Revisión crítica: efectividad del método no farmacológico: acupresión en el pliegue de la muñeca para la prevención y el tratamiento de náuseas y vómitos en pacientes post operados / Critical review: effectiveness of the non-pharmacological method: acupressure in the fold of the wrist for the prevention and treatment of nausea and vomiting in post-operated patients

El presente estudio tuvo como objetivo determinar la efectividad de la acupresión en el pliegue de la muñeca para la prevención y tratamiento de náuseas y vómitos post operatorios. La presente investigación es relevante porque ayudará a las enfermeras en centro quirúrgico a lograr un control efectivo de las náuseas y vómitos que se presentan en el post operatorio, utilizando estrategias no farmacológicas útiles para el control de estos síntomas. Formulándose la pregunta clínica: ¿el uso de la acupresión en el pliegue de la muñeca es efectiva para la prevención y el tratamiento de las náuseas y vómitos post operatorio?, para ello, se realizó una búsqueda de la información en base de datos Science Direct, PubMed, Cochrane y Biblioteca Virtual de Salud desarrollado mediante la elección de las palabras claves, registro escrito de búsqueda. Se analizaron 9 artículos de estudio de investigación experimental y revisiones bibliográficas sobre el tema, se seleccionó tres investigaciones mediante la lista de chequeo de validez aparente de Gálvez Toro. Así mismo se estructuró el comentario crítico usando la guía de revisiones sistemáticas y meta-análisis de Prisma; llegando a la respuesta de la pregunta clínica: el uso de la acupresión en el pliegue de la muñeca en pacientes post operados es efectiva porque reduce significativamente los vómitos y náuseas post operatorias.

Náuseas y vómitos: evaluación y manejo / Nausea and vomiting: assessment and management

Vomiting is a reflex action of motor and autonomous responses, resulting in violent expulsion of gastric contents through the mouth, triggered by humoral and neural stimuli. It must be distinguished from regurgitation or gagging. Nausea, on the other hand, is a subjective uncomfortable feeling that most people have experienced and is generally described as an imminent need to vomit, felt in the epigastrium and throat. These can be symptoms of a series of pathologies, and represent a reason for frequent consultation at emergency health care units. Both acute and chronic occurrence must be assessed carefully to identify its etiological agent in order to administer proper treatment focused on the symptoms. Nausea and vomiting during pregnancy, after chemotherapy, and cyclic vomiting syndrome will be further developed. In addition, nausea and vomiting treatment in the emergency room is reviewed.

El vómito es un reflejo coordinado de respuestas motoras y autonómicas que resulta en la expulsión violenta del contenido gástrico por la boca, activado por estímulos humorales o neuronales. Debe distinguirse de regurgitación o arcadas. La náusea, por otro lado, es una sensación subjetiva desagradable que la mayoría de las personas han experimentado en algún momento de su vida y, por lo general, reconocen como una sensación de inminente vómito, en el epigastrio o garganta. Son un síntoma de una pléyade de diversas patologías, y corresponde a un motivo de consulta frecuente en servicios de urgencia. Tanto su presentación aguda, como crónica deben ser evaluadas en forma integral de modo de identificar la etiología y poder brindar un tratamiento, tanto sintomático como dirigido. Las náuseas y vómitos en el embarazo, en relación a quimioterapia, y el síndrome de vómito cíclico serán abordados en profundidad. Del mismo modo se realiza una revisión del tratamiento de náuseas y vómitos indiferenciados, en el servicio de urgencia.

Utilização de experiências musicais como terapia para sintomas de náusea e vômito em quimioterapia / Use of musical experiences as therapy for symptoms of nausea and vomiting in chemotherapy / El uso de experiencias musicales como terapia para los síntomas de las náuseas y los vómitos en quimioterapia

Objetivou-se aplicar as experiências musicais para avaliação dos efeitos terapêuticos em náuseas e vômitos associados à quimioterapia antineoplásica e identificar alterações nos parâmetros vitais dos pacientes que participaram da experiência. Estudo descritivo, transversal, nível II, de abordagem quantitativa, realizado com treze pacientes de um ambulatório de quimioterapia de um hospital particular no município de São Paulo. Foram utilizados dois instrumentos, sendo um deles proposto pela MASCC (Multinational Association on Supportive Care in Cancer). A maior parte da amostra foi composta por pacientes do sexo feminino, com idade entre 40 a 60 anos, casadas e com câncer de mama. Reduziu-se a frequência cardíaca em 77% da amostra; a náusea diminuiu em 100% dos pacientes após a primeira experiência musical, e em 85% após a segunda. Concluiuse ter havido houve redução estatisticamente significativa dos sintomas de náusea e vômito após as experiências musicais.

