RESUMO
OBJECTIVE: To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality. METHODS: Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure. RESULTS: 63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality. CONCLUSION: Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis. STUDY TYPE: Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.
Assuntos
Gastrosquise/mortalidade , Nutrição Parenteral , Adulto , Feminino , Gastrosquise/cirurgia , Gastrosquise/terapia , Idade Gestacional , Mortalidade Hospitalar , Hospitais Pediátricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Doenças do Prematuro/cirurgia , Doenças do Prematuro/terapia , Jamaica/epidemiologia , Masculino , Mães , Nutrição Parenteral Total , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/complicações , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. METHODS: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. RESULTS: 145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). CONCLUSION: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.
RESUMO
Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3). Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%. .
Justificativa e objetivos: Delírio ao despertar é uma complicação preocupante após o uso de sevoflurano em anestesia geral. Este estudo procurou determinar a incidência de delírio ao despertar e os fatores de risco em pacientes de um hospital pediátrico especializado, em Kingston, Jamaica. Métodos: Estudo transversal e observacional, incluindo pacientes pediátricos com idades entre 3-10 anos, estado físico ASA I-II, submetidos à anestesia geral com sevoflurano para procedimentos eletivos em regime ambulatorial. Os dados coletados incluíram nível de ansiedade no pré-operatório medido com a Escala de Ansiedade Pré-operatória de Yale modificada, cirurgia realizada, duração da anestesia e analgésicos administrados. No período pós-operatório, os pacientes foram avaliados para verificar a incidência de delírio ao despertar, definido como Agitação com movimentos não-intencionais, inquietação ou debatimento; inconsolável e apático à presença de enfermeiros e/ou dos pais. A necessidade de tratamento farmacológico e as complicacões pós-operatórias relacionadas a episódios de delírio ao despertar também foram registradas. Resultados: 145 crianças foram incluídas, com incidência de delírio ao despertar em 28 (19,3%). Os episódios de delírio ao despertar apresentaram uma média de duração de 6,9 ±7,8 min; a intervenção farmacológica foi necessária em 19 pacientes (67,8%) e foi associada ao tempo de recuperação prolongado (49,4 ±11,9 versus 29,7 ±10,8 min para crianças não-agitadas; p<0,001). Os fatores positivamente associados ao delírio ao despertar incluíram idade mais jovem (p = 0,01, OR 3,3, IC95 1,2-8,6) e ansiedade moderada ...
Introducción y objetivos: El delirio de urgencias es una complicación angustiante del uso del sevoflurano en anestesia general. Este estudio intentó determinar la incidencia de delirio de urgencias y los factores de riesgo en pacientes de un hospital pediátrico especializado en Kingston, Jamaica. Métodos: Estudio transversal y observacional que incluía pacientes pediátricos con edades entre 3 y 10 años, estado físico ASA I-II, sometidos a la anestesia general con sevoflurano para procedimientos electivos en régimen ambulatorio. Los datos compilados incluyeron un nivel de ansiedad en el preoperatorio medido con la Escala de Ansiedad Preoperatoria de Yale modificada, cirugía realizada, duración de la anestesia y analgésicos administrados. En el período postoperatorio los pacientes fueron evaluados para verificar la incidencia de delirio de urgencias, definido como agitación con movimientos no intencionales, inquietud o desesperación; inconsolable y apático a la presencia de los enfermeros y/o de los padres. También se registraron la necesidad de tratamiento farmacológico y las complicaciones postoperatorias relacionadas con los episodios de delirio de urgencias. Resultados: Se incluyeron 145 niños, con una incidencia de delirio de urgencias en 28 (19,3%). Los episodios de delirio de urgencias tuvieron una media de duración de 6,9 ± 7,8 min; la inter-vención farmacológica se hizo necesaria en 19 pacientes (67,8%) y se asoció con el tiempo de recuperación prolongado (49,4 ± 11,9 versus 29,7 ± 10,8 min para niños no agitados; p < 0,001). Los factores positivamente asociados con el delirio de urgencias incluyeron la edad más joven (p = 0,01, OR: 3,3, IC 95%: 1,2-8,6) y la ansiedad moderada y grave preinducción (p < 0,001, OR: 5.6, IC 95%: 2,3-13,0). Las complicaciones del delirio ...
