Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study.

BACKGROUND: Limited information is available on the symptomatic complications that occur in the last days of life. AIM: We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units. DESIGN: Prospective longitudinal observational study. MEASUREMENTS: Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death. SETTING/PARTICIPANTS: We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil. RESULTS: A total of 352 patients were enrolled (MD Anderson Cancer Center = 151, Barretos Cancer Hospital = 201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p < 0.001), pneumonia (p = 0.003), peritonitis (p = 0.03), metabolic acidosis (p < 0.001), and upper gastrointestinal bleed (p = 0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p < 0.001). CONCLUSION: Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.

Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia / Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation

JUSTIFICATIVA E OBJETIVOS: A clonidina e a dexmedetomidina são agonistas alfa2-adrenérgicos que, quando administrados por via peridural, possuem propriedades analgésicas e potencializam os efeitos dos anestésicos locais. A presente pesquisa objetivou avaliar a analgesia e a sedação produzidas pela clonidina ou dexmedetomidina associadas à ropivacaína, por via peridural, no pós-operatório de colecistectomia por via subcostal. MÉTODO: Participaram do estudo aleatório e duplamente encoberto 40 pacientes, de ambos os sexos, com idade variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia por via subcostal, os quais foram distribuídos em dois grupos: clonidina (GC), em que foi administrada clonidina (1 ml = 150 µg) associada à ropivacaína a 0,75 por cento (20 ml) por via peridural; dexmedetomidina (GD), em que foi injetada dexmedetomidina (2 µg.kg-1) associada à ropivacaína a 0,75 por cento (20 ml) por via peridural. A analgesia e a sedação foram observadas 2, 6 e 24 horas após o término da anestesia. RESULTADOS: Ocorreu sedação depois de 2 e 6 horas em ambos os grupos, sendo que houve diferença estatística significante entre os tempos de 2 e 6 horas no grupo dexmedetomidina. Houve analgesia em ambos os grupos, especialmente depois de 2 e 6 horas. Foi detectada diferença estatística significante entre os tempos de 2, 6 e 24 horas no grupo dexmedetomidina; no grupo clonidina essa diferença estatística significante foi observada entre os tempos de 2 e 6 horas e entre 2 e 24 horas. CONCLUSÕES: Os resultados permitiram concluir que a clonidina ou a dexmedetomidina associadas à ropivacaína a 0,75 por cento asseguraram analgesia e sedação nos tempos de observação de 2 e 6 horas após o término da anestesia, nos pacientes submetidos à colecistectomia por via subcostal e que a clonidina promove analgesia mais prolongada.

[Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation.]. / Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia.

BACKGROUND AND OBJECTIVES: Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The goal of this study was to evaluate the analgesia and sedation promoted by clonidine or dexmedetomidine associated to epidural ropivacaine, in the postoperative period of subcostal cholecystectomy. METHODS: Forty patients of both gender participated in this randomized double-blind study , aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to subcostal cholecystectomy. The subjects were distributed in two groups: Clonidine (CG), receiving clonidine (1 mL = 150 microg) associated to 0.75% epidural ropivacaine (20 mL); Dexmedetomidine (DG), receiving dexmedetomidine (2 microg.kg-1) associated to 0.75% epidural ropivacaine (20 mL). Analgesia and sedation were evaluated 2, 6 and 24 hours anesthetic recovery. RESULTS: Both groups present some grade of sedation in the moments 2 and 6 hours , with statistically significant difference between the two moments for the dexmedetomidine group. There has been analgesia in both groups, especially at 2 and 6 hours. There have been statistically significant difference among periods of 2, 6 and 24 hours in the dexmedetomidine group; in the clonidine group, this statistically significant difference was observed between the periods of 2 and 6 hours and between 2 and 24 hours. CONCLUSIONS: Our results allowed to conclude that the association of clonidine or dexmedetomidine to 0.75% ropivacaine induces analgesia and sedation in 2 and 6 hours after anesthetic recovery in patients submitted to subcostal cholecystectomy and that clonidine promotes more prolonged analgesia.

Analgesia e sedação da associação da clonidina e ropivacaína a 0, 75 por cento por via peridural no pós-operatório de colecistectomia aberta / Analgesia and sedation with epidural clonidine associated to 0. 75 percent ropivacaine in the postoperative period of open cholecystectomy

