RESUMO
AIM: To evaluate the efficiency in the control of the post-surgical paediatric pain of the combination of a weak opioid [tramadol (T)] and an NSAID (paracetamol), comparing its administration through "Nursing-PCA" (NCA) techniques or through continuous i.v. infusion. METHODS: The investigation has been carried out in 30 patients (mean 9.5 months) selected according to their foreseeable degree of moderate-hard pain. All of them consumed in the postoperative period: rectal paracetamol (20 mg/Kg) every 8 hours and tramadol in two groups. Group I: PCA pump with tramadol that was handled by the nurse. Initial dose: 0.5 mg/Kg NCA, bolus injection 0.3 mg/Kg with an interval of 10 minutes for security and a highest dose of 1.2 mg/Kg/4 h every 4 hours. Group II: continuous infusion i.v. of tramadol (6 mg/Kg/24 h). The pain was evaluated, as well as the sedative action, saturation oxygen, respiratory and hemodynamics parameters, adverse effects, and efficiency during the first 24 hours, as well as the number of total dose of drugs asked in the Nursing PCA group. RESULTS: Pain decreased in both groups. There were more sedative effects in group II and the total dose of tramadol was higher. There were no cases of respiratory depression. CONCLUSIONS: The combination of tramadol and paracetamol through "Nursing PCA" has turned out to be an efficient method in the treatment of the post-surgical pain in little children and those whose are in their lacteal period. It is a possible alternative of the continuous infusion of Morphine in these patients.
Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Tramadol/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Injeções Intravenosas , Masculino , Medição da Dor , Cuidados Pós-Operatórios/métodosRESUMO
From 1993 to 1995 bladder augmentation was performed in 11 female and 4 male patients from 1 to 13 years old (average age 6.7 years). Indications included neurogenic bladder, extrophy and epispadias with small bladder. A ventriculoperitoneal shunt had been performed in 6 patients for hydrocephalus. We used 22 segments since 5 patients had 2 segments. Segments included sigmoid in 12 cases, stomach in 5, small bowel in 1, cecum and appendix in 2. We have used the AMS-800 artificial urinary sphincter in 7 patients. Upper tracts and renal function have remained stable in these patients. Continence was achieved in 7 of 9 cases with augmentation, and in 6 of those patients with artificial urinary sphincter. The most common complication was leaks and the hematuria-dysuria syndrome when stomach was used.
Assuntos
Bexiga Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/complicações , Lactente , Masculino , Estudos Retrospectivos , Incontinência Urinária/cirurgia , Esfíncter Urinário Artificial , Doenças Urológicas/complicações , Doenças Urológicas/cirurgiaRESUMO
We report a case of non-parasitic splenic cyst, diagnosed by abdominal ultrasound scan. These were treated by partial splenectomy. The anatomopathological study indicated the existence of epithelial coating.