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1.
Rev. méd. Maule ; 39(3): 52-66, dic. 2024.
Article in Spanish | LILACS | ID: biblio-1586587

ABSTRACT

Rapid sequence intubation is the preferred method of securing the airway in patients who are critically ill, or at risk for aspiration. This involves the administration of an anesthetic induction agent followed rapidly by a neuromuscular blocking agent to create optimal intubation conditions and minimize the duration of the patient's apnea and the time the airway is unprotected. Furthermore, the risk that the patient may be expected to aspirate gastric contents can be mitigated by incorporating medications and techniques to reduce the possible adverse effects of airway manipulation.


La intubación de secuencia rápida, es el método preferido para asegurar la vía aérea en pacientes con enfermedades graves que conllevan riesgo de broncoaspiración. Esta implica la administración de un agente de inducción anestésica o hipnótico, seguido rápidamente de un agente bloqueador neuromuscular, para crear condiciones óptimas de intubación y minimizar la duración de la apnea del paciente y el tiempo en que la vía aérea está desprotegida. Además, el riesgo que se presupone a que el paciente pueda aspirar el contenido gástrico, puede ser mitigado, incorporando medicamentos y técnicas para disminuir los posibles efectos adversos de la manipulación de la vía aérea.


Subject(s)
Humans , Female , Middle Aged , Intubation, Intratracheal/methods , Neuromuscular Blocking Agents/supply & distribution , Anti-Anxiety Agents/supply & distribution , Anti-Anxiety Agents/therapeutic use , Hypnotics and Sedatives/supply & distribution , Hypnotics and Sedatives/therapeutic use , Neuromuscular Blocking Agents/therapeutic use
2.
Rev. cir. traumatol. buco-maxilo-fac ; 24(2): 7-11, abr.-jun. 2024. tab
Article in English | LILACS, BBO | ID: biblio-1572333

ABSTRACT

Background: Patients with anxiety require the use of special methods to enable dental treatment, in order to minimize the stress of the professional in relation to the patient, besides making the procedure more comfortable. The aim this research was evaluate of the sedative effectiveness of the muscle relaxant, Cyclobenzaprine Hydrochloride 10mg in patients submitted to removals of third molars. Material and methods: A randomized, triple-blind, placebo-controlled clinical trial involving 10 patients was conducted. Participants received 10mg of Cyclobenzaprine or placebo given the night before and 1 hour before surgery. The split-mouth method was used, and for each patient two third molars were removed, in two different surgical times. Anxiety was evaluated subjectively through scales. Results: Patients presented scores that showed low dental anxiety and slightly reduced pressure variables. The Verbal Anxiety Scale presented lower values for cyclobenzaprine (1.20 ± 0.92) compared to placebo (1.30 ± 1.06), suggesting a reduction in anxiety level. The Visual Analogue Scale did not present reduced values for cyclobenzaprine (3.51 ± 2.38) compared to placebo (3.20 ± 2.36) or baseline (3.42 ± 2.35). The Spielberger Inventory presented higher results for cyclobenzaprine (40.5) when compared with placebo (39.00). The Trieger Test showed higher results and longer execution time when patients took cyclobenzaprine, suggesting a greater cognitive alteration when submitted to sedation by muscle relaxant. However, there was no statistically significant dif ference between the analyzed variables. Conclusions: The use of Cyclobenzaprine was not effective in the control of anxiety in patients submitted to third molar extraction... (AU)


Introdução: Pacientes com ansiedade requerem a utilização de métodos especiais para viabilizar o tratamento odontológico, a fim de minimizar o estresse do profissional em relação ao paciente, além de tornar o procedimento mais confortável. O objetivo desta pesquisa foi avaliar a eficácia sedativa do relaxante muscular Cloridrato de Ciclobenzaprina 10mg em pacientes submetidos a exodontias de terceiros molares. Materiais e métodos: Foi realizado um ensaio clínico randomizado, triplo-cego, controlado por placebo envolvendo 10 pacientes. Os participantes receberam 10mg de Ciclobenzaprina ou placebo na noite anterior e 1 hora antes da cirurgia. Foi utilizado o método de boca dividida, e para cada paciente foram removidos dois terceiros molares, em dois tempos cirúrgicos diferentes. A ansiedade foi avaliada subjetivamente por meio de escalas. Resultados: Os pacientes apresentaram escores que mostraram baixa ansiedade odontológica e variáveis de pressão ligeiramente reduzidas. A Escala Verbal de Ansiedade apresentou valores menores para Ciclobenzaprina (1,20 ± 0,92) em relação ao placebo (1,30 ± 1,06), sugerindo redução do nível de ansiedade. A Escala Visual Analógica não apresentou valores reduzidos para Ciclobenzaprina (3,51 ± 2,38) em relação ao placebo (3,20 ± 2,36) ou basal (3,42 ± 2,35). O Inventário de Spielberger apresentou resultados superiores para a Ciclobenzaprina (40,5) quando comparado ao placebo (39,00). O Teste de Trieger apresentou resultados superiores e maior tempo de execução quando os pacientes tomaram Ciclobenzaprina, sugerindo maior alteração cognitiva quando submetidos à sedação por relaxante muscular. No entanto, não houve diferença estatisticamente significativa entre as variáveis analisadas. Conclusões: O uso da Ciclobenzaprina não foi eficaz no controle da ansiedade em pacientes submetidos à extração de terceiros molares... (AU)


