ABSTRACT
Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]
Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]
Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]
Subject(s)
Humans , Male , Female , Middle Aged , Midazolam/therapeutic use , Fentanyl/therapeutic useABSTRACT
Introducción: En de la población adulta predomina la enfermedad pulmonar, pero el coronavirus infantil grave parece más tipificado por una respuesta inflamatoria inmunomediada, con o sin síndrome inflamatorio multisistémico asociado. Objetivo: Examinar un paciente pediátrico con accidente cerebrovascular, como consecuencia de la enfermedad producida por el coronavirus tipo 2. Presentación del caso: Lactante femenina de 6 meses, que se presentó a emergencia con historia de fiebre de 39 oC, sin predominio de horario, de 10 días de evolución que no cedió con antipiréticos tipo acetaminofén, y dificultad respiratoria en los 3 días previos a su presentación en emergencia del hospital. Antecedentes familiares patológicos positivos, por la enfermedad del coronavirus en su padre. En la radiografía de tórax se observó infiltrado alveolar derecho y se ingresó con diagnóstico de neumonía por síndrome respiratorio agudo grave por coronavirus tipo 2. La tomografía de cráneo registró foco isquémico frontal parasagital derecho y parietal izquierdo; posteriormente se confirmó con resonancia magnética, en cuyo informe se definió la presencia de infartos en fase aguda a nivel frontal derecho y parietal izquierdo. Conclusiones: Se expuso una manifestación infrecuente en población pediátrica asociada a la enfermedad por coronavirus. La tasa de eventos tromboembólicos en el curso de las infecciones virales no es baja, y por coronavirus no es la excepción. Se requieren mayores estudios y pruebas para determinar el papel del síndrome respiratorio agudo severo por coronavirus tipo 2 en el accidente cerebrovascular pediátrico(AU)
Introduction: Pulmonary disease predominates in the adult population, but severe infantile coronavirus appears more typified by an immune-mediated inflammatory response, with or without associated multisystem inflammatory syndrome. Objective: To examine a pediatric patient with stroke resulting from coronavirus type 2 disease. Case presentation: 6-month-old female infant presenting to emergency with history of fever of 39 â with no hourly predominance, of 10 days of evolution that did not subside with acetaminophen-type antipyretics and respiratory distress in the three days prior to presentation to hospital emergency. Positive family history of coronavirus disease in his father. Chest X-ray showed right alveolar infiltrate and she was admitted with a diagnosis of severe acute respiratory syndrome pneumonia due to coronavirus type 2. The cranial tomography recorded a right frontal parasagittal and left parietal ischemic focus, later confirmed by magnetic resonance imaging whose report defined the presence of acute phase infarcts at the right frontal and left parietal levels. Conclusions: An infrequent manifestation in pediatric population associated with coronavirus disease is exposed. The rate of thromboembolic events in the course of viral infections is not low and coronavirus is no exception. Further studies and evidence are required to determine the role of severe acute respiratory syndrome due to coronavirus type 2 in pediatric stroke(AU)
Subject(s)
Humans , Female , Infant , Pneumonia/diagnosis , Seizures/diagnosis , Skull/diagnostic imaging , Stroke/diagnosis , Dysentery, Amebic/diagnosis , COVID-19/etiology , Benzodiazepines/therapeutic use , Midazolam/therapeutic use , Ceftriaxone/therapeutic use , Clarithromycin/therapeutic use , Acetaminophen/therapeutic useABSTRACT
O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.
Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Technology Assessment, Biomedical , Midazolam/therapeutic use , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Influenza Vaccines/therapeutic use , Propofol/therapeutic use , Chloroquine/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Fentanyl/therapeutic use , Cross-Sectional Studies , Cohort Studies , Enoxaparin/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Copper/therapeutic use , Lopinavir/therapeutic use , Resveratrol/therapeutic use , Interferon alpha-2/therapeutic use , Hydroxychloroquine/therapeutic use , Ketamine/therapeutic useABSTRACT
Introducción: El paraganglioma es un tumor neuroendocrino poco frecuente que surge de los paraganglios autonómicos extraadrenales en diversos lugares del organismo. También se les conoce como feocromocitomas extraadrenales. Alrededor de 90 por ciento son benignos y se curan mediante la extirpación quirúrgica, el restante 10 por ciento son malignos, y pueden provocar metástasis a distancia. El diagnóstico es importante por su riesgo de malignidad, por las implicaciones de otras neoplasias asociadas y dada la posibilidad de realizar estudios genéticos para la detección de otros casos dentro de una misma familia. Objetivo: Exponer aspectos clínico-epidemiológicos de esta enfermedad y las implicaciones perioperatorias concernientes a la conducta anestésica perioperatoria de estos pacientes. Caso clínico: Paciente femenina, de 56 años de edad con antecedentes de hipertensión arterial de más dos años de evolución y difícil control, diabetes mellitus e historia de cefalea, palpitaciones y sensación de calor. Diagnóstico imagenológico de una masa pararrenal sospechosa de paraganglioma que se confirmó por estudio histopatológico posterior a la exceresis. Conclusiones: La técnica anestésica para la resección de estos tumores es un desafío importante para el anestesiólogo que debe enfrentar dicha intervención quirúrgica, planteándose los riesgos de las etapas pre-, intra- y posoperatoria(AU)
Introduction: Paraganglioma is a rare neuroendocrine tumor that emerging from the extra-adrenal autonomic paraganglia and it may occur in several parts of the body. Paraganglioma is also named extra-adrenals pheochromocytomas. Roughly 90 percent of these tumors are benign and can be excised through surgery whereas 10 percent of them are malignant and cause distant metastasis. Paragangliomas are closely linked to pheochromocytomas because they cannot be differentiated at cell level and often share the same clinical manifestations such as hypertension, episodic headache, sweating and tachycardia. The diagnosis of these tumors is important because of risk of becoming malignant, the implications of other related neoplasias and the possibility of making genetic studies to detect other cases in the same family. Objective: To expose about epidemiology, clinical manifestations, diagnostic tests and perioperative management of these tumors by a presentation of a clinical case. Case Report: Female 56 years old, clinical history of 2 years of uncontrolled hypertension, diabetes mellitus, who presented with headache, palpitations and feeling of warm. She was diagnosed with a pararrenal mass suspected of paraganglioma associated with catecholamine hypersecretion, confirmed by histopathology. Conclusions: The treatment of these tumors requires a more complete surgical resection possible since the prognosis depends. Surgical management of pheochromocytoma needs special perioperative requirements. The anesthesiologist must observe this surgery, establish the risks of the phase pre-intra and postoperative(AU)
