Time de acesso vascular e terapia infusional: satisfação da equipe de saúde em hospital pediátrico / Vascular access and infusional therapy team: satisfaction of the health team at pediatric hospital / Equipo de acceso vascular y terapia infusional: satisfacción del equipo de salud en hospital pediátrico

Objetivos: Conhecer a satisfação e qualidade do serviço sobre time de acesso vascular e terapia infusional (TAVTI) e identificar a importância do TAVTI para a equipe de saúde. Metodo: Trata-se de uma pesquisa de campo exploratória, descritiva, com abordagem quantitativa e qualitativa. Aplicamos formulários para 149 profissionais. Resultados: Dos participantes, 46,97%(n:70) refere total satisfação frente ao TAVTI; a minoria 0,67%(n:1) demonstra insatisfação total; a maioria considera o serviço muito importante 71,14%(n:106) e excelente atuação para 44,96%(n:67). Apenas 1,34%(2) dos profissionais considerou a qualidade do trabalho regular. Dos participantes, 126 declararam: serviço humanizado; seguro para o paciente; necessita de capacitação e treinamento; material seguro; período integral. Conclusão: A atuação do TAVTI demonstra ser efetiva. Constatou-se a satisfação da equipe de saúde e a importância na pediatria devido à preservação do acesso venoso e o desejo dos profissionais em manter o TAVTI período integral. Frente ao percentual de qualidade considerado, excelente e ótimo.(AU)

Objectives: To know the satisfaction and quality of service on the vascular access and infusional therapy team (TAVTI) and to identify the importance of TAVTI for the health team. Methodo: This is an exploratory, descriptive field research, with a quantitative and qualitative approach. We apply forms to 149 professionals. Results: Of the participants, 46.97% (n: 70) reported total satisfaction with TAVTI; the minority 0.67% (n: 1) shows total dissatisfaction; the majority considered the service very important 71.14% (n: 106) and excellent performance for 44.96% (n: 67). Only 1.34% (2) of the professionals considered the quality of work to be regular. Of the participants, 126 declared: humanized service; safe for the patient; needs qualification and training; safe material; Full time. Conclusion: The performance of TAVTI proves to be effective. The satisfaction of the health team and the importance in pediatrics were found due to the preservation of venous access and the desire of professionals to maintain TAVTI full time. In view of the percentage of quality considered, excellent and great.(AU)

Objetivos: Conocer la satisfacción y calidad del servicio del equipo de acceso vascular y terapia infusional (TAVTI) e identificar la importancia de TAVTI para el equipo de salud. Metodo: Se trata de una investigación de campo exploratoria, descriptiva, con enfoque cuantitativo y cualitativo. Aplicamos formularios a 149 profesionales. Resultados: De los participantes, el 46,97% (n: 70) reportaron satisfacción total con TAVTI; la minoría 0,67% (n: 1) muestra total insatisfacción; la mayoría consideró el servicio muy importante 71,14% (n: 106) y excelente desempeño para el 44,96% (n: 67). Solo el 1,34% (2) de los profesionales consideró regular la calidad del trabajo. De los participantes, 126 declararon: servicio humanizado; seguro para el paciente; necesita cualificación y formación; material seguro; período integral. Conclusión: La actuación de TAVTI demuestra ser eficaz. La satisfacción del equipo de salud y la importancia en pediatría se encontraron debido a la preservación del acceso venoso y el deseo de los profesionales de mantener TAVTI a tiempo completo. En vista del porcentaje de calidad considerado, excelente y óptimo.(AU)

Content Translation And Validation Of The Pediatric PIV Infiltration Scale Into Brazilian Portuguese / Traducción y validación del contenido de la Pediatric PIV Infiltration Scale para el portugués brasileño / Tradução e validação de conteúdo da Pediatric PIV Infiltration Scale para o português brasileiro

ABSTRACT Objectives: to translate, adapt and validate the PIV Infiltration Scale content into Brazilian Portuguese. Methods: a methodological study. Initial translation was performed by two bilingual translators, translation synthesis; backtranslation to the original language; elaboration of the translated version and adapted by expert consensus; content validation and pretest. Results: the Pediatric PIV Infiltration Scale has been translated and adapted. Discrepancies were sorted out by consensus. The scale content was validated by nine experts, reaching a global content validity index of 0.95. Pretest was performed by applying the scale to 33 intravenous device insertion sites of 17 newborns and 16 children. The predominant infiltration grades were 2 and 3. Conclusions: the Pediatric PIV Infiltration Scale's translated version achieved equivalence to Brazilian Portuguese and was validated by experts.