Introducción: Los pacientes con ansiedad requieren el uso de métodos especiales que permitan el tratamiento odontológico, con el fin de minimizar el estrés del profesional en relación con el paciente, además de hacer más cómodo el procedimiento. El objetivo de esta investigación fue evaluar la eficacia sedante del relajante muscular Ciclobenzaprina Clorhidrato 10 mg en pacientes sometidos a extracciones de terceros molares. Material y métodos: Se realizó un ensayo clínico aleatorizado, triple ciego, controlado con placebo en 10 pacientes. Los participantes recibieron 10 mg de ciclobenzaprina o placebo la noche anterior y 1 hora antes de la cirugía. Se utilizó el método de boca dividida, y para cada paciente se extrajeron dos terceros molares, en dos tiempos quirúrgicos diferentes. La ansiedad se evaluó subjetivamente a través de escalas. Resultados: Los pacientes presentaron puntajes que mostraron ansiedad dental baja y variables de presión levemente reducidas. La Escala de Ansiedad Verbal presentó valores más bajos para la ciclobenzaprina (1,20 ± 0,92) en comparación con el placebo (1,30 ± 1,06), lo que sugiere una reducción en el nivel de ansiedad. La Escala Visual Analógica no presentó valores reducidos para ciclobenzaprina (3,51 ± 2,38) en comparación con placebo (3,20 ± 2,36) o basal (3,42 ± 2,35). El Inventario de Spielberger presentó resultados superiores para la ciclobenzaprina (40,5) en comparación con el placebo (39,00). El Test de Trieger mostró mayores resultados y mayor tiempo de ejecución cuando los pacientes tomaban ciclobenzaprina, sugiriendo una mayor alteración cognitiva cuando se sometían a sedación con relajante muscular. Sin embargo, no hubo diferencia estadísticamente significativa entre las variables analizadas. Conclusiones: El uso de Ciclobenzaprina no fue efectivo en el control de la ansiedad en pacientes sometidos a extracción de terceros molares... (AU)


Subject(s)
Humans , Male , Female , Dental Care , Dental Anxiety , Operative Time , Hypnotics and Sedatives , Molar, Third/surgery
3.
Rio de Janeiro; s.n; s.n; 20240000. 99 p.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1572278

ABSTRACT

A pouca sedação em Unidades de Terapia Intensiva Pediátrica (UTIP) pode gerar estresse psicológico e físico desnecessário, além de extubação acidental. Em contrapartida, a super sedação pode provocar o uso da ventilação mecânica prolongada, levando ao maior tempo de internação dentro da UTIP, além de síndrome de abstinência, tolerância e delírio. Neste sentido, delimitou-se como objeto de estudo a identidade do cuidado de enfermagem frente às reações adversas do uso de analgésicos e sedativos nas crianças gravemente doentes. Os objetivos são: descrever as reações adversas do uso de sedativos e analgésicos identificadas pela equipe de enfermagem; analisar a prática do cuidado da equipe de enfermagem frente às reações adversas do uso de sedativos e analgésicos nas crianças; e discutir as implicações da prática do cuidado da enfermagem prestada à criança que apresenta reações adversas no uso de analgésicos e sedativos. Trata-se de um estudo de abordagem qualitativa. Foram entrevistados 15 membros da equipe de enfermagem que trabalhavam em uma UTIP de um hospital especializado em doenças crônicas e raras, utilizando-se a técnica de entrevista, o formulário de caracterização dos participantes, o diário de campo para observação não participante e a coleta de informações nos prontuários. Contou-se com o apoio do software Iramuteq para realizar a Análise Textual Discursiva. Obteve-se que as principais reações adversas identificadas pelos profissionais de enfermagem foram irritabilidade, choro e agitação. A prática do cuidado de enfermagem é desenvolvida de acordo com as reações adversas previamente identificadas e varia conforme profissional de enfermagem que atende a criança, não existindo um padrão institucional pré-estabelecido. Entre os cuidados descritos estão: banho momo, administração de doses fracionadas de sedação segundo a prescrição médica e acalento pelo familiar responsável ou pelo próprio profissional. No entanto, não foram observados registros no prontuário acerca dessas reações adversas, bem como desses cuidados relatados. Destaca-se que existe insegurança por parte da equipe de enfermagem no que tange os seus conhecimentos sobre as reações adversas relacionadas ao uso de sedativos e analgésicos e, como implicações para a prática, a falta de identidade no seu cuidado interferindo em sua autonomia e protagonismo profissional, sendo a figura do médico percebida como o mais atuante nessa temática. Conclui-se que a equipe de enfermagem reconhece alguns sinais e sintomas das reações adversas no uso de sedativos e analgésicos. Todavia, se faz necessário um aprimoramento e atualizações frente à utilização desses medicamentos, suas reações adversas e cuidados que devem ser prestados, de modo a reconhecer sua atuação e perceber sua posição dentro da equipe multiprofissional.


