RESUMEN
Postoperative analgesia may be complicated by the occurrence of acute opiate tolerance and hyperalgesia. We present the case of a patient who underwent gynecological surgery that was complicated by intense pain in the immediate postoperative period. The pain was attributed to the development of acute opiate tolerance caused by the brief infusion of a high dose of remifentanil. The opiate tolerance was complicated by tactile hyperalgesia at the site of the surgical wound. Pain management with the usual dose of nonsteroidal anti-inflammatory drugs associated with a high dose of morphine (50 mg administered in less than 2 hours) produced no analgesic or adverse effects. The pain was finally brought under control by epidural perfusion of ropivacaine and fentanyl and subsequently maintained with multimodal analgesia.
Asunto(s)
Amidas/uso terapéutico , Analgesia Epidural , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Fentanilo/uso terapéutico , Hiperalgesia/inducido químicamente , Morfina/uso terapéutico , Dolor Postoperatorio/inducido químicamente , Piperidinas/efectos adversos , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Enfermedades de los Anexos/cirugía , Amidas/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Resistencia a Medicamentos , Tolerancia a Medicamentos , Femenino , Fentanilo/administración & dosificación , Humanos , Hiperalgesia/tratamiento farmacológico , Histerectomía , Ketorolaco/administración & dosificación , Ketorolaco/uso terapéutico , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Remifentanilo , RopivacaínaRESUMEN
Antibodies to influenza A2, influenza B, parainfluenza 2 and 3, adenovirus and respiratory syncytial viruses were determined in thirty nine children with acute laryngotracheobronchitis; nine cases were not included in the analysis because of the presence of anticomplementary sera; 40% of cases were positive, 20% to influenza A2, 10% to influenza B (one case of double infection with influenza B and parainfluenza 2 viruses), 6.7% to respiratory syncytial virus and 3.3% to parainfluenza 2. Results are compared with previous studies done in Mexico.