Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Sep 2003
Drug-delivery systems for local anesthetics: therapeutic applications.
Many researchers in the last four decades have been devoted to the development of drug-delivery systems. Since its first application in the pharmaceutical industry, many results have been obtained especially in the molecular manipulation of carriers and their interaction with encapsulated drugs. These new carriers have the advantage of bypassing encapsulated drugs restraining physicochemical properties (such as water or membrane solubility), thus improving pharmacodynamics (therapeutic effect potentiation), pharmacokinetics (control of tissue absorption and distribution) and toxic effects (lower local and systemic toxicity). Liposomes and cyclodextrins are among the most important carriers which have shown to be quite advantageous in the development of drug-delivery systems for local anesthetics. This study aimed at reviewing the interaction of local anesthetics with liposomes and cyclodextrins, the development of basic and applied research on the field, in addition to therapeutic applicability of these formulations. ⋯ Although studies are still in progress, drug-delivery systems are flagging a new direction for the development of safer and more effective local anesthetic formulations.
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Rev Bras Anestesiol · Sep 2003
Spinal anesthesia for cesarean section: comparative study between isobaric and hyperbaric bupivacaine associated to morphine.
Bupivacaine preparations, plain or with glucose, are frequently used in the clinical practice. Blockade upper level is determined by local anesthetic spread in the CSF. This study aimed at comparing isobaric and hyperbaric bupivacaine in patients submitted to spinal anesthesia for Cesarean section. ⋯ We concluded that 12.5 mg isobaric and hyperbaric bupivacaine associated to morphine (100 microg) in spinal anesthesia for Cesarean section in term pregnant women are effective and present similar profiles.
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Pain and anxiety may cause major discomfort, increase the risk for postoperative complications in surgical patients and may even prolong their hospital stay. This study aimed at reviewing concepts of sedation and analgesia in intensive care, updating knowledge and reviewing information available in the literature as well as already published consensus. ⋯ In spite of the therapeutic armamentarium available, there is a lack of understanding about major characteristics of drugs used for sedation and analgesia in Intensive Care. Developed consensus try to explain qualities and side-effects of most popular drugs, normalizing their use for ICU analgesia and sedation to benefit and faster recover patients.
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Rev Bras Anestesiol · Aug 2003
[Comparison between pressure controlled and controlled mandatory ventilation in the treatment of postoperative hypoxemia after myocardial revascularization].
Pressure controlled ventilation (PCV) has been used as the ventilation mode of choice in coronary artery bypass graft surgery patients who develop severe hypoxemia in the immediate postoperative period. However, there are no evidences showing that pressure controlled ventilation is more effective in reversing postoperative hypoxemia than controlled mandatory ventilation (CMV). This study aimed at comparing the effects of both ventilation modes on systemic oxygenation in cardiac surgery patients who develop hypoxemia characterized by PaO2/FiO2 ratio lower than 200 in the immediate postoperative period. ⋯ Both ventilatory modes were equally effective in reversing hypoxemia observed in the immediate cardiac surgery postoperative period. Results show that inspiratory flow patterns are not relevant in the treatment of post cardiac surgery hypoxemia.
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Rev Bras Anestesiol · Aug 2003
[Effects of low spinal morphine doses associated to intravenous and oral ketoprofen in patients submitted to cesarean sections].
Low spinal morphine doses are effective in relieving postoperative pain of patients submitted to Cesarean sections, with low incidence of side-effects. This study aimed at evaluating postoperative analgesia and the incidence of side-effects in patients submitted to Cesarean sections under spinal anesthesia with hyperbaric bupivacaine and 0.05 mg and 0.1 mg morphine associated to intravenous and oral ketoprofen. ⋯ Spinal 0.05 mg and 0.1 mg morphine associated to intravenous and oral ketoprofen have provided the same postoperative analgesia and have determined the same incidence of side-effects.