RESUMEN Objetivos: traducir, adaptar y validar el contenido de la PIV Infiltration Scale al portugués brasileño. Métodos: estudio metodologico. La traducción inicial fue realizada por dos traductores bilingües, síntesis de traducción; traducción al idioma original; elaboración de la versión traducida y adaptada por consenso de expertos; validación de contenido y pretest. Resultados: la PIV Infiltration Scale pediátrica ha sido traducida y adaptada. Las discrepancias se resolvieron por consenso. El contenido de la escala fue validado por nueve expertos, alcanzando un índice de validez de contenido global de 0.95. La prueba preliminar se realizó aplicando la escala a 33 sitios de inserción de dispositivos intravenosos de 17 recién nacidos y 16 niños. Los grados de infiltración predominantes fueron 2 y 3. Conclusiones: la versión traducida de la PIV Infiltration Scale pediátrica logró equivalencia con el portugués brasileño y fue validada por expertos.

RESUMO Objetivos: traduzir, adaptar e validar o conteúdo da PIV Infiltration Scale para o português brasileiro. Métodos: estudo metodológico. Foram realizadas tradução inicial por dois tradutores bilingues, síntese da tradução; tradução de volta ao idioma original; elaboração da versão traduzida e adaptada por consenso de especialistas; validação do conteúdo e pré-teste. Resultados: a Pediatric PIV Infiltration Scale foi traduzida e adaptada. As discrepâncias foram resolvidas por consenso. O conteúdo da escala foi validado por nove especialistas, alcançando índice global de validade de conteúdo de 0,95. O pré-teste foi realizado através da aplicação da escala em 33 locais de inserção de dispositivos intravenosos de 17 recém-nascidos e 16 crianças. Os graus de infiltração predominantes foram o 2 e 3. Conclusões: a versão traduzida da escala Pediatric PIV Infiltration Scale alcançou equivalência ao português brasileiro e foi validada por especialistas.

Bloqueadores neuromusculares en infusión continua en anestesia general endovenosa total / Neuromuscular blocking drugs in continuous infusion in total intravenous general anesthesia

Introducción: La administración de agentes anestésicos de forma endovenosa dio inicio a una nueva modalidad que implicó la administración de anestésicos en forma de infusiones continuas. Objetivo: Actualizar la información sobre la función de los bloqueadores neuromusculares cuando se administran en infusión continua en anestesia general endovenosa total. Desarrollo: Los bloqueadores neuromusculares se pueden administrar en infusión continua para mantener una concentración plasmática estable y lograr una adecuada relajación del paciente durante el procedimiento quirúrgico, así como una recuperación más rápida y segura de forma espontánea, basándose en el inicio de acción del fármaco utilizado, pero fundamentalmente del alcance de su efecto máximo. A pesar de ello es importante administrar una dosis de carga inicial que deben oscilar entre 2 y 3 DE 95 (dosis efectiva para disminuir la respuesta al estímulo en 95 por ciento de su valor inicial) y continuar con la administración en infusión continúa como parte del mantenimiento de la anestesia. Conclusiones: Independientemente de los diferentes criterios entre autores, la mayoría coinciden que las infusiones continuas logran mantener mayor estabilidad en sangre y por ende, menor dosis de bloqueadores neuromuscular, menores tiempos reales de reversión y menos efectos adversos(AU)

Introduction: The administration of anesthetic agents intravenously started a new modality that involved the administration of anesthetics in the form of continuous infusions. Objective: To update the information on the function of neuromuscular blocking drugs when administered in continuous infusion in total intravenous general anesthesia. Development: Neuromuscular blocking drugs can be administered in continuous infusion to maintain a stable plasma concentration and achieve adequate relaxation of the patient during the surgical procedure, as well as a faster and safer spontaneous recovery, based on the action onset of the drug used, but fundamentally on its maximum effect. Despite this, it is important to administer an initial loading dose that must range from 2 to 3 DE 95 (effective dose to decrease the response to the stimulus in 95 percent of its initial value) and continue with the administration in continuous infusion as part of the maintenance of anesthesia. Conclusions: Regardless the different criteria among authors, most agree that continuous infusions are effective in maintaining greater blood stability and, therefore, lower doses of neuromuscular blocking drugs, shorter real reversal times and fewer adverse effects(AU)

Variante de cálculo de infusión de ketamina en la TIVA manual / A Variant for calculating ketamine infusion in manual total intravenous anesthesia

Introducción: Un requisito en la conducción de la anestesia intravenosa total, en modo manual, radica en la necesidad de realizar ajustes de dosificación temporales para evitar la acumulación plasmática del fármaco. Desde hace algunos años existe el interés de emplear otros fármacos como la ketamina. Objetivos: Comparar la variación temporal de la concentración plasmática de ketamina al aplicar una variante de cálculo de decrecimiento de la velocidad de infusión (Vinf) con una velocidad de infusión invariable. Métodos: Se realizó un estudio analítico que describe el cálculo de dosificación para TIVA manual, la simulación farmacocinética del comportamiento de la concentración plasmática de la ketamina en caso de administrarse invariablemente con esos regímenes de dosificación, en un paciente virtual, de 70 Kg, según el modelo de Domino y el análisis de la variante de cálculo de decrecimiento de la Vinf del medicamento. Se estimó una significación estadística de un 95 por ciento (p<0.05). Resultados: la variante de cálculo de decrecimientode la velocidad de infusión: Vinf (tn) = Vinf (tn-1) _ [(Vinf (tn-1) x e(1 + 1/t)t)/100] = Vinf (t n-1) x 0,85 permitió valores más estables de la concentración plasmática, aproximadas a la del modelo ideal (p>0,05), por espacio de 6 h. Conclusiones: es probable que el decrecimiento de la dosis de ketamina, establecido por la variante de cálculo e infusión propuesta, posibilite una mejor estabilidad de la concentración plasmática(AU)

