RESUMO
One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 µg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.
Assuntos
Nitroglicerina , Vasodilatadores , Humanos , Artéria Radial , Resultado do Tratamento , Cateterismo Cardíaco/efeitos adversos , Espasmo/diagnóstico , Espasmo/etiologia , Espasmo/prevenção & controleRESUMO
The essential oil of Alpinia zerumbet (EOAz) presents myorelaxant and antispasmodic actions on cardiac and smooth muscles. The aim of this study was to investigate the effect of EOAz on the skeletal muscle contraction in post-stroke spasticity. Fifteen adults with unilateral hemiparesis and spasticity resulting from stroke were submitted to surface electromyography readings of the gastrocnemius muscle, before and after 10 daily applications (dermal 0.05 mL per muscle belly) of EOAz. The healthy contralateral muscles without applying the oil were used as controls. The analysis showed that, in both lateral and medial gastrocnemius, the values of all studied variables (root mean square, maximum amplitude and median power frequency) were significantly decreased in pathological legs during muscle contraction (Wilcoxon test, p < 0.05). Moreover, spastic muscles presented different results before and after dermal application of EOAz: The mean values of root mean square and median power frequency were significantly increased in lateral and medial gastrocnemius, and also, the maximum amplitude increased in medial gastrocnemius (Mann-Whitney test, p < 0.05). The results suggest that EOAz acts in the skeletal spastic muscle contraction by promoting relaxation and improvement of the muscular performance. Thus, the EOAz can be useful for the clinical management of secondary effects in patients with cerebral vascular disease.
Assuntos
Alpinia/química , Relaxantes Musculares Centrais/uso terapêutico , Músculo Esquelético/efeitos dos fármacos , Óleos Voláteis/uso terapêutico , Espasmo/prevenção & controle , Acidente Vascular Cerebral/complicações , Administração Cutânea , Adulto , Eletromiografia , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/isolamento & purificação , Óleos Voláteis/administração & dosagem , Óleos Voláteis/isolamento & purificação , Folhas de Planta/química , Espasmo/etiologiaRESUMO
BACKGROUND: Low-level laser therapy (LLLT) has been shown to modulate the inflammatory process without adverse effects , by reducing pain and swelling and promoting the repair of damaged tissues. Because pain, swelling and muscle spasm are complications found in virtually all patients following oral surgery for the removal of impacted teeth, this model has been widely used to evaluate the effects of LLLT on the inflammatory process involving bone and, connective tissue and the muscles involved in mastication. METHODS/DESIGN: After meeting the eligibility criteria, 60 patients treated at a Specialty Dental Center for the removal of impacted lower third molars will be randomly divided into five groups according to the type of laser therapy used at the end of surgery (intraoral irradiation with 660 nm laser; extraoral irradiation with 660 nm laser; intraoral irradiation with 808 nm laser; extraoral irradiation with 808 nm laser and no irradiation). To ensure that patients are blinded to the type of treatment they are receiving, the hand piece of the laser apparatus will be applied both intraorally and extraorally to all participants, but the device will be turned on only at the appropriate time, as determined by the randomization process. At 2 and 7 days after surgery, the patients will be evaluated by three blinded evaluators who will measure of swelling, mouth opening (muscle spasm evaluation) and pain (using two different pain scales). The 14-item Oral Health Impact Profile (OHIP-14) will be used to assess QOL. All data will be analyzed with respect to the normality of distribution using the Shapiro-Wilk test. Statistically significant differences between the experimental groups will be determined using analysis of variance, followed by a suitable post hoc test, when necessary. The significance level will be set at α = 0.05. DISCUSSION: The lack of standardization in studies with regard to the samples, methods and LLLT parameters complicates the determination of the actual effect of laser therapy on this model. The present study aims to provide a randomized, controlled, double-blind trial to compare four different LLLT parameters in relation to the outcomes of pain, swelling and muscle spasm following surgery for the extraction of impacted third molars and evaluate the effects os surgery on patients' quality os life (QOL). TRIAL REGISTRATION: Brazilian Registry of Clinical Trials - Rebec (RBR-6XSB5H).
