ABSTRACT
En el presente artículo se revisa el caso de una persona adulta hospitalizada en una unidad de paciente crítico, quien ha evolucionado con agitación durante la estadía hospitalaria y que requiere curación de úlceras por presión. A la valoración la enfermera se anticipa a la reacción negativa que podría tener el paciente ante el dolor asociado a la técnica, por lo cual utiliza la hipnosis clínica con el objetivo de favorecer la disposición del paciente a mejorar su comodidad; para lograr realizar la curación sin signos de dolor en la monitorización ni en el reporte subjetivo, se constata el mejoramiento del bienestar general del paciente relacionado con la relajación involucrada en el proceso. Se presenta el proceso de enfermería, la descripción del procedimiento y se motiva a los profesionales de enfermería a incorporar la hipnosis dentro de su repertorio de competencias para la gestión del cuidado.
In this article, we review the case of an adult person hospitalized in a critical patient unit, who has become agitated, and who requires treatment for pressure sores. During assessment, the nurse anticipates the patient's possible negative reaction associated to the pain, and thus uses the clinical hypnosis technique in order to favor the patient's better disposition. This procedure improved the patient's comfort, and the healing treatment was performed without signs of pain. As a result of the enhanced relaxation, the patient's overall wellbeing was ensured. The nursing process is presented as well as the specific procedure. Nursing professionals are encouraged to incorporate the hypnosis into their competences repertoire for the care management.
No presente artigo revisa-se o caso de uma pessoa adulta hospitalizada em uma unidade de paciente crítico, quem tem evoluído com agitação durante a estadia hospitalar e que requer cura de úlceras por pressão. À avaliação, a enfermeira antecipa-se à reação negativa que poderia ter o paciente perante a dor associada à técnica, pelo qual utiliza a hipnose clínica com o objetivo de favorecer a disposição do paciente para melhorar seu conforto, consegue-se realizar a cura sem signos de dor na monitorizarão nem no relatório subjetivo, constata-se a melhora do bem-estar geral do paciente relacionado com a relaxação envolvida no processo. Apresenta-se o processo de enfermagem, a descrição do procedimento e motiva-se aos profissionais de enfermagem a incorporar a hipnose dentro de seu repertório de competências para a gestão do cuidado.
Subject(s)
Humans , Male , Aged , Aged, 80 and over , Nursing , HypnosisABSTRACT
Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.
ABSTRACT
Objective To investigate the relationship between N-methyl-D aspartate (NMDA) receptors and the hypnotic and analgesic effects of enflurane, isoflurane and sevoflurane. Methods Kunming mice weighing 18-22 g were used in this study. The experiment was carried out in 2 parts. In Part I 120 mice were randomly divided into 3 groups (n =40 each); each group received intraperitoneal (IP) enflurane 2 ml?kg-1 or isoflurane 1.2 ml?kg-1 or sevoflurane 5 ml?kg-1 . Each group was further divided randomly into 4 subgroups ( n = 10 each) and each subgroup received artificial cerebro-spinal fluid (aCSF) 10 ?l or NMDA 25, 50 or 75 ng in 10 ?l aCSF injected into the lateral ventricle of the brain as soon as the animals lost righting reflex. The time for the recovery of righting reflex was recorded. In Part Ⅱ 160 mice were randomly divided into 4 groups ( n = 40 each) : ( 1) control group received no inhalation anesthetic; (2) enflurane group received enflurane 1.5 ml?kg-1 subcutaneously s.c. ; (3) isoflurane group isoflurane 0.8 ml?kg-1 s.c. and (4) sevoflurane group sevoflurane 4.5 ml ?kg-1 s.c. Each group was further divided randomly into 4 subgroups ( n = 10 each). Each subgroup received intrathecal (IT) aCSF 10 ?l or NMDA 2.5 ng or 5.0 ng or 10 ng in aCSF 10 ?l at 10 min after subcutaneous injection of inhalation anesthetic. 6% acetic acid 0.1 ml?10 g-1 was injected IP at 1 min after intrathecal administration. The number of writhing induced by acetic acid was recorded. Results In Part Ⅰ of the experiment there was no significant difference in the duration of anesthesia induced by the 3 inhalation anesthetics between the 4 subgroups. In Part Ⅱ subcutaneous injection of the 3 inhalation anesthetics significantly reduced the number of writhing induced by IP acetic acid. In control group which received no inhalation anesthetic there was no significant difference in the number of writhing between the 4 subgroups. In the 3 inhalation anesthetic groups NMDA5. 0 and 10 ng IT significantly increased the number of writhing induced by IP acetic acid in a dose dependent manner as compared with aCSF subgroup. Conclusion Cerebral NMDA receptors do not play an important role in the hypnotic effect of enflurane, isoflurane and sevoflurane while spinal NMDA receptors are involved in the analgesic effect of the 3 inhalation anesthetics.