Introduction: A requirement in the manual conduction of total intravenous anesthesia is the need to make temporary dosage adjustments to avoid drug accumulation in plasma. For some years there has been interest in using other drugs such as ketamine. Objectives: To compare the temporal variation of ketamine concentration in plasma when applying a variant for calculating the decrease in the infusion rate (Vinf) with an invariable infusion rate. Methods: An analytical study was carried out describing the dosage calculation for manual total intravenous anesthesia, the pharmacokinetic simulation of the behavior of ketamine concentration in plasma in case of being invariably administered with these dosing regimens, in a virtual patient, of 70 kg, according to the Domino model and the analysis of the variant for calculating the decrease of ketamine infusion rate. A statistical significance of 95 percent was estimated (p<0.05). Results: The variant for calculating the decrease of the infusion rate: Vinf (tn) = Vinf (tn-1) _ [(Vinf (tn-1) x e (1+1/t) t)/100] = Vinf (tn -1) x 0.85 allowed more stable values of plasma concentration, which approximate that of the ideal model (p>0.05), for a time of 6 hours. Conclusions: Probably, the decrease of the ketamine dose, established by the proposed calculation and infusion variant, allows better stability of plasma concentration(AU)

Administración de lidocaína en infusión continua en pacientes sometidos a procedimientos quirúrgicos abdominales oncológicos / Administration of lidocaine by continuous infusion in patients undergoing oncological adnominal surgical procedures

Introducción: La administración de lidocaína intravenosa para el control del dolor posoperatorio ha ganado interés. Su aplicación en el periodo perioperatorio a dosis baja reduce el dolor y el consumo de opioides en el posoperatorio. Objetivo: Evaluar la eficacia de la administración de lidocaína en infusión continua en el tratamiento del dolor posoperatorio en pacientes intervenidos quirúrgicamente por enfermedad abdominal oncológica. Métodos: Se realizó un estudio cuasi experimental en pacientes intervenidos por procedimiento quirúrgico abdominal oncológico a quienes se les administró infusión continua de lidocaína. Seguidamente se les evaluó la intensidad del dolor con la escala visual análoga. Esta se aplicó a los 30 min, 2, 6, 12 y 24 h después de la operación. Se determinó la presencia o no de complicaciones intra- y posoperatorias. Resultados: Los pacientes entre 31 y 50 años de edad prevalecieron en ambos grupos. El sexo masculino predominó en el grupo estudio y el femenino en el control. En el grupo estudio la respuesta no fue satisfactoria solo en dos pacientes, en 11 pacientes fue satisfactoria, en el testigo en cinco pacientes fue no satisfactoria. En el grupo estudio tres pacientes tuvieron dolor por menos de 2 h y fue catalogado entre ligero y moderado. En el control 12 presentaron dolor por más de 4 h catalogado entre moderado y grave. En dos pacientes aparecieron efectos adversos. Conclusiones: Con la administración de lidocaína se logra una disminución del dolor y del consumo de opioides(AU)

Introduction: The intravenous administration of lidocaine for postoperative pain control has gained interest. Its administration in the perioperative period and at a low dose reduces postoperative pain and opioid use. Objective: To evaluate the effectiveness of continuous infusion of lidocaine in the treatment of postoperative pain in surgically intervened patients with oncologic abdominal disease. Methods: A quasiexperimental study was performed in patients undergoing oncologic abdominal surgical procedures and who were given continuous infusion of lidocaine. The pain intensity was then evaluated with the analogue visual scale. This was applied after 30 minutes, two, six, twelve and twenty-four hours after the operation. The presence or absence of intraoperative and postoperative complications was determined. Results: Patients aged 31-50 prevailed in both groups. The male gender predominated in the study group and the female gender, in the control group. In the study group, the response was not satisfactory only in two patients, while it was satisfactory in 11 patients; in the control group, it was not satisfactory in 5 patients. In the study group, three patients had pain for less than 2 hours and this was classified as mild to moderate. In the control group 12 of them presented pain for more than 4 hours, which was classified as moderate and severe. Adverse effects appeared in two patients. Conclusions: The administration of lidocaine leads to a decrease in pain and opioid consumption(AU)

Protocolo de cuidados de enfermagem para detecção de infiltração e extravasamento em neonatos / Nursing care protocol for detection of infiltration and extravasation in neonates

