Revista brasileira de anestesiologia
-
Rev Bras Anestesiol · Jul 2012
Case ReportsUse of sugammadex after neostigmine incomplete reversal of rocuronium-induced neuromuscular blockade.
Neuromuscular blockers (NMB) have been used for more than half of a century in anesthesia and have always been a challenge for anesthesiologists. Until recently, the reversal of nondepolarizing neuromuscular blockers had only one option: the use of anticholinesterase agents. However, in some situations, such as deep neuromuscular blockade after high doses of relaxant, the use of anticholinesterase agents does not allow adequate reversal of neuromuscular blockade. Recently, sugammadex, a gamma-cyclodextrin, proved to be highly effective for reversal of NMB induced by steroidal agents. ⋯ Adequate recovery of residual neuromuscular blockade is required for full control of the pharynx and respiratory functions in order to prevent complications. Adequate recovery can only be obtained by neuromuscular junction monitoring with TOF ratio greater than 0.9. Often, the reversal of NMB with anticholinesterase drugs may not be completely reversed. However, in the absence of objective monitoring this diagnosis is not possible. The case illustrates the diagnosis of residual NMB even after reversal with anticholinesterase agents, resolved with the administration of sugammadex, a safe alternative to reverse the NMB induced by steroidal non-depolarizing agents.
-
Rev Bras Anestesiol · Jul 2012
Randomized Controlled TrialThe effect of "multiphase sedation" in the course of computed tomography and magnetic resonance imaging on children, parents and anesthesiologists.
We aimed to investigate the effect on children undergoing Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), their parents and attending anesthesiologist of "multiphase sedation" which we define as "the intended sedation level achieved with one or more agents through the same or different routes with more than one administration". ⋯ "Multiphase sedation" procedure provides children to feel less pain and anxiety, and decreases parental anxiety while increasing their satisfaction. It supplies a comfortable and safe sedation, as it provides a short and problem-free preparation process for the attending anesthetist as well.
-
Rev Bras Anestesiol · Jul 2012
Randomized Controlled TrialAssessment of preemptive analgesia efficacy in surgical extraction of third molars.
Literature on preemptive analgesia is controversial. Reliability of results and difficult reproducibility of research contribute for non-elucidation of the subject. The aim of this study is to test the efficacy of oral ketoprofen (150 mg) preemptively administrated two days before third molar surgery, compared with postoperative administration in the same patient. ⋯ In this experimental model, preemptive analgesia was not effective in reducing postoperative pain in surgical extraction of third molar compared with the postoperative administration of the same drug.
-
Prolonged use of opioids is a possibility for chronic pain treatment. Opioids are effective for virtually all chronic noncancer pain syndromes, but may cause dependence. The aim of this paper is to review the use and rotation of opioids in chronic non-oncologic pain. ⋯ Opioids are drugs with proven efficacy for chronic non-oncologic pain, but its prescription should meet certain criteria in order to reduce the incidence of adverse effects and addiction.