Electro-acupuncture reduces the need for additional anesthetics in experimental studies / Eletroacupuntura reduz a necessidade de doses adicionais de anestésicos em estudos experimentais

PURPOSE: To evaluate the possible beneficial effects of electro-acupuncture in rats subjected to ketamine/xylazine (KX) intra-peritoneal (i.p.) anesthesia. METHODS: Forty-eight male Wistar rats were distributed in four equal groups. All rats received i.p. injections of ketamine (90 mg/kg) +xylazine (10 mg/kg) anesthesia. Basal values group (control) rats (BV) received no additional treatment. The equivalent of the human right ST36 (Zusanli) and CV-12(Zhongwan) acupoints were chosen for needling and electrical stimulation. AC rats were needled with sterilized disposable stainless steel needles at right ST36 and CV12 acupoints; needles were retained for 30 minutes. EAC10 rats, after needle insertion as described, had electrodes connected to both needles and to an electro stimulator model NKL EL-608; pulsed square waves, 10 Hz, 10 mA, was applied for 30 minutes. EAC100 rats were submitted to EA as described. However, a greater frequency (100 Hz) was used. RESULTS: Thirty-seven rats remained under adequate anesthetic level during the experiment. However, maintenance anesthesia was required by 11 rats. Need for additional anesthesia decreased to 9.1 percent in EAC100 rats compared to BV (36.3 percent). CONCLUSION: Both the AC and the EAC10/100 prolong the anesthetic effect of the combination Ketamine-xylazine in rats, allowing longer duration of anesthesia with a lower dose of anesthetic, thereby reducing the occurrence of complications.

OBJETIVO: Avaliar os possíveis efeitos benéficos da eletroacupuntura em ratos submetidos à anestesia intraperitoneal (i.p.) com ketamina / xilazina. MÉTODOS: Quarenta e oito ratos Wistar foram randomizados em quatro grupos iguais. Todos os ratos receberam injeções i.p. de ketamina (90 mg / kg) + xilazina (10 mg / kg). Os ratos do grupo Valores Basais (controle - BV) não receberam nenhum tratamento adicional. Os acupontos equivalentes aos humanos E-36 (Zusanli) e VC-12 (Zhongwan) foram escolhidos para inserção de agulhas e estimulação elétrica. Os ratos do grupo AC foram estimulados com agulhas esterilizadas descartáveis, de aço inoxidável, nos acupontos E-36 direito e VC12. As agulhas foram mantidas por 30 minutos. Nos ratos do grupo EAC10, após agulhamento, como descrito, eletrodos foram conectados às agulhas e ao eletro-estimulador modelo NKL EL-608 e aplicadas ondas quadradas pulsantes, 10 Hz, 10 mA, por 30 minutos. Os ratos do grupo EAC100 foram submetidos à EA como descrito. No entanto, uma maior freqüência (100 Hz) foi utilizada. RESULTADOS: Trinta e sete ratos permaneceram no nível anestésico adequado durante o experimento. No entanto, a manutenção da anestesia foi se fez necessária em 11 animais. Nos ratos do grupo EAC100 a necessidade de anestesia complementar diminuiu para 9,1 por cento em comparação com ratos do grupo BV (36,3 por cento). CONCLUSÃO: Tanto a AC como a EAC10/100 prolongam o efeito anestésico da combinação ketamina-xilazina em ratos, permitindo maior duração da anestesia com menor dose de anestésico, reduzindo assim a ocorrência de complicações.

Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin®) when compared with 20 mg piroxicam alone (Feldene®) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

Pharmacologic interventions for reducing spasticity in cerebral palsy.

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol.

Analgesia, sedación y relajación muscular en la Unidad de Terapia Intensiva / Analgesia, sedation and muscular relaxation in the Intensive care unit

Muchos de los pacientes internados en la unidad de terapia intensiva (UTI) requieren analgesia, sedación o relajación muscular (traumatismos graves, quemados, postquirúrgicos, patología coronaria, pancreatitis aguda, etc.) presentando en la mayoría de los casos dolor, ansiedad o sufrimiento. Los tratamientos instituidos para aliviar a estos pacientes, son muchas veces determinados por la tradición, la costumbre, o la conveniencia del médico tratante, que está más preocupado por otros problemas "médicos" del paciente. Los dolores postoperatorio y postraumático son inadecuadamente tratados en un altísimo porcentaje de pacientes, tanto que tres de cada cuatro pacientes, experimentan dolor moderado a severo en los dos primeros días luego de la intervención quirúrgica; y que en uno de ellos persistirá el dolor por más de 72 hs. El control inadecuado del dolor postoperatorio y postraumático tiene como causas principales la ignorancia, la presencia de mitos y la desorganización de los recursos disponibles. En nuestra UTI encontramos estas tres realidades. Para tratar de modificarlas decidimos orientar nuestros esfuerzos en dos sentidos: educación y protocolización. Se realizó una revisión bibliográfica sobre analgesia, sedación y relajación muscular, en la que se incluyen las complicaciones más frecuentes producidas por el dolor, métodos de evaluación y cuantificación de síntomas y terapéuticas, análisis crítico de las diferentes modalidades de administración de fármacos, etc. Asimismo se describen las diferentes drogas analgésicas, sedantes y relajantes musculares existentes en nuestro medio, como también técnicas de analgesia regional utilizables en la UTI. Utilizando como marco teórico dicha revisión, se diseñó un protocolo de trabajo con instrucciones prácticas para el uso racional de las drogas analgésicas, sedantes y relajantes musculares existentes en nuestro medio, como también técnicas de analgesia regional utilizables en la UTI. Se incluyeron apartados especiales sobre valoración del dolor y la sedación, tratamiento de la excitación psicomotriz aguda, esquemas de infusión de drogas, drogas reversoras, secuencia de intubación rápida, etc. En el presente trabajo presentamos la revisión bibliográfica utilizada y el protocolo de trabajo utilizado, durante dos años, en la unidad de terapia intensiva del Hospital General de Agudos "Dr. Cosme Argerich".