A fim de investigar a associação entre alterações do tônus uterino e a ocorrência de anormalidades da freqüência cardíaca fetal (FCF) após analgesia obstétrica, em especial após o bloqueio combinado raqui-peridural, foi conduzido estudo prospectivo randomizado e encoberto, com setenta e sete parturientes que solicitaram analgesia regional durante o trabalho de parto. As pacientes do grupo estudo (41 casos) receberam duplo bloqueio com sufentanil e bupivacaína e as do grupo controle (36 casos) foram submetidas à peridural com as mesmas drogas. Monitorizou-se o tônus uterino por meio de cateter intra-amniótico de aferição da pressão intra-uterina e a freqüência cardíaca fetal durante 15 minutos antes e 30 minutos após a indução da analgesia. Pesquisaram-se os seguintes desfechos após a administração da analgesia: ocorrência de aumento do tônus uterino superior ou igual a 10mmHg em relação aos valores pré-analgesia e presença de desacelerações prolongadas da FCF ou bradicardia. Foram ainda quantificados os escores maternos de dor, a pressão arterial materna e o uso de ocitocina, antes e após o bloqueio. Observou-se associação significativa tanto do aumento de tônus uterino quanto das alterações da FCF com a analgesia combinada, nos primeiros 15 minutos após sua administração. O aumento de tônus foi encontrado em 17 de 41 casos no grupo estudo e em 6 de 36 pacientes nos controles (p=0,02). Alterações da FCF foram vistas em 11 dos 17 casos de aumento de tônus nas parturientes que receberam analgesia combinada, versus 1 de 6 no grupo peridural (p<0,001) A análise de regressão logística apontou o tipo de analgesia como fator independentemente associado ao aumento de tônus uterino, mesmo inserindo-se o uso de ocitocina como covariável. Também revelou o aumento de tônus como único fator independentemente associado ao desenvolvimento de anormalidades da FCF, mesmo com a hipotensão materna como covariável. Demonstrou-se ainda correlação entre o rápido declínio da dor com a técnica combinada e a probabilidade estimada de ocorrência simultânea de aumento do tônus e alterações da FCF. Os presentes achados reforçam a teoria de que o duplo bloqueio pode levar a aumento transitório de tônus uterino e culminar em anormalidades da FCF / In order to investigate the association between uterine tone elevation and fetal heart rate (FHR) abnormalities following labor analgesia - mainly with combined spinal-epidural (CSE) technique - a prospective double-blinded randomized study was conducted with seventy seven parturients who requested labor analgesia. Study group (41 cases) received CSE with sufentanil and bupivacaine and control group (36 cases) received epidural analgesia with the same drugs. Intra-uterine pressure was monitored with intra-amniotic pressure device and FHR with external transducer, both for at least 15 minutes before and 30 minutes after analgesia induction. The primary outcomes were the occurrence of an elevation of 10mmHg or more on uterine tone compared to the values before analgesia and the presence of prolonged fetal heart rate decelerations or fetal bradycardia. Maternal pain scores, blood pressure and use of oxytocin were also computed. A significant association was noticed between elevation of uterine tone and fetal heart rate abnormalities with combined spinal-epidural analgesia, at the first 15 minutes of administration. Uterine tone elevation was observed in 17 out of 41 CSE subjects and only 6 out of 36 controls (p=0.02). Fetal heart rate abnormalities were seen in 11 out of 17 cases that had hypertonus with combined analgesia and in only one of the 6 epidural patients (p<0.001). Logistic regression analysis revealed the mode of analgesia as the independent factor for the elevation of uterine tone, even with oxytocin use as a covariate. It also pointed out the uterine tone elevation as the only independent factor related to the development of fetal heart rate abnormalities, even with maternal hipotension as a covariate. A correlation was found between the fast onset pain relief provided by CSE analgesia and the estimated probability of uterine tone elevation and simultaneous fetal heart rate abnormalities. The present results strengthen the hypothesis that CSE analgesia can lead to a transient increase in uterine tone, leading to fetal bradycardia