A via intravenosa é o principal acesso para a administração de fármacos em recém-nascidos internados em UTIN, sendo vital para sua sobrevivência. A vigilância constante do dispositivo intravenoso, quando periférico, fornece à equipe pistas sobre a sua permeabilidade, e permite a identificação precoce de complicações. Apesar de não serem totalmente evitáveis, complicações sérias podem ser reduzidas através de uma avaliação sistemática. Objetivos: Construir um protocolo de cuidados de enfermagem para a detecção precoce de infiltração e extravasamento em neonatos e validar o conteúdo e aparência do protocolo de cuidados de enfermagem para a detecção precoce de infiltração e extravasamento em neonatos com especialistas. Estudo metodológico não-experimental de validação de instrumento. O protocolo foi construído com base no Modelo de Iowa. O processo de construção do protocolo deu-se em três etapas: 1) Revisão sistemática da literatura; 2) Construção do protocolo com base nas Evidências disponíveis e 3)Validação do Conteúdo do Protocolo por Especialistas. Na revisão sistemática foram selecionados 17 artigos para a construção do protocolo. A produção científica foi agrupada em cinco grupos temáticos correspondentes aos seguintes itens: Educação permanente da equipe; Avaliação horária do local de inserção do dispositivo intravenoso periférico (DIP); Uso da técnica tocar /olhar/comparar; Uso de película transparente para fixação do DIP e Uso de escala de infiltração/extravasamento adequada para a idade neonatal. Foram considerados válidos os itens que obtiveram IVC ≥ 0,78. A etapa de construção do protocolo, com base nas evidências disponíveis, deu origem à primeira versão do instrumento que foi enviada para a validação de conteúdo e aparência por 17 especialistas. Os itens foram revisados e adequados a partir das sugestões dos especialistas, ainda que tenham obtido IVC maior ou igual a 0,78, pois considera-se que na carência de evidências fortes a opinião dos especialistas é altamente recomendável pra validar protocolos clínicos, de acordo o Modelo de Iowa. Dos cinco itens avaliados o que suscitou maior dúvida entre os especialistas foi a avaliação do local de inserção do DIP a cada 30/15 minutos, durante a infusão de soluções com alto potencial de dano o qual obteve IVC de 0,76. Os outros itens obtiveram IVC maior ou igual a 0,88, mostrando uma alta validade de conteúdo. O protocolo como um todo obteve IVC de 0,89. O conteúdo e a aparência do Protocolo de Cuidados para Detecção Precoce de Infiltração e Extravasamento no Neonato, de acordo com o julgamento dos especialistas, foi considerado adequado e as sugestões consideradas adequadas foram incluídas no Protocolo. Recomendase a validação do referido protocolo na prática clínica para que possa ser incorporado como nova tecnologia de cuidado aos neonatos em uso de terapia intravenosa, promovendo a segurança e a qualidade da assistência de enfermagem.(AU)

Indicadores de qualidade na assistência de terapia intravenosa em um hospital universitário: uma contribuição da enfermagem / Indicadores de calidad enapoyo de la terapia intravenosa en un hospital universitario: una contribución de la enfermería / Quality indicators in support of intravenous therapy in a university hospital: a contribution of nursing

Objectives: to understand the indicators of quality of care for intravenous therapy in the neonatal intensive care unit of a university hospital. Method: a non-experimental descriptive study with a quantitative approach in the NICU of a university hospital, through a systematic survey on the protocol of intravenous care: peripheral venous access, PICC and central venous catheter. Excel and presented in tables-statistical treatment, where the data were pooled and processed in Microsoft Office program was conducted. The study was approved by the CEP HUAP/UFF under Protocol 01660412.9.0000.5243. Results: in the data analysis, the results showed a greater need for technical training and maintenance of venous access catheter peripheral, PICC, and umbilical catheter. Conclusion: so, the health professional should facilitate and promote patient safety for the sake of your well being and quality of life, avoiding the risks and adverse effects.

Objetivos: compreender os indicadores de qualidade da assistência de terapia intravenosa na unidade de terapia intensiva neonatal de um hospital universitário. Método: estudo descritivo não experimental, com abordagem quantitativa na UTI Neonatal de um Hospital Universitário, por intermédio de um questionário sistematizado sobre o protocolo da assistência intravenosa: acesso venoso periférico, PICC e cateter umbilical. Foi realizado tratamento estatístico, onde os dados foram agrupados e processados no programa Microsoft Office-Excel e apresentados através de tabelas. O estudo obteve a aprovação do CEP do HUAP/UFF sob Protocolo nº 01660412.9.0000.5243. Resultados: na análise dos dados, os resultados mostraram uma maior necessidade de capacitação técnica e manutenção dos acessos do cateter venosos periférico, PICC, e cateter umbilical. Conclusão: assim, o profissional de saúde deve facilitar e promover a segurança do paciente em prol do seu bem estar e qualidade de vida, evitando os riscos e efeitos adversos.