Subject(s)
Humans , Female , Middle Aged , Paraganglioma/surgery , Paraganglioma/diagnostic imaging , Surgical Procedures, Operative , Midazolam/therapeutic use , Early Detection of Cancer/methods , Lidocaine/therapeutic use , AnesthesiologistsABSTRACT
Introducción: Las técnicas de administración de anestesia en cirugía torácica han experimentado gran evolución y mayor fundamento científico. La anestesia intravenosa total basada en la analgesia favorece a que el período perioperatorio transcurra sin dolor y la recuperación sin complicaciones. Objetivo: Comparar la efectividad y seguridad de dos técnicas de anestesia intravenosa total en cirugía torácica electiva con remifentanilo como base analgésica. Métodos: Estudio causiexperimental, prospectivo realizado en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, en el período comprendido entre enero de 2013 a enero de 2015, en 45 pacientes, programados para cirugía torácica electiva, divididos en dos grupos según hipnótico utilizado. Grupo A: Propofol/Remifentanil y Grupo B: Midazolam/Remifentanil. Se evaluaron variables hemodinámicas en diferentes momentos del período intraoperatorio. Variables de oxigenación (PaO2 y SaO2) durante la ventilación unipulmonar y los tiempos de recuperación anestésica. Resultados: Predominaron los pacientes mayores de 60 años en los dos grupos, con estado físico ASA III. No hubo diferencias en la oxigenación arterial entre los grupos. Hubo disminución de la tensión arterial sistólica en el grupo A sin diferencias significativas. La recuperación de la anestesia fue significativamente más demorada en el grupo B. Conclusiones: La técnica de anestesia intravenosa total con remifentanil como base analgésica asociado a propofol resultó segura y efectiva en pacientes operados de cirugía torácica(AU)
Introduction: Anesthesia administration techniques in thoracic surgery have undergone great evolution and greater scientific foundation. Total intravenous anesthesia based on analgesia favors the perioperative period without pain and recovery without complications. Objective: To compare the effectiveness and safety of two techniques of total intravenous anesthesia in elective thoracic surgery with remifentanil as an analgesic base. Methods: Prospective and causiexperimental study carried out at Dr. Salvador Allende Clinical-Surgical Teaching Hospital, in the period from January 2013 to January 2015, with 45 patients scheduled for elective thoracic surgery, who were divided into two groups according to the hypnotic drug used. Group A: propofol/remifentanil, and group B: midazolam/remifentanil. Hemodynamic variables were evaluated at different times during the intraoperative period. Oxygenation variables (PaO2 and SaO2) during unipulmonary ventilation and anesthetic recovery times. Results: Patients older than 60 years predominated in the two groups, with a physical status of ASA III. There were no differences in arterial oxygenation between the groups. There was a decrease in systolic blood pressure in group A without significant differences. The recovery of anesthesia was significantly more delayed in group B. Conclusions: The total intravenous anesthesia technique with remifentanil as an analgesic base associated with propofol was safe and effective in patients undergoing thoracic surgery(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thoracic Surgery/methods , Midazolam/therapeutic use , Propofol/therapeutic use , Anesthesia, Intravenous/methods , Prospective Studies , Non-Randomized Controlled Trials as Topic , Remifentanil/therapeutic useABSTRACT
ABSTRACT Objective: To establish the prevalence of delirium and its subsyndrome in intensive care and to associate it with the use of sedative and analgesia, severity and mortality. Method: Carried out in two intensive care units of adult patients, this is a quantitative and transversal study, with 157 patients, using the Richmond Agitation-Sedation Scale to assess the level of sedation and the Intensive Care Delirium Screening Checklist for delirium. The T test and Chi-square test were applied for statistical analysis. Results: The prevalence of delirium was 22.3%, and 49.7% of the subsyndrome. Associations of the use of midazolam with the presence of delirium (p=0.05) and subsyndromal delirium (p<0.01), use of clonidine with the appearance of delirium (p<0.01) and of fentanyl with subsyndromal delirium (p=0.09). There were no significant differences between the mortality of patients with delirium (p=0.40) and subsyndromal delirium (p=0.86), as well as association with the mortality score. Conclusion: The use of sedoanalgesia is associated with the presence of delirium and subsyndromal delirium. No significant statistical associations were found between the severity and mortality scores.
RESUMEN Objetivo: Establecer la prevalencia del delirio y su subsíndrome en pacientes de cuidados intensivos y asociarlos con el uso de la sedoanalgesia, con la gravedad y con la mortalidad. Método: Realizado en dos unidades de cuidados intensivos de pacientes adultos, se trata de un estudio cuantitativo y transversal, con 157 pacientes, utilizando las escalas Richmond Agitation-Sedation Scale (Escala de agitación-sedación de Richmond) para evaluar el nivel de sedación y la de la Intensive Care Delirium Screening Checklist (Lista de verificación para la detección del delirio en cuidados intensivos) para el delirio. Se aplicaron las pruebas de T y Chi-cuadrado para el análisis estadístico. Resultados: La prevalencia del delirio fue del 22,3%, y la del subsíndrome fue del 49,7%. Se han encontrado asociaciones del uso de midazolan con la presencia de delirio (p = 0,05) y del deilirio subsindromático (p < 0,01), del uso de clonidina con la aparición de delirio (p < 0,01) y de fentanil con el delirio subsindromático (p = 0,09). No se registraron diferencias significativas entre la mortalidad de los pacientes con delirio (p = 0,40) y el delirio. Conclusión: El uso de sedoanalgesia se asocia con la presencia de delirio y delirio subsindromático. No se encontraron asociaciones estadísticas significativas entre la gravedad y las puntuaciones de mortalidad.
RESUMO Objetivo: Estabelecer a prevalência do delirium e sua subsíndrome em pacientes de terapia intensiva e associar com uso de sedoanalgesia, gravidade e mortalidade. Método: Realizado em duas Unidades de Terapia Intensiva de pacientes adultos, trata-se de estudo quantitativo e transversal, com 157 pacientes, utilizando as escalas Richmond Agitation-Sedation Scale para avaliação do nível de sedação e Intensive Care Delirium Screening Checklist para delirium. Foi aplicado o teste t e qui-quadrado para análise estatística. Resultados: A prevalência de delirium foi 22,3% e da subsíndrome 49,7%. Foram encontradas associações do uso de midazolan com a presença de delirium (p=0,05) e delirium subsindromático (p<0,01), uso de clonidina com o aparecimento de delirium (p<0,01) e de fentanil com o delirium subsindromático (p=0,09). Não houve diferenças significativas entre mortalidade de paciente com delirium (p=0,40) e delirium subsindromático (p= 0,86), bem como associação com o escore de mortalidade. Conclusão: O uso de sedoanalgesia está associado à presenta de delirium e delirium subsindromático. Não foram encontradas associações estatísticas significativas entre os escores de gravidade e mortalidade.