A fim de investigar a associação entre alterações do tônus uterino e a ocorrência de anormalidades da freqüência cardíaca fetal (FCF) após analgesia obstétrica, em especial após o bloqueio combinado raqui-peridural, foi conduzido estudo prospectivo randomizado e encoberto, com setenta e sete parturientes que solicitaram analgesia regional durante o trabalho de parto. As pacientes do grupo estudo (41 casos) receberam duplo bloqueio com sufentanil e bupivacaína e as do grupo controle (36 casos) foram submetidas à peridural com as mesmas drogas. Monitorizou-se o tônus uterino por meio de cateter intra-amniótico de aferição da pressão intra-uterina e a freqüência cardíaca fetal durante 15 minutos antes e 30 minutos após a indução da analgesia. Pesquisaram-se os seguintes desfechos após a administração da analgesia: ocorrência de aumento do tônus uterino superior ou igual a 10mmHg em relação aos valores pré-analgesia e presença de desacelerações prolongadas da FCF ou bradicardia. Foram ainda quantificados os escores maternos de dor, a pressão arterial materna e o uso de ocitocina, antes e após o bloqueio. Observou-se associação significativa tanto do aumento de tônus uterino quanto das alterações da FCF com a analgesia combinada, nos primeiros 15 minutos após sua administração. O aumento de tônus foi encontrado em 17 de 41 casos no grupo estudo e em 6 de 36 pacientes nos controles (p=0,02). Alterações da FCF foram vistas em 11 dos 17 casos de aumento de tônus nas parturientes que receberam analgesia combinada, versus 1 de 6 no grupo peridural (p<0,001) A análise de regressão logística apontou o tipo de analgesia como fator independentemente associado ao aumento de tônus uterino, mesmo inserindo-se o uso de ocitocina como covariável. Também revelou o aumento de tônus como único fator independentemente associado ao desenvolvimento de anormalidades da FCF, mesmo com a hipotensão materna como covariável. Demonstrou-se ainda correlação entre o rápido declínio da dor com a técnica combinada e a probabilidade estimada de ocorrência simultânea de aumento do tônus e alterações da FCF. Os presentes achados reforçam a teoria de que o duplo bloqueio pode levar a aumento transitório de tônus uterino e culminar em anormalidades da FCF / In order to investigate the association between uterine tone elevation and fetal heart rate (FHR) abnormalities following labor analgesia - mainly with combined spinal-epidural (CSE) technique - a prospective double-blinded randomized study was conducted with seventy seven parturients who requested labor analgesia. Study group (41 cases) received CSE with sufentanil and bupivacaine and control group (36 cases) received epidural analgesia with the same drugs. Intra-uterine pressure was monitored with intra-amniotic pressure device and FHR with external transducer, both for at least 15 minutes before and 30 minutes after analgesia induction. The primary outcomes were the occurrence of an elevation of 10mmHg or more on uterine tone compared to the values before analgesia and the presence of prolonged fetal heart rate decelerations or fetal bradycardia. Maternal pain scores, blood pressure and use of oxytocin were also computed. A significant association was noticed between elevation of uterine tone and fetal heart rate abnormalities with combined spinal-epidural analgesia, at the first 15 minutes of administration. Uterine tone elevation was observed in 17 out of 41 CSE subjects and only 6 out of 36 controls (p=0.02). Fetal heart rate abnormalities were seen in 11 out of 17 cases that had hypertonus with combined analgesia and in only one of the 6 epidural patients (p<0.001). Logistic regression analysis revealed the mode of analgesia as the