Objetivos: conocer los indicadores de calidad de la atención para la terapia intravenosa en la unidad de cuidados intensivos neonatales de un hospital universitario. Métodos: se realizó un estudio descriptivo no experimental con un enfoque cuantitativo en la UCIN de un hospital universitario, a través de un estudio sistemático sobre el protocolo de atención por vía intravenosa: el acceso venoso periférico, PICC y el catéter venoso central. Excel y se presenta en las tablas-Se llevó a cabo un tratamiento estadístico, donde se reunieron y se procesaron en el programa de Microsoft Office a los datos. El estudio fue aprobado por el CEP Huap/UFF en virtud del protocolo 01660412.9.0000.5243. Resultados: en el análisis de los datos, los resultados mostraron una mayor necesidad de capacitación técnica y de mantenimiento de acceso del catéter venoso, catéter periférico, PICC, y umbilical. Conclusión: así, el profesional de la salud debe facilitar y promover la seguridad del paciente en aras de su bienestar y calidad de vida, evitando los riesgos y efectos adversos.

Retrograde Venous Perfusion in Chronic Ulcers of Lower Limb.

Chronic foot ulcers are difficult to treat. These patients need prolong treatment which is costly and often associated with non-compliance. These patients are vulnerable to develop gangrene leading to amputation. Retrograde venous perfusion (RVP) is a new therapeutic approach which was recently introduced to the treatment of diabetic foot as an adjunctive line to systemic therapy and local therapy. It is based on principle of regional anesthesia. Recently, Latin American investigators, applied this approach to local therapy of pedal ischemia. Since then this approach was mainly employed for therapy of diabetic neuropathic pedal ulcers. In this work, the efficacy of this approach was explored in 5 group of chronic foot disorder – 1) Diabetic foot presenting as foot infection, 2) Dibetic neuropathic pedal ulcers, 3) Diabetic pedal ischemia and infection, 4) Nondiabetic post traumatic foot ulcers, 5) Non-diabetic ischemic ulcer and pre-gangrene or gangrene. The present study was conducted on 56 patients having non healing ulcer of lower limb. Regular dressing and debridment and retrograde venous perfusion therapy was done in all patients. Results were assessed after completion of therapy. The following conclusions are drawn from the present study. Out of all diabetic patients, 23.7% of cases presented as diabetic foot. The incidence of diabetic foot patients was 64.29% out of all studied patients with ulcer foot. Maximum number of patients, 28.57% were in 31-40 years age group. The mean age of the patients was 44.4 years. There was male predominance with male and female ratio being 1.55:1. Mean reduction of ulcer size after RVP therapy was 63.89%. Maximum improvement was found in patients with diabetic pedal ischemia and infection i.e. 70% where as patients with non diabetic post traumatic foot ulcers had minimum improvement i.e. 52.22%. Whole foot or more than 4 toe amputation was not required in any patient in therapy group. After RVP therapy gangrene or pre-gangrene was prevented in 72.73% of patients. Minimum days of stay was 11-15 days in 32.14% of patients. Average duration of hospital stay was 18 days. Patients with foot ulcer in whom RVP therapy was not done, average duration of hospital stay was 31 days. This denotes that RVP reduces the time of therapy an avoids prolonged treatment. The ratio of diabetic and non-diabetic patients with neuropathy was 2.5:1. In Doppler ultrasound study, patients with sign of ischemia, ankle-brachial pressure index was less than 0.6 in 22 patients, out of them 16 patients were diabetic. After RVP therapy 93.33% of diabetic foot patients and 80% of non-diabetic foot ulcer patients ankle-brachial ratio became more then 0.8 denoting that after RVP therapy the blood flow in lower limb was increased. The present study confirms the good result in respect to decrease in ulcer size, overcome critical complications which are threatening the foot, early healing of ulcer, increase blood flow in ischemic foot, check progression of gangrene and pre-gangrene and to conserve the foot to avoid amputation. This study entailed expansion of the application of RVP to intractable post-traumatic ulcers of the foot and lower leg, as well as, to critical pedal ischemia in diabetic and non-diabetic patients.

Animal model of rapid crystalloid infusion in rats

PURPOSE: To describe an animal model of rapid intravenous infusion with different volumes of crystalloid and discuss the clinical findings. METHODS: Fifty six male Wistar rats were used, divided randomly in seven groups (n = 8). The rats of groups 1 to 6 received lactated Ringer´s solution intravenously, in the rate of 25 ml/min, with different volumes proportional to blood volume (BV). The rats of group 0 were submitted to the same procedure, but did not receive the fluid (control group). The data included respiratory rate, heart rate, saturation of peripheral oxygen (SpO2) in two times (before and after the infusion), and upshots (respiratory arrest and death). Dunnett´s test and ANOVA were used. RESULTS: The clinical signs significantly changed in the 2, 2.5 and 3 fold BV groups. The respiratory arrest was observed in the 1.5, 2, 2.5 and 3 fold BV groups, but death was present only in 2.5 and 3 fold BV groups. CONCLUSIONS: The infusion of crystalloid in the same volume of blood volume did not cause significant variation in respiratory and heart rate, saturation of peripheral oxygen and did not induce respiratory arrest. The infusion of a volume of 3 fold blood volume was lethal to all animals.

