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Braz. arch. biol. technol ; 63: e20200206, 2020. tab, graf
Article in English | LILACS | ID: biblio-1132262


Abstract The high prevalence of anxiety disorders associated with pharmacotherapy side effects have motivated the search for new pharmacological agents. Species from Citrus genus, such as Citrus limon (sicilian lemon), have been used in folk medicine as a potential therapy to minimize emotional disorders. In order to searching for new effective treatments with fewer side effects, the present study evaluated the anxiolytic mechanism of action and the hypnotic-sedative activity from the Citrus limon fruit's peels essential oil (CLEO). Adults male Swiss mice were submitted to barbiturate-induced sleep test; elevated plus-maze (EPM) and light-dark box (LDB) (evaluation of the mechanism of action); rotarod; and catalepsy tests. CLEO oral treatment decreased latency and increased the sleep total time; moreover it induced in animals an increased the number of entries and percentage of time spent into open arms of the EPM; an increased the number of transitions and the percentage of time into light compartment in the LDB; which were only antagonized by flumazenil pretreatment, with no injury at motor function. Thus, results suggest that CLEO treatment induced an anxiolytic behavior suggestively modulated by the benzodiazepine binding site of the GABAA receptor or by an increase of GABAergic neurotransmission, without cause impairment in the motor coordination.

Animals , Male , Mice , Anxiety/drug therapy , Anti-Anxiety Agents/therapeutic use , Oils, Volatile/therapeutic use , Citrus/chemistry , GABA Modulators/pharmacology , Hypnotics and Sedatives/therapeutic use , Anti-Anxiety Agents/isolation & purification , Maze Learning/drug effects , Hypnotics and Sedatives/isolation & purification
Einstein (Säo Paulo) ; 18: eAO5395, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133746


ABSTRACT Objective To investigate the prevalence of palliative sedation use and related factors. Methods An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant's familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data. Results In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field. Conclusion The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.

RESUMO Objetivo Verificar a prevalência e os fatores associados ao uso de sedação paliativa. Métodos Trata-se de estudo observacional realizado a partir do preenchimento de um questionário eletrônico com 23 questões objetivas enviado a médicos paulistas. Foram avaliados os dados demográficos, a prevalência e a frequência de uso da sedação paliativa; o nível de conhecimento a respeito da técnica; e as motivações para sua utilização. Visando minimizar o viés de recordação, questões sobre a frequência de uso e motivações para tal, as respostas deveriam se referir ao último ano em relação à data de preenchimento da pesquisa. Foi utilizada estatística descritiva para sumarizar os resultados. Resultados Foram enviados 20.168 e-mails e obtiveram-se 324 respostas válidas, resultando em 2% de adesão. A prevalência de utilização da sedação paliativa ao longo do histórico de atuação profissional foi de 68%, mas apenas 48% utilizaram a sedação paliativa no último ano, motivados, principalmente, pela presença de dor no paciente (35%). A frequência de uso foi de uma a seis vezes (66%), e a principal razão para não empregar a sedação paliativa foi a ausência de pacientes elegíveis (64%). Aproximadamente 83% dos médicos sentiam-se confortáveis quanto ao uso de sedação paliativa, mas apenas 26% possuíam formação teórica específica na área. Conclusão A prevalência de uso da sedação paliativa é alta, sendo utilizada, na maioria das vezes, para proporcionar o alívio da dor do paciente. Por outro lado, sua frequência de utilização é baixa, principalmente pela ausência de pacientes elegíveis.

Humans , Palliative Care/statistics & numerical data , Terminal Care , Hypnotics and Sedatives/therapeutic use , Pain , Palliative Care/methods , Palliative Care/ethics , Prevalence , Advance Care Planning/ethics
Rev. bras. anestesiol ; 68(1): 42-48, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897799


Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1, Group C getting clonidine 1 and Group D patients receiving dexmedetomidine 0.5 The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo-cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 de tramadol (Grupo T), 1 de clonidina (Grupo C) e 0,5 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis.

