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1.
Rev. esp. anestesiol. reanim ; 63(5): 289-296, mayo 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-152293

RESUMO

El sangrado en el paciente traumatizado representa la primera causa de muerte potencialmente prevenible. La coagulopatía aguda traumática es una entidad específica con una fisiopatología diferente a las de otras causas de sangrado masivo. Un correcto manejo del sangrado del paciente politraumatizado precisa una identificación precoz de dicha coagulopatía, con el fin de iniciar en el menor tiempo posible la llamada resucitación hemostática. Ha habido importantes novedades en el manejo de esta entidad que se están incorporando a las guías actuales. Por ejemplo, la administración de ácido tranexámico o la utilización de ratios de transfusión cercanas al 1:1:1 (plasma fresco congelado: concentrado de plaquetas:concentrado de hematíes). Estas actuaciones y otras que analizaremos a continuación han logrado mejorar el pronóstico de estos pacientes con el aval de la evidencia científica (AU)


Bleeding is the most common preventable cause of death in trauma patients. Acute traumatic coagulopathy is a specific condition with a different pathophysiology from other causes of the massive bleeding. An early identification of the coagulopathy is fundamental to implementing rapid treatment. There have been many changes in the management of massive hemorrhage, for example, the administration of the tranexamic acid and the use of balanced transfusion ratio. This review presents these practical points, some of them with scientific evidence, in order to achieve a beneficial effect for patient outcomes (AU)


Assuntos
Humanos , Masculino , Feminino , Hemorragia/terapia , Medicina Transfusional/instrumentação , Medicina Transfusional/métodos , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Fibrinogênio/uso terapêutico , Ácido Tranexâmico/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Cálcio/uso terapêutico , Ferimentos e Lesões/sangue , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia , Transtornos Hemostáticos/diagnóstico , Transtornos Hemostáticos/terapia
2.
Rev Esp Anestesiol Reanim ; 63(5): 289-96, 2016 May.
Artigo em Espanhol | MEDLINE | ID: mdl-26164470

RESUMO

Bleeding is the most common preventable cause of death in trauma patients. Acute traumatic coagulopathy is a specific condition with a different pathophysiology from other causes of the massive bleeding. An early identification of the coagulopathy is fundamental to implementing rapid treatment. There have been many changes in the management of massive hemorrhage, for example, the administration of the tranexamic acid and the use of balanced transfusion ratio. This review presents these practical points, some of them with scientific evidence, in order to achieve a beneficial effect for patient outcomes.


Assuntos
Transtornos da Coagulação Sanguínea , Traumatismo Múltiplo , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Hemorragia/etiologia , Humanos , Ácido Tranexâmico/uso terapêutico , Reação Transfusional
3.
Angiology ; 64(7): 535-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23052724

RESUMO

We evaluated mean platelet volume (MPV; an indicator of vascular risk) and platelet distribution width in patients with stable chronic obstructive pulmonary disease (COPD; n = 85). We also included a control group of 34 smokers without airflow limitation. Mean platelet volume was significantly higher in patients with COPD (10.69 ± 1.0 vs 9.96 ± 1.10 fL, P < .001) than in the smoker controls. White blood cell (WBC) count was also significantly higher in patients with COPD than in the smoker controls (10,642 ± 1247 vs 7136 ± 1887/µL, P < .001). There was a correlation between MPV and WBC in patients with COPD, especially in those at stage III (r = .530, P = .004) and IV (r = .389, P = .023). Mean platelet volume did not correlate with any indices of COPD severity. In patients with COPD, MPV and WBC levels are higher than those of smokers with normal pulmonary function and are significantly correlated. Whether these effects relate to vascular risk in patients with COPD remain to be established.


Assuntos
Plaquetas/patologia , Tamanho Celular , Leucócitos/metabolismo , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/sangue , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas
4.
Minerva Anestesiol ; 78(3): 358-68, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22357373

RESUMO

Prothrombin complex concentrates (PCCs) are purified drug products with hemostatic activity derived from a plasma pool. Today, PCCs contain a given and proportional amount of four non-activated vitamin K-dependent coagulation factors (II, VII, IX, and X), a variable amount of anticoagulant proteins (proteins C and S, and in some antithrombin) and low-dose heparin. In some countries PCC products contained only three clotting factors, II, IX, and X. Dosage recommendations are based on IU of F-IX, so that one IU of F-IX represents the activity of F-IX in 1 mL of plasma. Reversion of the anticoagulant effect of vitamin K antagonists (VKAs) in cases of symptomatic overdose, active bleeding episodes, or need for emergency surgery is the most important indication for PCCs and this effect of PCCs appears to be more complete and rapid than that caused by administration of fresh frozen plasma. They may be considered as safe preparations if they are used for their approved indications at the recommended dosage with adequate precautions for administration, and have been shown to be effective for reversing the effect of VKAs. Their adequate use based on decision algorithms in the perioperative setting allows a rapid normalization of International Normalized Ratio (INR) for performing emergency surgery, minimizing bleeding risk. This review aims to propose two algorithms for the use of PCCs in the perioperative setting, one to calculate the PCCs dose to be administered in a bleeding patient and/or immediately before urgent surgery, based on patient's clinical status, prior INR and INR target and another for reversing the action of oral anticoagulants depending on urgency of surgery.