The study aimed to evaluate the therapeutic effects of musical experiments in nausea and vomiting associated with antineoplastic chemotherapy, and to identify changes in vital parameters of the patients who participated in the experience. This is a descriptive, transversal study, level II, which used a quantitative approach, conducted with thirteen patients from an outpatient chemotherapy unit, of a private hospital in São Paulo City. Two instruments were used, one of them proposed by MASCC (Multinational Association on Supportive Care in Cancer). The participants were predominantly females, aged 40 to 60 years, married and with breast cancer. Heart rate has decreased in 77% of the sample, and the reduction of nausea occurred in 100% of patients after the first musical experience, and in 85% after the second one. Patients reported disbelief in music in relieving nausea and vomiting before the sessions, and relief of nausea after them. It was concluded that there was a statistically significant reduction of the symptoms nausea and vomiting after the musical experiences.

Objetivó-se evaluar los efectos terapéuticos de experimentos musicales en las náuseas y los vómitos asociados con la quimioterapia del cáncer, e identificar cambios en los parámetros vitales de los pacientes sometidos a esa experiencia. Estudio descriptivo, exploratorio, transversal, nivel II, con enfoque cuantitativo, llevado a cabo con 13 pacientes de un ambulatorio de quimioterapia, en un hospital privado en São Paulo. En la recopilación de datos, utilizó-se dos instrumentos, uno que fue propuesto por la MASCC (Multinational Associationon Supportive Care in Cancer). Lla mayoría de los participantes estaba compuesta por pacientes de sexo femenino, con edades entre 40 y 60 años, casados y con cáncer de mama. Con respecto a los signos vitales, hubo reducción de la frecuencia cardíaca en 77%; e de las náuseas en el 100% de los pacientes después de la primera experiencia musical, y en el 85% después de la segunda. Antes de las sesiones, los pacientes reportaron falta de fe en la música para el alivio de las náuseas y los vómitos; y alivio de las náuseas después de las sesiones. En conclusión, hubo una reducción estadísticamente significativa en las puntuaciones de náuseas y vómitos después de las experiencias musicales.

[Appeal of herbal plants as a mechanism for the relief of acute vomiting induced by chemotherapy]

Acute vomiting is one of the most common side effects of chemotherapy during the first 24h in patients with cancer. This study investigated the palliative effect of ginger extract on the rate of this complication. This study was a randomized, double-blind, placebo-controlled clinical trial that was conducted from August to December 2009 in Imam Khomeini Hospital on 80 women with breast cancer undergoing 1-day chemotherapy periods and suffering from vomiting. After obtaining written consent, the samples were randomly assigned into intervention and control groups. Two groups were matched with each other based on the age and emetic risk of chemotherapy drugs used. Participants of the ginger group received ginger capsules[250mg, orally], four times a day [1gr/d] and the samples from the control group received placebo capsules containing starch from three days before to three days after chemotherapy. During this period, to measure the effect of capsules, a two-part questionnaire was used. So, the patients filled these tools out every night. Then, gathered data were analyzed using statistical tests like Fisher's exact, Kruskal-Wallis and Chi-square by the STATA software version 8. The two groups were matched with each other according to the emetic risk of chemotherapy drugs and disease duration [p=0.1, p=0.06, respectively]. Results indicated that the cases of vomiting in the acute phase were significantly lower in the ginger group compared with placebo group [p=0.04]. Also taking ginger capsules compared with placebo did not wake certain complications [p=0.06]. Taking ginger powder capsules [1gr/d] starting three days before chemotherapy for six days and beyond the routine anti-emetic regimen could reduce the acute phase vomiting

Acupressure as a safe and easy method in post Management chemotherapy of nausea and Vomiting among leukemic children