Humans , Male , Female , Adult , Shivering/drug effects , Tramadol/therapeutic use , Clonidine/therapeutic use , Dexmedetomidine/therapeutic use , Hypnotics and Sedatives/therapeutic use , Intraoperative Complications/drug therapy , Anesthesia, Spinal/adverse effects , Narcotics/therapeutic use , Double-Blind Method , Prospective Studies
Rev. gaúch. enferm ; 39: e20170157, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-960821


Resumo OBJETIVO Descrever os cuidados multiprofissionais para manejo de pacientes críticos em delirium na UTI a partir das evidências encontradas na literatura. MÉTODOS Trata-se de uma revisão integrativa realizada no período de 1º de fevereiro a 30 de junho de 2016 através de busca nas bases de dados PubMed, Scopus, Web of Science e CINAHL com os descritores delirium, critical care e intensive care units que finalizou com 17 estudos originais. RESULTADOS Foram encontrados um bundle e uma diretriz, duas revisões sistemáticas, evidência 1a e quatro ensaios clínicos, evidência 1b e 2b, os demais estudos de coorte e observacionais. Os cuidados multiprofissionais foram apresentados para melhor entendimento em diagnóstico de delirium, pausa de sedação, mobilização precoce, diretrizes para dor, agitação e delirium, agitação psicomotora, orientação cognitiva, promoção do sono, ambiente e participação da família. CONCLUSÃO Os cuidados para delirium são abrangentes e pouco específicos, determinando seu aspecto multifatorial.

Resumen OBJETIVO Se objetivó describir los cuidados multiprofesionales para manejo de pacientes críticos en delirium en la UTI a partir de las evidencias encontradas en la literatura. MÉTODOS Se trata de una revisión integradora realizada en el período del 1 de febrero al 30 de junio de 2016 a través de búsqueda en PubMed, Scopus, Web of Science, and CINAHL con descriptores delirium, critical care e intensive care units que finalizó 17 estudios originales. RESULTADOS Fueron encontrados un bundle, una directriz, dos revisiones sistemáticos, evidencia 1a, cuatro ensayos clínicos, evidencia 1b y 2b, los demás estudios de cohorte y observacionales. Los cuidados multiprofesionales fueron presentados para mejor entenderse el diagnóstico de delirium, pausa de sedación, movilización temprana, directrices para dolor, agitación, y delirium, agitación psicomotora, orientación cognitiva, promoción de sueño, ambiente y participación de la familia. CONCLUSIÓN Los cuidados para delirium son más amplio y poco específicos, determinando su aspecto multifactorial.

Abstract OBJECTIVE To describe the multiprofessional care for the management of critical patients in delirium in the ICU from the evidences found in the literature. METHODS This integrative review was carried out in the period from February 1 to June 30, 2016 through searches on PubMed, Scopus, Web of Science, and CINAHL, with the following descriptors: delirium, critical care e intensive care units, which brought up 17 original papers. RESULTS A bundle and a guideline, two systematic reviews, evidence 1a and four clinical trials, evidence 1b and 2b, cohort and observational studies were found. The multiprofessional care was presented to better understand the diagnosis of delirium, sedation pause, early mobilization, pain, agitation and delirium guidelines, psychomotor agitation, cognitive orientation, sleep promotion, environment and family participation. CONCLUSION The care for delirium is wide and not specific, which determines its multifactorial aspect.

Humans , Patient Care Team , Critical Care/methods , Delirium/therapy , Orientation , Psychomotor Agitation , Psychomotor Agitation/drug therapy , Psychomotor Agitation/therapy , Sensory Aids , Sleep , Antipsychotic Agents/therapeutic use , Caregivers , Practice Guidelines as Topic , Combined Modality Therapy , Delirium/nursing , Delirium/drug therapy , Delirium/rehabilitation , Patient Care Bundles , Hypnotics and Sedatives/therapeutic use , Intensive Care Units , Music Therapy
Rev. paul. pediatr ; 34(4): 408-411, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-830743


Abstract Objective: To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. Methods: All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. Results: The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. Conclusions: The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