Subject(s)
Female , Humans , Male , Middle Aged , Critical Care/statistics & numerical data , Delirium/epidemiology , Analgesics/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam/administration & dosage , Midazolam/adverse effects , Midazolam/therapeutic use , Chi-Square Distribution , Propofol/administration & dosage , Propofol/adverse effects , Fentanyl/administration & dosage , Fentanyl/adverse effects , Prevalence , Cross-Sectional Studies , Clonidine/administration & dosage , Clonidine/adverse effects , Delirium/chemically induced , Analgesics/administration & dosage , Hypnotics and Sedatives/administration & dosage , Intensive Care UnitsABSTRACT
ABSTRACT Objective: To establish the prevalence of delirium and its subsyndrome in intensive care and to associate it with the use of sedative and analgesia, severity and mortality. Method: Carried out in two intensive care units of adult patients, this is a quantitative and transversal study, with 157 patients, using the Richmond Agitation-Sedation Scale to assess the level of sedation and the Intensive Care Delirium Screening Checklist for delirium. The T test and Chi-square test were applied for statistical analysis. Results: The prevalence of delirium was 22.3%, and 49.7% of the subsyndrome. Associations of the use of midazolam with the presence of delirium (p=0.05) and subsyndromal delirium (p<0.01), use of clonidine with the appearance of delirium (p<0.01) and of fentanyl with subsyndromal delirium (p=0.09). There were no significant differences between the mortality of patients with delirium (p=0.40) and subsyndromal delirium (p=0.86), as well as association with the mortality score. Conclusion: The use of sedoanalgesia is associated with the presence of delirium and subsyndromal delirium. No significant statistical associations were found between the severity and mortality scores.
RESUMEN Objetivo: Establecer la prevalencia del delirio y su subsíndrome en pacientes de cuidados intensivos y asociarlos con el uso de la sedoanalgesia, con la gravedad y con la mortalidad. Método: Realizado en dos unidades de cuidados intensivos de pacientes adultos, se trata de un estudio cuantitativo y transversal, con 157 pacientes, utilizando las escalas Richmond Agitation-Sedation Scale (Escala de agitación-sedación de Richmond) para evaluar el nivel de sedación y la de la Intensive Care Delirium Screening Checklist (Lista de verificación para la detección del delirio en cuidados intensivos) para el delirio. Se aplicaron las pruebas de T y Chi-cuadrado para el análisis estadístico. Resultados: La prevalencia del delirio fue del 22,3%, y la del subsíndrome fue del 49,7%. Se han encontrado asociaciones del uso de midazolan con la presencia de delirio (p = 0,05) y del deilirio subsindromático (p < 0,01), del uso de clonidina con la aparición de delirio (p < 0,01) y de fentanil con el delirio subsindromático (p = 0,09). No se registraron diferencias significativas entre la mortalidad de los pacientes con delirio (p = 0,40) y el delirio. Conclusión: El uso de sedoanalgesia se asocia con la presencia de delirio y delirio subsindromático. No se encontraron asociaciones estadísticas significativas entre la gravedad y las puntuaciones de mortalidad.
RESUMO Objetivo: Estabelecer a prevalência do delirium e sua subsíndrome em pacientes de terapia intensiva e associar com uso de sedoanalgesia, gravidade e mortalidade. Método: Realizado em duas Unidades de Terapia Intensiva de pacientes adultos, trata-se de estudo quantitativo e transversal, com 157 pacientes, utilizando as escalas Richmond Agitation-Sedation Scale para avaliação do nível de sedação e Intensive Care Delirium Screening Checklist para delirium. Foi aplicado o teste t e qui-quadrado para análise estatística. Resultados: A prevalência de delirium foi 22,3% e da subsíndrome 49,7%. Foram encontradas associações do uso de midazolan com a presença de delirium (p=0,05) e delirium subsindromático (p<0,01), uso de clonidina com o aparecimento de delirium (p<0,01) e de fentanil com o delirium subsindromático (p=0,09). Não houve diferenças significativas entre mortalidade de paciente com delirium (p=0,40) e delirium subsindromático (p= 0,86), bem como associação com o escore de mortalidade. Conclusão: O uso de sedoanalgesia está associado à presenta de delirium e delirium subsindromático. Não foram encontradas associações estatísticas significativas entre os escores de gravidade e mortalidade.
Subject(s)
Female , Humans , Male , Middle Aged , Critical Care/statistics & numerical data , Delirium/epidemiology , Analgesics/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam/administration & dosage , Midazolam/adverse effects , Midazolam/therapeutic use , Chi-Square Distribution , Propofol/administration & dosage , Propofol/adverse effects , Fentanyl/administration & dosage , Fentanyl/adverse effects , Prevalence , Cross-Sectional Studies , Clonidine/administration & dosage , Clonidine/adverse effects , Delirium/chemically induced , Analgesics/administration & dosage , Hypnotics and Sedatives/administration & dosage , Intensive Care UnitsABSTRACT
ABSTRACT Objective: to identify the factors associated to Potential Drug Interactions with High Alert Medications in the Intensive Care Unit of a Sentinel Hospital. Methods: a cross-sectional, retrospective study using a quantitative approach carried out at a Sentinel Hospital in Rio de Janeiro. The research was based on the analysis of the prescriptions of patients hospitalized in the Intensive Care Unit of the Hospital, in a period of one year, in order to identify the drug interactions related to high alert medications in these prescriptions. Results: Of the 60 prescriptions analyzed, 244 were selected. In these prescriptions, 846 potential drug interactions related to high alert medications and 33 high alert medications were identified. Of the 112 types of potential drug interactions identified, some were more recurrent: tramadol e ondansetron, midazolam and omeprazole, regular insulin and hydrocortisone, fentanyl and midazolam, and regular insulin and noradrenaline. The variables polypharmacy, length of hospital stay, and some specific medications were associated with drug interactions with high alert medications. Conclusion and Implications for practice: It is important to strengthen strategies to reduce adverse drug events. Therefore, the relevance of studies that investigate the origin of these events is highlighted. Drug interactions can represent medication errors. It's indispensable to work with strategies to better manage the medication system.