Assuntos
Inflamação/prevenção & controle , Terapia com Luz de Baixa Intensidade/métodos , Dente Serotino/cirurgia , Projetos de Pesquisa , Extração Dentária/efeitos adversos , Brasil , Protocolos Clínicos , Método Duplo-Cego , Dor Facial/etiologia , Dor Facial/prevenção & controle , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Terapia com Luz de Baixa Intensidade/efeitos adversos , Músculos da Mastigação/fisiopatologia , Músculos da Mastigação/efeitos da radiação , Medição da Dor , Qualidade de Vida , Espasmo/etiologia , Espasmo/fisiopatologia , Espasmo/prevenção & controle , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
In the present work a comparative quantitative evaluation of the differential effects of neuromuscular blockers on twitches and tetani was performed, encompassing: atracurium, cisatracurium, mivacurium, pancuronium, rocuronium and vecuronium. The sciatic nerve-extensor digitorum longus muscle of the rat was used, in vitro. Twitches were evoked at 0.1 Hz and tetani at 50 Hz. The differential effects of the studied compounds on twitches and tetani were statistically compared using simultaneous confidence intervals for the ratios between mean IC(50) for the block of twitches and mean IC(50) for the block of tetani. The results of ratios of mean IC(50) together with their corresponding 95% simultaneous confidence intervals were: vecuronium: 2.5 (1.8-3.5); mivacurium: 3.8 (3.0-4.9); pancuronium: 3.9 (2.0-7.6); rocuronium: 6.1 (3.8-9.9); atracurium: 9.0 (6.4-12.6); cisatracurium: 13.1 (6.0-28.4). Using the criteria that neuromuscular blockers displaying disjunct confidence intervals for the ratios of mean IC(50) differ statistically with regard to differential effects on twitches and tetani, significant differences in ratios of IC(50) were detected in the following cases: vecuronium vs. rocuronium, vs. atracurium and vs. cisatracurium and mivacurium vs: cisatracurium and vs. atracurium. The results show that the magnitude of the differential effects of neuromuscular blockers on twitches and tetani, as evaluated in the present work in the form of ratios of mean IC(50), does not depend on the chemical structure (comparing steroidal and isoquinolinic compounds), but seems to depend on differential pre- and post-synaptic effects of the compounds. It is also suggested that the greater the ability of a compound to block twitches and tetani in a differential manner, the safer is the compound from the clinical anesthesiology viewpoint.
Assuntos
Músculo Esquelético/efeitos dos fármacos , Bloqueadores Neuromusculares/uso terapêutico , Tetania/prevenção & controle , Animais , Intervalos de Confiança , Feminino , Técnicas In Vitro , Masculino , Contração Muscular/efeitos dos fármacos , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Bloqueadores Neuromusculares/farmacologia , Junção Neuromuscular/efeitos dos fármacos , Junção Neuromuscular/fisiologia , Ratos , Ratos Wistar , Espasmo/fisiopatologia , Espasmo/prevenção & controle , Tetania/fisiopatologiaRESUMO
OBJECTIVE: To assess different approaches to the dental management of lip injuries caused by self-inflicted oral trauma in 7 patients. METHOD AND MATERIALS: The patients were grouped based on 3 treatment approaches: group 1, placement of an oral appliance; group 2, botulinum toxin type A neuromuscular block; and group 3, oral surgery. RESULTS AND CONCLUSION: Neuromuscular block can be the first choice of treatment for patients with self-injurious behavior since botulinum toxin A injection is a well-tolerated, safe, and effective procedure, permitting improvement in muscle spasticity, bruxism, range of mouth opening, oral hygiene, and lip trauma. The second option would be the use of the oral appliance, and the last choice is oral surgery. Laser therapy was also found to be effective when applied to traumatic injuries in patients who present self-inflicted oral trauma.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Lábio/lesões , Protetores Bucais , Fármacos Neuromusculares/uso terapêutico , Procedimentos Cirúrgicos Bucais/métodos , Comportamento Autodestrutivo/prevenção & controle , Bruxismo/prevenção & controle , Paralisia Cerebral/complicações , Criança , Coma/complicações , Feminino , Humanos , Terapia a Laser , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Amplitude de Movimento Articular/fisiologia , Espasmo/prevenção & controle , Língua/lesõesRESUMO
Devido ao esforço excessivo da coluna lombar, é alta a incidência de lombalgia entre lixeiros. Este estudo visou avaliar a eficácia da técnica de energia muscular com relaxamento pós-isométrico (TEM/RPI) para reduzir a dor de lombalgias agudas mecânicas em coletores de lixo e verificar a repercussão da técnica sobre a amplitude de movimento. Do quadro de trabalhadores de uma empresa de coleta de lixo, foram selecionados todos os portadores de lombalgia aguda.