Assuntos
Fatores de Coagulação Sanguínea/uso terapêutico , Hemostáticos/uso terapêutico , Assistência Perioperatória/métodos , Algoritmos , Anticoagulantes/efeitos adversos , Antídotos/administração & dosagem , Antídotos/efeitos adversos , Antídotos/química , Antídotos/uso terapêutico , Fatores de Coagulação Sanguínea/administração & dosagem , Fatores de Coagulação Sanguínea/efeitos adversos , Fatores de Coagulação Sanguínea/análise , Fatores de Coagulação Sanguínea/química , Testes de Coagulação Sanguínea , Perda Sanguínea Cirúrgica/prevenção & controle , Coagulação Intravascular Disseminada/complicações , Monitoramento de Medicamentos , Emergências , Medicina Baseada em Evidências , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Hemostáticos/administração & dosagem , Hemostáticos/efeitos adversos , Hemostáticos/química , Humanos , Falência Hepática/complicações , Hemorragia Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Tromboembolia/induzido quimicamente , Tromboembolia/prevenção & controle , Vitamina K/antagonistas & inibidores
5.
Platelets ; 23(6): 447-54, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22070405

RESUMO

UNLABELLED: To evaluate Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) in non-diabetic subjects, according to obstructive sleep apnoea syndrome (OSAS) severity and the associations of these indices with anthropometric characteristics and parameters of breathing function during sleep. MATERIALS AND METHODS: We included 610 non-diabetic subjects with suspected OSAS, evaluated by polysomnography. According to their apnoea-hypopnoea index (AHI), patients were divided into Group A (n=148) with AHI<5/h; Group B (n=121) with AHI: 5-14.9/h; Group C (n=85) with AHI: 15-29.9/h and Group D (n=256) with AHI ≥ 30/h. MPV and PDW were measured using an automated blood cell counter. RESULTS: MPV was significantly higher in group D (mean value 12.1 ± 1.3 fl) than in groups A (9.8 ± 1.1 fl), B (9.8 ± 1.6 fl), and C (11.5 ± 1.3 fl) (p<0.001). The same pattern was observed in PDW values (15.9 ± 2.2 fl for group D and 13.2 ± 2.2 fl for group A, 14.1 ± 2.8 fl for group B, and 15 ± 2.2 fl for group C, p<0.001). Significant correlations were seen between MPV and AHI (p<0.001), average pulse oxygen saturation (SpO(2)) (p<0.001), minimum SpO(2) (p<0.001) and percent of the total sleep time with SpO(2) lower than 90% (t<90%) (p<0.001) during sleep, Arousal Index (p<0.001) and Epworth sleepiness scale (ESS) (p=0.028). Similarly, PDW was correlated with AHI (p<0.001), average SpO(2) (p=0.001), minimum SpO(2) (p<0.001), t<90% (p=0.002), and Arousal Index (p<0.001). CONCLUSIONS: MPV and PDW are higher in non-diabetic patients with severe OSAS and are correlated with different parameters of breathing function during sleep.


Assuntos
Plaquetas/patologia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/patologia , Idoso , Antropometria , Contagem de Células Sanguíneas , Tamanho Celular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio , Polissonografia , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Fases do Sono
6.
Rev Neurol ; 30(5): 421-7, 2000.
Artigo em Espanhol | MEDLINE | ID: mdl-10775967

RESUMO

INTRODUCTION: The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. OBJECTIVES: To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. PATIENTS AND METHODS: We studied the patients with non traumatic rhabdomyolysis (creatinkinase > 1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. RESULTS: We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. CONCLUSION: CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.


Assuntos
Creatina Quinase/sangue , Serviços Médicos de Emergência , Doença Aguda , Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Valores de Referência , Rabdomiólise/complicações , Rabdomiólise/diagnóstico , Doenças Urológicas/complicações , Doenças Urológicas/diagnóstico
7.
Rev. neurol. (Ed. impr.) ; 30(5): 421-427, 1 mar., 2000. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-128547

RESUMO

Introduction. The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. Objectives. To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. Patients and methods. We studied the patients with non traumatic rhabdomyolysis (creatinkinase >1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. Results. We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. Conclusion. CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.(AU)