RESUMEN Objetivo: identificar los puntos asociados a las Interacciones Medicamentos Potenciales con Medicamentos de alta vigilancia en un Centro de Cuidados Intensivos de un Hospital de Guardia. Métodos: estudio transversal, retrospectivo, de abordaje cuantitativo, realizado en un hospital de guardia en Rio de Janeiro. Esta investigación se basó en el análisis de las prescripciones medicamentosas de pacientes internados en un Centro de Cuidados Intensivos de un hospital, en un período de 1 año, con el objetivo de identificar las interacciones medicamentosas relacionadas con Medicamentos de alta Vigilancia recurrentes en las mismas. Resultados: de los informes analizados, se seleccionaron 244 prescripciones medicamentosas. En las 244 prescripciones de medicamentos, se pudieron identificar 846 Interacciones de Medicamentos Potenciales (IMP) relacionados a Medicamentos de Alta Vigilancia y 33 Medicamentos de Alta Vigilancia. De los 112 tipos de interacciones de medicamentos potenciales identificados, algunos han sido más recurrentes; a saber: tramadol y ondansetrón, midazolam y omeprazol, insulina regular e hidrocortisona, fentanilo y midazolam, insulina regular y noradrenalina. Las variables polifarmacia, tiempo de internación y algunos medicamentos específicos se asociaron a las interacciones medicamentosas potenciales con Medicamentos de Alta Vigilancia. Conclusión e Implicaciones para la práctica: es importante fortalecer las estrategias para reducir los eventos adversos relacionados con medicamentos. Por lo tanto, se destaca la relevancia de los estudios que plantean la naturaleza de estos eventos. Las interacciones medicamentosas pueden provocar errores de medicación. Es imprescindible trabajar con estrategias para administrar mejor el sistema de medicación.
RESUMO Objetivo: Identificar os fatores associados às Interações Medicamentosas Potenciais com Medicamentos de alta vigilância em Centro de Terapia Intensiva de um Hospital Sentinela. Métodos: Estudo transversal, retrospectivo, de abordagem quantitativa, realizado em um hospital sentinela no Rio de Janeiro. A pesquisa apoiou-se na análise das prescrições de pacientes internados no setor, com recorte temporal de 1 ano, a fim de identificar as interações medicamentosas relacionadas a medicamentos de alta vigilância recorrentes nas mesmas. Resultados: Dos 60 prontuários analisados, selecionaram-se 244 prescrições. Nelas identificaram-se 846 interações medicamentosas potenciais, relacionadas aos medicamentos de alta vigilância e 33 medicamentos de alta vigilância. Dos 112 pares de interações identificadas, foram mais recorrentes: tramadol e ondansetrona, midazolam e omeprazol, insulina regular e hidrocortisona, fentanil e midazolam, e insulina regular e noradrenalina. As variáveis polifarmácia, tempo de internação e alguns medicamentos específicos foram associadas às interações com medicamentos de alta vigilância. Conclusão e Implicações para a prática: É importante fortalecer as estratégias para reduzir os eventos adversos relacionados a medicamentos. Portanto, destaca-se a relevância de estudos que levantem a natureza desses eventos. As interações medicamentosas podem configurar erros de medicação. Portanto, é indispensável que se trabalhe com estratégias para melhor manejar o sistema de medicação.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Drug Prescriptions/statistics & numerical data , Drug Interactions , Pharmacovigilance , Tramadol/therapeutic use , Health Profile , Midazolam/therapeutic use , Omeprazole/therapeutic use , Hydrocortisone/therapeutic use , Norepinephrine/therapeutic use , Fentanyl/therapeutic use , Medical Records , Cross-Sectional Studies , Retrospective Studies , Ondansetron/therapeutic use , Polypharmacy , Insulin, Regular, Human/therapeutic use , Patient Safety , Amiodarone/therapeutic use , Inpatients , Intensive Care Units , Length of Stay/statistics & numerical dataABSTRACT
Resumen El miedo y la ansiedad de los niños por el tratamiento dental pueden conducir a dificultades en el manejo de la conducta por parte del profesional, lo cual puede ser una barrera para el éxito del tratamiento dental. Los niños no cooperadores pueden necesitar recibir tratamiento dental bajo sedación, la que se indica cuando la guía de comportamiento no farmacológico no tiene éxito. Existen ensayos controlados aleatorios que comparan diferentes protocolos sedantes para procedimientos dentales; sin embargo, la evidencia de superioridad de una forma sobre otra es débil. El objetivo del presente estudio es evaluar el efecto sedativo de Midazolam por vía subcutánea, con y sin ketamina, en procedimientos odontológicos realizados en pacientes pediátricos no cooperadores. Se llevó a cabo un ensayo clínico aleatorizado, cruzado, con cegamiento simple, en 13 niños (10 del género masculino y 3 del femenino) de 19 a 48 meses de edad, ASA I y comportamiento Frankl I. Los dos métodos se aplicaron en el mismo paciente, y el orden de los mismos fue asignado aleatoriamente, para las dos citas de tratamiento. En cada sesión se evaluaron: el comportamiento general del paciente, los movimientos corporales y el llanto, por medio de la escala de Houpt modificada. Además, se monitorearon la frecuencia cardíaca y la saturación de oxígeno por medio de un oxímetro de pulso.