Inadequate sedation in Pediatric Intensive Care Units (PICU) can generate unnecessary psychological and physical stress, in addition to accidental extubating. On the other hand, oversedation can lead to the use of prolonged mechanical ventilation, leading to longer hospitalization in the PICU in addition to withdrawal syndrome, tolerance, and delirium. In this sense, the identity of nursing care in the face of adverse reactions from the use of analgesics and sedatives in seriously ill children was defined as the object of study. The objectives are to describe the adverse reactions caused using sedatives and analgesics identified by the nursing team; analyze the care practice of the nursing team in the face of adverse reactions from the use of sedatives and analgesics in children; and discuss the implications of nursing care practice provided to children who present adverse reactions to the use of analgesics and sedatives. This is a qualitative study. Fifteen members of the nursing team who worked in a PICU of a hospital specializing in chronic and rare diseases were interviewed, using the interview technique, the participant characterization form, the field diary for non-participant observation and data collection. information in medical records. The Iramuteq software was supported, and discursive textual analysis was used. It was found that the main adverse reactions identified by nursing professionals were irritability, crying and agitation. The practice of nursing care is developed according to previously identified adverse reactions and varies depending on the nursing professional who cares for the child, and there is no pre-established institutional standard. Among the care described are warm bath, administration of fractional doses of sedation according to medical prescription and comfort by the responsible family member or by the professional himself, however, no records were observed in the medical records regarding these adverse reactions, as well as this reported care. It is noteworthy that there is insecurity on the part of the nursing team regarding their knowledge about adverse reactions related to the use of sedatives and analgesics and, as implications for practice, the lack of identity in their care, interfering with their autonomy and protagonism professional, with the doctor being perceived as the most active on this topic. It is concluded that the nursing team recognizes some signs and symptoms of adverse reactions in the use of sedatives and analgesics, however, improvement and updates are necessary regarding the use of these medications, their adverse reactions and the care that must be provided to recognize their performance and understand their position within the multidisciplinary team.


Una mala sedación en las Unidades de Cuidados Intensivos Pediátricos (UCIP) puede generar estrés psicológico y físico innecesario, además de extubaciones accidentales. Por otro lado, la sobresedación puede llevar al uso de ventilación mecánica prolongada, provocando una hospitalización más prolongada en la UCIP además de síndrome de abstinencia, tolerancia y dehrio. En este sentido, se definió como objeto de estudio la identidad del cuidado de enfermería ante las reacciones adversas por el uso de analgésicos y sedantes en niños gravemente enfermos. Los objetivos son: describir las reacciones adversas provocadas por el uso de sedantes y analgésicos identificadas por el equipo de enfermería; analizar la práctica de cuidados del equipo de enfermería ante las reacciones adversas por el uso de sedantes y analgésicos en niños; y discutir las implicaciones de la práctica de los cuidados de enfermería brindados a niños que presentan reacciones adversas al uso de analgésicos y sedantes. Este es un estudio cualitativo. Se entrevistó a quince miembros del equipo de enfermería que trabajaban en una UCIP de un hospital especializado en enfermedades crónicas y raras, utilizando la técnica de la entrevista, la ficha de caracterización participante, el diario de campo para la observación no parficipante y la recolección de información en historias clínicas. Se apoyó el software Iramuteq y se utiliz6 análisis textual discursivo. Se encontró que las principales reacciones adversas identificadas por los profesionales de enfermería fueron irritabilidad, llanto y agitaci6n. La práctica del cuidado de enfermería se desarrolla según reacciones adversas previamente identificadas y varía dependiendo del profesional de enfermería que atiende al niño, no existiendo un estándar institucional preestablecido. Entre los cuidados descritos se encuentran: baño tibio, administración de dosis fraccionadas de sedación según prescripción médica y confort por parte del familiar responsable o por el propio profesional, sin embargo, no se observaron registros en las historias clínicas respecto a estas reacciones adversas, así como estos ínformamn cuidados. Se destaca que existe inseguridad por parte del equipo de enfermería respecto de su conocimiento sobre las reacciones adversas relacionadas al uso de sedantes y analgésicos y, como implicaciones para la práctica, la falta de identidad en su cuidado, interfiriendo en su autonomía y protagonismo profesional, siendo el médico el más activo en este tema. Se concluye que el equipo de enfermería reconoce algunos signos y síntomas de reacciones adversas en el uso de sedantes y analgésicos, sin embargo, es necesario mejorar y actualizar respecto al uso de estos medicamentos, sus reacciones adversas y los cuidados que se deben brindar para reconocer su desempeño y comprender su posición dentro del equipo multidisciplinario.


