ABSTRACT
Sedation for procedures performed outside the operating room (OR) doubles the mortality rate of procedures perfomed in the OR. The levels of sedation are: anxiolysis, moderate sedation, deep sedation, and general anesthesia; passing from one level to the next depending on the dose of the drug, the period of administration, the use of concomitant drugs and type of stimulus. Prevention of complications is achieved by reducing expectations, assessing and monitoring the patient, and awaiting for the effects of the drugs. Respiratory complications are the main cause of morbi-mortality associated to the use of sedation: respiratory depression induced by drugs, airway obstruction and laryngospasm. Cardiovascular complications are directly related to the level of sedation, but can also be secondary to hypoxemia, vagovagal reflexes due to distention of the gastric tract, hypotension, arrhythmia, arterial hypertension and myocardial ischemia; and anaphylaxis. Other complications can be: adverse reaction to drugs, bronchopulmonary aspiration, eye damage, mistakes in drug administration, respiratory failure, and prolonged amnesia.
La sedación para procedimientos fuera de pabellón tiene el doble de mortalidad que los pacientes de pabellón. La profundidad de sedación se divide en Ansiolisis, Sedación Moderada, Sedación Profunda y Anestesia General; pasando de un estado a otro dependiendo de dosis de droga, tiempo de administración, uso de otras drogas y estímulo. La prevención de las complicaciones se logra: bajando las expectativas, evaluando a los pacientes, monitorizando y esperando el efecto de los medicamentos. Las complicaciones respiratorias: Son la primera causa de morbimortalidad asociada al uso de sedación: depresión respiratoria inducida por drogas, obstrucción de vía aérea y espasmo laríngeo. Las complicaciones cardiovasculares: están en directa relación con la profundidad de sedación, pero pueden producirse secundariamente a hipoxemia, reflejos vagales por distensión del tubo digestivo: hipotensión, arritmias, hipertensión arterial e isquemia miocárdica; y anafilaxia. Otras Complicaciones pueden ser: reacción adversa a drogas, aspiración broncopulmonar, daño ocular, errores de administración de fármacos, tórax leñoso, amnesia prolongada.
Subject(s)
Humans , Endoscopy, Gastrointestinal/methods , Premedication/adverse effects , Conscious Sedation/adverse effects , Deep Sedation/adverse effects , Anesthesia, General/adverse effects , Emergencies , Monitoring, Physiologic , Midazolam/adverse effectsABSTRACT
Rhizobium radiobacter is an uncommon agent of infection and has been associated with indwelling intravascular devices such as catheter in immunocompromised patients. Here, we report a case of R. radiobacter recovered from blood cultures in stem cell transplantation in a pediatric patient and present an extensive characterization of its antimicrobial susceptibility profile. The isolate presented low MICs to many antimicrobial agents, but high MICs to ceftazidime, piperacillin-tazobactam, aztreonam, and fosfomycin.
Subject(s)
Humans , Male , Child , Anti-Infective Agents/administration & dosage , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/blood , Microbiological Techniques , Rhizobium/immunology , Rhizobium/isolation & purification , Rhizobium/pathogenicity , Microbial Sensitivity Tests , Chemotherapy-Induced Febrile Neutropenia/etiology , Chemotherapy-Induced Febrile Neutropenia/drug therapy , Premedication/adverse effects , Stem Cell TransplantationABSTRACT
CONTEXT AND OBJECTIVE: Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication. DESIGN AND SETTING: Prospective and randomized study at Hospital das Clínicas, Universidade Estadual Paulista, Botucatu. METHODS: Thirty patients presenting American Society of Anesthesiologists (ASA) physical status I and II who were scheduled for elective lower abdominal surgery were utilized. The patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. Ten patients (Gcontrol) received preoperative and intraoperative passive thermal insulation. Ten patients (Gpre+intra) underwent preoperative and intraoperative active warming. Ten patients (Gintra) were only warmed intraoperatively. RESULTS: After 45 min of preoperative warming, the patients in Gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (Gcontrol and Gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). The patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in Gcontrol at the end of surgery (p < 0.05). All the patients were hypothermic at admission to the recovery room (T CORE < 36° C). CONCLUSIONS: Forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.