One of the major problems facing the clinician dealing with cancer patient is the post chemotherapy nausea and vomiting. This study aimed to assess the effect of acupressure as a method to manage nausea and vomiting post chemotherapy in leukemic children. The study was conducted in pediatric hematology oncology unit at Tanta university hospital from May to August 2010. A convenient sample of 60 children with acute lymphoblast leukemia [ALL] was included in the study .Their ages ranged between 6-18 years. All of them were under chemotherapy. They were divided into two equal groups, group 1 [received acupressure at p 6 acupoint plus routine hospital care, group 11 as a control group [received routine hospital care only]. Visual analog scale [VAS] and Rhodes index scale [INVR] were used to assess intensity, duration and frequency of nausea and vomiting post chemotherapy. Results revealed significant reduction in the amount of vomiting and the intensity of nausea over time among acupressure group, compared to the usual-care group. Concerning child distress from nausea and vomiting, significant improvement was detected regarding the duration, seventy and distress from nausea and vomiting after one hour as well as after 2-3 hours in comparison with immediately after one hour .But no significant between after one hour and 2-3 hours . In conclusion, Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for children undergoing chemotherapy to reduce the amount and intensity of nausea and vomiting. Thus should be applied to children undergoing chemotherapy

[Effect of Stachys lavandulifolia on fatigue, nausea and vomiting associated with primary dysmenorrheal]

Because of importance and outbreak of dysmenorrhea and Its effect on life of 50% of population in the world[women], this study was done. To evaluate the therapeutic effects of Stachys lvandulifolia on fatigue, nausea, and vomiting associated with primary dysmenorrhea. This was a randomized clinical trial performed on 50 women aged 18-25 years and 50-60 kg whight suffering from primary dysmenorrhea. Fatigue, nausea, and vomiting were evaluated by visual analogue scale [VAS]. Initially, the study population was requested to consume the Stachys lvandulifolia flowers at a dose of 10 gr of brewed powder three time a day and for a total of 5 days [2 days before pain to 3 days after pain], based on a common traditional administration. Later, the members of both groups were followed up for three cycles. Fatigue, nausea, and vomiting as well as the side-effects were evaluated following consumption of brewed powder of Stachys lvandulifolia flowers. Statistical analysis was performed using t-test and chi-square test. Following consumption of Stachys lvandulifolia the level of fatigue considerably reduced among test group and the difference was significant [p=0/000], statistically. Likewise, a significant difference in severity of nausea between the test and control groups was shown [p=0/006]. No statistically significant difference regarding the severity of vomiting was established between two groups. According to our data, it could be concluded that the use of Stachys lvandulifolia, based on a traditional administration, causes favorable therapeutic effects by reducing the degree of fatigue and nausea in primary dysmenorrhea with no obvious side-effect yet with no effect on vomiting

[Effect of music therapy on chemotherapy nausea and vomiting in children with malignancy]

Nausea and vomiting is one of the major side-effects of chemotherapy. Due to complex nature of its management, both medical and non-medical therapies are recommended. This study aimed to investigate the effect of music therapy on chemotherapy nausea and vomiting in children with malignancy. In this quasi-experimental study, 30 children aged 8-12 who were under chemotherapy were recruited. After getting the current treatments, the children listened to a kind of music for 45 minutes at 6, 9, and 12 hours after the beginning of the chemotherapy. Nausea and vomiting was measured using both numerical and descriptive scales every 8 hours for 24 hours after beginning of the chemotherapy. Data were analyzed using Willcoxon and Mcnemar statistical tests in the SPSS, version 11.5. The rate of nausea was declined significantly at the 16[th] and 24[th] hours after music therapy. Assessment of nausea by descriptive scale showed a decline only at 24[th] hours after music therapy. The rate of vomiting did not show any significant difference between two stages. Music therapy could decrease the amount of nausea in children with malignancy under chemotherapy; however, it does not any effect on the rate of vomiting

Comparison between ginger and vitamin B6 efficacy in the treatment of nausea and vomiting during pregnancy

