RESUMEN
We investigated the effect of EMLA cream (active ingredients: 25 mg lidocaine and 25 mg prilocaine per gram of cream) on subjective experience of pain in connection with vaccination. The study was conducted as a double-blind, randomized, placebocontrolled trial in a general practice setting. The subjects were ten to fifteen year-olds, who were due to be inoculated with measles-mumps-rubella vaccine. Of the 118 children entering the trial, 117 completed the treatment (EMLA 58, placebo 59). Treatment time was at least 60 minutes for all children. The children reported similar degrees of pain immediately after vaccination in both groups, one third of both treatment and placebo groups reporting medium to strong pain (not significant). On the day after vaccination, more than half the families (59%) said that they would use the cream again in connection with future vaccinations; again, there was no statistically significant difference between the two groups in this respect. Based on these results, we conclude that use of EMLA cream as a topical local anaesthetic does not reduce the experience of pain in connection with the administration of measles-mumps-rubella vaccine to older children.
Asunto(s)
Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Vacuna Antisarampión/administración & dosificación , Vacuna contra la Parotiditis/administración & dosificación , Prilocaína/administración & dosificación , Vacuna contra la Rubéola/administración & dosificación , Adolescente , Niño , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Inyecciones Intravenosas/efectos adversos , Combinación Lidocaína y Prilocaína , Masculino , PlacebosRESUMEN
A 44-year-old woman was seen on three separate occasions for acute pulmonary edema which had developed 30 minutes after ingestion of a single hydrochlorothiazide-amiloride (Moduretic) tablet. Eighteen cases of hydrochlorothiazide-induced pulmonary edema have been reported previously. Clinical findings and investigations in the present and previous cases indicate a noncardiogenic cause for the pulmonary edema. Increased pulmonary vascular permeability is probably involved. So far, attempts to demonstrate an immunological mechanism have failed and the pathophysiology remains uncertain. The reaction may be difficult to differentiate from left ventricular failure in patients with cardiac disease. Attention should be drawn to this severe but rare side effect of a frequently used diuretic.