CONTEXTO E OBJETIVO: Hipotermia inadvertida no perioperatório é freqüente durante anestesia subaracnóidea e após a administração de midazolam. O objetivo foi avaliar os efeitos do aquecimento da pele no intra-operatório, associado ou não ao aquecimento da pele durante o período de 45 minutos no pré-operatório, na prevenção de hipotermia intra- e pós-operatória determinada pela anestesia subaracnóidea em pacientes com medicação pré-anestésica com midazolam. TIPO DE ETUDO E LOCAL: Estudo prospectivo e aleatório, realizado no Hospital das Clínicas, Universidade Estadual Paulista (Unesp), Botucatu, SP. MÉTODOS: O estudo foi realizado em 30 pacientes com estado físico ASA (da Sociedade Norte-americana de Anestesiologistas) I e II submetidos à cirurgia eletiva do abdômen. Como medicação pré-anestésica, utilizou-se o midazolam, 7,5 mg via intramuscular (IM) e anestesia subaracnóidea padrão. Em 10 pacientes (Gcontrole) utilizou-se isolamento térmico passivo; 10 pacientes (Gpré+intra) foram submetidos a aquecimento ativo no pré- e intra-operatório; e 10 pacientes (Gintra) foram aquecidos ativamente somente no intra-operatório. RESULTADOS: Após 45 minutos de aquecimento no pré-operatório, os pacientes do Gpré+intra apresentaram temperatura central mais elevada em relação aos dos grupos não aquecidos antes da anestesia (p < 0,05) mas não no início da cirurgia (p > 0,05). Os pacientes que receberam aquecimento no intra-operatório apresentaram temperatura central mais elevada no final da cirurgia em relação aos de Gcontrole (p < 0,05). Todos os pacientes estavam hipotérmicos na admissão da sala de recuperação pós-anestésica (temperatura central < 36° C). CONCLUSÕES: 45 minutos de aquecimento no pré-operatório combinado com aquecimento no intra- operatório não evita, mas minimiza a ocorrência de hipotermia determinada pela anestesia subaracnóidea em pacientes que receberam midazolam como medicação pré-anestésica.
Subject(s)
Adult , Female , Humans , Male , Anesthesia, Spinal/adverse effects , Anti-Anxiety Agents/adverse effects , Heating/methods , Hypothermia/prevention & control , Midazolam/adverse effects , Analysis of Variance , Anti-Anxiety Agents/administration & dosage , Body Temperature/drug effects , Body Temperature/physiology , Hypothermia/chemically induced , Intraoperative Care/methods , Midazolam/administration & dosage , Premedication/adverse effects , Preoperative Care/methods , Prospective Studies , Skin Temperature/drug effects , Skin Temperature/physiology , Time FactorsABSTRACT
Se realizó un estudio descriptivo y transversal de 50 pacientes atendidas en el servicio de legrados del Hospital General Docente "Alberto Fernández Montes de Oca", del municipio San Luis, en el período comprendido desde abril hasta mayo de 1998, con el fin de determinar las ventajas del ketalar como anestesia general endovenosa, a través de la premedicación con difenhidramina y sin ella. Se determinó la aparición de complicaciones en cada uno de los grupos, así como también el costo de los medicamentos, donde se comprobó que éstos se reducen notablemente con la premedicación, lo que significa un ahorro para la unidad y para el Sistema Nacional de Salud(AU)
A descriptive and cross-sectional study of 50 patients cared at the service of curettages of "Alberto Fernández Montes de Oca" General Teaching Hospital, of San Luis municipality, was conducted in the period comprised from April to May of 1998 so as to determine the advantages of ketalar as a general endovenous anesthesia, through the premedication with diphenhydramine and without it. The appearance of complications in each of the groups was determined, as well as the medicines cost and it was checked that the costo can be remarkably reduced with the premedication which means a saving for the unit and for the National Health System(AU)
Subject(s)
Humans , Premedication/adverse effects , Curettage/methods , Diphenhydramine/therapeutic use , Anesthesia, Intravenous/adverse effects , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Succinylcholine causes prolonged apneas in a proportion if subjects that have genetical defect of butyrylcholinesterase, due to the presence of unusual alleles in the locus BCHE. To estimate allele frequences of 3 variants of serum butyrylcholinesterase, BCHE*U, BCHE*A and BCHE*F in an urban population of Santiago, Chile, different phenotypes for the locus BCHE were determined in 300 blood samples coming from patients of a private clinical laboratory. The population was formed by an admixture of Amerindian and European (mostly spanich) people. The frequency of BCHE*A was similar to the expected for this population, but BCHE*F frequency was greater than predicted. Eight subjects had a genotype BCHE AK. The higher frequency found for BCHE*F is probably due to the use of more precise detection techniques. Although the used method cannot distinguish BCHE UK from BCHE UU, the findings of individuals with BCHE AK, must lead to the suspicion that the frequency of the allel BCHE K is not negligible in Santiago