Nausea and vomiting are among the most common complication during pregnancy. The use of medication especially in the first weeks of pregnancy may cause stress in pregnant woman and their family, because of the risk of teratogenesity. We performed this study to determine the effectiveness of ginger compared to vitamin B6 for treatment of nausea and vomiting during pregnancy. A total number of 80 pregnant women with nausea and vomiting before the 20th week of gestation that did not take any medication were included in this randomized, double blind clinical trial during a period of 11 months. They were randomly divided into 2 groups to take oral ginger or vitamin B6 for 4 days. All participants scored the severity of their nausea using visual analog scale and recorded the number of vomiting episodes in the previous 24 hours before treatment and during 4 consecutive days while taking the treatment. Seven days later in a follow-up visit, a five-item Likert scale was used to assess the severity of symptoms. The data were analyzed with SPSS software using t-test and Kroskal-Wallis test. Severity of nausea [P<0.001] and episodes of nausea [P<0.01] and vomiting [P<0.0001] was decreased significantly in the ginger groups [P<0.000], but comparing with vitamin B6 group it didn't have a significant difference in reducing severity of nausea and episodes of nausea as well as vomiting. Ginger was effective for treatment of nausea and vomiting in pregnancy, but its application needs further studies to determine the proper dosage and the impact of this drug on pregnant mothers and their fetus

Effect of ginger's utilization on the relief of nausea and vomiting associated with early pregnancy

Complementary and alternative therapy [CAT] is becoming increasingly acceptable to the general public and is increasingly used around the world. it is not a new issue, as many of these therapies have been used for centuries. Herbal products are generally perceived as being natural and free of side effects. This study aimed to assess the effect of ginger's utilization on relief of nausea and vomiting associated with early pregnancy. A quasi-experimental research design was adopted. The study was carried out at the antenatal clinic of El-Shatby Maternity University hospital. A total of [40] early pregnant woman [from 6-12 weeks of pregnancy] comprised the study subjects. They were equally matched and distributed into a study and control group. An interview schedule was used for data collection. The results revealed a statistically significant difference in the relieve of nausea and vomiting between study and control group. For women looking for a reduction of their nausea, dry retching and vomiting, the use of ginger in early pregnancy will reduce the severity of their symptoms and presents them with an alternative choice of treatment for the management of their symptoms

Síndrome de vómitos cíclicos / Syndrome of cyclic vomitings

El síndrome de vómitos cíclicos es un trastorno funcional que constituye un serio problema social y que altera la dinámica familiar como consecuencia de la intensidad de los vómitos. Hicimos una revisión del tema referido a la infancia e incluimos concepto, etiologías y patogénesis más aceptadas, así como los criterios establecidos para el diagnóstico. Se citan los diagnósticos diferenciales más frecuentes, evaluación clínica y pruebas diagnósticas. Se analizan algunos aspectos del tratamiento en la fase aguda y el tratamiento abortivo y profiláctico de las crisis. Se muestran los resultados clínico-epidemiológicos en 19 pacientes tratados ambulatoriamente durante dos años en nuestra consulta especializada de gastroenterología. El síndrome de vómitos cíclicos es relativamente frecuente en nuestro servicio ambulatorio y el diagnóstico basado en los síntomas clínicos es útil en el tratamiento y evolución de estos.

Cyclic vomiting syndrome is a functional disorder that constitutes a serious social problem and disturbs family dynamics due to vomiting intensity. We made a literature review on this problem in childhood and included the most accepted concepts, etiologies and pathogenesis as well as the diagnostic criteria. Most frequent differential diagnosis, the clinical evaluation and the diagnostic tests were stated. Some aspects of treatment of this disease in acute phase and the abortive and prophylactic treatment of the vomit attacks were analyzed. The clinical and epidemiological results of 19 patients treated by the outpatient service for two years in our specialized gastroenterology department were shown. Cyclic vomit syndrome is often seen in our outpatient service and the diagnosis based on clinical symptoms is useful for treatment and evolution of these patients.

efficacy of transcutaneous electrical nerve stimulation in control of nausea and vomiting in patients undergoing chemotherapy