Abstract Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak. The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients. A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Anxiety/drug therapy , Midazolam/therapeutic use , Ketamine/therapeutic useABSTRACT
This paper pretends to demonstrate the effect of the combination of transversus abdominis plane block (TAP block) and Serratus plane block (SP block) techniques in analgesia of 4 dogs undergoing total unilateral mastectomy. Dogs were premedicated with methadone (0.5mg.kg-1) intramuscularly. Anesthesia was induced with propofol (6mg.kg-1) and midazolam (0.3mg.kg-1) and maintained with isoflurane. SP and TAP block were performed unilaterally using ultrasound by the injection of bupivacaine 0.25% (0.3mL kg-1) diluted with NaCl solution 1:1. Heart rate (HR), respiratory rate (f), non-invasive arterial pressure, esophageal temperature (T), oxygen saturation (SpO2) and electrocardiogram were monitored continuously. Animals were monitored for two and four hours after extubation for pain by using the Canine Acute Pain Scale from Colorado State University. Two hours after extubation, tramadol (4mg.kg-1) and dipyrone (25mg.kg-1) was administered to all dogs. It was not observed any alteration on cardiac rhythm. HR, f, T and mean arterial pressure remained below the preincisional values for all dogs. No dog required intraoperative rescue analgesia. Recovery from anesthesia was without any complication. All animals scored 0 (0/5) at pain scale, two and four hours after extubation and none of them expressed concern over the surgical wound. Dogs were able to walk before two hours after extubation. The combination of both techniques is effective in anesthetic blocking the thoracic and abdominal walls and it is suggested both may be included in the multimodal analgesia protocols for this type of surgery.(AU)
Este trabalho pretende demonstrar o efeito analgésico da combinação das técnicas de bloqueio do plano transverso abdominal (TAP block) e bloqueio do plano serrátil (SP block) em 4 cadelas submetidas à mastectomia unilateral total. Os animais foram pré-medicados com metadona (0,5mg.kg-1) por via intramuscular. A anestesia foi induzida com propofol (6mg.kg-1) e midazolam (0,3mg.kg-1) e mantida com isoflurano. Os bloqueios SP e TAP foram realizados unilateralmente, utilizando ultrassonografia, pela injeção de bupivacaína a 0,25% (0,3mL.kg-1), diluída com solução de NaCl a 1:1. A frequência cardíaca (FC), frequência respiratória (f), pressão arterial não invasiva, temperatura esofágica (T), saturação de oxigênio (SpO2) e eletrocardiograma foram monitorados continuamente. Os animais foram monitorizados durante duras e quatro horas após a extubação para a dor usando a Escala de Dor Aguda Canina da Universidade Estadual do Colorado. Duas horas após a extubação, tramadol (4mg.kg-1) e dipirona (25mg.kg-1) foram administrados a todos os cães. Não foi observada qualquer alteração no ritmo cardíaco. HR, f, T e pressão arterial média permaneceram abaixo dos valores basais para todos os cães. Nenhum cão requereu resgate analgésico intra-operatório. Não houve complicações na recuperação anestésica. Todos os animais apresentaram escore 0 (0/5) na escala de dor, duras e 4 quatro horas após a extubação e nenhum expressou desconforto com a ferida cirúrgica. Todos os cães foram capazes de caminhar antes de duas horas após extubação. A combinação de ambas as técnicas é eficaz no bloqueio anestésico das paredes torácica e abdominal e sugere-se que ambos podem ser incluídos nos protocolos de analgesia multimodal para este tipo de cirurgia.(AU)
Subject(s)
Animals , Female , Dogs , Abdominal Muscles/drug effects , Anesthesia, Conduction/veterinary , Anesthetics, Local/analysis , Isoflurane/therapeutic use , Mastectomy/veterinary , Midazolam/therapeutic use , Propofol/therapeutic useABSTRACT
Introdução: O macaco-capuchinho é uma espécie de primata não humano que demonstra grande potencial para estudos pré-clínicos devido às semelhanças anatômicas e fisiológicas com os seres humanos. Objetivo: Estudar os índices de deformação miocárdica em macacos-capuchinhos anestesiados utilizando speckle tracking. Métodos: Foram utilizados dezesseis animais do Parque Zoobotânico, em Teresina, Piauí, Brasil, com restrição química, utilizando uma combinação de cetamina e midazolam. Os estudos ecocardiográficos foram obtidos nos modos B, M e Doppler, medindo-se strain e strain rate através de speckle tracking. Resultados: As variáveis que apresentaram coeficientes de correlação estatisticamente significativos em relação ao peso foram a parede livre do ventrículo esquerdo em diástole (PLVEd), diâmetro interno do ventrículo esquerdo em diástole (DIVEd), diâmetro interno do ventrículo esquerdo em sístole (DIVEs), onda E, A'VD, movimento do anel mitral (MAM) e excursão sistólica do plano do anel tricúspide (TAPSE). A frequência cardíaca (FC) mostrou correlação positiva com a onda E e a onda A e correlação negativa com o tempo de relaxamento isovolumétrico (TRIV). A fração de encurtamento (FS) apresentou correlação positiva com a razão entre as ondas E e A (r = 0,61). TAPSE mostrou correlações positivas com E'VD e A'VD. Os valores obtidos para o strain circunferencial (-18,17 ± 4,68%), radial (47,13 ± 5,24%) e longitudinal (-26,46 ± 5,155%) para os macacos-capuchinhos estavam dentro dos intervalos normais para machos e fêmeas. Conclusão: O presente estudo fornece os primeiros valores de referência para medidas ecocardiográficas em modos B, M e Doppler para macacos-capuchinhos anestesiados com cetamina e midazolam. Os valores de strain e strain rate obtidos utilizando a técnica de speckle tracking mostraram-se semelhantes aos obtidos em seres humanos, sugerindo que esta ferramenta pode ser explorada em estudos pré-clínicos utilizando o modelo do macaco-capuchinho
Introduction: The capuchin monkey is a type of nonhuman primate that has shown great potential for preclinical studies because of its anatomical and physiological similarities to humans. Objective: To study the indices of myocardial deformation in anesthetized capuchin monkeys using speckle tracking. Methods: Sixteen animals from the Zoobotanical Park, Teresina, Piauí, Brazil, were used and chemically restrained using a combination of ketamine and midazolam. Echocardiography recordings were obtained in B, M and Doppler modes, and strain and strain rate were measured using speckle tracking. Results: The variables that showed statistically significant correlation coefficients in relation to weight were LVFWd, LVIDd, LVIDs, E wave, A'RV, MAM and TAPSE. HR showed a positive correlation with the E wave and A wave and a negative correlation with IVRT. FS presented a positive correlation with the E/A wave relationship (r = 0.61). TAPSE showed positive correlations with E'RV and A'RV. The values obtained for circumferential (-18.17 ± 4.68%), radial (47.13 ± 5.24%) and longitudinal (- 26.46 ± 5.15%) strain for the capuchin monkeys were within the normal ranges for males and females. Conclusion: The present study provides the first reference values for echocardiographic measurements in B, M and Doppler modes for capuchin monkeys anesthetized with ketamine and midazolam. The strain and strain rate values obtained using speckle tracking showed similarities with those obtained in humans, suggesting that this tool has the potential to be exploited in preclinical studies using the capuchin monkey model
Subject(s)
Animals , Anesthetics, Intravenous/therapeutic use , Echocardiography/methods , Models, Animal , Myocardial Contraction , Diagnostic Imaging , Echocardiography, Doppler/methods , Heart Defects, Congenital/genetics , Heart Rate , Heart Ventricles , Hematologic Tests/methods , Ketamine/therapeutic use , Midazolam/therapeutic use , Guidelines as Topic/methods , Data Interpretation, StatisticalABSTRACT
Introducción: La traqueostomía percutánea es un procedimiento frecuente en la Unidad de Terapia Intensiva indicado en el manejo del paciente críticamente enfermo que requiere ventilación mecánica prolongada. El objetivo del estudio es describir la experiencia de traqueostomía percutánea sin broncoscopía, utilizando la técnica Ciaglia Blue Rhino en la unidad de terapia intensiva del IGSS. Métodos: Estudio descriptvo, observacional, longitudinal y analítco, incluyendo a 42 pacientes críticos ingresados a UTIA del Instituto Guatemalteco de Seguridad Social, a los que se realizó traqueostomía percutánea durante un periodo de 12 meses (Febrero 2016 a Febrero 2017). Se registraron variables demográficas, de severidad, días de ventilación mecánica antes del procedimiento y las complicaciones. Resultados: Se reclutaron 42 pacientes con una edad media de 68 años, con predominio del sexo masculino (28 pacientes). La media de puntuación del Sofa Score fue de 9.3 puntos. Los pacientes requirieron en promedio 13.4 días de ventilación mecánica antes del procedimiento. El 9.53% de pacientes presentaron complicaciones transoperatorias siendo estas: punción inadvertida del tubo orotraqueal (2 casos) y sangrado autolimitado del sito de la traqueostomía (2 casos). Mientras que el 4.76% presentaron complicaciones post-operatorias. Conclusiones: La traqueostomía percutánea por dilatación sin broncoscopía mediante la técnica Ciaglia Blue Rhino es un procedimiento seguro, que se puede realizar al pie de la cama del paciente, con un bajo índice de complicaciones.