independent factor for the elevation of uterine tone, even with oxytocin use as a covariate. It also pointed out the uterine tone elevation as the only independent factor related to the development of fetal heart rate abnormalities, even with maternal hipotension as a covariate. A correlation was found between the fast onset pain relief provided by CSE analgesia and the estimated probability of uterine tone elevation and simultaneous fetal heart rate abnormalities. The present results strengthen the hypothesis that CSE analgesia can lead to a transient increase in uterine tone, leading to fetal bradycardia

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-19Bitstream added on 2014-06-13T20:09:24Z : No. of bitstreams: 1 ramirezuscategui_ra_me_jabo.pdf: 633568 bytes, checksum: 300dc921484da70446a47334974c06bd (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Com o objetivo de avaliar a analgesia pós-operatória, o consumo anestésico e os efeitos cardiorrespiratórios da analgesia pré, intra pós-operatória usando metadona e pré-operatória usando tramadol, durante a mastectomia, foram realizados dois estudos clínicos experimentais prospectivos de tipo cego em 88 cadelas, submetidas à mastectomia unilateral terapêutica, anestesiadas com propofol e isofluorano. O grupo TRAM (34 animais) recebeu 5 mg/kg de tramadol IM no período pré-operatório, o grupo MET1 (34 animais) recebeu 0,5 mg/kg de metadona IM no mesmo período e os grupos MET2 e MET3 (10 animais cada) receberam o mesmo tratamento nos períodos intra e pós-operatórios, respectivamente. Foram avaliados: os requerimentos de propofol, isofluorano e os parâmetros cardiorrespiratórios (FC, f, PAM, PAD PAS, EtCO2, SpO2, Temp) no período transoperatório; e a analgesia pós-operatória durante as 4 e 12 horas, usando a Escala de dor da Universidade de Melbourne. Os requerimentos de propofol e isofluorano, a FC, SpO2, PAS e f foram similares para todos os grupos. A PAM e PAD foram menores no grupo TRAM que no MET1 durante a indução anestésica, a EtCO2 foi significativamente maior nos grupos MET1 e MET2 que no grupo TRAM no trans-cirúrgico. Os requerimentos de suplementação analgésica (resgate) e o consumo de analgésicos foram menores no grupo MET1 que no TRAM. A intensidade da dor foi menor no MET1 e MET2. O uso da analgesia pré ou intra-operatória com metadona é efetivo no controle da dor pós-operatória, permite um plano anestésico mais estável e menor depressão cardiovascular / In order to evaluate the postoperative analgesic, anesthetic consumption and cardiorespiratory effects of pre, intra and post-operative analgesia, using methadone and pre-operatory using tramadol, two prospective blind studies clinical trial were conducted, in 88 bitches, submitted to therapeutic unilateral mastectomy, anesthetized with propofol and isoflurane. The TRAM group (34 animals) received 5 mg/kg of Tramadol IM in the pre-operative time, the MET1 group (34 animals) received 0.5 mg / kg IM methadone in the same period and MET2 and MET3 groups (10 animals each) received the same treatment in intra and post-operative times respectively. Were evaluated: the propofol and isoflurane requirements, cardiorespiratory parameters (HR, f, MAP, DAP, PAS, EtCO2, SpO2, Temp) during the perioperative time. The post operatory analgesia was assessed during the 4 and 12 hours, using the University of Melbourne pain scale. The propofol and isoflurane requirements, HR, SpO2, SAP and f were similar in all groups. MAP and DAP were lower in the TRAM that MET1 during anesthetic induction, the EtCO2 was significantly greater in MET1 and MET2 groups than in the TRAM for trans-surgery time. The requirements of supplemental analgesia (rescue), and analgesic consumption were significantly lower in MET1 group, than in the TRAM. Pain intensity was lower in MET1 and MET2 groups. The use of pre or intra-operative analgesia with methadone is effective in controlling postoperative pain, allows a more stable anesthetic plane and less cardiovascular depression

