RESUMO
BACKGROUND: The bispectral index (BIS) is a value derived from an electroencephalograph (EEG); it is correlated with depth of sedation and loss of consciousness. Therefore, it has been considered that its control on sedation depth could influence cost saving in drugs as well as decreased anesthesia costs. METHODS: A total of 175 patients were studied. One hundred patients were given intravenous (i.v.) anesthesia, 50 were observed with a BIS monitor, and the remainder went into the control group. Seventy five patients were given balanced general anesthesia: fifty were observed with BIS monitor, while the remainder functioned as the control group. Drug consumption per patient was measured a to maintain BIS value between 60 and 40, and the cost was calculated. RESULTS: Average drug costs for anesthesia were greater in BIS-controlled groups. Anesthesia cost/h was lower in prolonged procedures (>4 h). The bispectral Index as a sedation monitor during anesthesia is an excellent tool, although it did not show a real economic advantage, and we considered that it world only be feasible during long-term procedures.
Assuntos
Anestesia/economia , Anestésicos Intravenosos/economia , Sedação Consciente , Hipnóticos e Sedativos/economia , Anestesia/métodos , Anestésicos Intravenosos/farmacologia , Custos de Medicamentos , Eletroencefalografia , Humanos , Hipnóticos e Sedativos/farmacologia , Monitorização Intraoperatória/métodos , Resultado do TratamentoRESUMO
Preventive analgesia produced by ketorolac and metamizol was evaluated during a prospective study randomized in two groups. One hundred twenty children were included aged from 3 to 6 years who underwent surgery by different procedures. Analgesic dose was applied 15 min prior to surgery by intravenous (i.v.) via. Technique used was inhaled general anesthesia; use of opioids was avoided. Pain evaluation at the end of surgery (and during the following 48 to 72 h) as well as bleeding time, platelet count, and alterations in white blood cell count were dependent variables. As soon as patients arrived in the recovery room, pain was measured by modified McGrath scales and the chromatic EVA. In ketorolac group, 40% of children showed no pain and 55% presented mild to moderate pain (1-6). In metamizol group, 40% of children referred no pain, while 55% evaluated pain as minimal to moderate. Analgesia produced by both drugs presented no significant statistical diference (p > 0.5). Troughout followup, maximum pain referred had a values of 6 and 7, respectively, for ketorolac and metamizol. Fifteen min after analgesic dose, pain was referred as 3 and 4. No alterations were observed in bleeding time, platelet count, and white blood cell count. We conclude that both analgesics prevent hyperalgesia during post-surgical period.
Assuntos
Analgesia , Anti-Inflamatórios não Esteroides/uso terapêutico , Dipirona/uso terapêutico , Cetorolaco/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Los bloqueadores neuromusculares no depolarizantes (BNM-ND) actualmente disponibles, tienen características farmacológicas que permiten su uso en pacientes con insuficiencia renal terminal (IRT), con un mejor margen de seguridad. Entre ellos se encuentra el bromuro de rocuronio. Para probar la utilidad del rocuronio en este tipo de pacientes se diseñó un estudio prospectivo, descriptivo, longitudinal y experimental. Se estudiaron 18 pacientes con IRT, con el fin de medir la duración de acción y el tiempo de recuperación del BNM-ND producido por una sola dosis de relajante igual a 0.600 mg/kg (2DE90), con anestesia total intravenosa basada en propofol + fentanil y ventilación con oxígeno al 100 por ciento, en pacientes sometidos a colocación de catéter de Tenchkoff. Los resultados fueron: condiciones para intubación traqueal en un tiempo promedio de 65 segundos, profundidad máxima del bloqueo 93 por ciento, recuperación al 25 por ciento en 30 minutos, recuperación 25-75 por ciento 30 min. Y 25-80 por ciento 40 minutos, es decir, lo doble que el paciente sano. Se revirtieron cinco pacientes que recibieron dosis adicional y no hubo casos de recurarización. Se concluyó que el rocuronio tiene un buen margen de seguridad en pacientes con IRT siempre y cuando se tenga en mente que la vida media de eliminación se prolonga un 100 por ciento y que se rehuyere del monitoreo del BNM.