Avaliação farmacodinâmica e análise físico-química de duas formulações de propofol usadas em infusão alvo-controlada / Pharmacodynamic evaluation and physical/chemical analysis of two formulations of propofol used in target-controlled infusion / Evaluación farmacodinámica y análisis físico-químico de dos formulaciones de propofol usadas en infusión objeto-controlada

JUSTIFICATIVA E OBJETIVOS: Existem várias formulações de propofol para uso clínico à disposição do anestesiologista. O objetivo desse estudo foi analisar as propriedades físico-químicas, o efeito farmacodinâmico e a equivalência farmacêutica e clínica do fármaco referência de propofol e uma formulação similar. MÉTODOS: Dezesseis voluntários participaram desse estudo aleatório, duplamente encoberto e pareado entre as formulações Diprivan® e Propovan®. As formulações foram administradas em regime de infusão alvo-controlada com concentração-alvo de 3,0 µg.mL-1 por 15 minutos. As variáveis estudadas foram a área sob a curva (ASC) do gráfico do índice bispectral (BIS) em relação ao tempo, o BIS mínimo atingido e o tempo para tal e o tempo de recuperação. As duas formulações foram submetidas às análises de tamanho de partículas da emulsão lipídica, potencial de superfície e quantificação de princípio ativo. RESULTADOS: Não houve diferença entre as formulações quando se comparou a ASC, BIS mínimo atingido e o tempo decorrido para tal. O tempo de recuperação com a formulação similar foi menor em relação à referência (oito e 10 min, respectivamente, p = 0,014). O tamanho médio de partículas da emulsão lipídica, potencial de superfície e a quantificação de princípio ativo foram semelhantes nas duas formulações. CONCLUSÃO: Não houve diferença clínica significativa entre o uso de propofol referência Diprivan® e seu similar Propovan® durante a infusão. Entretanto, o tempo de recuperação foi mais prolongado com o fármaco referência. Embora as análises com as duas formulações estudadas mostrarem resultados semelhantes quanto a sua caracterização físico-química, outros estudos devem ser realizados para justificar tal diferença.

BACKGROUND AND OBJECTIVES: There are several formulations of propofol available to the anesthesiologist for clinical use. The aim of this study was to analyze the physicochemical properties, pharmacodynamic effect, and pharmaceutical and clinical equivalence of the reference drug propofol as well as a similar formulation. METHOD: Sixteen volunteers were enrolled in this randomized, double-blind, and paired study of Diprivan® and Propovan® formulations. Formulations were given as target-controlled infusion with target concentration of 3.0 μg.mL-1 for 15 minutes. Variables studied were the area under the curve (AUC) of the bispectral index (BIS) graph regarding time, minimum BIS reached and time to reach it, and recovery time. The two formulations were sent to analysis of particle size of lipid emulsion, surface potential, and active principle quantification. RESULTS: There was no difference between the formulations when comparing AUC, minimum BIS reached and time to reach it. The similar formulation recovery time was lower compared to the reference formulation (eight and 10 min, respectively, p = 0.014). Mean particle size of lipid emulsion, surface potential, and active ingredient quantification were similar for both formulations. CONCLUSION: There was no clinically significant difference between the use of propofol, reference Diprivan®, and the similar Propovan® during infusion. However, the recovery time was longer with the reference drug. Although analysis of both formulations studied show similar results regarding its physicochemical characterization, further studies should be conducted to justify this difference.

JUSTIFICATIVA Y OBJETIVOS: Existen varias formulaciones de propofol para el uso clínico que están disponibles para el anestesiólogo. El objetivo de este estudio, fue analizar las propiedades físico-químicas, el efecto farmacodinámico y la equivalencia farmacéutica y clínica del fármaco referencia de propofol y una formulación similar. MÉTODO: Dieciséis voluntarios participaron en este estudio aleatorio, doble ciego y pareado entre las formulaciones Diprivan® y Propovan®. Las formulaciones fueron administradas en un régimen de infusión objeto-controlada con una concentración objetivo de 3,0 µg.mL-1 durante 15 minutos. Las variables estudiadas fueron el área bajo la curva (ASC) del gráfico del índice bispectral (BIS) con relación al tiempo, el BIS mínimo alcanzado y el tiempo para tal, y el tiempo de recuperación. Las dos formulaciones se sometieron a los análisis de tamaño de partículas de la emulsión lipídica, potencial de superficie y cuantificación del principio activo. RESULTADOS: No hubo diferencia entre las formulaciones cuando se comparó la ASC, el BIS mínimo alcanzado y el tiempo transcurrido para tal. El tiempo de recuperación con la formulación similar fue menor con relación a la referencia (8 y 10 min, respectivamente, p = 0,014). El tamaño promedio de partículas de la emulsión lipídica, potencial de superficie y la cuantificación del principio activo, fueron similares en las dos formulaciones. CONCLUSIONES: No hubo diferencia clínica significativa entre el uso de propofol referencia Diprivan® y su similar Propovan® durante la infusión. Sin embargo, el tiempo de recuperación se extendió más con el fármaco de referencia. Aunque los análisis de las formulaciones estudiadas muestren resultados similares en cuanto a su caracterización físico-química, otros estudios deben ser realizados para justificar tal diferencia.