Orientador: Newton Nunes / Banca: Roberta Carareto / Banca: João Moreira da Costa Neto / Resumo: A anestesia epidural, quando comparada à anestesia geral, apresenta algumas vantagens como redução dos custos, minimização dos riscos anestésicos por ocasionar poucas alterações respiratórias e cardiovasculares. Mas tem sido utilizada basicamente para cirurgias no membro posterior e inguinais já que o anestésico local quando administrado no espaço compreendido entre a sétima vértebra lombar e a primeira vértebra sacral proporciona bloqueio máximo até a quarta vértebra lombar. Uma alternativa para bloqueios mais craniais é a utilização do cateter epidural. Tal estudo avaliou, comparativamente os efeitos de duas doses de lidocaína (4 e 6 mg/Kg) administradas por via epidural na altura da primeira vértebra lombar em cadelas submetidas à ovariohisterectomia. Foram utilizadas 16 cadelas SRD, pesando entre 4 e 20 Kg e entre 1 e 6 anos. Todas receberam butorfanol e etomidato, ambos por via intravenosa nas doses de 0,4 mg/Kg e 2 mg/Kg respectivamente. Foram avaliados parâmetros cardiovasculares, hemogasométricos, ventilometricos e relacionados à analgesia. Os parâmetros fisiológicos avaliados não apresentaram diferença entre os grupos em com o uso de diferentes doses de lidocaína. Relativamente à analgesia, 25% dos animais do G4 apresentaram escore de dor considerado insuficiente. Contudo conclui-se que as duas doses de lidocaína, depositadas na altura da primeira vértebra lombar, não interferem nos parâmetros ventilométricos, hemogasométricos e cardiovasculares. E a dose de 6 mg/Kg determina melhor analgesia que a de 4 mg/Kg / Abstract: Epidural anesthesia compared to general anesthesia has some advantages such as reducing cost, minimizing the risks of anesthesia by causing fewer respiratory and cardiovascular changes. But it has been used primarily for surgery in the posterior limb and inguinal as the local anesthetic when administered in the space between the seventh lumbar and first sacral vertebra provides maximum block until the fourth lumbar vertebra. An alternative to more bloks cranial is the use of epidural catheter. This study evaluated the comparative effects of two doses of lidocaine (4 and 6 mg/Kg) administered epidurally at the time of the first lumbar vertebra en bitches submitted to ovariohisterectomy. !6 mongrel dogs were used, weighing between 4 and 20 Kg ande between 1 and 6 years old. All received butorphanos and etomidate, both intravenously ins doses of 0,4mg/Kg to 2 mg/Kg respectively. We assessed cardiovascular, blood gas ventilometric and analgesia. The physiological parameters evaluated did not differ between the groups using different doses of lidocaine. For analgesia, 25% of animals in G4 had a pain score considered insufficient. However, it is conclused that two doses os lidocaine, deposited at the time of the first lumbar vertebra, the parameters do not interfere ventilometric, blood gas and cardiovascular diseases. And the dose of 6 mg/Kg determines the better analgesia of 4 mg/Kg / Mestre

Submitted by Sandro Camargo (sandro.camargo@unipampa.edu.br) on 2015-03-08T23:29:10Z No. of bitstreams: 1 127110021.pdf: 485296 bytes, checksum: b949c004a5c8effa9dcfd58b5d1cac06 (MD5) / Made available in DSpace on 2015-03-08T23:29:10Z (GMT). No. of bitstreams: 1 127110021.pdf: 485296 bytes, checksum: b949c004a5c8effa9dcfd58b5d1cac06 (MD5) Previous issue date: 2014-07-31 / Avaliou-se a analgesia no período do pós-operatório imediato em cadelas submetidas à ovariohisterectomia, anestesiadas com isofluorano e infusão contínua de tiletamina/zolazepam. Os animais foram divididos em dois grupos (n=10): grupo controle (GC) e grupo tiletamina/zolazepam (GTZ). A MPA foi realizada com acepromazina (0,05 mg/kg) e meperidina (5 mg/kg) IM. A indução anestésica feita com propofol (4 mg/kg) e a manutenção anestésica com isoflurano (1,9 V%), utilizando-se ventilação controlada em todos os animais. Decorridos 10 minutos, os animais do GTZ receberam bolus IV de 0,6 mg/kg de