ABSTRACT
Objective To study the effect of small doses of remifentanil in preventing cardiovascular responses to extubation in the operation of obstructive sleep apnea hypoventilation syndrome (OSAHS) . Methods Eighty patients with snoring under general anesthesia were selected. The patients were randomly divided into treatment group and control group with 40 cases in each group. The two groups used the same induction anaesthetics, and sevoflurane and remifentanil were used in both groups for anesthesia maintainance. The control group discontinued all anesthetics at the end of surgery; The treatment group stopped sevoflurane alone, and decreased and continued the infusion of remifentanil until extubation. The changes of heart rate, systolic blood pressure, diastolic blood pressure and oxygen saturation before anesthesia (t1) , extubation (t2) , 5 min after extubation (t3) , 10 min after extubation (t4) and 15 min after extubation (t5) were recorded. Recovery indexesand adverse reactions of anesthesia were recorded. Results The heart rate, systolic blood pressure, diastolic blood pressure were significantly increased at t2, t3, t4 and t5 in the two groups (P< 0.05) . SpO2 in all time intervals after extubation was slightly decreased, but the difference was not statistically significant (P> 0.05) .No significant differences were found between the two groups in the recovery time of spontaneous respiration, extubation time and the time returning to the ward (P > 0. 05) . The incidence of adverse reactions was significantly lower in the treatment group (7.5％) than in the control group (30.0％) (P< 0.05) . Conclusion Small doses of remifentanil can effectively prevent the cardiovascular responses during extubation in OSAHS operations, reduce the adverse reactions and increase the safety of extubation.
ABSTRACT
La importancia de la patología psiquiátrica en la infancia y la adolescencia ha ido en ascenso, debido al aumento en su diagnóstico y a sus implicancias socioculturales. El Trastorno por Déficit Atencional e Hiperactividad es el trastorno neurobiológico más diagnosticado en la práctica clínica infanto-juvenil, tanto así que debe ser conocido y manejado en la Atención Primaria por los médicos generales. Se ha descrito cierto grado de sobrediagnóstico influenciado, entre otros motivos, por las altas expectativas sociales respecto del rendimiento escolar/conductual de los niños, así como la presencia de otras patologías que se pueden manifestar con síntomas TDAH-like. En este sentido, la relación entre SAOS y TDAH, cobra gran relevancia, puesto que ambas patologías presentan una amplia prevalencia en nuestro país y un alto nivel de comorbilidad psiquiátrica/médica, además de relacionarse a través de una compleja y aún no muy bien conocida interacción neuropsicológica.
The importance of psychiatric disorders in childhood and adolescence has been increasing due to the increase in its diagnosis and its cultural implications. The Attention Deficit Hyperactivity Disorder is the neurobiological disorder most commonly diagnosed in the child-adolescent clinical practice, so much so that must be managed in primary care. It described some degree of overdiagnosis influenced by high school-social expectations and behavioral performance of children, and the presence of other conditions. In this sense, the relationship between OSA and ADHD, is very relevant, because both disorders share a wide prevalence in our country and a high level of psychiatric and medical comorbidity. In adittion, these interact through a complex and still not well known neuropsychological mechanism.
Subject(s)
Humans , Child , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit Disorder with Hyperactivity/psychology , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/psychologyABSTRACT
A Síndrome de Apneia Obstrutiva do Sono (SAOS) constitui um grave problema de saúde pública. O diagnóstico e tratamento atempado da doença, mediante ventilação não invasiva (VNI), diminui o impacto desta doença a nível da procura de cuidados de saúde e respectiva despesa. Neste trabalho, pretende-se avaliar os ganhos obtidos em doentes com SAOS moderado-grave, no espaço temporal de um ano, e respectivo impacto económico, quer para o doente, quer para o SNS. Mais especificamente, averigua-se se o tratamento com VNI permite reduzir: sonolência diurna; acidentes de viação; número de internamentos; número de dias de internamento; número de episódios de urgência; número de consultas da especialidade; e respectivos custos. Para avaliar resultados e custos, recorreu-se à escala de sonolência (ESE), aos grupos de diagnóstico homogéneos (GDH's) publicados e/ ou contratualizados. Na análise estatística de dados recorremos a técnicas descritivas e inferenciais (test-t para amostras emparelhadas e coeficiente de correlação de Spearman), adoptando um nível de significância de 5%. Os nossos resultados mostram uma redução significativa da sonolência diurna (p<0.001), dos acidentes de viação (p<0.001), do número de urgências (p<0.001), do número de internamentos (p<0.001), do número de dias de internamento (p<0.001). Demonstra-se igualmente uma redução significativa dos custos com urgências (p<0.001) e consultas de especialidade (p<0.001) para o utente, e dos custos de urgências (p<0.001) e internamentos (p<0.001) para o SNS. Nas consultas de especialidade não houve redução significativa em número (p=0.269) nem de custos para o SNS (p=0.269). No que diz respeito à relação da severidade da SAOS com os acidentes de viação e com a sonolência diurna os resultados não foram significativos. Em conclusão, o tratamento das SAOS com VNI, mesmo no espaço temporal de um ano, reduz, quer o recurso aos serviços de saúde e custos associados, quer a sonolência diurna e acidentes de viação associados.
Obstructive Sleep Apnea Syndrome (OSAS) is a serious public health problem. The timely diagnosis and treatment of disease through noninvasive ventilation (NIV) reduces the impact of this disease on the demand for health care and related expense. The objective of this study was to measure the economic impact of one year of treatment with noninvasive ventilation in patients with moderate-severe OSAS, an also for the national healthcare system (NHS). More specifically, we'll study if the treatment with NIV reduces: daytime sleepiness; motor vehicle accidents; number of hospitalizations; number of days of hospitalization; number of urgency episodes; number of medical specialty visits; and there costs. To assess outcomes and costs, we used the sleepiness scale (ESS) and the homogeneous diagnostic groups (HDG's) approved by law and/ or by contract celebrated between the hospital and the NHS. The techniques of statistical data analysis we used were descriptive and inferential statistics (t test for paired samples and Spearman's correlation coefficient), adopting a significance level of 5%. Our results show a significant reduction in daytime sleepiness (p<0.001), road traffic accidents (p<0.001), the number of urgencies (p<0.001), the number of hospitalizations (p<0.001), the number of days hospitalization (p<0.001). It also reveal a significant reduction in urgencies costs (p<0.001) and medical specialty visits (p<0.001) for the patients, and the costs of emergencies (p<0.001) and hospitalization (p<0.001) for the NHS. There wasn't significant reduction on medical specialty visits (p=0.269) as well as in costs to the NHS (p=0.269). With regard to the relationship of the severity of OSAS with road traffic accidents and daytime sleepiness the results were also not significant. In conclusion, treatment of OSAS with NIV, even in temporal space of year, reduces the use of health services and associated costs, as well as daytime sleepiness and road traffic accidents.
