (95% CI)) were observed for combinations of ketamine and midazolam relative midazolam alone: anxiolysis (1.2 (0.94-1.52); p= 0.15; I2 = 80%; GRADE = very low); satisfactory sedation (1.2 ( 1.10-1.31); p< 0.001; I2 = 71%; GRADE = very low); behavior during parental separation (1.2 (1.06-1.36); p= 0.003; I2 = 88%; GRADE = very low); facial mask acceptance (1.13 (1.04-1.24); p= 0.007; I2 = 49%; GRADE = very low); behavior during venipuncture (1.32 (1.11-1.57); p= 0.002; I2 = 66%; GRADE = very low). Conclusions While similar probabilities of obtaining anxiolysis were found, adequate sedation, calm behavior during child's separation from parents, low levels of fear during face mask adaptation, and cooperative behavior during peripheral venous cannulation were more likely with midazolam-ketamine combinations.

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

Abstract Background This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I2= 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I2= 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I2= 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p= 0.05; I2= 97%; GRADE: very low). Conclusions Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Análise da readmissão hospitalar do paciente com diagnóstico de esquizofrenia em um hospital psiquiátrico de referência no sul catarinense / Analysis of hospital readmission of the patient diagnosed with schizophrenia admitted to a psychiatric hospital in southern Santa Catarina

A esquizofrenia é um transtorno mental com sério comprometimento não apenas nas funções psiquiátricas do paciente, mas também no que abrange seu ciclo de apoio social e suas relações interpessoais. Este trabalho tem como objetivo principal tecer uma análise sobre as principais características do paciente com diagnóstico de esquizofrenia, assim como a abordagem de fatores sociodemográficos em um ponto de vista voltado à frequente institucionalização de tais pacientes, em um hospital psiquiátrico no sul catarinense, no período de janeiro 2007 a dezembro de 2016. Trata-se de um estudo observacional, retrospectivo, de abordagem quantitativa, com coleta de dados secundários obtidos através da análise de prontuários médicos de indivíduos com no mínimo duas internações, os quais 344 pacientes compuseram a amostra final. A população é 71,8% do sexo masculino, a média de idade é de 48,8 anos e é majoritariamente composta por indivíduos solteiros ou divorciados (88,1%). Maior parte das internações é de caráter voluntário (66,8%), além de que 72,1% das altas são do tipo melhorado. O número mediano de internações é 11, o tempo de reinternação de 2 meses e o tempo em comunidade de 3 meses. Observou-se que, como outros centros de hospitalização psiquiátrica, os pacientes com esquizofrenia tendem a perpetuar um perfil reinternante ao longo da vida, tornando imprescindível o acompanhamento dos mesmos fora da área hospitalar, a fim de garantir um curso mais brando da doença e reintegração social dessas pessoas.

Schizophrenia is a mental disorder with serious commitment, not only patient's psychiatric functions, but also when it comes to social support and interpersonal relationships. This paper aims to analyze the main features of the patient with the diagnosis of schizophrenia, as well as the socio-demographics factors involved on the frequent institutionalization of such patients in a mental hospital in southern Santa Catarina, from January 2007 to December 2016. This is an observational, retrospective and quantitative approach, with secondary data collection obtained through the analysis of medical records of individuals with at least two hospitalizations, which 334 patients composed the final sample. The population is 71.8% male, the average age is 48.8 years old and is mostly composed of single or divorced individuals (88.1%). Most of the hospitalizations are volunteer (66.8%) and 72.1% of the discharges are medically improved. The median number of hospitalizations is 11, the period of hospitalization is 2 months and the time in community is 3 months. It was noticed that, as seen at others psychiatric hospitalization centers, schizophrenic patients tend to perpetuate a readmission status throughout life, making it essential a treatment and rehabilitation follow-up outside the hospital environment, in order to ensure a smoother course of illness, besides social reintegration of such patients.