Despite advances in antiemetic treatment, complications are still problematic for a significant number of patients after chemotherapy. This study was performed to determine the efficacy of transcutaneous electrical nerve stimulation [TENS] in the control of nausea and vomiting in patients undergoing chemotherapy at Nemazee Hospital in Shiraz, southern Iran.32 subjects with cancer from Outpatients Depatment in Nemazee Hospital affiliated to Shiraz University of Medical Sciences, in Shiraz, southern Iran were enrolled. The patients were randomly divided into two equal groups of TENS and placebo. Patients in both groups were matched for age, severity of nausea and vomiting and type of malignancy. Cisplatin or cyclophosphamide was used for chemotherapy and granistron along with dexametasone were used as antiemetic agents. In the test group, the p6 acupuncture point [acupoint] was stimulated by TENS when the antiemetic agent was administered and continued during wakening every 2 hours for 72 hours after chemotherapy. The placebo group was similarly treated but with an off mode stimulator. In regard to the severity of nausea, no statistically significant difference was observed between the two groups in the first 24 hours of chemotherapy but the intensity of nausea in the TENS group was significantly lower than those of the placebo group during 48 and 72 hours of chemotherapy. The mean frequency of vomiting during first, second and third 24 hours was significantly lower in the control group. TENS can be used as an adjunct with antiemetics for controlling nausea and vomiting induced by chemotherapy

Clinical study of Jawarish Anarain in vomiting during pregnancy

Morning sickness or simple emesis along with nausea is commonly present in 50% ladies during their pregnancy upto 12-14 weeks but when it becomes severe, it is called as hyperemesis gravidarum which exerts deleterious effects on the health of mother as well as of the baby. It may be a symptom of various medical-surgical-gynaecological complications and if it is not controlled in its early phase sometimes a hard decision of termination of pregnancy has to be undertaken. The guideline for treating ailments during pregnancy is first that the drug should be safe not to hinder with the continuation of gestation period. In this protective mode of treatment, our Unani herbal formulations have proved their superiority over the drugs of other systems. Present study was carried out to assess the efficacy of Jawarish Anarain in vomiting during pregnancy and results found were very encouraging

[ comparison of the acupressure and pyridoxine effect on severity of both nausea and vomiting in primigravida women]

Gastric disorders especially nausea and vomiting are the most common complaint during pregnancy. Previous studies have shown that nearly 20% of pregnant women visited physician for these problems. The aim of this study was to compare the effect of acupressure and Vit. B6 [pyridoxine] on reduction of nausea and vomiting in primigravida women. In a clinical trial study, 100 women with gestational age of 10-16 weeks and single fetus were randomly selected from primigravida women who referred to antenatal care centers of Ahvaz for nausea and vomiting. Then they were allocated to acupressure [n=50] or pyridoxine group [n=50]. Treatment with acupressure or pyridoxine was carried out for four days. In acupressure group sea band was placed on the neiguan [p6] point of hand and in pyridoxine group, each patient had 40 mg of Vit. B6 every day. Severity of nausea and vomiting was recorded by each subjects. Data was analyzed by Chi-square, Manwithney, Wilcoxon and t-tests. Our results showed that nausea score and frequency of vomiting were decreased significantly by both treatments [p<0.001]. Also acupressure was significantly more effective in reduction of vomiting frequency [p<0.001]. The severity of nausea was not different in two groups. Our results showed that acupressure was more effective than Vitamin. B6 in treatment of pregnancy vomiting. Regarding the fact that sea band is cheap, comfortable, available and easily use, it is recommended to reduce vomiting in pregnancy

A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy.

OBJECTIVE: To compare the efficacy of ginger to vitamin B6 in the treatment of nausea and vomiting of pregnancy. STUDY DESIGN: A randomized double-blind controlled trial. SETTING: The Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital. SUBJECTS: Women with nausea and vomiting of pregnancy at or before 16 weeks of gestation, who attended the antenatal care clinic. The subjects requested anti-emetics, had no medical complications, non-hospitalized and were able to attend a one week follow-up visit. From November, 1999 to November 2000, 138 women participated and gave consent for the study. METHOD: The subjects were randomly allocated into two groups to take either 500 mg of ginger orally or an identical 10 mg of vitamin B6 one capsule three times daily for three days. Subjects graded the severity of their nausea using visual analogue scales before treatment and recorded the number of vomiting episodes in the previous 24 hours and again during three consecutive days of treatment. MAIN OUTCOME MEASURES: The change of nausea scores and the number of vomiting episodes during three days of treatment. RESULTS: The 64 subjects in each group remained in the study. The demographic data were comparable in both groups. The ginger and vitamin B6 significantly reduced the nausea scores from 5.0 (SD, 1.99) to 3.6 (SD, 2.48) and 5.3 (SD, 2.08) to 3.3 (SD, 2.07) respectively, with p < 0.001. The mean score change after treatment with ginger was 1.4 (2.21), less than with vitamin B6, which was 2.0 (2.19) but with no statistically significant difference (95% CI -1.4 to 0.2, p = 0.136). The ginger and vitamin B6 also significantly reduced the number of vomiting episodes from 1.9 (2.06) to 1.2 (1.75) and 1.7 (1.81) to 1.2 (1.50) respectively, with p < 0.01. The mean number change after treatment with ginger was 0.7 (2.18), more than with vitamin B6, which was 0.5 (1.44) but with no statistically significant difference, (p = 0.498). There were some minor side effects in both groups such as sedation (26.6% vs 32.8%, p = 0.439), and heartburn (9.4% vs 6.3%, p = 0.510), a non-significant difference. CONCLUSION: The nausea score and the number of vomiting episodes were significantly reduced following ginger and vitamin B6 therapy. Comparing the efficacy, there was no significant difference between ginger and vitamin B6 for the treatment of nausea and vomiting during pregnancy.