Resumo Objetivo: Descrever a eficácia e a segurança do hidrato de cloral na sedação de lactentes para testes de função pulmonar. Métodos: Foram avaliadas retrospectivamente todas as tentativas de sedação para exames de função pulmonar em lactentes feitas entre junho 2007 e agosto 2014. Apneia obstrutiva do sono e cardiopatia foram contraindicações para os exames. Dados antropométricos, indicação do exame, dose empregada, desfechos da sedação e intercorrências clínicas foram registrados e descritos. Resultados: Avaliaram-se as tentativas de sedação de 277 lactentes (165 meninos) com mediana de 51,5 semanas de vida (14-182). A principal indicação para os testes foi sibilância recorrente (56%) e a dose de hidrato de cloral usada variou entre 50-80mg/kg (via oral). Dezoito (6,5%) lactentes apresentaram algum tipo de intercorrência clínica e foram as mais frequentes: tosse e/ou secreção na via aérea (1,8%); desconforto respiratório alto (1,4%) e vômitos (1,1%). Um lactente prematuro apresentou bradicardia por cerca de 15 minutos, responsiva a estimulação tátil. Todos os efeitos adversos observados foram transitórios e não houve necessidade de manobras de reanimação e uso de medicações injetáveis. Conclusões: Os dados demonstraram que o hidrato de cloral, nas doses empregadas, é um medicamento seguro e eficaz para a sedação de lactentes em procedimentos de curta duração, como os testes de função pulmonar. Devido à possibilidade de eventos adversos graves, as recomendações referentes à dosagem e contraindicações devem ser seguidas de forma rígida e os lactentes devem ser monitorados por equipe treinada.

Humans , Male , Female , Infant , Child, Preschool , Respiratory Function Tests , Chloral Hydrate/therapeutic use , Conscious Sedation , Hypnotics and Sedatives/therapeutic use , Retrospective Studies , Treatment Outcome
Rev. bras. anestesiol ; 66(6): 583-593, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-829717


Abstract This study was designed to investigate whether dexmedetomidine and thiopental have cerebral protective effects after focal cerebral ischemia in rats. Thirty male Sprague Dawley rats were randomly assigned to three groups: control group (Group C, n = 10), dexmedetomidine group (Group D, n = 10), thiopental group (Group T, n = 10). After all rats were anesthetized, they were intubated, then mechanically ventilated. A catheter was inserted into the right femoral artery for continuous mean arterial pressure, physiological parameters and blood sampling at baseline, 5 min after occlusion and 20 min after reperfusion. A catheter was inserted into the left femoral vein for intravenous (IV) medication administration. Right common carotid artery of each rat was isolated and clamped for 45 min. At the end of the duration common carotid artery were unclamped and the brain reperfusion was achieved for 90 min. Dexmedetomidine was administered for Group D IV infusion, and Group T received thiopental IV. According to histopathologic scores cerebral ischemia was documented in all rats in Group C, but no ischemia was found in three rats in Group T and in four rats in Group D. Grade 3 cerebral ischemia was documented in three rats in Group C, and in only one rat in both groups T and D. For histopathologic grades the difference between Group T and Group D was not significant (p > 0.05). But the differences between Group C and Group T (p < 0.05) and Group C and Group D (p < 0.01) were statically significant. In conclusion, we demonstrated that dexmedetomidine and thiopental have experimental histopathologic cerebral protective effects on experimental focal cerebral ischemia in rats.

Resumo Este estudo foi desenhado para investigar se dexmedetomidina e tiopental têm efeitos protetores cerebrais após isquemia cerebral focal em ratos. Trinta ratos da linhagem Sprague Dawley foram randomicamente alocados em três grupos: controle (Grupo C, n = 10), dexmedetomidina (Grupo D, n = 10) e tiopental (Grupo T, n = 10). Após a anestesia, foram intubados e ventilados mecanicamente. Um cateter foi inserido na artéria femoral direita para monitoração contínua da pressão arterial média (PAM) e dos parâmetros fisiológicos e para coleta de amostras de sangue na fase basal, 5 minutos após a oclusão e 20 minutos após a reperfusão. Um cateter foi inserido na veia femoral esquerda para administração intravenosa (IV) de medicamentos. A artéria carótida comum direita de cada rato foi isolada e pinçada durante 45 minutos. No fim dos 45 minutos, o pinçamento foi removido e a reperfusão do cérebro foi obtida por 90 minutos. Dexmedetomidina foi administrada por infusão IV no Grupo D e tiopental no Grupo T. De acordo com as pontuações histopatológicas, isquemia cerebral foi observada em todos os ratos do Grupo C, mas não foi encontrada em três ratos do Grupo T e em quatro ratos do Grupo D. O grau 3 de isquemia cerebral foi encontrada em três ratos do grupo C e em apenas um rato de ambos os grupos T e D. Para os graus histopatológicos, a diferença entre o Grupo T e o Grupo D não foi significativa (p > 0,05). Porém, as diferenças entre o Grupo C e o Grupo T (p < 0,05) e entre o Grupo C e o Grupo D (p < 0,01) foram estatisticamente significativas. Em conclusão, demonstramos que dexmedetomidina e tiopental têm efeitos histopatológicos protetores cerebrais sobre isquemia cerebral focal experimental em ratos.

