Articles: postoperative.
-
Rev Bras Anestesiol · Sep 2002
[Dexmedetomidine and sufentanil as intraoperative analgesics: comparative study.].
The use of alpha2-agonists to control heart rate and blood pressure, to attenuate hemodynamic responses to tracheal intubation and extubation and to reduce anesthetics requirement are already well established in the literature since clonidine introduction for therapeutic use. Dexmedetomidine, recently approved for clinical use, presents more alpha2-adrenergic receptors selectively, and therefore less adverse effects combined with marked analgesic and sedative properties. This has raised the interest in using it to replace opioids, known for their potent analgesic and sedative properties. This study aimed at comparing dexmedetomidine and sufentanil analgesias during continuous infusion for ENT, head and neck procedures. ⋯ Dexmedetomidine as intraoperative analgesic was more effective as compared to sufentanil in the procedures selected for this study regarding hemodynamic stability, emergence and anesthetic recovery conditions.
-
The controversy over preemptive analgesia continues unabated, with studies both supporting and refuting its efficacy. The timing of an analgesic intervention and presence of a placebo control may have significant impact on the interpretation of results and may have led to the premature conclusion that preemptive analgesia is of limited clinical utility. A review of the recent literature using strict definitions of preemptive and preventive analgesia is required in order to clarify the broader issue of the benefits of perioperative analgesia. ⋯ Studies that used a preventive design had a greater likelihood of finding a beneficial effect. The application of preventive perioperative analgesia (not necessarily preincisional) is associated with a significant reduction in pain beyond the clinical duration of action of the analgesic agent, in particular for the N-methyl-D-aspartate antagonists. The classical definition of preemptive analgesia should be abandoned in favor of preventive analgesia. This will broaden the scope of inquiry from a narrow focus on preincisional versus postincisional interventions to one that aims to minimize postoperative pain and analgesic requirements by reducing peripheral and central sensitization arising from noxious preoperative, intraoperative and postoperative inputs.
-
Pediatr Crit Care Me · Jul 2002
Mortality risk factors of a pediatric population with fulminant hepatic failure undergoing orthotopic liver transplantation in a pediatric intensive care unit.
To determine risk factors of mortality in the preoperative, perioperative, and immediate postoperative period of a pediatric population that has undergone orthotopic liver transplantation for fulminant hepatic failure in a pediatric intensive care unit. DESIGN: Retrospective review of medical records. SETTING: A pediatric intensive care unit in a children's hospital. PATIENTS: Sixty patients with fulminant hepatic failure who fulfilled King's College criteria for liver transplantation. INTERVENTION: Orthotopic liver transplantation was performed according to standard techniques. Before transplantation, patients were admitted to a pediatric intensive care unit when intensive care was required, and patients were always admitted to a pediatric intensive care unit after the operation. Measurements: A total of 20 variables were studied via univariate and multivariate analysis; statistical significance was accepted when p
-
Rev Bras Anestesiol · Jul 2002
[Efficacy of propofol and propofol plus dexamethasone in controlling postoperative nausea and vomiting of gynecologic laparoscopy.].
Gynecological laparoscopy is a procedure associated to a high incidence of postoperative nausea and vomiting (PONV). This study aimed at comparing the efficacy of propofol or propofol plus dexamethasone in preventing PONV in patients submitted to gynecological laparoscopy. ⋯ Propofol or propofol plus dexamethasone were efficient in preventing PONV in patients submitted to gynecological laparoscopy.
-
Respiratory complications are responsible for a major number of elderly deaths after surgical procedures. Aging entails an important decrease in respiratory system functional reserves, while an increasing number of elderly people are being submitted to increasingly complex procedures. This study is a review of the respiratory system during aging and of anesthesia-induced changes in the elderly, emphasizing preoperative evaluation of respiratory function, postoperative pulmonary complications and details of anesthetic management. ⋯ Aging brings about several respiratory system changes. Evidences have shown that, even in the absence of pulmonary disease, advanced age is a risk factor for postoperative pulmonary complications. It is necessary a thorough evaluation of preoperative respiratory function, adequate anesthetic management and specific postoperative care.