Subject(s)
Analgesics/adverse effects , Hypnotics and Sedatives/adverse effects , Pediatric Nursing , Intensive Care Units, Pediatric
4.
Rev. cient. cienc. salud ; 6: 1-7, 30-01-2024.
Article in Spanish | LILACS, BDNPAR | ID: biblio-1577950

ABSTRACT

Introducción. La mala calidad del sueño es muy común en estos tiempos debido a diferentes factores, y esto se ve en mayor cantidad en la población universitaria en donde es muy importante que los mismos tengan una buena calidad de sueño para obtener resultados favorables en su desempeño académico. Objetivo. Determinar la calidad del sueño de los estudiantes de medicina de la Universidad del Pacifico en el año 2023. Materiales y Métodos. Estudio observacional analítico de corte transversal que incluyó a estudiantes de medicina de la Universidad del Pacifico de primero al sexto año del periodo académico 2023. Se utilizó el cuestionario de Calidad de Sueño de Pittsburg (PSQI) previo asentimiento de los estudiantes. Resultados. Participaron del estudio158 estudiantes, 77.8%(n=123) del sexo femenino. La frecuencia de malos soñadores entre todos los encuestados fue de un 56.96% (n=90). La frecuencia de uso de medicación hipnótica el 21.52 % (34/158) afirma utilizarlo. Se halló relación significativa entre el sexo y la calidad del sueño p: 0.021. Conclusión. Es alta la frecuencia de malos soñadores en la población de estudio, sería bueno analizar cambios en los horarios de clase y prácticas de manera a lograr una mejor calidad de sueño en los estudiantes, ya que esto podría ayudarlos a obtener mejores resultados tanto en lo académico como en su calidad de vida. Palabras clave: calidad del sueño; estudiantes; medicación hipnótica


Introduction. Poor quality of sleep is very common these days due to different factors, and this is seen in greater quantities in the university population where it is very important that they have good quality of sleep to obtain favorable results in their academic performance. Objective. Determine the quality of sleep of medical students at the Universidad del Pacifico in the year 2023. Materials andMethods.An analytical cross-sectional observational study was carried out on medical students at the Universidad del Pacifico from the first to the sixth year of their degree. during the 2023 academic period. The instrument used was the Pittsburg Sleep Quality Questionnaire (PSQI) with prior consent from the students. Results. A total of 158 surveys were analyzed, 77.8% (123/158) were female and 22.15% (35/158) were male. The frequency of bad dreamers among all respondents was 56.96% (90/158). A significant relationship was found between sex and sleep quality p: 0.021. Regarding the frequency of use of hypnotic medication, 21.52% (34/158) claim to use it. Conclusion.The frequency of bad dreamers is high in the study population, it would be good to analyze changes in class and practice schedules in order to achieve a better quality of sleep in the students, since this could help them obtain better results both in academically as well as in their quality of life. Key words: sleep quality; students; hypnotic medication


Subject(s)
Humans , Male , Female , Adolescent , Adult , Sleep Quality , Quality of Life , Students , Students, Medical , Hypnotics and Sedatives
5.
Pesqui. bras. odontopediatria clín. integr ; 24: e230043, 2024. tab, graf
Article in English | LILACS, BBO | ID: biblio-1550596

ABSTRACT

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.


Subject(s)
Midazolam/administration & dosage , Dental Care for Children , Hypnotics and Sedatives/administration & dosage , Nitrous Oxide/administration & dosage , Deep Sedation
6.
Braz. J. Anesth. (Impr.) ; 73(6): 751-757, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520380

ABSTRACT

Abstract Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.mr-2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL-1 plus 0.5 μg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg-1 plus 0.5 mg.kg-1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0-0) vs. 0 (0-0) (p = 0.239) and 1 (0-1) vs. 3 (1-4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group - 2 (0-2) vs. 1 (0-1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 μg.kg-1.min-1 vs. 195 ± 44 μg.kg-1.min-1 (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Propofol , Unconsciousness , Single-Blind Method , Colonoscopy , Anesthetics, Intravenous , Hypnotics and Sedatives
7.
Arch. argent. pediatr ; 121(4): e202202806, ago. 2023. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1442558