Animals , Male , Rats , Thiopental/therapeutic use , Brain Ischemia/prevention & control , Neuroprotective Agents/therapeutic use , Dexmedetomidine/therapeutic use , Hypnotics and Sedatives/therapeutic use , Respiration, Artificial , Reperfusion Injury/prevention & control , Brain Ischemia/pathology , Rats, Sprague-Dawley , Anesthesia
Online braz. j. nurs. (Online) ; 15(2): 157-166, jun. 2016. tab
Article in English, Spanish, Portuguese | LILACS, BDENF | ID: biblio-1122049


OBJETIVO: avaliar o processo de sedação e analgesia em pacientes sob ventilação mecânica invasiva (VMI). MÉTODO: estudo transversal, observacional, realizado de setembro de 2014 a fevereiro de 2015 na UTI de uma instituição de ensino de Goiânia/GO. A amostra foi constituída de 30 pacientes maiores de 18 anos, intubados e sedados há mais de 24 horas (protocolo no. 763.827/2014). RESULTADOS: foram utilizadas analgesia e sedação contínua e intermitente, sendo o fentanil e o dormonid as drogas mais usadas. DISCUSSÃO: o tratamento padrão entre pacientes críticos e submetidos à VMI foi a sedação contínua, administrada devido à ansiedade, para facilitar o cuidado da equipe de enfermagem. A principal indicação para sedação foi a manutenção de VMI. CONCLUSÃO: falta padronização das condutas no manejo da sedação. Recomenda-se a elaboração de protocolos com atuação da equipe multiprofissional.

AIM: to evaluate the process of sedation and analgesia in patients undergoing invasive mechanical ventilation (IMV). METHOD: cross-sectional, observational study conducted from September 2014 to February 2015 in the ICU of a teaching institution in Goiânia/GO. The sample consisted of 30 patients over 18 years old, intubated and sedated for more than 24 hours (protocol no. 763.827/2014). RESULTS: continuous and intermittent sedation, and analgesia were used, with fentanyl and midazolam hydrochloride commonly used drugs. DISCUSSION: the standard treatment for critically ill patients and submitted to IMV was continuous sedation administered due to anxiety in order to facilitate the nursing staff care. The main indication for sedation was the maintenance of IMV. CONCLUSION: lack standardization of approaches in the management of sedation. It is recommended to develop protocols with multidisciplinary effort.

OBJETIVO: evaluar el proceso de sedación y analgesia en pacientes bajo ventilación mecánica invasiva (VMI). MÉTODO: estudio transversal, observacional, realizado de septiembre de 2014 a febrero de 2015 en la UTI de una institución de educación de Goiânia/GO. La muestra fue constituida de 30 pacientes mayores de 18 años, intubados y sedados hace más de 24 horas (protocolo no. 763.827/2014). RESULTADOS: fueron utilizadas analgesia y sedación continua e intermitente, siendo el fentanil y el dormonid las drogas más usadas. DISCUSIÓN: el tratamiento estándar entre pacientes críticos y sometidos a la VMI fue la sedación continua, administrada debido a la ansiedad, para facilitar el cuidado del equipo de enfermería. La principal indicación para sedación fue el mantenimiento de VMI. CONCLUSIÓN: falta estandarización de las conductas en el manejo de la sedación. Se recomienda la elaboración de protocolos con actuación del equipo multidisciplinar.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Respiration, Artificial , Deep Sedation , Hypnotics and Sedatives , Inpatients , Intensive Care Units , Hypnotics and Sedatives/therapeutic use , Inpatients/statistics & numerical data
Clinics ; 71(1): 5-9, Jan. 2016. tab
Article in English | LILACS | ID: lil-771945


