oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Adrenalina como coadyuvante epidural para analgesia postoperatoria
Mugabure Bujedo,B.; González Santos,S.;
Revista de la Sociedad Espa?ola del Dolor , 2010,
Abstract: epinephrine has been combined with neuraxial and peripheral local anesthetics since heinrich braun first experimented with its use in the early 1900s. a century of use attests to the general safety of adjuvant epinephrine, yet we have only modest understanding of its intended effects, which include prolonging block duration, reducing plasma concentrations of local anesthetics, reducing surgical bleeding and intensifying anesthesia and analgesia. the long-held belief that epinephrine exerts most of these effects, including any associated complications, by causing vasoconstriction is doubtlessly too simplistic and has been recently challenged. the main part of this chapter will therefore focus on the advantages and disadvantages of epinephrine in epidural analgesia and on optimizing postoperative analgesia by adding epinephrine and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine.
THORACIC EPIDURAL ANAESTHESIA AND ANALGESIA IN PATIENTS UNDERGOING ESOPHAGOPLASTY  [PDF]
Laura Magdalena Nicolescu,S. Lunc?
Jurnalul de Chirurgie , 2011,
Abstract: Epidural anesthesia and analgesia is widely used to manage major abdominal surgery, but its effects in managing patients submitted to esophagoplasty are still debated. The aim of this study was to assess the influence of thoracic epidural anaesthesia on postoperative respiratory function, digestive complications and postoperative stress in patients with esophagoplasty. Twenty-six patients were admitted in a prospective study. The patients were divided into two groups: fourteen were in group A, and received general anaesthesia for esophagoplasty, and twelve were in group B, and received general anaesthesia combined with epidural thoracic anaesthesia and postoperative epidural thoracic analgesia for the same surgery procedure. When compare the two groups, the outcomes were better in group B: the rate of postoperative pneumonia was lowered from 35,7% to 16,7%, the postoperative mecanical ventilation under six hours was increased from 21,43% to 100%, the incidence of adult respiratory detrease syndrome was decreased from 28,5% to 8,3%, the digestive recovery after four days was increased from 57,1% to 75%. The cortizolemia was also lowered at six hours from 52mg% to 23mg%, and at 24 hours, from 22 to 11mg%. Identically, the sanguine lactate at four hours decreased from 6 to 3 mEq%. In conclusion, this study suggest that patients undergoing esophagoplasty will receive substantial benefit from combined general and epidural anesthesia with continuing postoperative epidural analgesia.
Analgesia epidural para el trabajo de parto
Zafra Pedone,Juan Carlos; Calvache Espa?a,José Andrés;
Iatreia , 2008,
Abstract: introduction: pain associated with labor affects every woman and it leads to maternal and fetal alterations that may interfere with its normal course. epidural analgesic techniques are available to control such pain. their results are satisfactory to patients and they are associated with favorable outcomes. however, they have seldom been used in the cauca department of colombia. objective: to describe the experience with the use of epidural analgesia in obstetrical patients at a university hospital in colombia. materials and methods: a descriptive case series study was carried out during two months in 2006, in popayán, colombia. data were collected on 41 patients admitted in the process of labor who were offered and accepted the use of epidural analgesia. variables on the clinical situation of the patients, the evolution of labor, and the maternal and fetal outcomes were evaluated. analyses were performed by means of descriptive statistics. results: average age of the patients was 23.4 years; 65.9% of them were nulliparous, and 85.4% had term pregnancies. at the moment of the dural puncture the mode of cervical dilation was 6 cm and that of pain on a visual analog scale was 8. average latency time (between the application of the drug and the start of its effect) was 14.1 minutes. 95.1% of the patients required a reinforcement applied on the average 80 minutes after the induction of analgesia and 61%, a second reinforcement administered on the average 49 minutes after the first. delivery was vaginal in 36 patients and by cesarean section in 5. adaptation of all newborns was successful: the mode of the apgar scale at one minute was 9. conclusions: our results agree with those of other studies in that epidural analgesia is an effective way to control labor pain.
Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective  [PDF]
Christopher L. Wu,Jamie D. Murphy
Advances in Anesthesiology , 2014, DOI: 10.1155/2014/948164
Abstract: The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, decreased morbidity, and improvement in patient-centered outcomes. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes and discuss future research in this area 1. Introduction The use of perioperative epidural anesthesia-analgesia provides superior postoperative analgesia [1–3] versus conventional opioids, is associated with beneficial physiologic effects [4], and has been shown to improve patient-centered outcomes [5]. However, the benefits of perioperative epidural anesthesia-analgesia are not definitive in part due to some of the methodological issues present in available studies. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes which includes mortality, major morbidity, and patient centered outcomes but not technical failures or complications. We will also discuss future research in this area. 2. Effect on Mortality The overall effect of epidural anesthesia-analgesia on perioperative mortality is controversial. Because of the relatively rare incidence of this endpoint, one option is to utilize a large database which would be able to capture rare outcomes such as death. We have used a 5% nationally random sample of Medicare beneficiaries (1997–2001) to examine the association between the presence or absence of postoperative epidural analgesia and perioperative (7- and 30-day) mortality [6–10]. In our initial analysis [6], we examined several surgical procedures (based on International Statistical Classification of Diseases, Ninth Revision (ICD-9) codes) and divided patients into 2 groups, depending on the presence or absence of postoperative epidural analgesia. Mortality at 7 and 30 days after surgery was examined and multivariate regression analyses incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status were undertaken. Our first publication using the Medicare claims data found that the presence of epidural analgesia was associated with significantly lower odds of death at 7 days (odds ratio (OR) = 0.52; 95% confidence interval (CI): 0.38–0.73; ) and 30 days (OR = 0.74; 95% CI: 0.63–0.89; ) postoperatively, thus suggesting that postoperative epidural analgesia may contribute to lower odds of death after surgery [6]. Subsequent analyses of the Medicare claims data also revealed that the presence of postoperative epidural analgesia may be associated with lower
Anestesia multimodal infantil: analgesia epidural
López-García,J. C.; Castejón,J.; Moreno,M.; Ramírez-Navarro,A.;
Revista de la Sociedad Espa?ola del Dolor , 2004,
Abstract: the use of anesthetic anal analgesic medicaments by epidural punction is actually a very littled used technic at pediatric patients, although reports in this subject show a high clinical efficacy. the aim of present report is synthesize, based on medical literature and personal experience, the accurate application of the technic at pediatric patients wich have suffered surgical interventions, and also the systematic exposition of complications able to appear in these patients.
Adrenalina como coadyuvante epidural para analgesia postoperatoria Epinephrine as epidural adjuvant for postoperative analgesia  [cached]
B. Mugabure Bujedo,S. González Santos
Revista de la Sociedad Espa?ola del Dolor , 2010,
Abstract: La adrenalina ha sido ampliamente utilizada junto con anestésicos locales, tanto a nivel periférico como central, desde que Heinrich Braun fuera el pionero en experimentar con ella al inicio de 1900. Un siglo de uso atestigua su seguridad general como coadyuvante, a pesar de que todavía poseemos un conocimiento parcial de su modo de actuar, consiguiendo una prolongación del bloqueo nervioso, una reducción de las concentraciones plasmáticas de los anestésicos locales, una reducción del sangrado quirúrgico y una potenciación del efecto analgésico. El convencimiento durante largo tiempo de que la adrenalina muestra todos estos efectos beneficiosos, así como los negativos, únicamente por vasoconstricción, es demasiado simplista y actualmente insuficiente. El objetivo principal de esta revisión se centrará en demostrar como la adrenalina epidural es capaz de mejorar la analgesia postoperatoria cuando forma parte de una mezcla junto a bupivacaína o ropivacaína y fentanilo. Epinephrine has been combined with neuraxial and peripheral local anesthetics since Heinrich Braun first experimented with its use in the early 1900s. A century of use attests to the general safety of adjuvant epinephrine, yet we have only modest understanding of its intended effects, which include prolonging block duration, reducing plasma concentrations of local anesthetics, reducing surgical bleeding and intensifying anesthesia and analgesia. The long-held belief that epinephrine exerts most of these effects, including any associated complications, by causing vasoconstriction is doubtlessly too simplistic and has been recently challenged. The main part of this chapter will therefore focus on the advantages and disadvantages of epinephrine in epidural analgesia and on optimizing postoperative analgesia by adding epinephrine and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine.