Assuntos
Humanos , Pré-Escolar , Criança , Procedimentos Cirúrgicos Ambulatórios/instrumentação , Delírio do Despertar/epidemiologia , Sevoflurano/administração & dosagem , Anestesia Geral/instrumentação , Estudos Transversais/instrumentação , Fatores de RiscoRESUMO
In situ (1)H NMR data are reported for 106 Ru(porp)(RSH)(2) species, where porp is the dianion of ß-octaethylporphyrin (OEP), meso-tetraphenylporphyrin (TPP), and its para-substituted tetraphenyl analogues (T-p-XPP; X = OMe, Me, F, Cl, CO(2)Me, CF(3)), meso-tetrakis(3,5-dimethylphenyl)porphyrin (T-m,m'-Me(2)PP), and meso-tetramesitylporphyrin (TMP), and R = Me, Et, (n)Pr, (i)Pr, (n)Bu, (t)Bu, (n)Hex, Bn (benzyl), Ph, and p-MeOC(6)H(4). The upfield shifts in the SH resonances upon coordination of the thiol reflect changes in the porphyrin ring current and are analyzed using an empirical model that depicts quantitatively the nonbonding, electronic, and steric interactions between the thiol ligands, where steric factors dominate, and the porphyrin plane, where electronic factors dominate; such interactions are typically involved in small-molecule recognition within metalloporphyrin systems. Implications of the findings to hemethiolate proteins and surface coordination chemistry are also briefly presented.
Assuntos
Complexos de Coordenação/química , Porfirinas/química , Rutênio/química , Compostos de Sulfidrila/química , Complexos de Coordenação/síntese química , Modelos MolecularesRESUMO
Thirty-two Ru(porp)L(2) complexes have been synthesized, where porp = the dianion of meso-tetramesitylporphyrin (TMP) or meso-tetrakis(4-methylphenyl)porphyrin (H(2)T-pMe-PP), and L = a thiol, a sulfide, a disulfide, or a trisulfide. Species studied were with RSH [R = Me, Et, (n)Pr, (i)Pr, (t)Bu, Bn (benzyl), and Ph], RSR (R = Me, Bn), RSSR (R = Me, Et, (n)Pr, Bn) and MeSS(t)Bu, and RSSSR (R = Me, Bn). All the species except two, which were the isolated Ru(T-pMe-PP)((t)BuSH)(2) and Ru(TMP)(MeSSMe)(2), were characterized in situ. The disulfide complex was characterized by X-ray analysis. (1)H NMR data for the coordinated thiols are the first reported within metalloporphyrin systems, and are especially informative because of the upfield shifts of the axial sulfur-containing ligands due to the porphyrin π-ring current effect, which is also present in the di- and trisulfide species. The disulfide in the solid state structure of Ru(TMP)(MeSSMe)(2) is η(1)(end-on) coordinated, the first example of such bonding in a nontethered, acyclic dialkyl disulfide; (1)H-(1)H EXSY NMR data in solution show that the species undergoes 1,2-S-metallotropic shifts. Stepwise formation of the bis(disulfide) complex from Ru(TMP)(MeCN)(2) in solution occurs with a cooperativity effect, resembling behavior of Fe(II)-porphyrin systems where crystal field effects dominate, but ligand trans-effects are more likely in the Ru system. The η(1)(end-on) coordination mode is also favored for the trisulfide ligand. Discussed also are the remarkable linear correlations that exist between the ring-current shielding shifts for the axial ligand C(1) protons of Ru(porp)(RS(x)R)(2) and x (the number of S atoms). The Introduction briefly reviews literature on Ru- and Fe porphyrins (including heme proteins) with sulfur-containing ligands or substrates, and relationships between our findings and this literature are discussed throughout the paper.