OBJECTIVE: To determine the therapeutic effects of two selective GABA-A agonists, zopiclone and eszopiclone, in the treatment of insomnia. METHODS: This study comprised a phase III, single-center, randomized, double-blind, double-dummy, parallel-group, non-inferiority trial. Patients were randomized to receive zopiclone 7.5 mg or eszopiclone 3 mg, both orally, for four weeks. In total, 199 patients were evaluated during two visits and then followed for at least six weeks. The primary endpoint was the Insomnia Severity Index after four weeks of treatment. Secondary endpoints were obtained through polysomnography data, including total sleep time, sleep latency and sleep efficiency. The frequency of adverse events was also analyzed. NCT01100164. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of eszopiclone over zopiclone. Analysis of objective parameters assessed by polysomnography showed that eszopiclone increased total sleep time and also improved sleep efficiency. The safety profile of both study treatments was similar and the most common events reported in both groups were dysgeusia, headache, dizziness, irritability and nausea. Adverse events were observed in 223 patients, 109 (85.2%) in the eszopiclone group and 114 (87.7%) in the zopiclone group. CONCLUSION: Based on the Insomnia Severity Index at the end of four weeks of treatment, eszopiclone demonstrated efficacy comparable to that of zopiclone in the treatment of insomnia, increasing total sleep time as well as sleep efficiency according to polysomnography.

Adult , Female , Humans , Male , Middle Aged , Young Adult , Azabicyclo Compounds/therapeutic use , Eszopiclone/therapeutic use , Hypnotics and Sedatives/therapeutic use , Piperazines/therapeutic use , Sleep Initiation and Maintenance Disorders/drug therapy , Azabicyclo Compounds/adverse effects , Double-Blind Method , Dysgeusia/chemically induced , Eszopiclone/adverse effects , Headache/chemically induced , Hypnotics and Sedatives/adverse effects , Polysomnography , Piperazines/adverse effects , Treatment Outcome
Braz. oral res. (Online) ; 30(1): e107, 2016. tab, graf
Article in English | LILACS | ID: biblio-951964


Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Humans , Male , Female , Child, Preschool , Child Behavior/drug effects , Conscious Sedation/methods , Dental Care for Children/methods , Midazolam/therapeutic use , Proportional Hazards Models , Prospective Studies , Reproducibility of Results , Analysis of Variance , Age Factors , Treatment Outcome , Dental Anxiety/prevention & control , Statistics, Nonparametric , Dental Caries/therapy , Hypnotics and Sedatives/therapeutic use , Anesthesia, General/methods , Ketamine/therapeutic use , Anesthetics, Dissociative/therapeutic use
Säo Paulo med. j ; 133(1): 67-67, Jan-Fev/2015.
Article in English | LILACS | ID: lil-733005


BACKGROUND: Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality. OBJECTIVES: To evaluate the effects of pharmacological interventions to reduce sleepiness or to improve alertness at work and decrease sleep disturbances whilst of work, or both, in workers undertaking shift work. METHODS: Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and PsycINFO up to 20 September 2013 and up to July 2013. We also screened reference lists of included trials and relevant reviews. Selection criteria: We included all eligible randomised controlled trials (RCTs), including cross-over RCTs, of pharmacological products among workers who were engaged in shift work (including night shifts) in their present jobs and who may or may not have had sleep problems. Primary outcomes were sleep length and sleep quality while of work, alertness and sleepiness, or fatigue at work. Data collection and analysis: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We performed meta-analyses where appropriate. ...

Humans , Hypnotics and Sedatives/therapeutic use , Melatonin/therapeutic use , Sleep Disorders, Circadian Rhythm/drug therapy , Sleep/drug effects , Wakefulness-Promoting Agents/therapeutic use
Yonsei Medical Journal ; : 772-777, 2015.
Article in English | WPRIM | ID: wpr-77287


PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.

Adult , Analgesia/methods , Analgesics/therapeutic use , Arthroscopy/adverse effects , Female , Humans , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , Pain Management , Pain Measurement , Pain, Postoperative/drug therapy , Postoperative Period , Prospective Studies , Pyridines/therapeutic use , Rotator Cuff/injuries , Sleep/drug effects , Treatment Outcome , Visual Analog Scale
Clinics ; 69(11): 777-786, 11/2014. tab, graf
Article in English | LILACS | ID: lil-731102


Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

Child , Child, Preschool , Female , Humans , Male , /therapeutic use , Anesthesia/methods , Dexmedetomidine/therapeutic use , Premedication/methods , Anesthetics, Dissociative/therapeutic use , Hypnotics and Sedatives/therapeutic use , Ketamine/therapeutic use , Midazolam/therapeutic use , Randomized Controlled Trials as Topic
Lima; s.n; 2014. 59 p. tab, graf.
Thesis in Spanish | LILACS, LIPECS | ID: lil-737420