ABSTRACT

Introducción. La adecuada sedación y analgesia es fundamental en el tratamiento de pacientes que requieren asistencia ventilatoria mecánica (AVM). Se recomienda la utilización de protocolos y su monitoreo; son dispares los resultados reportados sobre adhesión e impacto. Objetivos. Evaluar el impacto de la implementación de un protocolo de sedoanalgesia sobre el uso de benzodiacepinas, opioides y evolución en la unidad de cuidados intensivos pediátricos (UCIP), en pacientes que requieren AVM mayor a 72 horas. Métodos. Estudio tipo antes-después, no controlado, en la UCIP de un hospital pediátrico. Se desarrolló en 3 etapas: preintervención de diagnóstico situacional (de abril a septiembre de 2019), intervención y posintervención de implementación del protocolo de sedoanalgesia, educación sobre uso y monitorización de adherencia y su impacto (de octubre de 2019 a octubre de 2021). Resultados. Ingresaron al estudio 99 y 92 pacientes en las etapas pre- y posintervención, respectivamente. Presentaron mayor gravedad, menor edad y peso en el período preintervención. En la comparación de grupos, luego de ajustar por gravedad y edad, en la etapa posintervención se reportó una reducción en los días de uso de opioides en infusión continua (6 ± 5,2 vs. 7,6 ± 5,8; p = 0,018) y los días de uso de benzodiacepinas en infusión continua (3,3 ± 3,5 vs. 7,6 ± 6,8; p = 0,001). No se observaron diferencias significativas en los días de AVM y en los días totales de uso de benzodiacepinas. Conclusión. La implementación de un protocolo de sedoanalgesia permitió reducir el uso de fármacos en infusión continua.


Introduction. Adequate sedation and analgesia is essential in the management of patients requiring mechanical ventilation (MV). The implementation of protocols and their monitoring is recommended; mixed results on adherence and impact have been reported. Objectives. To assess the impact of the implementation of a sedation and analgesia protocol on the use of benzodiazepines, opioids, and evolution in the pediatric intensive care unit (PICU) in patients requiring MV for more than 72 hours. Methods. Before-and-after, uncontrolled study in the PICU of a children's hospital. The study was developed in 3 stages: pre-intervention for situational diagnosis (from April to September 2019), intervention, and post-intervention for implementation of a sedation and analgesia protocol, education on use, and monitoring of adherence and impact (from October 2019 to October 2021). Results. A total of 99 and 92 patients were included in the study in the pre- and post-intervention stages, respectively. Patients had a more severe condition, were younger, and had a lower weight in the preintervention period. After adjusting for severity and age, the group comparison in the post-intervention stage showed a reduction in days of continuous infusion of opioids (6 ± 5.2 versus 7.6­5.8, p = 0.018) and days of continuous infusion of benzodiazepines (3.3 ± 3.5 versus 7.6 ± 6.8, p = 0.001). No significant  differences were observed in days of MV and total days of benzodiazepine use. Conclusion. The implementation of a sedation and analgesia protocol resulted in a reduction in the use of continuous infusion of drugs.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Analgesia , Analgesics, Opioid , Pain , Respiration, Artificial/methods , Benzodiazepines/therapeutic use , Intensive Care Units, Pediatric , Hypnotics and Sedatives
8.
Braz. J. Anesth. (Impr.) ; 73(3): 283-290, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1439617

ABSTRACT

Abstract Background: Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. Methods: The sample included 64 persons with ASD, aged 2-59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5 mg.kg−1, maximum 15 mg) or oral midazolam (0.5 mg.kg−1) associated with oral S(+)-ketamine (3 mg.kg−1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. Results: According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. Conclusion: The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism.


Subject(s)
Humans , Autism Spectrum Disorder/chemically induced , Autism Spectrum Disorder/drug therapy , Ketamine , Preanesthetic Medication , Midazolam , Double-Blind Method , Conscious Sedation , Hypnotics and Sedatives
9.
Beijing Da Xue Xue Bao ; (6): 324-327, 2023.
Article in Chinese | WPRIM | ID: wpr-986855

ABSTRACT

OBJECTIVE@#To study the effect of propofol used for painless gastroscopy and colonoscopy on psychomotility recovery.@*METHODS@#One hundred adult patients undergoing painless gastroscopy and colonoscopy were recruited, aged 18-72 years, with American Society of Anesthesiologist (ASA) physical status Ⅰ-Ⅱ. According to age, the patients were divided into youth group (20-39 years old, 27 cases), middle age group (40-54 years old, 37 cases), and elder group (55-64 years old, 36 cases). Propofol was continuously infused according to the patients' condition to mantain the bispectal index (BIS) score 55-64. All the patients received psychomotility assesment 30 min before the operations when the discharge criteria were met including number cancellation test, number connection test and board test. The heart rate, blood pressure, saturation of pulse oximetry, electrocardiograph and BIS were monitored during the operation. The operating time, recovery time, total volume of propofol and discharge time were recorded. If the results obtained were inferior to those before operation, a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels.@*RESULTS@#All the patients completed the first and second assessments, and 25 patients had taken the third assessment. There was no statistically significant difference in the results of psychomotility assessment when the patients met the discharge standard. Furthermore, the results were analyzed by grouping with age, and there was no statistical difference in the test results of the youth and middle age groups compared with the preoperative group, among which, the efficiency of the number cancellation test was significantly better than that before operation in the youth group (P < 0.05). However, in the elderly patients the number cancellation efficiency, number connection test and board test were significantly inferior to that before operation (P < 0.05). There was no significant difference in the accuracy of number cancellation compared with that before operation. The patients who needed the third test in the elder group were significantly more than in the other groups (P < 0.05). Compared with the preoperative results, there was no statistical difference in the test results of those who completed the third test.@*CONCLUSION@#The psychomotility function of the patients who underwent painless gastroscopy and colonoscopy was recovered when they met discharge criteria. The elderly patients had a prolonged recovery period.