tiletamina/zolazepam seguido pela infusão contínua IV na taxa de 0,06mg/kg/min,. Os animais do GC receberam bolus e infusão contínua de solução de NaCl 0,9% nos volumes, taxas e vias iguais aos calculados para os animais do GTZ. As soluções foram administradas por bomba de infusão durante 60 minutos. O procedimento cirúrgico foi realizado sempre pela mesma equipe cirúrgica. Após extubação dos animais e mensuração deste tempo em ambos os grupos, foi realizada a primeira avaliação da analgesia e, a partir daí, a cada 30 minutos durante 4 horas (M0, M30, M60, M90, M120, M150, M180, M210, M240), valendo-se da escala de dor da Universidade de Melbourne, executada sempre pelo mesmo avaliador o qual não tinha conhecimento prévio do tratamento administrado. O resgate analgésico foi efetuado com 4 mg/kg de tramadol nos animais que obtivessem escore igual ou superior a 12. Os escores foram submetidos à análise estatística utilizando-se teste de Mann-Whitney. A necessidade de resgate analgésico foi avaliada pelo método de sobrevivência de Kaplan-Meier. Em todas as análises, o nível de significância adotado foi 5%. Para avaliação da recuperação anestésica, foi utilizada a escala de recuperação proposta por Pinho (2000) para determinação dos escores, a qual exemplifica valores de 1 a 5 alistados na classificação de escore. Os escores de dor, expressos em mediana (máximos/mínimos) foram significativamente menores no GTZ em T30 (7,5, 2 e 8), T90 (19, 5 e 9) e T150 (18,5, 6 e 10 ). O resgate analgésico foi necessário em 70% dos animais do GC e em nenhum do GTZ. Analisando-se os resultados, pode-se concluir que o uso da associação de tiletamina/zolazepam no trans-operatório forneceu analgesia no pós-operatório imediato satisfatória, reduzindo o requerimento analgésico. / The aim of the study was to evaluated postoperative the analgesia in dogs undergoing ovariohysterectomy, anesthetized with isoflurane, and continuous infusion of tiletamina-zolazepam. The animals were divided into two groups (n = 10): control group (CG) and tiletamina-zolazepam group (GTZ). MPA was performed with acepromazine (0.05 mg / kg) and meperidine (5 mg / kg) IM. Anesthesia induced with propofol (4 mg / kg) and was maintained with isoflurane (1.9% V), using controlled ventilation in all animals. After 10 minutes, the animals received GTZ bolus of 0.6 mg / kg tiletamine / zolazepam followed by continuous infusion at the rate of 0.06 mg / kg / min of the same drugs IV. The animals of the CG received bolus and continuous infusion of NaCl 0.9% in volume, rate and equal to the calculated routes for animals GTZ. The solutions were administered by infusion pump for 60 minutes. The surgical procedure was performed by the same surgical team. After extubation of animals and measurement of this time in both groups, the first assessment of analgesia was achieved and, thereafter, every 30 minutes for 4 hours (M0, M30, M60, M90, M120, M150, M180, M210, M240), drawing on the pain scale at the University of Melbourne, always performed by the same examiner who was unaware of the treatment administered. The analgesic rescue was performed with 4 mg / kg of tramadol in animals which received a score less than 12. Scores were statistically analyzed using the Mann-Whitney test. The need for rescue analgesia was assessed by survival Kaplan-Meier. In all analyzes, the significance level was 5%. To review the anesthetic recovery, the scale of recovery proposed by Pinho (2000) for determining the scores, which exemplifies values 1-5 listed in the classification score was used. Pain scores, expressed as median and maximum-minimum values: were significantly lower in the GTZ in T30 (7.5, 2:08), T90 (19, 5:09) and T150 (18.5, 6 and 10). The rescue analgesic was required in 70% of animals in any of the GC and GTZ. Analyzing the results, we can conclude that the use of the combination of tiletamina-zolazepam intraoperatively provided satisfactory analgesia in the immediate postoperative period, reducing the analgesic requirement.

