Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
8.
Br J Anaesth ; 110(1): 87-95, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23048069

RESUMO

BACKGROUND: An organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients' requirements. METHODS: Patients from the orthopaedic, gynaecological, visceral, and trauma surgery departments of the university hospital were involved in two prospective surveys. Survey 1 was performed at baseline and survey 2 was performed after the implementation of QMS within an interval of 1 year. The patients were asked to report pain intensity on the visual rating scale, incidence of analgesia-related side-effects, and incidence of pain interference with the items of life quality and their satisfaction with the treatment of POP. RESULTS: Patients from Survey 2 (n=251) reported 25-30% less pain than those from Survey 1 (n=269) (P<0.0001). Nausea was reported by 40% of the patients from Survey 1 vs 17% from Survey 2, vomiting by 25 vs 11% and fatigue by 76% in Survey 1 vs 30% in Survey 2 (P<0.0001). Life quality and patients' satisfaction improved in Survey 2 vs Survey 1 (P<0.001). CONCLUSIONS: The implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction.


Assuntos
Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Clínicas de Dor , Medição da Dor , Equipe de Assistência ao Paciente/organização & administração , Satisfação do Paciente , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
9.
Klin Padiatr ; 224(2): 72-5, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21815129

RESUMO

OBJECTIVE: Acupuncture is successfully used to alleviate vomiting in children after general anesthesia. However there is no data on treatment of vomiting in children with gastroenteritis (GE) and pneumonia (PM). METHODS: Descriptive analysis of 18 cases, where acupuncture was used as an individual therapy attempt to treat vomiting in children with GE or PM before starting the conventional antiemetic therapy. Feasibility and acceptance by patients and parents as well as the incidence of vomiting and use of antiemetic drugs after acupuncture were recorded. RESULTS: Acupuncture was feasible in all children and application of the indwelling needles was tolerated without fear. Side effects were not observed. 13 patients stopped vomiting immediately after the insertion of acupuncture needles, none of the patients required conventional antiemetic medication. CONCLUSION: Acupuncture for the treatment of vomiting is feasible and acceptable. Suggested antiemetic effect should be examined in a randomized multicenter controlled trial.


Assuntos
Acupuntura Auricular/instrumentação , Gastroenterite/terapia , Pneumonia/terapia , Vômito/terapia , Pontos de Acupuntura , Doença Aguda , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Agulhas , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Estudos Retrospectivos
11.
Anaesthesia ; 63(12): 1343-8, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19032304

RESUMO

SUMMARY: The number of publications on the peri-operative use of auricular acupuncture has rapidly increased within the last decade. The aim was to evaluate clinical evidence on the efficacy of auricular acupuncture for postoperative pain control. Electronic databases: Medline, MedPilot, DARE, Clinical Resource, Scopus and Biological Abstracts were searched from their inception to September 2007. All randomised clinical trials on the treatment of postoperative pain with auricular acupuncture were considered and their quality was evaluated using the Jadad scale. Pain intensity and analgesic requirements were defined as the primary outcome measures. Of 23 articles, nine fulfilled the inclusion criteria. Meta-analytic approach was not possible because of the heterogeneity of the primary studies. In eight of the trials, auricular acupuncture was superior to control conditions. Seven randomised clinical trials scored three or more points on the Jadad scale but none of them reached the maximum of 5 points. The evidence that auricular acupuncture reduces postoperative pain is promising but not compelling.


Assuntos
Acupuntura Auricular , Dor Pós-Operatória/prevenção & controle , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Lab Anim ; 41(1): 55-62, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17234050

RESUMO

The objective of the study was to evaluate the effects of ketamine on intestinal microcirculation in pentobarbital-anaesthetized rats during experimental endotoxaemia. A prospective, randomized, controlled study was carried out using 32 male Lewis rats. The animals were divided into four groups (n = 8 each). All animals were initially anaesthetized with 60 mg/kg pentobarbital (i.p.). Group 1 served as a control (18.5 mg/kg/h pentobarbital i.v.). Groups 2 and 4 received an endotoxin intravenous infusion of 15 mg/kg lipopolysaccharide (LPS) from Escherichia coli. Groups 3 and 4 also received 10 mg/kg/h ketamine (i.v.). After 2 h of observation, the animals were examined for intestinal functional capillary density (FCD) and leukocyte adherence to the venular endothelium by means of intravital fluorescence microscopy (IVM). Subsequent to this examination, blood samples were collected to determine release of the cytokines tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6 and IL-10. Endotoxaemia tended to decrease intestinal FCD (mucosa: -10.1%, muscularis longitudinalis: -2%, muscularis circularis: -9.8%) and significantly increase leukocyte adherence within submucosal venules (collecting venules: +133%, postcapillary venules: +207%; P<0.05). TNF-alpha, IL-1beta, IL-6 and IL-10 levels were significantly elevated following endotoxin challenge. The addition of ketamine to pentobarbital anaesthesia did not significantly affect FCD, leukocyte behaviour or cytokine levels. In conclusion, intravenous pentobarbital anaesthesia with the additional administration of ketamine did not cause alterations within the microcirculation or changes in cytokine release during endotoxaemia. In rats, the combination of pentobarbital and ketamine is suitable for use during the study of intestinal microcirculation in experimental endotoxaemia.