El Objetivo del estudio fue determinar los conocimientos que tienen las enfermeras sobre el cuidado de pacientes con sedoanalgesia en la Unidad de Cuidados Intensivos de la Clínica San Pablo 2011. Metodología: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal, la población fue de 20. La técnica fue la encuesta y el instrumento un cuestionario aplicado previo consentimiento informado. Resultados: del 100 por ciento (20), 60 por ciento (12) conocen y 40 por ciento (8) no conocen; en cuanto a los aspectos conceptuales 70 por ciento (14) conocen y 30 por ciento (6) no conocen, a cerca de la valoración 70 por ciento (14) conocen y 30 por ciento (6) no conocen, en cuanto a los niveles de sedación 80 por ciento (16) conocen y 20 por ciento (4) no conocen; de las medidas complementarias 90 por ciento (18) conocen y 10 por ciento (2) no conocen. Conclusión: El mayor porcentaje de enfermeros conocen sobre el cuidado de pacientes con sedoanalgesia referido por fármacos más utilizados, valoración del dolor y medidas para promover un entorno físico favorable, sin embargo existe un porcentaje significativo que no conocen a cerca del nivel de sedación en pacientes con ARDS, post operado cardiovascular y las recomendaciones antes de iniciar sedación en el paciente crítico...

The aim of the study was to determine the knowledge they have nurses on the care of patients with sedoanalgesia in the Intensive Care San Pablo Clinic, 2011. Methodology is the study level application, quantitative, cross-sectional method, the population was 20. Technique was the survey instrument and a questionnaire administered prior informed consent. Results: of 100 per cent (20), 60 per cent (12) know and 40 per cent (8) do not know; about conceptual aspects 70 per cent (14) meet and 30 per cent (6) does not know, to about the value 70 per cent (14) meet and 30 per cent (6) not known, in terms of levels of sedation 80 per cent (16) know and 20 per cent (4) do not know; accompanying measures 90 per cent (18) know and 10 per cent (2) do not know. Conclusion: The highest percentage of nurses know about caring for patients referred by sedoanalgesia drugs most used pain assessment and measures to promote a favorable physical environment, however there is a significant percentage who do not know about the level of sedation in patients with ARDS, after cardiovascular surgery and recommendations before starting sedation in critically ill patients...

Humans , Male , Adult , Female , Middle Aged , Analgesia , Nursing Care , Aftercare , Hypnotics and Sedatives/therapeutic use , Pain Management , Intensive Care Units , Evaluation Studies as Topic , Cross-Sectional Studies
Article in Korean | WPRIM | ID: wpr-202153


PURPOSE: This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation. METHODS: Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model. RESULTS: Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients). CONCLUSION: Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

Age Factors , Aged , Consciousness , Device Removal , Female , Humans , Hypnotics and Sedatives/therapeutic use , Intensive Care Units , Intubation, Intratracheal/mortality , Kaplan-Meier Estimate , Male , Middle Aged , Nurses/statistics & numerical data , Proportional Hazards Models , Psychomotor Agitation , Retrospective Studies , Risk Factors , Workload
Rev. gaúch. enferm ; 34(3): 55-63, set. 2013. tab
Article in Portuguese | LILACS, BDENF | ID: lil-695256


Estudo transversal prospectivo que teve como objetivo descrever o conhecimento da equipe de enfermagem sobre uma avaliação comportamental de dor. Realizado em hospital privado da cidade de São Paulo, Brasil, em novembro de 2011, com profissionais de enfermagem de uma UTI geral adulto. Estes responderam a um questionário com dados sociodemográficos e questões referentes ao conhecimento sobre uma avaliação comportamental de dor. A análise dos dados foi descritiva e a média de acertos por categoria profissional foi comparada por teste Mann-Whitney. Dos 113 participantes, mais de 70% demonstraram ter conhecimento sobre os principais aspectos dessa avaliação e não houve diferença estatisticamente significativa entre as categorias profissionais. Concluiu-se que o conhecimento dos profissionais foi satisfatório, mas pode ser aprimorado.

Estudio transversal prospectivo que tuvo como objetivo describir el conocimiento del equipo de enfermería con relación a evaluación del comportamiento del dolor. Realizado en un hospital privado de la ciudad de São Paulo, Brasil en noviembre de 2011 con profesionales de enfermería de una UTI general adulto. La población estudiada respondió a un cuestionario con datos demográficos y preguntas relacionadas al conocimiento sobre una evaluación de comportamiento del dolor. El análisis de datos fue descriptivo y el promedio de aciertos por categoría profesional fue comparado por el test de Mann-Whitney. De los 113 participantes, el 70% demostró el conocimiento de los principales aspectos de esta evaluación y no hubo diferencia estadísticamente significativa entre las categorías profesionales. Se concluye que el conocimiento de los profesionales era satisfactorio, pero se puede mejorar.