Subject(s)
Adult , Aged , Middle Aged , Adolescent , Humans , Young Adult , Propofol , Hypnotics and Sedatives , Gastroscopy/methods , Conscious Sedation/methods , Colonoscopy/methods
10.
Zhongguo zhenjiu ; (12): 634-638, 2023.
Article in Chinese | WPRIM | ID: wpr-980772

ABSTRACT

OBJECTIVE@#To observe the clinical efficacy of Bushen Anshen acupuncture (acupuncture for tonifying kidney and calming spirit ) in treating perimenopausal insomnia (PMI) of kidney-yin deficiency.@*METHODS@#A total of 72 patients with PMI of kidney-yin deficiency were randomized into an observation group (36 cases, 1 case dropped off) and a control group (36 cases, 1 case dropped off). Acupuncture was applied at Baihui (GV 20) and bilateral Shenshu (BL 23), Taixi (KI 3), Anmian (Extra) in the observation group, while sham acupuncture of shallow needling at non-acupoints was applied in the control group. The treatment was required once every other day, 3 times a week for 10 times in the two groups. Before and after treatment, Pittsburgh sleep quality index (PSQI) was used to evaluate the subjective sleep quality, and polysomnography (PSG) was used to monitor the objective sleep quality in the two groups.@*RESULTS@#After treatment, the scores of sleep quality, sleep latency, sleep duration, sleep efficiency, hypnotic, daytime dysfunction and total score of PSQI were decreased compared with those before treatment in the observation group (P<0.01), the scores of sleep duration, sleep efficiency and total score of PSQI were decreased compared with those before treatment in the control group (P<0.05); the scores of sleep quality, sleep latency, sleep efficiency, hypnotic and total score of PSQI in the observation group were lower than those in the control group (P<0.05). After treatment, the sleep time was prolonged, the sleep efficiency was improved, the sleep latency and the awake time after falling asleep were shortened, the arousal awake index was reduced (P<0.01) when PSG indexes were monitored, and the percentage of non-rapid eye movement sleep period 1 (N1%) was decreased while the percentage of non-rapid eye movement sleep period 3 (N3%) was increased (P<0.05) compared with those before treatment in the observation group; there was no statistical difference in the PSG indexes compared with those before treatment in the control group (P>0.05). After treatment, compared with the control group, the sleep time was prolonged, the sleep efficiency was improved, the sleep latency and the awake time after falling asleep were shortened, the arousal awake index and N1% were decreased in the observation group (P<0.01).@*CONCLUSION@#Bushen Anshen acupuncture can effectively improve the subjective and objective sleep quality in PMI patients of kidney-yin deficiency.


Subject(s)
Humans , Sleep Initiation and Maintenance Disorders/therapy , Perimenopause , Yin Deficiency , Acupuncture Therapy , Kidney , Hypnotics and Sedatives
11.
Chin. med. sci. j ; Chin. med. sci. j;(4): 1-10, 2023.
Article in English | WPRIM | ID: wpr-981596

ABSTRACT

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.


Subject(s)
Humans , Aged , Dexmedetomidine/adverse effects , Hemodynamics , Hypnotics and Sedatives/pharmacology , Blood Pressure , Heart Rate
12.
Zhongguo Zhong Yao Za Zhi ; (24): 4295-4301, 2023.
Article in Chinese | WPRIM | ID: wpr-1008684

ABSTRACT

Ziziphi Spinosae Semen(ZSS) is an edible TCM derived from the dried ripe seeds of Ziziphus jujube Mill. var. spinosa(Bunge)Hu ex H. F. Chou(Rhamnaceae), which has the effects of nourishing the heart, tonifying the liver, calming the heart, tranquilizing the mind, arresting sweating, and promoting fluid production, and is widely used in the treatment and health care of diseases related to cardiovascular, nervous, and immune systems. Jujuboside B(JuB), one of the main active ingredients of ZSS, possesses various pharmacological effects with application values. This paper reviewed the chemical structure and pharmacological effects of JuB. JuB has sedative, hypnotic, antitumor, anti-platelet, anti-inflammatory, and other biological activities, which shows the potential thera-peutic effects on insomnia, tumors, coronary artery disease, airway inflammation, and liver injury. However, there are some limitations to the results of current studies. More comprehensive studies, including basic research and clinical trials, need to be carried out to provide more reliable evidence.