Assuntos
Analgésicos/farmacologia , Anestésicos , Endotoxemia/fisiopatologia , Intestinos/efeitos dos fármacos , Ketamina/farmacologia , Pentobarbital , Anestesia Intravenosa , Animais , Pressão Sanguínea/efeitos dos fármacos , Citocinas/biossíntese , Endotoxemia/imunologia , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/fisiopatologia , Intestinos/irrigação sanguínea , Intestinos/imunologia , Masculino , Microcirculação/efeitos dos fármacos , Ratos , Ratos Endogâmicos Lew
14.
Clin Hemorheol Microcirc ; 34(3): 427-38, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16614467

RESUMO

To explore the effects of metronidazole (Me) on intestinal microcirculation in septic rats, intravital microscopy (IVM) following 16 hours of colon ascendens stent peritonitis (CASP model) was used. Four groups of animals were studied: control group (sham operation) and CASP group, each with and without Me treatment (10 mg/kg i.v.). In order to investigate the substance-specific effects of Me independently of the antibacterial effects within a pathologically altered microcirculation, a second experimental series with lipopolysaccharide challenge (LPS model) was carried out. The LPS model consisted of the four groups (control animals and LPS animals (15 mg/kg i.v. LPS from E. coli) with and without Me). IVM in the LPS experiments was performed following a two hour observation period. Me treated CASP or LPS animals, as compared with untreated, demonstrated significant improvement of functional capillary density (FCD) of the intestinal wall. The increase in the number of leukocytes firmly adhered to the endothelium (leukocyte sticking) in the untreated CASP or LPS animals within the V1 venules of the intestinal submucosal layer, was significantly reduced in the Me treated animals. In conclusion, Me exerts beneficial anti-bacterial and anti-inflammatory effects within the septic microcirculation.


Assuntos
Anti-Infecciosos/uso terapêutico , Intestinos/irrigação sanguínea , Metronidazol/uso terapêutico , Peritonite/tratamento farmacológico , Animais , Bactérias Anaeróbias/efeitos dos fármacos , Adesão Celular/efeitos dos fármacos , Citocinas/sangue , Citocinas/efeitos dos fármacos , Endotoxemia/sangue , Endotoxemia/tratamento farmacológico , Masculino , Veias Mesentéricas/fisiologia , Microcirculação/efeitos dos fármacos , Microcirculação/fisiopatologia , Microscopia de Fluorescência/métodos , Peritonite/sangue , Ratos , Ratos Endogâmicos Lew , Gravação em Vídeo
15.
Pain ; 114(3): 320-327, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15777857

RESUMO

Auricular acupuncture (AA) is known to be effective in treatment of various pain conditions, but still there have been no randomized controlled studies of AA for treatment of acute postoperative pain. Therefore we tested whether AA of specific points is superior to sham acupuncture for complementary analgesia after total hip arthroplasty in a patient-anesthesiologist-evaluator-analyst blinded study. The patients were randomly allocated to receive true AA (lung, shenmen, thalamus and hip points) or sham procedure (4 non-acupuncture points on the auricular helix). Permanent press AA needles were retained in situ 3 days after surgery. Postoperative pain was treated with intravenous piritramide (opioid receptor agonist with analgesic potency of 0.7 compared with morphine) using a patient-controlled analgesia (PCA) pump. The time to the first analgesic request, the amount of postoperative piritramide via PCA and pain intensity on a 100-mm visual analogue scale (VAS-100) were used to evaluate postoperative analgesia. Intraoperative anesthetic requirement, incidence of analgesia-related side effects, inflammation parameters and success of patients' blinding were also recorded. Fifty-four patients (29 AA and 25 controls) completed the study. Piritramide requirement during 36 h after surgery in AA group was lower than in control: 37+/-18 vs. 54+/-21 mg; mean+/-SD; P=0.004. Pain intensity on VAS-100 and incidence of analgesia-related side effects were similar in both groups. The differences between the groups as regard patients' opinions concerning success of blinding were not significant. Findings from our study demonstrate that AA could be used to reduce postoperative analgesic requirement.


Assuntos
Analgesia por Acupuntura/métodos , Acupuntura Auricular/métodos , Artroplastia de Quadril , Dor Pós-Operatória/terapia , Idoso , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Terapia Combinada , Feminino , Humanos , Ibuprofeno/administração & dosagem , Ibuprofeno/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Pirinitramida/administração & dosagem , Pirinitramida/efeitos adversos , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...