Background: Percutaneos dilatatonal tracheostomy techniques have facilitated the procedure in the Intensive Care Unit. The purpose of the study is to describe our experience using this technique, in the ICU. Methods: We collected data from forty two patents during a year. The demographic variables were recorded, also we reviewed the severity of illness, number of days of mechanical ventlaton prior to the procedure, intraoperatve and postoperatve complicatons as well. Results: Forty two patents were included, mean age was 68 years old, most of them were men (28 patents). The mean Sofa Score was 9.3 points. In average, the patents requiered 13.4 days of mechanical ventlaton prior to the perutaneos dilatatonal tracheostomy. In two patents the endotracheal tube was accidentally punctured and two patents had self-limited bleeding at the surgical site. None of the complications were life-threatng to the patents. Conclusions: Percutaneos dilatatonal tracheostomy techniques using the Ciaglia Blue Rhino technique without fber optc bronchoscope is an easy procedure with a low incidence of complications.
Subject(s)
Humans , Male , Female , Middle Aged , Critical Care , Fentanyl/therapeutic use , Intraoperative Complications/diagnosis , Midazolam/therapeutic use , Propofol/therapeutic use , Respiration, Artificial , Respiratory Therapy , Surgical Procedures, Operative , Observational StudyABSTRACT
Introducción: Con frecuencia anestesiólogos son requeridos para trabajar fuera de pabellón quirúrgico intrahospitalario. Un campo interesante es la sedación en la consulta odontológica. Esto plantea un desafío dada la lejanía de un hospital, que le impide contar con ayuda inmediata en caso de una situación de emergencia y a la angustia que genera al paciente el procedimiento, por lo que debe lograrse un perfecto balance entre seguridad y ansiolisis. Material y Método: Se estudiaron pacientes sometidos a instalación de implantes dentales. Se comparó el uso de midazolam (M) y clonazepam (C) evaluando la satisfacción del implantólogo y del paciente. Resultados: Se estudiaron 67 pacientes y al evaluar su satisfacción, ésta se catalogó como buena y muy buena con ambos fármacos. Sin embargo en la evaluación del odontólogo se encontraron diferencias, ya que en el grupo M, tres casos fueron evaluados como regulares y ningún caso en el grupo C (p < 0.05). La causa de esta mala evaluación, fue explicada por el operador debido a que estos enfermos no fueron capaces de abrir la boca de manera satisfactoria. No se registraron episodios de desaturación, hipotensión, ni crisis hipertensiva. Discusión: Se demostró que la sedación con benzodiacepinas fue útil y segura. Sin embargo, la utilización de midazolam llevaría a un estado de hipnosis más profundo que impediría al paciente abrir bien su boca, hecho que dificultó el procedimiento dental. En conclusión el clonazepam podría tener la ventaja de lograr altos niveles de satisfacción tanto del profesional como del paciente.
Background: Increasingly, anesthesiologists are often required to perform procedures outside the operating room. An interesting field is sedation in the dental office. This poses a major challenge given the remoteness of a hospital and the anxiety generated in the patient. Therefore a perfect balance must be achieved between anxiolysis and safety for each case. Materials and Methods: We prospectively studied patients undergoing dental implants. We compared the use of two benzodiazepines, midazolam (M) and clonazepam (C) and evaluated the satisfaction of both the dental surgeon and the patient. Results: We studied 67 patients. When assessing patient satisfaction the patients were classified as good and very good with both drugs. However dentists in the evaluation some differences were found between the two groups, in the M group, three cases were evaluated as fair and no cases in group C (p <0.05). The cause of this poor assessment was explained by the operator, as a result of these three patients not being able to open their mouths during the procedure. There were no episodes of desaturation, hypotension or hypertensive crisis in any of the patients. Discussion: We demonstrated that sedation with benzodiazepines in the dentist's office as a useful and safe alternative with either midazolam or clonazepam. However, the use of midazolam leads to a deeper state of hypnosis that would prevent the patient to open the mouth suffuciently, making it difficult a dental procedure. In conclusion clonazepam could have the advantage of achieving high levels of satisfaction from both the dentist and the patient.
Subject(s)
Humans , Midazolam/therapeutic use , Clonazepam , Dental Implantation/methods , Drug Evaluation , Hypnotics and Sedatives , Patient SafetyABSTRACT
Resumen Las náuseas y vómitos postoperatorios (NVPO) son un problema frecuente en los pacientes quirúrgicos. Cuando no son prevenidos adecuadamente pueden provocar mayor morbilidad, estadía prolongada en la unidad de recuperación postoperatoria y hospitalización no planificada. El objetivo del equipo quirúrgico debe ser la profilaxis de las NVPO más que su tratamiento, con el fin de disminuir significativamente su incidencia y complicaciones asociadas. Los principales factores de riesgo para NVPO son: sexo femenino, historia de NVPO en cirugías previas y/o cinetosis, no fumar, uso de opioides sistémicos en el postoperatorio, someterse a ciertos tipos de cirugía (como colecistectomía, cirugía laparoscópica y cirugía ginecológica), utilizar anestésicos volátiles y/u óxido nitroso intraoperatorios, y duración de la cirugía. Sugerimos objetivar el riesgo de NVPO utilizando las escalas de riesgo de NVPO de Apfel o Koivuranta. Los principales fármacos antieméticos usados como profilaxis y tratamiento en el período perioperatorio son dexametasona, ondansetrón y droperidol. Existen estrategias generales que se pueden utilizar para reducir el riesgo quirúrgico basal de NVPO como evitar la anestesia general, privilegiando la anestesia regional, utilizar propofol para la inducción y mantención de la anestesia, evitar el uso de óxido nitroso y/o anestésicos inhalatorios, minimizar el uso postoperatorio de opioides sistémicos y recibir una hidratación intravenosa abundante durante la cirugía. La etiología de las NVPO es multifactorial, por lo que la prevención y tratamiento deben incluir diferentes clases de antieméticos, que actúen sobre los diferentes receptores de náuseas y/o vómitos hasta el momento conocidos, junto con las estrategias generales antes mencionadas.
