RESUMEN
Introducción: El dolor postoperatorio es constante e infratratado en los pacientes intervenidos quirúrgicamente por urgencias traumatológicas. La utilización de opioides es referencia de la mayoría de las técnicas de analgesia postoperatoria. Objetivo: Describir los efectos de la infusión intravenosa contínua de tramadol en los procedimientos quirúrgicos traumatológicos de urgencia. Diseño metodológico: Estudio descriptivo, prospectivo y longitudinal en 83 pacientes sometidos a cirugía traumatológica de urgencia y seleccionados aleatoriamente. Se estudiaron las variables: tensión arterial sistólica y diastólica, frecuencia cardiaca, frecuencia respiratoria, saturación periférica de oxígeno, evolución del dolor postoperatorio, analgesia de rescate y efectos colaterales. Resultados: El tratamiento ofrecido en la investigación proporcionó una estabilidad hemodinámica y respiratoria con una potencia analgésica de acuerdo a su farmacocinética clínica y a su biodisponibilidad. Aparecieron efectos colaterales menores (náuseas, vómitos y sedación) por poseer menor afinidad por los receptores opioides que el compuesto original, la morfina. Conclusión: La descripción del tramadol en infusión continua intravenosa permitió mostrar un método analgésico efectivo en la cirugía urgente traumatológica.
Postoperative pain is constant and it is undertreated in patients underwent surgery from traumatic emergencies. Opioids use is reference of most of postoperative analgesia techniques. Aim: To describe the effects of Tramadol continuous intravenous perfusion on emergency traumatic surgical procedures. Methodological design: A longitudinal, prospective and descriptive study made in 83 patients underwent emergency traumatic surgery, randomly selected. Following variables were studied: systolic and diastolic arterial tension, frequently of cardiac origin, respiratory frequency, peripheral saturation oxygen, postoperative pain course, rescue analgesia, and side effects. Results: Treatment offered in this research allowed a hemodynamic and respiratory stability with an analgesic power according its clinical pharmacokinetics, and to its bioavailability. There were minor side effects (nauseas, vomiting and sedation) due to the lower affinity to opioids receptors than original compound, the morphine. Conclusions: Description of Tramadol intravenous continuous perfusion allowed showing an effective analgesic method in traumatic urgent surgery.
RESUMEN
Objective To evaluate the efficacy of combined various surgical procedures for the treatment of post-traumatic epilepsy.Methods According to the preoperative primary location of epileptogenic focus and the monitoring results of intraoperative electrocorticography and depth electrodes,21 seizure patients were treated with various surgical procedures: 7 cases with epileptogenic focus resection,8 cases with epileptogenic focus resection combined with multiple subpial transection(MST),4 cases with anterior temporal lobectomy combined with amygdalo-hippocampotomy,1 case with selective amygdalo-hippocampotomy under neuronavigation,and 1 case with anterior callosotomy combined with MST and bipolar coagulation on funtional cortexes. Results All the patients were followed up from 3 months to 10 years postoperatively,and the surgical outcomes were such as the followings: satisfactory outcome in 9 cases(42.9%),marked improvement in 7 cases(33.3%),improvement in 3 cases(14.3%),slight improvement in 1 case(4.8%) and no improvement in 1case(4.8%).There was no died cases caused by the surgical procedures.Eight patients had temporary dysfunction after operation,but all recovered in four weeks after surgery.Conclusion The combined various surgical procedures are effective and safe for the treatment of post-traumatic epilepsy.