Primer caso de leucemia mieloide aguda tratado en Cuba con altas dosis de antraciclinas en la inducción / First case of acute myeloid leukemia treated in Cuba using high doses of anthracycline in induction

La leucemia mieloide aguda abarca un heterógeneo espectro de enfermedades, de naturaleza maligna y clonal, que representan un reto formidable para la medicina moderna. Con la excepción de la leucemia promielocítica, los resultados terapéuticos alcanzados continúan siendo desalentadores. Recientemente han surgido datos que demuestran mejores resultados con el uso de altas dosis de antraciclinas en la inducción. Se presentó el primer caso en Cuba, en cuya inducción se utilizó la rubidomicina a 100 mg/m² por 3 d, más el arabinósido de citosina a 100 mg/m² por 7 d, ambos en infusión endovenosa continua. La evolución clínica es satisfactoria hasta el momento. Se revisó brevemente la literatura médica al respecto...

The acute myeloid leukemia includes an heterogeneous spectrum of diseases of malignant and clonal origin representing a challenge of the current medicine. With the exception of the pro-myelocytic, the achieved therapeutical results continue being discouraging. Recently are available data demonstrating better results with the use of high doses of anthracycline in the induction. This is the first case in Cuba where in induction it was used the 100 mg/m² rubidomicin plus 100 mg/m2 for three days plus 100 mg/m² arabinoside for seven days, both in continuous intravenous infusion. The clinical course is satisfactory until now. Authors made a brief review of medical literature in this respect...

Influência da heparina sódica na ocorrência de laminite eqüina induzida por sobrecarga de carboidratos / Influence of heparin in occurrence of carbohydrate overload-induced equine laminitis

Avaliou-se a eficiência da infusão intravenosa de heparina sódica (100UI/kg/8h, a partir de 24h após o fornecimento de carboidrato, até completar 48h) no controle da laminite eqüina experimentalmente induzida por sobrecarga de carboidrato (17,6g de amido de milho/kg de peso corpóreo). Foram utilizados 15 eqüinos adultos, distribuídos em três grupos experimentais: GI (grupo-controle); GII (grupo laminite) e GIII (grupo laminite+heparina). Posteriormente ao fornecimento de carboidrato, os animais foram submetidos a exames físicos e laboratoriais durante um período de 48 horas. Ao final do experimento, os animais foram submetidos à eutanásia pela aplicação intravenosa de 5ml de maleato de acepromazina seguida de 1g de tiopental sódico e 1 litro de solução saturada de KCl para a obtenção de amostras de tecidos dos cascos, necessárias ao exame histológico. Os animais de GII e GIII, submetidos à sobrecarga de carboidratos, desenvolveram laminite, exibindo claudicação 12 e 24h após o fornecimento de carboidrato, respectivamente, bem como aumentos da freqüência cardíaca e do tempo de preenchimento capilar. As alterações histológicas, semelhantes em GII e GIII, eram do tipo degenerativo, como adelgaçamento de lâminas epidérmicas, retração, achatamento e deslocamento de lâminas dérmicas, vacuolização epidérmica e desorganização do tecido epidérmico. A infusão da heparina sódica não preveniu ou atenuou a degeneração laminar.

The efficacy of intravenous heparin administration (100UI/kg/8h, from 24 to 48h after carbohydrate administration) in the control of carbohydrate overload-induced equine laminitis (17.6g of corn starch/kg live weight) was evaluated. Fifteen horses were allocated into three experimental groups: GI (control group), GII (laminitis group), and GIII (laminitis+heparin group). These animals were submitted to physical and laboratorial examination during 48h. After that time, they were euthanized with intravenous administration of 5ml of acepromazine followed by 1g of thiopental sodium and 1 liter of saturated solution of KCl to obtain hoof tissues samples for histological examination. GII and GIII horses developed laminitis, showing lameness 12 and 24h after carbohydrate administration, respectively, as well increased heart rate and capillary refill time. The histological alterations, similar in GII and GIII, were degenerative lesions, as thinness of epidermal lamina, retraction, flattening and dislocation of the dermal lamina, epidermal vacuolization, and disruption of the epidermal tissues. The occurrence of laminar degeneration was not prevented or attenuated with intravenous heparin administration.