Subject(s)
Humans , Drugs, Chinese Herbal/pharmacology , Saponins/pharmacology , Hypnotics and Sedatives , Sleep Initiation and Maintenance Disorders , Ziziphus/chemistry
13.
Zhongguo Zhong Yao Za Zhi ; (24): 5122-5130, 2023.
Article in Chinese | WPRIM | ID: wpr-1008710

ABSTRACT

Insomnia is extremely common and is a risk factor for a variety of physical and psychological disorders in addition to contributing to the reduced quality of life of patients and the burden of healthcare costs. Although cognitive behavioral therapy is the first-line treatment for insomnia, its difficulty of access and high cost have hindered its application. Therefore, pharmacotherapy remains the common treatment choice for patients and clinicians. Existing chemical drugs including benzodiazepine receptor agonists, dual orexin receptor antagonists, melatonin and its receptor agonists, histamine antagonists, antidepressants, and antipsychotics are able to induce and/or maintain sleep and have good therapeutic effects on acute insomnia, but their efficacy on chronic insomnia is indefinite. Furthermore, they have several side effects and affect sleep structure and physiological function. Under the guiding principle of holistic view and treatment based on syndrome differentiation, traditional Chinese medicine(TCM) has shown a good effect in clinical practice, but with little high-grade clinical evidence. The mechanism, dose, half-life period, adjustment of sleep structure, and side effects of hypnotic drugs are key factors to be considered for clinical use. This paper analyzed and summarized the drugs for insomnia from the above aspects, and is expected to provide references for the application and development of sedative and hypnotic drugs.


Subject(s)
Humans , Sleep Initiation and Maintenance Disorders/chemically induced , Quality of Life , Sleep , Hypnotics and Sedatives/pharmacology , Antidepressive Agents/pharmacology
15.
Braz. J. Anesth. (Impr.) ; 73(5): 641-664, 2023. tab, graf
Article in English | LILACS | ID: biblio-1520344

ABSTRACT

Abstract Background: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%). Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications..


Subject(s)
Conscious Sedation , Dexmedetomidine , Anesthesia , Patient Safety , Hypnotics and Sedatives , Anesthesiology
17.
Braz. J. Anesth. (Impr.) ; 73(4): 477-490, 2023. tab, graf
Article in English | LILACS | ID: biblio-1447620

ABSTRACT

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.


Subject(s)
Humans , Child , Anesthesia , Ketamine , Anxiety , Preanesthetic Medication , Midazolam , Hypnotics and Sedatives
18.
Rev. chil. anest ; 52(3): 309-314, 2023. tab
Article in English | LILACS | ID: biblio-1577962

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI), and it presents a higher risk of myocardial infarction, severe bleeding, transfusión, dialysis, and mortality. Dexmedetomidine has a protective effect on AKI after adult cardiac surgery. We want to study the impact of dexmedetomidine on the incidence of AKI in the postoperative period of TAVI procedure in our center. METHODS: We performed a retrospective cohort study comparing the administration of dexmedetomidine (DEX group) versus other sedatives (NO-DEX group) during elective TAVI procedure under transfemoral approach. RESULTS: A total of 122 patients were included in the study. Both groups presented a similar incidence of AKI (19,8% DEX group; 19,2% NO-DEX group; p = 0,949). A subgroup analysis with patients presenting chronic kidney disease showed an AKI incidence of 24%, without statistically significant differences between both groups either. CONCLUSIONS: We did not find any difference on AKI incidence, length of hospital stay, 30-day mortality or 12-month mortality in patients undergoing TAVI procedure under sedation with dexmedetomidine compared to other sedatives in our center. It would be interesting to study this hypothetical association through studies with larger samples and better designs.


INTRODUCCIÓN: La insuficiencia renal aguda (AKI) es una complicación frecuente tras el implante de válvula aórtica transcatéter (TAVI), y presenta un mayor riesgo de infarto agudo de miocardio, sangrado severo, transfusión, diálisis y mortalidad. La dexmedetomidina presenta un efecto protector sobre AKI tras cirugía cardíaca en el adulto. Queremos estudiar el impacto de la dexmedetomidina en la incidencia de AKI en el posoperatorio de procedimiento TAVI en nuestro centro. MÉTODOS: Hemos realizado un estudio de cohorte retrospectiva comparando la administración de dexmedetomidina (grupo DEX) frente a otros sedantes (grupo NO-DEX) durante el procedimiento TAVI electivo con abordaje transfemoral. RESULTADOS: Se incluyeron en el estudio un total de 122 pacientes. Ambos grupos presentaron una incidencia similar de AKI (19,8% el grupo DEX; 19,2% el grupo NO-DEX; p = 0,949). En un análisis de subgrupo en pacientes con insuficiencia renal crónica mostró una incidencia del 24% sin diferencias estadísticamente significativas entre ambos grupos tampoco. CONCLUSIONES: No hemos encontrado ninguna diferencia en la incidencia de AKI, duración de estancia hospitalaria, mortalidad a 30 días y mortalidad a 12 meses en pacientes intervenidos de TAVI bajo sedación con dexmedetomidina comparada con otros sedantes en nuestro centro. Sería interesante estudiar esta hipotética asociación mediante estudios con muestras mayores y mejor diseñados.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Dexmedetomidine/administration & dosage , Acute Kidney Injury/epidemiology , Transcatheter Aortic Valve Replacement/methods , Hypnotics and Sedatives/administration & dosage , Retrospective Studies , Conscious Sedation , Creatinine/urine , Creatinine/blood , Acute Kidney Injury/prevention & control , Transcatheter Aortic Valve Replacement/adverse effects , Length of Stay
19.
Rev. chil. anest ; 52(3): 289-296, 2023. tab
Article in Spanish | LILACS | ID: biblio-1577948