Abstract Postoperative nausea and vomiting (PONV) are a common problem in surgical patients. When not properly prevented, they can lead to increased morbidity, prolonged stay in the postoperative recovery unit and unplanned hospitalization. The objective of the surgical team should be the prophylaxis of PONV rather than its treatment, in order to significantly reduce its incidence and associated complications. The main risk factors for PONV are: female sex, history of PONV in prior surgeries and/or motion sickness, non-smoking, use of systemic opioids postoperatively, undergo certain types of surgery (such as cholecystectomy, laparoscopic surgery and gynecological surgery), use volatile anesthetics and/or intraoperative nitrous oxide, and duration of surgery. We suggest to objectify the risk of PONV using the Apfel or Koivuranta PONV risk scales. The main anti-emetic drugs used as prophylaxis and treatment in the perioperative period are dexamethasone, ondansetron and droperidol. There are general strategies that can be used to reduce the baseline surgical risk of PONV such as avoiding general anesthesia, favoring regional anesthesia, using propofol for induction and maintenance of general anesthesia, avoiding the use of nitrous oxide and/or inhalational anesthetics, minimizing the postoperative use of systemic opioids and to receive an abundant intravenous hydration during surgery. The etiology of PONV is multifactorial, so prevention and treatment should include different classes of antiemetics, acting on the different receptors of nausea and/or vomiting so far known, together with the general strategies mentioned above.
Subject(s)
Humans , Postoperative Nausea and Vomiting/prevention & control , Antiemetics/therapeutic use , Midazolam/therapeutic use , Butyrophenones/therapeutic use , Propofol/therapeutic use , Risk Factors , Adrenal Cortex Hormones/therapeutic use , Risk Assessment , Postoperative Nausea and Vomiting/therapy , Dihydroxytryptamines/antagonists & inhibitors , Antiemetics/administration & dosageABSTRACT
La sedoanalgesia en pacientes bajo ventilación mecánica artificial se recomienda para lograr una mejor satisfacción del paciente y prevenir complicaciones. El objetivo de este trabajo fue realizar una revisión bibliográfica sobre la acción sedoanalgésica de la combinación de midazolam-morfina comparado con midazolam-ketamina en pacientes críticos tratados con ventilación mecánica artificial. Se realizó una búsqueda manual y digital en diferentes bases de datos como Scielo, IBECS, MEDLINE, Google Scholar, Cochrane y Wh, con los descriptores en inglés siguientes: sedation, midazolam-ketamine, midazolam-morfina AND mechanical ventilation AND crtical illness [MeSH Terms]. Se encontró un total de 60 artículos, todos realizados en seres humanos, 32 en los últimos 5 años, pero solo 16 a texto completo. De ellos, 7 eran revisiones sistemáticas sobre el tema y solo 4 ensayos clínicos. Ninguno utilizó la asociación midazolam-ketamina para la sedación. En la revisión realizada no se encontró ningún artículo que informara sobre las ventajas de la asociación midazolam-ketamina en la sedación del paciente crítico ventilado mecánicamente, lo que le confiere novedad a la investigación(AU)
The sedoanalgesia is recommended for patients under artificial mechanical ventilation in order to achieve better patient satisfaction and to prevent complications. The objective of this work was to carry out a literature review about the sedoanalgesic effect to the combination of midazolam-morphine compared with comidazolam-ketamine in critically ill patients treated with artificial mechanical ventilation. A manual and digital search was carried out in different databases such as Scielo, IBECS, MEDLINE, Google Scholar, Cochrane, and Wh, using the following descriptors in English: sedation, midazolam-ketamine, midazolam-morphine, AND mechanical ventilation AND critical illness (MeSH terms). We found 60 articles, all of which reported human-related cases, 32 in the last 5 years, but only 16 at full text. Out of these, seven were systematic reviews about the subject and only four, clinical trials. We did not find any articles in the review that reported about the advantages of the association midazolam-ketamine in sedation of mechanically ventilated critically ill patients, a fact that confers novelty to the investigation.
Subject(s)
Humans , Respiration, Artificial/methods , Midazolam/therapeutic use , Critical Care/methods , Ketamine/therapeutic use , Drug Therapy, Combination/standards , Deep Sedation/methodsABSTRACT
The use of serum lactate has become increasingly common in Veterinary Medicine, since it is an excellent marker of tissue oxygenation, elevated in situations of tissue hypoxia, where anaerobic glycolysis is used as an energy source. Studies point out its use in dogs as a prognostic factor in several affections; however it is not commonly used in domestic felines due to the high stress threshold of the species, which may interfere with their values. The aim of the present study was to evaluate serum lactate values in domestic cats during physical restraint and after chemical restraint using the combination of 8mg/kg ketamine-S, 0.4 mg/kg midazolam, and 2 mg/kg Tramadol. To this end, 20 clinically healthy female cats without defined race, from six months to five years of age, were divided into two groups, GPR (n = 10) represented by felines that had only physical restraint and the GCR (n = 10) by felines that underwent physical restraint (TPR) and after 30 hours by chemical restraint (TCR). It was observed that in both groups (GPR and CPR) during physical restraint presented hyperlactatemia (GPR = 6.23 ± 0.9 mmol/L GCR Tpr = 6.66 ± 1.59 mmol/L) and mean values of 4.42 ± 1.28 mmol/L during chemical restraint (GCR Tcr). It was concluded that physical restraint interferes with serum lactate values, with the reduction of such values with the use of chemical restraint in the feline species.(AU)
A utilização do lactato sérico é cada vez mais comum na Medicina Veterinária, por ser um excelente marcador de oxigenação tecidual, elevando-se em situações de hipóxia tecidual e realizando a glicólise anaeróbica como fonte de energia. Pesquisas científicas em cães o apontam como fator prognóstico em diversas afecções, sendo pouco utilizado em felinos domésticos devido ao elevado limiar de estresse da espécie, podendo interferir em seus valores. Assim, este trabalho avaliou os valores de lactato sérico em felinos domésticos durante contenção física e após contenção química, utilizando a associação de 8 mg/kg de cetamina-S, 0,4 mg/kg de midazolam e 2 mg/kg de cloridrato de tramadol. Foram estudados 20 felinos, fêmeas, sem raça definida, de seis meses a cinco anos de idade, clinicamente saudáveis, divididos em dois grupos, com GPR (n = 10) representado por felinos que passaram apenas por contenção física e com GCR por felinos que passaram por contenção física (TPR) e após 30 horas por contenção química (TCR). Foi observado em ambos os grupos (GPR e GCR) e durante a contenção física a hiperlactatemia sérica (GPR = 6.23 ± 0.9 mmol / L GCR TPR = 6.66 ± 1.59 mmol / L) com valores médios de 4,42 ± 1,28 mmol/L durante a contenção química (GCR TCR). Conclui-se que a contenção física interfere nos valores do lactato sérico, com redução dos valores na utilização da contenção química na espécie felina.(AU)
Subject(s)
Animals , Cats , Analgesia/veterinary , Lactic Acid/blood , Restraint, Physical/veterinary , Ketamine/therapeutic use , Midazolam/therapeutic use , Tramadol/therapeutic useABSTRACT
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.