There was few human study evaluated the analgesic effect of acupuncture on central nervous system (CNS). The electrical temporal summation (TS) pain model has been validated and provides the opportunity to study the central inhibition effect of acupuncture in healthy humans. The present study aimed to: 1. systematically review available randomised, controlled trials (RCTs) of acupuncture on experimentally induced pain in healthy humans; 2. conduct a RCT to assess the effect of manual acupuncture (MA) and electro-acupuncture (EA) on TS of pain and the spatial (i.e. the local and remote sites to acupuncture stimulation) and the temporal (i.e. immediately after and 24-hours after the intervention) characteristics of this effect. The systematic review was carried out in accordance with the requirements of a Cochrane Systematic Review. The methodological quality and credibility of the acupuncture intervention of the included RCTs were assessed. The Review Management software (RevMan version 4.2, The Cochrane Library) was used for data extraction and data analysis. 605 papers were identified from four databases (Pubmed, Cochrane Library, CINAHL and EMBASE). Only nine papers met the inclusion criteria. The methodological quality and credibility of the acupuncture invention were satisfactory. The pain models and interventions applied varied substantially from study to study. Consequently, meta-analyses were not conducted. Comparing acupuncture with non-invasive control, significant acupuncture analgesia was reported. These studies also demonstrated that invasive controls produced analgesia. For the RCT of acupuncture on TS, 27 healthy volunteers were recruited and randomly assigned to either EA, MA or sham-acupuncture (SA) group, with nine volunteers in each group. To test pain thresholds, transcutaneous electrical stimulation was delivered to two sites on the anterior aspects of both legs and one site on the dorsum of the non-dominant forearm. Pain thresholds to single electrical stimulation (SPT) and to TS stimulation (TST) were assessed before, 30-minutes after and 24-hours after the intervention. Acupuncture was given to Zusanli (ST36) and Fenglong (ST 40) on the dominant leg. The level of anxiety was assessed before and after acupuncture with Spielberg State and Anxiety Inventory. The three groups were comparable at baseline. The level of anxiety did not change significantly after acupuncture. EA significantly increased SPT and TST on the treatment leg 24-hour after the treatment when compared with SA (p less than 0.05), but did not increase those measured on the non-treatment leg or the forearm. The fact that such an effect increased within 24 hours after acupuncture might indicate the potential role of neurohumoral mechanisms in acupuncture analgesia. The analgesia effect of EA on TS tended to be localised at the needling site. This observation is different from the understanding of the wide-spread effect of acupuncture. The discrepancy could be due to the small sample size of the current study. In conclusion, this is the first study that demonstrates EA elicits a strong inhibition on the CNS in health humans. Such a central effect lasts more than 24 hours, and limits to the site where acupuncture is applied. These findings need to be confirmed in other TS models.

During surgery, both anesthesia and tissue damage cause physiological stress responses in the body. The hypothalamic-pituitary-adrenal (HPA) axis is activated with increased levels of glucocorticoids. After surgical procedures the stress response may be a cause of postoperative morbidity and pre-emptive analgesic treatment can attenuate the stress response during the postoperative period. In laboratory animals, buprenorphine is a commonly used analgesic. Subcutaneous (s.c.) administration of buprenorphine is most common, but oral administration would be preferable in many cases, enabling administration without any handling of the rat. In this thesis we studied the surgical stress response in laboratory rats during surgery and in the postoperative period, and its modulation by s.c. injection and oral voluntary ingestion (VI) of buprenorphine. Corticosterone levels and the clinical parameters body weight, water intake and behavior were observed. The concentration of buprenorphine in plasma was measured as well as stock-related differences in postoperative recovery. During surgery and anesthesia there was a higher corticosterone release during a more severe surgery and corticosterone levels were reduced more effectively after buprenorphine treatment than after lidocaine treatment. Buprenorphine treatment, independent of the route of administration, led to better postoperative recovery in body weight and water intake compared to local anesthetics. VI of buprenorphine resulted in a suppression of plasma corticosterone levels compared to s.c. buprenorphine treatment and treatment with local anesthetics during the first day after surgical catheterization. The corticosterone levels of all buprenorphine treated groups had, by the second postoperative day, reverted to the normal diurnal rhythm of corticosterone secretion. Buprenorphine treatment increased locomotor activity in non-operated rats only. The effect of buprenorphine in operated rats could not be detected via the monitoring of locomotor activity or the time spent resting in the present study. Treatment with buprenorphine by VI has similar effects on postoperative plasma corticosterone levels in both Wistar and Sprague-Dawley rats. VI of buprenorphine resulted in a buprenorphine concentration in plasma at least as high as by s.c. treatment. Thus, administration by VI of buprenorphine appears to be an effective stress-reducing method for administrating postoperative analgesia to laboratory rats.