This investigation consisted on a prospective cross-sectional study that aimed to describe the nursing team knowledge on behavioral assessment of pain. The study was conducted in a private hospital in the city of São Paulo, Brazil, in November 2011, with nursing professionals from a general adult intensive care unit. They answered a questionnaire that contained sociodemographic data and questions related to knowledge about a behavioral assessment of pain. Descriptive data analysis was carried out and the average positive score was compared among categories using the Mann-Whitney test. Out of the 113 participants, over 70% have demonstrated knowledge of the main aspects of this assessment and there was no statistical significant difference among the professional categories. It was concluded that the knowledge of the professionals was satisfactory, but it can be improved.

Adult , Female , Humans , Male , Critical Illness/psychology , Illness Behavior , Nonverbal Communication , Nursing Assistants/psychology , Nurses/psychology , Nursing Diagnosis , Nursing, Team , Pain Measurement , Pain/diagnosis , Analgesics/therapeutic use , Brazil , Critical Care Nursing/education , Critical Illness/nursing , Cross-Sectional Studies , Educational Measurement , Hospitals, Private , Hospitals, Urban , Hypnotics and Sedatives/therapeutic use , Intensive Care Units , Nursing Assistants/education , Pain Management/nursing , Pain Management/psychology , Pain Measurement/nursing , Pain Measurement/psychology , Pain/nursing , Pain/physiopathology , Pain/psychology , Patient Care Team , Prospective Studies , Surveys and Questionnaires
Med. infant ; 19(4): 260-263, dic. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-774350


Introducción: La administración de midazolam por atomizador nasal podría ser eficaz y segura en emergencias pediátricas. Objetivos: describir la administración de midazolam utilizando el atomizador nasal; conocer las complicaciones asociadas. Métodos: Diseño: descriptivo, prospectivo. Pacientes que recibieron midazolam mediante MAD®, entre el 01/08/2007 y el 30/03/2008. Resultados: el dispositivo fue usado 28 veces; niños con edad media de 38 meses, 64% de sexo masculino. Motivos de uso: procedimientos 71,43% y convulsiones 28,57%. Procedimientos: la media de dosis utilizada fue 0,27mg/kg, la media de comienzo de acción 3 minutos. En las convulsiones febriles, luego de fracasar la búsqueda de un acceso endovenoso, se procedió a la administración de la droga por MAD® siendo el tiempo medio desde el inicio del episodio convulsivo hasta el comienzo de la administración de la droga de 3.42 minutos y la dosis media 0.3 mg/kg. No se observaron complicaciones. Conclusiones:1) la administración de midazolam por el atomizador nasal es segura y eficaz; 2) no hubo complicaciones.

Introduction: Midazolam administration using an intranasal spray (MAD®) may be efficacious and safe in pediatric emer-gencies. Objectives: 1) To describe midazolam administration using an intranasal atomizer. 2) To assess the complications associated with intranasal midazolam. Methods: Design: A descriptive and prospective study in patients who were ad-ministered midazolam via MAD® between 01/08/2007 and 30/03/2008. Results: Intranasal midazolam was used 28 times in children with a mean age of 38 months (SD 28.44); 64% were boys. Reasons for administrartion were: Procedures in 71.43% (n=20) and seizures in 28.57% (n=8). Procedures: Mean dose used was 0.27 mg/kg (SD 0.35), and mean time to effect onset was 3 minutes (SD 3.5). In febrile seizures, after search for intravenous access had failed, midazolam was administered using MAD® with a mean time interval between seizure onset and drug administration of 3.42 (SD 6.61) min-utes and at a mean dose of 0.3 mg/kg. No complications were observed. Conclusions: 1) Intranasal midazolam administration was safe and efficacious. 2) No complications were observed.

Humans , Male , Female , Child, Preschool , Ambulatory Care , Emergencies , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/therapeutic use , Midazolam/administration & dosage , Midazolam/therapeutic use , Nebulizers and Vaporizers , Administration, Intranasal , Seizures, Febrile/therapy