RESUMEN
BACKGROUND: Catecholamine release is a physiological response to stress. The extent to which perioperative stress provokes the central release of catecholamines, which modulate pain perception in the spinal cord, still remains unknown. The perioperative course of catecholamine concentrations in the cerebrospinal fluid (CSF) and plasma was examined. METHODS: A prospective study was performed in 25 patients (ASA III, 60-84 years) undergoing elective hip joint replacement in spinal catheter anesthesia. The concentrations of dopamine, epinephrine and norepinephrine in the CSF and plasma were measured before anesthesia, immediately after surgery, and 6 and 24 h post-operatively. RESULTS: In most patients, dopamine and epinephrine were not detectable in CSF. CSF-norepinephrine concentrations decreased from median [interquartile-range] 159 [124;216] pre-anesthesia to 116 [79;152] pmol/l immediately post-operatively and were slightly elevated 24 h post-operatively (180 [134;302] pmol/l) (P=0.05). Dopamine plasma concentrations were not detectable or were barely above the detection threshold. Plasma epinephrine increased from 61 [28;77] pmol/l pre-anesthesia to 112 [69;138] pmol/l 6 h post-operatively and returned to baseline 24 h post-operatively (P=0.001). Plasma norepinephrine concentrations increased intra-operatively from 298 [249;422] to 556 [423;649] pmol/l and remained elevated 24 h after surgery (P=0.009). There was no association between changes in CSF or plasma norepinephrine or epinephrine concentrations and changes in heart rate (HR) or mean arterial pressure (MAP). CONCLUSION: During spinal anesthesia for elective hip joint replacement, norepinephrine concentrations were greater in plasma than in CSF. CSF dopamine and epinephrine concentrations were essentially undetectable. The changes in CSF-norepinephrine concentrations and the changes of plasma norepinephrine concentrations showed no association with each other; nor were there correlations between clinical stress parameters (HR, MAP) or visual analog scale pain, and the changes in CSF norepinephrine concentrations.
Asunto(s)
Anestesia Raquidea/métodos , Catecolaminas/sangre , Catecolaminas/líquido cefalorraquídeo , Atención Perioperativa/métodos , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Presión Sanguínea/efectos de los fármacos , Dopamina/sangre , Dopamina/líquido cefalorraquídeo , Procedimientos Quirúrgicos Electivos/métodos , Epinefrina/sangre , Epinefrina/líquido cefalorraquídeo , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Monitoreo Fisiológico/métodos , Norepinefrina/sangre , Norepinefrina/líquido cefalorraquídeo , Dolor/tratamiento farmacológico , Dimensión del Dolor/efectos de los fármacos , Dimensión del Dolor/métodos , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To assess whether local active warming can lessen acute pelvic pain of gynaecological origin compared with traditional methods in a prehospital setting. DESIGN: Prospective, randomised, single-blinded study. Setting. Prehospital emergency system. Population. Women calling emergency ambulance for pelvic pain. METHODS: Women were randomised in two groups: resistive heating (group 1) or passive warming (group 2), each treatment was initiated at the emergency site. MAIN OUTCOME MEASURES: Pain on visual analogue scale (VAS), anxiety and nausea, given as mean (SD). RESULTS: Prior to the interventions, all women were vasoconstricted and had comparable pain scores. Then, group 1 showed a significant (P < 0.01) reduction in pain (VAS: 72.2 [10.5] mm to 32.4 [18.0] mm), anxiety (VAS: 59.0 [10.9] mm to 37.5 [24.1] mm), nausea (VAS: 42.7 [6.2] mm to 21.6 [5.0] mm) and heart rate (101 [12] beats per minute [bpm] to 59 [8] bpm), as well as in the number of vasoconstricted women (from 19/19 (constricted/dilated) to 2/19 (constricted/dilated)), whereas scores in group 2 remained unchanged. There were no significant changes in blood pressure in either group. CONCLUSIONS: Local warming is an effective emergency care measure for acute pelvic pain.
Asunto(s)
Tratamiento de Urgencia/métodos , Hipertermia Inducida/métodos , Dolor Pélvico/terapia , Adulto , Femenino , Humanos , Satisfacción del Paciente , Estudios Prospectivos , Método Simple Ciego , Resultado del TratamientoRESUMEN
Continuous peripheral oxygen saturation monitoring using a finger pulse oximeter is standard in prehospital emergency medicine. Forehead peripheral oxygen saturation monitoring has been enhanced for better performance during movement and in cold ambient temperatures, both of which are common during emergency transport. We compared a new forehead monitor with standard finger pulse oximeter. The forehead technique had significantly fewer mean (SD) alarms per patient (3.0 (2.2)) than the finger pulse oximeter (7.8 (4.0)) and shorter durations of malfunction (76 (60) s compared to 333 (170) s) when using the finger pulse oximeter. We conclude that measuring peripheral oxygen saturation monitoring with a forehead sensor provides better monitoring quality in emergency care.