JUSTIFICATIVA E OBJETIVOS: A clonidina, quando administrada por via peridural, possui propriedades analgésicas e potencializa os efeitos dos anestésicos locais, ocorrendo, contudo, efeitos colaterais que incluem hipotensão arterial, bradicardia e sedação. O objetivo desse trabalho foi avaliar a analgesia e a sedação da clonidina associada à ropivacaína a 0,75 por cento no pós-operatório de colecistectomia aberta. MÉTODO: Participaram da pesquisa 30 pacientes, de ambos os sexos, com idades variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia, os quais foram distribuídos em dois grupos: Controle (GC), em que foi administrada ropivacaína a 0,75 por cento (20 ml), associada ao cloreto de sódio a 0,9 por cento (1 ml); Experimento (GE), em que foi injetada ropivacaína a 0,75 por cento (20 ml), associada à clonidina (1 ml = 150 'g). A analgesia e a sedação foram observadas 2, 6 e 24 horas após o término do ato operatório. RESULTADOS: A média de idade no GC foi de 41 anos e de 37 anos no GE. A média de peso foi de 67 kg no GC e de 64 kg no GE. A sedação no pós-operatório foi significativamente maior nos pacientes as 2 e 6 horas do grupo experimento. A analgesia foi observada em maior número de pacientes do grupo experimento, quando comparada ao grupo controle. CONCLUSÕES: A associação de clonidina e ropivacaína produziu analgesia mais duradoura e sedação em pacientes, nos horários de observação de 2 e 6 horas.

BACKGROUND AND OBJECTIVES: Epidural clonidine has analgesic properties and potentiates local anesthetic effects; there are, however, some side effects including: arterial hypotension, bradycardia and sedation. This study aimed at evaluating analgesia and sedation of clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy. METHODS: Participated in this study 30 patients of both genders, aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to cholecystectomy, who were distributed in two groups: Control Group (CG) received 0.75% ropivacaine (20 ml) with saline solution (1 ml); Experimental Group (EG) received 0.75% ropivacaine (20 ml) with clonidine (1 ml = 150 µg). Analgesia and sedation were observed at 2, 6 and 24 postoperative hours. RESULTS: Mean age was 41 yr in CG and 37 yr in EG. Mean weight was 67 kg in CG and 64 kg to EG. Postoperative sedation was significantly higher at 2 and 6 hours in the Experimental Group. Analgesia was observed in more EG patients as compared to Control Group. CONCLUSIONS: The association of clonidine and ropivacaine has produced longer analgesia and sedation at 2 and 6 hours of observation.

JUSTIFICATIVA Y OBJETIVOS: La clonidina, cuando administrada por vía peridural, posee propiedades analgésicas y potencializa los efectos de los anestésicos locales, ocurriendo por ello, efectos colaterales que incluyen hipotensión, bradicardia y sedación. El objetivo de ese trabajo fue evaluar la analgesia y la sedación de la clonidina asociada a la ropivacaína a 0,75% en el pos-operatorio de colecistectomia abierta. MÉTODO: Participaron de la pesquisa 30 pacientes, de ambos sexos, con edades variando de 18 a 50 años, con peso entre 50 y 100 kg, estado físico ASA I y II, sometidos a colecistectomia, y que fueron distribuidos en dos grupos: Control (GC), en que fue administrada ropivacaína a 0,75% (20 ml), asociada al clorato de sodio a 0,9% (1 ml); Experimento (GE), en que fue inyectada ropivacaína a 0,75% (20 ml), asociada a la clonidina (1 ml = 150 µg). La analgesia y la sedación fueron observadas 2, 6 y 24 horas después del término del momento operatorio. RESULTADOS: La media de edad en el GC fue de 41 años y de 37 años en el GE. La media de peso fue de 67 kg en el GC y de 64 kg en el GE. La sedación en el pos-operatorio fue significativamente mayor en los pacientes a las 2 y 6 horas del grupo de experimento. La analgesia fue observada en mayor número de pacientes del grupo de experimento, cuando comparada al grupo control. CONCLUSIONES: La asociación de clonidina y ropivacaína produjo analgesia que dura más, y sedación en pacientes, en los horarios de observación de 2 y 6 horas.

Analgesia and sedation with epidural clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy.

BACKGROUND AND OBJECTIVES: Epidural clonidine has analgesic properties and potentiates local anesthetic effects; there are, however, some side effects including: arterial hypotension, bradycardia and sedation. This study aimed at evaluating analgesia and sedation of clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy. METHODS: Participated in this study 30 patients of both genders, aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to cholecystectomy, who were distributed in two groups: Control Group (CG) received 0.75% ropivacaine (20 ml) with saline solution (1 ml); Experimental Group (EG) received 0.75% ropivacaine (20 ml) with clonidine (1 ml = 150 microg). Analgesia and sedation were observed at 2, 6 and 24 postoperative hours. RESULTS: Mean age was 41 yr in CG and 37 yr in EG. Mean weight was 67 kg in CG and 64 kg to EG. Postoperative sedation was significantly higher at 2 and 6 hours in the Experimental Group. Analgesia was observed in more EG patients as compared to Control Group. CONCLUSIONS: The association of clonidine and ropivacaine has produced longer analgesia and sedation at 2 and 6 hours of observation.