RESUMEN
Epidural analgesia is often considered as risk of epidural haematoma in patient with essential thrombocythaemia because of the platelet disorder. In this observation, uncomplicated epidural analgesia was performed in a pregnant woman with asymptomatic essential thrombocythaemia, because the absence of bleeding symptoms was associated with normal thrombo-elastography and time of occlusion by PFA-100 suggesting normal platelet function. PFA-100 is a biological test evaluating platelet function in whole blood, which is easy and quick to perform. This case study suggests that this test might be useful in evaluating platelet function in obstetrics but must be validated before recommending its extensive use.
Asunto(s)
Analgesia Epidural , Analgesia Obstétrica , Trombocitosis/complicaciones , Adulto , Femenino , Hematoma , Humanos , Pruebas de Función Plaquetaria , Embarazo , Riesgo , Tromboelastografía , Trombocitosis/sangre , Trombocitosis/diagnósticoAsunto(s)
Analgesia/métodos , Articulación de la Rodilla/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Acetaminofén/administración & dosificación , Acetaminofén/análogos & derivados , Acetaminofén/uso terapéutico , Analgesia Controlada por el Paciente , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Artroplastia de Reemplazo de Rodilla , Bupivacaína/administración & dosificación , Bupivacaína/uso terapéutico , Clonidina/administración & dosificación , Clonidina/uso terapéutico , Humanos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Ligamentos Articulares/cirugía , Morfina/administración & dosificación , Morfina/uso terapéutico , Bloqueo Nervioso , Dolor Postoperatorio/prevención & control , Modalidades de Fisioterapia , Sufentanilo/administración & dosificación , Sufentanilo/uso terapéutico , Simpaticolíticos/administración & dosificación , Simpaticolíticos/uso terapéutico , Estimulación Eléctrica Transcutánea del NervioRESUMEN
Caudal and spinal anaesthesia are two techniques widely used in European children. The aim of this retrospective study was to evaluate the applicability of this practice in developing countries. The study concerned 1875 children, 1 day to 17 years old. isobaric 0.5% bupivacaine was used for spinal anaesthesia (n = 730) and mixture a of 1% lidocaine-0.25% bupivacaine with epinephrine 1/200,000 for caudal anaesthesia (n = 1,145). Spinal anaesthesia was performed in neonates and infants (< 3 years) and caudal anaesthesia in children (aged 14 days to 17 years) undergoing urological and lower extremity surgery. No variation of heart rate, blood pressure or blood oxygen saturation (SpO2) were observed during surgery. Failure of the technique was less than 1%. These two regional anaesthesia techniques are easy to perform and are inexpensive. This is advantageous for developing countries.
Asunto(s)
Anestesia Caudal , Anestesia Raquidea , Procedimientos Quirúrgicos Operativos , Adolescente , Factores de Edad , Niño , Preescolar , Países en Desarrollo , Humanos , Lactante , Recién Nacido , Estudios RetrospectivosRESUMEN
The pharmacokinetics of amikacin have been studied in 40 intensive care unit (ICU) patients using a two-compartment model and the Bayesian estimation method implemented in the USC PC-PACK program of Jelliffe et al. The volume of the central compartment was significantly higher in these patients (0.36 l.kg-1) than in the reference population (0.20 l.kg-1). A method has been designed to compute dosage regimens in order to maintain a constant steady-state average plasma concentration of 8 mg.l-1 for repeated i.v. infusions. The regimen calculated for the 'average' ICU patient varies between 11 mg.kg-1 three times per day for the patient with normal renal function and 6 mg.kg-1 every 2 days for the anuric patient. This regimen is intended to begin amikacin therapy in an ICU patient, while the population pharmacokinetic parameters would allow the individualization of the regimen by means of the Bayesian method.
Asunto(s)
Amicacina/administración & dosificación , Amicacina/farmacocinética , Amicacina/sangre , Anuria/metabolismo , Teorema de Bayes , Creatinina/sangre , Cuidados Críticos , Esquema de Medicación , Monitoreo de Drogas , Quimioterapia Asistida por Computador , Semivida , Humanos , Infusiones Intravenosas , Riñón/metabolismo , Programas InformáticosAsunto(s)
Anestesia , Pediatría , Encuestas y Cuestionarios , Francia/epidemiología , Humanos , Estudios RetrospectivosRESUMEN
We report a case of hypokalemic flaccid quadriplegia with sudden respiratory arrest in a 38-year-old woman discovered to have distal renal tubular acidosis which lead to the diagnosis of primary Sjögren's syndrome. This case is compared to 8 similar cases previously described in the literature.
Asunto(s)
Acidosis Tubular Renal/complicaciones , Hipopotasemia/complicaciones , Cuadriplejía/complicaciones , Insuficiencia Respiratoria/complicaciones , Síndrome de Sjögren/diagnóstico , Adulto , Femenino , Humanos , Túbulos Renales Distales/patología , Hipotonía Muscular/complicaciones , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/patologíaRESUMEN
The pharmacokinetics of amikacin has been studied in 40 intensive care unit patients using the bayesian estimation method implemented in the USC PC PACK program of Jelliffe. The volume of the central compartment was significantly higher in these patients than in the reference population, while other pharmacokinetic parameters did not differ significantly from the reference values. The population values may be employed, in addition to those supplied with the software, to adapt dosage regimens of amikacin in ICU patients.
Asunto(s)
Amicacina/farmacocinética , Amicacina/uso terapéutico , Adolescente , Adulto , Anciano , Amicacina/administración & dosificación , Teorema de Bayes , Humanos , Infusiones Intravenosas , Unidades de Cuidados Intensivos , Persona de Mediana Edad , Modelos Estadísticos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/metabolismoRESUMEN
UNLABELLED: Continuous epidural analgesia is an common technique in neo-natal surgery. It will be possible with a fitting material. Principal indications are: omphalocele, gastroschisis, oesophagol atresia an diagphragmatic hernia. TECHNIQUE: our protocol has been approved by the Regional Ethical Committee and informed written consent has been obtained from parents. General anaesthesia was induced and children were placed in lateral position. After skin preparation, the interspace L 3-L 4 has been punctured to identify the epidural space by loss of resistance. An epidural catheter (19 to 27 G) has been placed. 0.5 ml.kg-1 of 0.25% bupivacaine have been immediately injected, followed by a continuous injection of 0.3 ml.kg-1h-1 of the same bupivacaine. Epidural has been kept for four to five days. ADVANTAGES: very good analgesia; abdominal and vascular pressures decreased; to wean from respirator very quickly. No accident was founded.