Introducción. El pronóstico de la rabdomiólisis depende del desarrollo de fracaso renal agudo, el cual depende a su vez de la rapidez en instaurar medidas preventivas. El diagnóstico de certeza de rabdomiólisis se basa en el hallazgo de cifras elevadas de creatinquinasa en plasma, y el de sospecha suele recaer en los antecedentes inmediatos, como traumatismos. Habitualmente las rabdomiólisis de origen no traumático carecen de un antecedente llamativo, y la sospecha debería recaer en la clínica que presenten los pacientes, pero ésta ha sido escasamente estudiada. Objetivos. Describir la semiología asociada a cuadros de rabdomiólisis no traumáticas e identificar los síntomas que motivaron a los enfermos a acudir a urgencias, para facilitar la sospecha diagnóstica. Pacientes y métodos. Pacientes diagnosticados de rabdomiólisis no traumática (creatinquinasa >1.000 UI/l) en un servicio de urgencias externas hospitalarias a lo largo de un año. Obtuvimos información acerca de los síntomas padecidos, y del síntoma en concreto que los motivó a acudir a urgencias. Los síntomas referidos fueron clasificados en cuatro grupos: musculares, urinarios, neurológicos y otros. Resultados. Entrevistamos a 49 pacientes. Los grupos de síntomas aparecieron en los enfermos con las siguientes frecuencias relativas: musculares 51%, urinarios 18%, neurológicos 67% y otros 47%. Representaron el motivo principal de consulta con las siguientes frecuencias absolutas: musculares 16%, urinarios 2%, neurológicos 48%, otros 22%, musculares y neurológicos asociados 6%, neurológicos y otros asociados 6%. Conclusión. Debería determinarse la CK en todos aquellos pacientes que acudan a urgencias afectos de algún trastorno neurológico (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Creatina Quinase/sangue , Serviços Médicos de Emergência , Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Músculo Esquelético/patologia , Doença Aguda , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Rabdomiólise/complicações , Rabdomiólise/diagnóstico , Doenças Urológicas/complicações , Doenças Urológicas/diagnóstico , Valores de Referência , Estudos Prospectivos
8.
Clin Pharmacokinet ; 10(5): 451-5, 1985.
Artigo em Inglês | MEDLINE | ID: mdl-3930124

RESUMO

The possible development of a displacement interaction involving tolbutamide, in epileptic patients, has been explored by studying the serum protein binding of this drug in vitro in 199 samples of sera from patients treated with antiepileptic agents included in a programme of therapeutic drug monitoring. 82 of the samples were from patients receiving a single drug, 86 from patients treated with 2 drugs, and 31 from patients treated with 3 drugs. The free fraction of tolbutamide was higher in serum from patients treated with antiepileptic drugs than in serum from untreated 'normal' volunteers. The increase was more marked the greater the number of antiepileptic drugs administered. Valproate appeared to be the most powerful displacing agent.


Assuntos
Anticonvulsivantes/efeitos adversos , Proteínas Sanguíneas/metabolismo , Tolbutamida/sangue , Adolescente , Adulto , Anticonvulsivantes/sangue , Ligação Competitiva , Criança , Clonazepam/farmacologia , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenobarbital/farmacologia , Fenitoína/farmacologia , Ligação Proteica , Ácido Valproico/farmacologia
10.
Br J Pharmacol ; 60(1): 21-7, 1977 May.
Artigo em Inglês | MEDLINE | ID: mdl-884387

RESUMO

1. The relationship between plasma concentrations and cardiac effects of nortriptyline was studied in anaesthetized young and old rats. 2. Nortriptyline was administered by two consecutive intravenous infusions which resulted in a peak plasma concentration followed by steady state values. Increasing infusion rates were followed by proportional increases in the drug plasma concentrations ranging from 0.15 to 6.0 microgram/ml. 3. In young rats, nortriptyline induced an increase in the heart rate, a right rotation of the electrical axis and a prolongation of the PQ interval. Heart rate changes were not correlated with nortriptyline plasma concentrations, while significant correlations were found for the other two parameters. Plasma concentrations inducing 20% increase of the PQ interval and 40 degrees rotation of the electrical axis were 1.65 microgram/ml respectively. Arrhythmias occurred at concentrations higher than 5.2 microgram/ml. 4. Nortriptyline caused more severe cardiac effects in old than in young animals. However, plasma concentrations of nortriptyline in old rats were two to five times higher than those found in young rats at similar infusion rates. A higher concentration of the drug at its sites of action seems to be responsible for the more severe cardiac toxicity of nortriptyline observed in old rats.


Assuntos
Envelhecimento , Coração/efeitos dos fármacos , Nortriptilina/farmacologia , Animais , Cromatografia Gasosa , Eletrocardiografia , Frequência Cardíaca/efeitos dos fármacos , Cinética , Miocárdio/metabolismo , Nortriptilina/sangue , Nortriptilina/metabolismo , Ratos , Fatores de Tempo
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