Ensayo clínico controlado para evaluar eficacia y seguridad de dos soluciones de hidratación oral con composición OMS y diferente pH / Safety and efficacy of a Worls Health Organization-based oral rehydration solution with acid pH. A clinical, comparative controlled trial

Introducción. La Organización Mundial de la Salud (OMS) recomienda una fórmula única con sabor salado y pH alcalino para el tratamiento de la deshidratación por diarrea. Se ha considerado que el cambio de sabor de la solución de rehidratación oral (SRO) podría mejorar la aceptación de los pacientes. Estas fórmulas, con sabor más agradable a expensas de habérseles agregado ácido cítrico, están disponibles en México. Contienen la misma composición recomendada por la OMS pero con pH ácido, lo que podría aumentar el gasto fecal e incrementar los vómitos. El presente trabajo se diseñó con el objetivo de determinar la eficacia y seguridad de la SRO con pH ácido, en niños deshidratados por diarrea aguda. Material y métodos. Se dividieron al azar, en 2 grupos, 70 niños menores de 2 años de edad: el grupo A se trató con SRO-OMS (pH 8 ñ 0.05) y el grupo B con SRO con pH ácido (4.9 ñ 0.1). Resultados. El gasto fecal promedio (A: 10 ñ 7.9; B: 12 ñ 10.8 g/kg/hora) y la frecuencia de vómitos (A: 11; B 10 pacientes) fueron semejantes en ambos grupos. Trece casos fueron considerados fracasos, 10 del grupo A y 3 del B: por vómitos persistentes (4 del grupo A) o por gasto fecal alto (6 del A y 3 del B), sin mejoría de la deshidratación; todos ellos, excepto uno del grupo A, se hidrataron por sonda nosogástrica o después de la administración de atole de arroz, respectivamente. Conclusiones. El pH ácido de la SRO no se relacionó con mayor frecuencia de vómitos ni con aumento del gasto fecal. La menor frecuencia de fracasos sugiere que es igual o más efectiva que la SRO-OMS para el tratamiento de la deshidratación por diarrea

Nivel de conocimientos sobre prevención y cuidados de primeros auxilios en accidentes y problemas de salud mas frecuentes del niño / Level of knowledge about prevention and care of first aids in accidents and frequent health problems in children

A través de una encuesta se analizó en 60 madres que acudieron a las Unidades de Emergencia de los Hospitales Roberto del Río y Luis Calvo Mackenna,el nivel de conocimientos sobre prevención de accidentes y cuidados de primeros auxilios, en los problemas de salud que frecuentemente afectan al menor de 15 años. Las madres encuestadas eran menores de 30 años en casi el 50 por ciento; el 62 por ciento casada, el 85 por ciento desarrollaba actividades de dueña de casa; el 46 por ciento cursó entre 1º y 4º medio. El 75 por ciento tenía menos de 3 hijos. La población infantil en riesgo de sufrir accidentes correspondió a 129 niños. El 58 por ciento ha sufrido un accidente. Los resultados obtenidos fueron los siguientes: en caso de intoxicaciones la madre acude a un Servicio de Urgencia en un 30 por ciento, el 44 por ciento provoca vómitos y el 26 por ciento administra leche. El 50 por ciento acude al hospital en caso de desmayo; el 50 por ciento realiza medidas de prevención tanto en la cocina como en otras dependencias de la casa; el 50 por ciento coloca agua fría sobre las quemaduras; el 30 por ciento mantiene el orden en la casa como prevención de accidentes. El 75 por ciento lleva al niño a un Servicio de Urgencia en caso de fracturas, el 30 por ciento deja en reposo al niño con TEC. El 50 por ciento administra agua cocida en caso de diarrea. El 80 por ciento coloca alcohol sobre la herida. El 90 por ciento de las madres, acude a un Servicio de Urgencia en caso de convulsiones. Trasladan al niño a un Centro Asistencial, el 60 por ciento con cuerpo extraño en el pie, el 85 por ciento con cuerpo extraño en la nariz y el 90 por ciento cuando éste, está en el oído y el ojo