Analgesia postoperatoria con tramadol epidural tras histerectomía abdominal Epidural postoperative analgesia with tramadol after abdominal hysterectomy  [cached]
E. González-Pérez,N. González-Cabrera,C. G. Nieto-Monteagudo,D. P. C. águila
Revista de la Sociedad Espa?ola del Dolor , 2006,
Abstract: Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular cada 6 h. Grupo III: recibió 100 mg de tramadol por vía intramuscular cada 6 h. Se evaluó el comportamiento de la presión arterial media y la frecuencia cardíaca. Evaluamos la intensidad del dolor por medio de una Escala Visual Analógica. Fue utilizado metamizol sódico, 2 g endovenoso, como analgesia de rescate. Resultados: Se presentaron variaciones significativas de la frecuencia cardíaca y presión arterial media en el grupo I (P<0,05), mientras que en los grupos II y III resultaron muy significativas (P<0,01). La intensidad del dolor postoperatorio alcanzó valores más bajos en el grupo I (P>0,05), por lo que sólo 2 pacientes requirieron analgesia de rescate, mientras que el grupo II mostró las mayores variaciones (P<0,01), donde el 100% de los pacientes requirió analgesia de rescate. El grupo III, que recibió tramadol intramuscular, presentó un mayor número de efectos colaterales, fundamentalmente las náuseas, con 23,3%. Conclusiones: El uso de tramadol epidural es una alternativa eficaz para el manejo y tratamiento del dolor agudo postoperatorio, ya que ofrece una analgesia superior con escasos efectos adversos. Introduction: Postoperative pain is a special type of acute pain whose inadequate control leads to abnormal reactions. Objectives: To evaluate the utility of tramadol by the epidural route in the postoperative analgesia of patients undergoing abdominal hysterectomy. Material and method: 90 patients studied who conformed three groups: Group I: received 100 mg of epidural tramadol every 6 h. Group II: received 1.2 g of intramuscular metamizol every 6 h. Group III: received 100 mg of intramuscular tramadol every 6 h. Blood pressure and heart rate were measured. Pain intensity was evaluated by a visual analogical scale. Metamizol 2 g was used as rescue analgesia. Results: Significant variations of heart rate and mean blood pressure were found in group I (p < 0.05) whereas in group II and III they were very significant (p < 0.01). The intensity of postoperative pain reached lower values in group I (p < 0.05) and therefore only 2 patients required rescue analges
Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia
Nakamura, Giane;Ganem, Eliana Marisa;Rugolo, Ligia Maria Suppo de Souza;Castiglia, Yara Marcondes Machado;
Revista da Associa??o Médica Brasileira , 2009, DOI: 10.1590/S0104-42302009000400014
Abstract: objective: epidural (ea) and combined spinal-epidural (cse) techniques have both been utilized for labor analgesia. this study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. methods: forty pregnant women received epidural analgesia with 15 ml of 0.125% ropivacaine (ea group) and 5 μg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (cse group). pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. the newborns were evaluated by apgar and the neurological and adaptive capacity score (nacs) developed by amiel-tison. results: there were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and apgar score. motor block, labor analgesia duration, and epidural analgesia duration were greater in the cse group, whose seven mothers had mild pruritus. the nacs were greater in the ea group after half, two, and 24 hours. ninety five percent of ea group newborns and 60% of cse group newborns were found to be neurologically healthy at the 24 hour examination. conclusion: ea and cse analgesia relieved maternal pain during obstetric analgesia, but cse mothers had pruritus and a longer labor. newborns of mothers who received epidural analgesia showed the best nacs.
Does epidural clonidine improve postoperative analgesia in major vascular surgery?  [PDF]
Jelena Vukovi?,Papanna Ramakrishnan,Zoka Milan
Medicinski Glasnik , 2012,
Abstract: Aim To determine the quality and duration of the analgesic and haemodynamic effects of clonidine when used as an additional analgesic for postoperative epidural analgesia in major vascularsurgery. Methods The prospective, single-blinded study involved 60 patients randomised into three groups (20 patients each): Group BM—bupivacaine 0.125% and morphine 0.1 mg/ml; Group BC—bupivacaine 0.125% and clonidine 5 μg/ml; Group MC—morphine 0.1 mg/ml and clonidine 5 μg/ml continuously infused at 5 ml/h. The quality and duration of the analgesia measured by the Visual Analogue Scale (VAS) at rest and on movement, additional analgesia requirements, sedation scores, haemodynamic parameters and side effects(respiratory depression, motor block, toxic effects, nausea and pruritus) were recorded. Results The average VAS scores at rest and on movement were significantly lower in Group MC at two, six and 24 hours following the start of epidural infusion (P<0.05). The duration of the analgesic effect after finishing the epidural infusion was significantly longer in Group MC (P<0.05). Patients from Group MC were intubated longer. Additional analgesia consumption, sedation scoresand haemodynamic profiles were similar in all three groups. Prurituswas more frequent in morphine groups (P<0.05), but other sideeffects were similar in all three groups.Conclusion Under study conditions, clonidine added to morphine,not 0.125% bupivacaine, provided significantly better pain scoresat two, six and 24 hours following the start of epidural infusionand the longest-lasting analgesia following the discontinuationof epidural infusion. However, patients from the Group MC weremechanically ventilated longer than patients from other two groups.Continuous monitoring of the patient is necessary after theadministration of clonidine for epidural analgesia.
Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep
DeRossi, Rafael;Pompermeyer, Cassio Tadeu Dias;Silva-Neto, Amadeu Batista;Barros, Andrea Lantieri Correa de;Jardim, Paulo Henrique de Affonseca;Frazílio, Fabrício Oliveira;
Acta Cirurgica Brasileira , 2012, DOI: 10.1590/S0102-86502012000200007
Abstract: purpose: to determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. methods: six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1) ketamine (ke; 2.5 mg/kg), (2) magnesium sulphate (mg; 100 mg), and (3) ke + mg (kemg; 2.5 mg/kg + 100 mg, respectively). epidural injections were administered through the lumbosacral space. analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline) and after drug administration as needed. results: the duration of analgesia with the lumbosacral epidural kemg combination was 115 ± 17 min (mean ± sd), that is, more than twice that obtained with ke (41 ± 7 min) or mg (29 ± 5 min) alone. ke and kemg used in this experiment induced severe ataxia. the heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. conclusion: the dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.