ABSTRACT

Sedation consists in the administration of different types of drugs that produce central nervous system depression, decreasing alertness and anxiety, to allow medical procedures to be performed, which may or not be painful and require some degree of immobility. The physician in charge of the sedation of pediatric patients must know the physiological changes of the child, the pharmacokinetics and pharmacodynamics of the different medications to be used, as well as the possible complications that may occur before, during and after sedation, in order to provide a safe and quality care.


La sedación consiste en la administración de diferentes tipos de fármacos que producen depresión del sistema nervioso central, disminuyendo el estado de alerta y ansiedad, para permitir la realización de procedimientos médicos, que pueden ser dolorosos o no y que requieren algún grado de inmovilidad. El médico encargado de la sedación de pacientes pediátricos debe conocer los cambios fisiológicos del niño, la farmacocinética y farmacodinámica de los diferentes medicamentos a utilizar, además de las posibles complicaciones que se pueden presentar antes, durante y después de la sedación, con el fin de brindar una atención segura y de calidad.


Subject(s)
Humans , Child , Pediatrics , Conscious Sedation/methods , Deep Sedation/methods , Hypnotics and Sedatives/administration & dosage , Anesthetics/administration & dosage , Conscious Sedation/adverse effects , Risk Assessment , Patient Selection , Deep Sedation/adverse effects , Hypnotics and Sedatives/adverse effects , Anesthetics/adverse effects
20.
Rev. chil. anest ; 52(4): 369-373, 2023.
Article in Spanish | LILACS | ID: biblio-1578503

ABSTRACT

INTRODUCTION: Given the scenarios of care in critical patients in the emergency room, the administration of medications is required quickly, especially in patients with mental disturbance or shock. Intranasal drug administration has been shown to be a viable alternative for the management of critically ill adult and pediatric patients; and in some situations, in which there may be some limitation for the administration of oral medications. OBJETIVE: To know the mechanism of bioavailability and the pharmacological options for the administration of intranasal drugs in emergency room. METHODS: Search for meta-analyses, systematic reviews, articles and case reports via Cochrane, PubMed, ScienceDirect, EBSCO. RESULTS: Intranasal administration absorption depends on several factors, the most important being the placement of the drug and the rate of mucociliary clearance. Unlike the intravenous route, intranasal administration does not require sterile access, this generates greater speed in the preparation and administration of medications. There is a variety of medications and methods for the application of medications, including analgesics, inducers, sedatives, anesthetics, and some still under investigation. CONCLUSION: The intranasal route may be an option in situations in which timely administration of medications is required and appropriate dose selection in relation to the administered drug.


INTRODUCCIÓN: Ante los escenarios de atención en pacientes críticos en la sala de urgencias se requiere de la administración de medicamentos de manera rápida, especialmente en los pacientes con agitación psicomotriz o estado de choque. La administración de medicamentos por vía intranasal ha mostrado ser una alternativa viable para el manejo de paciente adulto y pediátrico en estado crítico; y en algunas situaciones en las que pueda existir alguna limitación para administración de medicamentos vía oral. OBJETIVO: Conocer el mecanismo de biodisponibilidad y las opciones farmacológicas para administración de medicamentos intranasales en sala de emergencias. MÉTODOS: Búsqueda de metaanálisis, revisiones sitemáticas, artículos y reportes de caso vía Cochrane, PubMed, ScienceDirect, EBSCO. RESULTADOS: Administración intranasal la absorción depende de varios factores, el más importante es la colocación de la droga y la tasa de aclaramiento mucociliar. A diferencia de la vía endovenosa, la administración intranasal no requiere un acceso estéril, esto genera mayor rapidez en la preparación y administración de los medicamentos. Existe variedad de medicamentos y métodos para aplicación de medicamento entre ellos analgésicos, inductores, sedantes, anestésicos y algunos aún en proceso de investigación. CONCLUSIÓN: La vía intranasal puede ser una opción en situaciones en las que se requiere de administración oportuna de medicamentos y seleccionar adecuadamente la dosis en relación con el fármaco administrado.


Subject(s)
Humans , Administration, Intranasal , Analgesics/administration & dosage , Hypnotics and Sedatives/administration & dosage , Midazolam , Biological Availability , Fentanyl , Mucociliary Clearance , Flumazenil , Critical Illness , Dexmedetomidine , Emergencies , Haloperidol , Analgesics/pharmacokinetics , Hypnotics and Sedatives/pharmacokinetics , Ketamine , Anesthetics , Naloxone
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