Subject(s)
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 useABSTRACT
Objective This study evaluated the provision of two configuration of the Elevated Pluz-Maze (EPM) by analizing the exploratory behaviour of female Wistar rats in different phases of the estrous cycle in EPMs with different gradients of luminosity between the open and enclosed arms (O/E∆Lux).Methods Female Wistar rats were treated with Midazolam (MDZ, 1.0 mg.kg-1) and were tested for their exploratory behaviour in either the EPM 10 O/E∆Lux or EPM 96 O/E∆Lux.Results A multiple regression analysis indicated that the O/E∆Lux is negatively associated with the %Open arm entries and %Open arm time, suggesting that as O/E∆Lux increases, the open arm exploration decreases. The estrous cycle phase did not influence the open-arm exploration in either EPM. MDZ- induced anxiolysis was detected in 96 O/E∆Lux EPM in all phases of the EC.Discussion Results of this study suggest the importance of the O/E∆Lux to establish the arm preference in the EPM, and to preserve the predictive validity of the EPM.
Objetivo Avaliar a provisão de duas configuracōes do Labirinto Elevado em Cruz (LEC) através do comportamento exploratório de ratas Wistar em diferentes fases do ciclo estral (CE) em LEC com diferentes gradientes de luminosidade entre os braços aberto e fechado (A/F∆Lux).Método Ratas Wistar foram tratadas com Midazolam (MDZ, 1.0 mg.kg-1) e foram testadas no LEC 10 A/F∆Lux ou LEC 96 A/F∆Lux.Resultados A análise de regressão múltipla indicou que o A/F∆Lux está negativamente associado com a % de entrada no braço aberto e % de tempo no braço aberto, sugerindo que no aumento do A/F∆Lux, a exploração do braço aberto diminui. A fase do CE não influenciou a exploração do braço aberto no LEC. A ansiólise induzida pelo MDZ foi demonstrada no 96 LEC A/F∆Lux em todas as fases do CE.Discussão Estes resultados sugerem a importância do A/F∆Lux para estabelecer a preferência da exploração do LEC e preservar a validade do LEC.
Subject(s)
Animals , Female , Anxiety/physiopathology , Behavior, Animal/physiology , Exploratory Behavior/physiology , Lighting , Maze Learning/physiology , Anti-Anxiety Agents/therapeutic use , Anxiety/drug therapy , Behavior, Animal/drug effects , Estrous Cycle/drug effects , Estrous Cycle/physiology , Exploratory Behavior/drug effects , Models, Animal , Maze Learning/drug effects , Midazolam/therapeutic use , Rats, Wistar , Time FactorsABSTRACT
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.
Subject(s)
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 TopicABSTRACT
Introdução: O umbigo é a única cicatriz natural visível do corpo. É parte essencial da estética abdominal, fato que torna a umbilicoplastia fundamental no sucesso da abdominoplastia. A posição e a naturalidade de contorno são os dois fatores mais relevantes na avaliação do resultado estético da cicatriz umbilical. Classificações e padronizações têm sido ferramentas importantes para aprimoramento do diagnóstico e refinamentos no tratamento dos distúrbios estéticos do abdome. Além disso, têm facilitado a reprodutibilidade dos procedimentos e servido de base para estudos comparativos. Objetivos: Apresentar a experiência do autor com uma padronização tática para o reposicionamento e reimplante da cicatriz umbilical em casos de abdominoplastias do grupo IV. Demonstrar a tática de realocação vertical do umbigo com detalhamento da nova posição, avaliar a qualidade do resultado obtido e o grau de satisfação das pacientes. Métodos: Vinte pacientes, todas do sexo feminino, foram submetidas ao procedimento entre maio de 2010 e maio de 2012. O período mínimo de acompanhamento foi de trinta dias e o máximo, de dois anos. Resultados: A maioria dos resultados foi considerada excelente, atingindo alto nível de satisfação das pacientes, sem apresentar grandes complicações. Não foram necessárias reintervenções. A técnica mostrou-se segura, simples e de fácil execução. Conclusão: A marcação e o planejamento cirúrgico, com a proposta de um limite caudal máximo para o reposicionamento da cicatriz umbilical, podem ser de grande valia tanto no auxílio aos diagnósticos mais complexos dos tipos de defeitos estéticos do abdome quanto nas indicações das técnicas de abdominoplastias mais adequadas ao tratamento.
Introduction: The navel is the only natural visible scar on the body. It is an essential part of abdominal aesthetics, making umbilicoplasty critical for the success of abdominoplasty. The position and natural contour are the two important factors that are most relevant in evaluating the aesthetic result of the umbilical scar. Classifications and standards are important tools to improve the diagnosis and refine the treatment of abdomen aesthetic disorders. Furthermore, it has facilitated appropriate reproduction of the procedure and served as a basis for comparative studies. Objectives: This study presents the author's experience with procedure standardization for repositioning and re-implantation of the umbilical scar in abdominoplasty group IV cases. The study demonstrates the navel vertical relocation technique, along with details of the new position, and assesses the quality of results obtained and the degree of patient satisfaction. Case studies and methods: Twenty female patients underwent the procedure between May 2010 and May 2012. The minimum follow-up period was thirty days and the maximum follow-up period was two years. Results: Most results were considered excellent, with a high level of patient satisfaction and no major complications. There was no need for re-intervention. The technique was shown to be safe, simple and easy to perform. Conclusion: The marking and surgical planning, with a proposed maximum end limit for repositioning of the umbilical scar, can be valuable both in aiding the most complex diagnoses of aesthetic abdomen defect types and evaluating the technical aspects of abdominoplasty that are most appropriate for treatment.