Anestesia en cirugia laparoscópica / Anesthesia in laparoscopic surgery

Los procedimientos laparoscópicos han sido llevados a cabo en el campo de la ginecología durante muchos años. Sin embargo, con el advenimiento de la colecistectomía laparoscópica se produjo un explosivo desarrollo de la cirugía video-endoscópica que llevó a la ejecución de procedimientos cada vez más ambiciosos entre los que se destacan la histerectomía, la hemicolectomía, la hernioplastía, la esplenectomía y la linfadenectomía pelviana. A pesar de las ventajas objetivas de la cirugía laparoscópica sobre el abordaje convencional, su ejecución involucra una serie de importantes alteraciones fisiopatológicas determinadas por la instalación de un neumoperitoneo de CO2, por la colocación del paciente en posición de Trendelemburg o Trendelemburg invertido y por la absorción del CO2 desde la cavidad abdominal hacia la circulación sanguínea. Estos cambios inducen una serie de importantes implicancias clínicas que se manifiestan a nivel de los aparatos Respiratorio, Cardiovascular y del Medio Interno y que conducen al análisis de un conjunto de consideraciones anestesiológicas tendientes a corregir estas alteraciones y a prevenir la aparición de complicaciones. Adicionalmente, el anestesiólogo debe tener en consideración el carácter de cirugía ambulatoria de los procedimientos laparoscópicos, lo que implica la necesidad de instrumentar una técnica anestésica que permita una rápida recuperación de los pacientes con la menor incidencia de efectos adversos postoperatorios. Finalmente, la realización de cirugía laparoscópica esta asociada a un amplio espectro de complicaciones que van desde trastornos menores en el postoperatorio tales como el dolor o las naúseas y vómitos hasta complicaciones que pueden amenazar la vida del paciente entre las que se destacan las lesiones por barotrauma inducidas por el neumoperitoneo o las injurias quirúrgicas sobre elementos nobles. La importancia de estas complicaciones obliga al anestesiólogo a extremar precauciones a fin de realizar un diagnóstico precoz y un efectivo tratamiento de las mismas.

Ventana analgésica y antiemética post-operatoria / Analgesic and anti-emetic trans-operative window

A cuarenta y cinco pacientes se les practicó histerectomía abdominal bajo anestesis general balanceada. Fueron clasificados en tres grupos para comparar el control del dolor, la náusea y el vómito postoperatorios. Al primer grupo se les administraron los analgésicos cuando lo solicitaron y si presentaban náusea y vómito se les aplicaba ondansetron. Los del segundo grupo recibieron los analgésicos inmediatamente después de la emersión anestésica sin que manifestaran dolor, y el antiemético únicamente si era requerido. El último grupo constituía la ventana analgésica y antiemética y se les prescribieron los medicamentos antes de terminar el procedimiento anestésico. En el 40 por ciento de las pacientes (18), bastó una dosis de buprenorfina para control del dolor asociada a dipirona con horario fijo, de los cuales, 12 pacientes (26.5 por ciento) pertenecían al tercer grupo. El efecto terapéutico del ondansetron quedó claramente demostrado al inhibir la náusea y el vómito que presentaron las pacientes del primero y segundo grupos, en tanto que la acción profiláctica fue evidente en las mujeres del tercer grupo. La somnolencia fue el efecto colateral más común (58 por ciento) que coadyuvó a la tranquilidad con que evolucionaron nuestras pacientes y que prueban categóricamente la ausencia de estas complicaciones post-operatorias