OBJETIVO: Describir el uso de sedantes, analgésicos y bloqueantes neuromusculares en infantes y niños críticamente enfermos en la Unidad de Cuidados Intensivos Pediátricos(PICU).MÉTODO: Estudio descriptivo, transversal y observacional realizado en niños críticamente enfermos de la PICU del Hospital E. Rebagliati Martins durante enero a diciembre del 2002. De un total de 249 infantes y niños hospitalizados en la PICU, se seleccionó una muestra representativa de 78 casos, de los cuales se revisó los datos de la historia clínica, sobre el registro de las características del uso de agentes sedantes, analgésicos y bloqueantes neuromusculares a corto plazo(menor de 6 horas), y largo plazo( mayor a 6 horas). RESULTADOS: El 62% fué de sexo masculino, 32% sexo femenino, con un promedio de edad de 5.3 años, +- 4.1 DS, 65% fueron de categoría quirúrgica; tuvieron un promedio de: Ventilación Mecanica de 2.7 dias, estancia en PICU de 6.3 dias, y Score de Glasgow de 9.8. Se usó el vecuronio en 5%, como agente bloqueante neuromuscular (NMBA) a corto plazo, la sedación y analgesia con midazolan(22%), metamizol(49%)y fentanilo(10%) respectivamente. La sedación, analgesia y relajación a largo plazo con midazolam(50%), fentanilo(50%) , metamizol(25%), y vecuronio(0.02%). Fueron usados simultáneamente midazolam y fentanilo en 23%, midazolam, fentanilo y metamizol en 5% de casos. No se encontró en ningun caso el registro de complicaciones y escalas de evaluación específicas, por el uso de estos agentes. CONCLUSIONES: La sedación y analgesia a corto plazo, es una práctica poco frecuente en la PICU del Hospital E. Rebagliatti Martins, asi mismo el bloqueo neuromuscular es casi inusual. Sin embargo la sedación y analgesia a largo plazo es de práctica relativamente frecuente(50%); no asi el bloqueo neuromuscular que es casi inusual. Palabras Claves: PICU: Unidad de Cuidados Intensivos Pediátricos, NMBA: agente de bloqueo neuromuscular; sedación, analgesia, relajación neuroromuscular, infantes, niños.

published_or_final_version / Anaesthesiology / Doctoral / Doctor of Philosophy

Previous studies in our laboratory have indicated that anesthetic block of neural activity at discrete sites within the limbic system, including the lateral hypothalamus and anterior cingulum bundle, causes a significant long-lasting analgesia during the formalin test. In this experiment, the local anesthetic lidocaine was microinjected into the dentate region of the hippocampus, an important limbic structure presumed to subserve the affective-motivational aspects of pain. The dentate gyrus is strategically situated at a point of convergence of widespread polysensory cortical input to the hippocampus, to allow modulation of cortical signals before they diverge into numerous limbic circuits. The results indicate that anesthetic block of the anterior region of the dentate gyrus produces analgesia in the rat during the formalin test. The analgesia produced by this procedure became apparent 30 minutes after regional block contralateral to the site of injury and persisted for the duration of the test period. These data provide further evidence that limbic forebrain structures are involved in pain and analgesia.