Cost-effectiveness of low-dose continuous infusion gemcitabine plus cisplatin versus standard dose gemcitabine plus cisplatin in stage III and IV non-small cell lung cancer

The purpose of this study was to assess the efficacy of low-dose continuous infusion gemcitabine 200 mg/m[2] once weekly on three consecutive out of 4 weeks for 6 cycles compared to the standard-dose gemcitabine 1000 mg/m[2] plus cisplatin in stage III and IV non-small cell lung cancer. Experimental Forty patients of non-small cell lung cancer with stage III and IV who are indicated for chemotherapy received low-dose continuous infusion gemcitabine 200 mg/m[2] plus cisplatin compared to forty patients of non-small cell lung cancer with stage III and IV who received the standard dose gemcitabine 1000 mg/m[2] plus cisplatin. The maximum duration of infusion of gemcitabine in combination with cisplatin was 24 hours with a dose of 200 mg / m[2] / day once weekly on three consecutive out of 4 weeks for 6 cycles. Cisplatin was given once every cycle with a dose of 100 mg/m[2]. This was compared to the standard-dose of gemcitabine 1000 mg/m[2] combined with cisplatin 100 mg/m[2] every 3 weeks for 6 weeks. Severe stomatitis, oesophagitis and myelosuppression were the worst common dose-limiting toxicities. Febrile neutropenia was observed in 8 out of the 40 patients who had received low-dose continuous infusion of gemcitabine as they developed bacteraemia. Occasional nausea, vomiting and diarrhea were also reported in both arms. There were 6 complete responses and 4 partial responses in the arm who received low-dose continuous infusion compared to 8 patients who had complete response and 4 patients with partial response in the standard dose arm. Low-dose continuous infusion gemcitabine for 24 hours with a dose of 200 mg/m[2]/day once weekly on three consecutive out of 4 weeks for 6 cycles gives results that are comparable to those of the standard-dose of gemcitabine but with a higher toxicity profile

Hemodynamic changes on color Doppler flow imaging and intravenous contrast-enhanced ultrasound for assessing transplanted liver and early diagnosis of complications / 华中科技大学学报（医学）（英德文版）

The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages postoperation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was increased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.

Corticosteroid-responsive enteropathy of infancy.

Nineteen American infants aged less than three months developed persistent diarrhoea, acidosis, hypoalbuminaemia, and malnutrition, without evidence of enteric pathogens. Symptoms began 11-59 days before admission to the University of North Carolina Children's Hospital, and infants were fed semielemental formula. Despite further treatment with amino acid-based formula by continuous nasogastric infusion, diarrhoea persisted. Endoscopic biopsies showed inflammation in the stomach, duodenum, and/or colon. A trial of intravenous corticosteroids was initiated in 14 infants. Corticosteroids were associated with rapid resolution of diarrhoea (duration after corticosteroids = 3.8 +/- 1.7 days [mean +/- SD]). In contrast, five infants with identical history were not treated with corticosteroids. In three infants, diarrhoea lasted for 92-147 days versus 31 +/- 3 total days in the treated group. In the other two infants, diarrhoea worsened after discharge, but were treated later with corticosteroids, with rapid resolution. Corticosteroids were uneventfully weaned over a four-month period. The results suggest that a trial of corticosteroids in infants with unresponsive persistent diarrhoea of unknown origin is beneficial and deserves prospective evaluation.

Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso / Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

JUSTIFICATIVA E OBJETIVOS: Embora a tetralogia de Fallot seja a mais comum das cardiopatias congênitas cianóticas, as publicações nacionais, relacionando essa doença com a prática anestésica são escassas. O objetivo deste relato é apresentar um caso de analgesia de parto em paciente portadora de tetralogia de Fallot não corrigida e diagnosticada durante a gestação. RELATO DO CASO: Paciente com 26 anos, 56 kg, 1,56 m, idade gestacional 32 semanas e 5 dias, com diagnóstico de tetralogia de Fallot realizado durante a gestação. Internou em trabalho de parto. A conduta obstétrica foi a de parto via baixa, sendo realizada analgesia através de bloqueio peridural com bupivacaína a 0,125 por cento e fentanil (100 æg) e colocação de cateter peridural. Após 1h30 minutos do início da analgesia, ocorreu o nascimento. O peso do recém-nascido foi 1485 g e o índice de Apgar 6 e 8 no primeiro e no quinto minutos, respectivamente. A paciente permaneceu estável e sem alterações hemodinâmicas e/ou eletrocardiográficas. CONCLUSÕES: A escolha da técnica anestésica é de fundamental importância no manuseio das pacientes com tetralogia de Fallot não corrigidas. Condições favoráveis do colo e boa dinâmica uterina, particularmente naquelas pacientes sem história de síncope, tornam-se imprescindíveis para uma boa indicação da analgesia de parto.

Hypoglycemia in the newborn.

Since a universal definition for hypoglycemia is lacking, an operational threshold for initiating therapy has been defined. Hypoglycemia is encountered in a variety of neonatal conditions including prematurity, growth retardation and maternal diabetes. Since hypoglycemia may be asymptomatic, routine screening for this condition in certain high risk situations is recommended. Supervised breast-feeding may be a treatment option in asymptomatic hypoglycemia. However, symptomatic hypoglycemia should always be treated with a continuous infusion of parenteral dextrose. Neonates needing dextrose infusion rates above 12 mg/kg/m should be investigated for refractory causes of hypoglycemia. Hypoglycemia has been linked to poor neuro-developmental outcome and hence aggressive screening and treatment is recommended.