Due to excessive effort at the lower back, there is a high incidence of low-back pain among garbage collectors. This study assessed the efficacy of a technique of muscle energy with post-contraction relaxation to reduce pain among garbage collectors with acute mechanical low-back pain...
Assuntos
Masculino , Adolescente , Adulto , Humanos , Doenças Profissionais/reabilitação , Dor Lombar/terapia , Espasmo/prevenção & controleRESUMO
This paper was designed to evaluate the effectivity of several vasodilators, applied topically, to attenuate the hyperreactivity of radial arteries (RA) implanted as aorto-coronary bypass. Remnant segments of the RA were obtained from 20 operations, and each of the segments was divided into 4 rings. The rings were incubated for 30 minutes in control conditions (n = 20) or in presence of 30 microM of Diltiazem (DILT, n = 6), 30 microM of mibefradil (MIBE, n = 4) or a mixture of 30 microM of verapamil + 30 microM of nitroglycerin (VP-NTG, n = 6). A subsequent exposure to KCl 80 mM (in absence of vasodilators) evoked a sustained contraction in control rings, which was attenuated by 35 +/- 9% by DILT, 48 +/- 13% by VP-NTG and by 69 +/- 20% by MIBE (p < 0.05). Preincubation with vasodilators also attenuated the rate and intensity of rhythmic contractions of the RA. In rings that were cold-stored during 24 hs and then restimulated with KCl 80 mM the depressing effect was still evident: DILT 53 +/- 6%, VP-NTG 46 +/- 14% and MIBE 61 +/- 9% (p < 0.05). The effect of MIBE was more intense and persistent than that of DILT or VP-NTG, even at concentrations eliciting a similar initial depression of contraction. It is concluded that the exposure to vasodilators during a period equivalent to the duration of the surgical preparation of the RA produces an attenuation of the arterial reactivity that might provide an additional protection against RA spasm during the immediate postoperative period.
Assuntos
Artéria Radial/efeitos dos fármacos , Vasodilatadores/farmacologia , Idoso , Ponte de Artéria Coronária/métodos , Diltiazem/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina/farmacologia , Artéria Radial/cirurgia , Espasmo/prevenção & controle , Verapamil/farmacologiaRESUMO
Este trabajo se diseñó para evaluar la efectividad de diversos vasodilatadores aplicados tópicamente para prevenir la hiperreactividad de las arterias radiales (AR) implantadas como bypass aortocoronario. De cada uno de los remanentes de AR provenientes de 20 pacientes operados se obtuvieron 4 anillos que se incubaron por 30 minutos en condiciones control (n = 20) o en presencia de 30 µM de diltiazem (DILT, n = 6), mibefradil (MIBE, n = 4) o mezcla de verapamil + nitroglicerina (VP-NTG, n = 6). La subsiguiente exposición a CIK 80 mM (en ausencia de vasodilatadores) provocó una contracción sostenida en los anillos control, que fue atenuada en un 35 ñ 9 por ciento por DILT, 48 ñ 13 por ciento por VP-NTG y 69 ñ 20 por ciento por MIBE (p < 0.05). La preincubación con vasodilatadores provocó también la disminución de frecuencia e intensidad de contracciones rítmicas espontáneas de la AR. En anillos almacenados en frío por 24 hs y luego reestimulados con CIK 80 mM el efecto depresor fue aun evidente: DILT 53 ñ 6 por ciento, VP-NTG 46 ñ 14 por ciento y MIBE 61 ñ 9 por ciento (p < 0.05). El efecto del MIBE fue más intenso y persistente que el de DILT o VP-NTG, aún a concentraciones que provocan un igual efecto depresor inicial. Se concluye que la exposición a vasodilatadores durante un período equivalente a la duración de la preparación de la AR a implantar produce una atenuación de la reactividad arterial que proporcionaría una protección adicional contra el espasmo durante el postoperatorio inmediato.
Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Técnicas In Vitro , Artéria Radial/efeitos dos fármacos , Vasodilatadores/farmacologia , Ponte de Artéria Coronária/métodos , Diltiazem/farmacologia , Mibefradil/farmacologia , Nitroglicerina/farmacologia , Artéria Radial/cirurgia , Espasmo/prevenção & controle , Verapamil/farmacologiaRESUMO
Este trabajo se diseñó para evaluar la efectividad de diversos vasodilatadores aplicados tópicamente para prevenir la hiperreactividad de las arterias radiales (AR) implantadas como bypass aortocoronario. De cada uno de los remanentes de AR provenientes de 20 pacientes operados se obtuvieron 4 anillos que se incubaron por 30 minutos en condiciones control (n = 20) o en presencia de 30 AM de diltiazem (DILT, n = 6), mibefradil (MIBE, n = 4) o mezcla de verapamil + nitroglicerina (VP-NTG, n = 6). La subsiguiente exposición a CIK 80 mM (en ausencia de vasodilatadores) provocó una contracción sostenida en los anillos control, que fue atenuada en un 35 ñ 9 por ciento por DILT, 48 ñ 13 por ciento por VP-NTG y 69 ñ 20 por ciento por MIBE (p < 0.05). La preincubación con vasodilatadores provocó también la disminución de frecuencia e intensidad de contracciones rítmicas espontáneas de la AR. En anillos almacenados en frío por 24 hs y luego reestimulados con CIK 80 mM el efecto depresor fue aun evidente: DILT 53 ñ 6 por ciento, VP-NTG 46 ñ 14 por ciento y MIBE 61 ñ 9 por ciento (p < 0.05). El efecto del MIBE fue más intenso y persistente que el de DILT o VP-NTG, aún a concentraciones que provocan un igual efecto depresor inicial. Se concluye que la exposición a vasodilatadores durante un período equivalente a la duración de la preparación de la AR a implantar produce una atenuación de la reactividad arterial que proporcionaría una protección adicional contra el espasmo durante el postoperatorio inmediato. (AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Técnicas In Vitro , Masculino , RESEARCH SUPPORT, NON-U.S. GOVT , Artéria Radial/efeitos dos fármacos , Vasodilatadores/farmacologia , Artéria Radial/cirurgia , Ponte de Artéria Coronária/métodos , Espasmo/prevenção & controle , Diltiazem/farmacologia , Mibefradil/farmacologia , Verapamil/farmacologia , Nitroglicerina/farmacologiaRESUMO
Os autores apresentam os resultados do uso do antagonista de cálcio "Nimodipina" na profilaxia do vasoespasmo cerebral pós-hemorragia meníngea espontânea por rotura de aneurisma. O trabalho é baseado no estudo duplo-cego de 30 pacientes dos quais 15 receberam minodipina e 15 placebo. É ressaltada a gravidade desta complicaçäo nos sangramentos subaracnóideos. Os resultados säo semelhantes aos da literatura a respeito, aparentemente indicando um efeito benéfico da droga nestes pacientes