Bakgrund: Nästan hälften av alla personer med kroniska ryggsmärtor anser att de inte får en tillräckligt god smärtlindring. Kronisk ryggsmärta definieras som smärta i ryggen vilken varar längre än den förväntade tiden för smärta efter operation eller som förekommer i mer än sex månader. Vanliga behandlingsmetoder för kroniska ryggsmärtor är smärtlindrande läkemedel, värme och/eller kylterapi och massage. I tidigare studier har personer med kroniska ryggsmärtor upplevt att de ses som gnälliga och missförstådda i mötet med vården där de har haft svårt att tala om alternativa smärtlindringsmetoder. Syfte: Att beskriva personers erfarenheter av att använda cannabis som smärtlindring vid kronisk ryggsmärta. Metod: Kvalitativ innehållsanalys av inlägg i diskussionsforum på internet. Resultat: Analysen resulterade i fyra kategorier: Smärtlindring med subkategorin Sidoeffekter/Bieffekter, Jämförelse med andra läkemedel, Sociala aspekter och Vårdmötet. Slutsats: Personer med kroniska ryggsmärtor är en notoriskt svårbehandlad patientgrupp. Cannabis har i denna studie visat sig ge god smärtlindring för vissa personer och vidare även lindrat illamående och sömnsvårigheter. Klinisk betydelse: Denna studie avser att öka kunskapen om personer med kroniska ryggsmärtor och deras erfarenheter av cannabis som smärtlindrande läkemedel. Förhoppningsvis leder resultatet till att förståelsen från sjuksköterskor ökar gentemot dessa personer och deras lidande och på så sätt förbättrar omvårdnaden i vårdmötet. / Background: Almost half of all people with chronic backpain argues that they receive insufficient pain relief. Chronic backpain is defined as pain that persists longer than expected after surgery or pain that remains after six months. Common treatments for chronic backpains are painkillers, massage, heat and/or cold therapy. People with chronic backpain feel they are winy and misunderstood in health care encounters and have problems talking about alternative ways of pain relief. Purpose: To describe peoples experiences of cannabis use for chronic backpains. Method: Qualitative content analysis of posts in discussion forums on internet. Results: Four categories emerged from analyzing the data: Pain relief with the subcategory side effects, comparison with other drugs, social aspects and health care encounters. Conclusion: People with chronic backpain is a notorious difficult patient group to treat. Cannabis has in this study shown to give some people sufficient pain relief and even helped with nausea and sleep problems. Clinical importance: This study aims at increasing knowledge about people with chronic backpain and their experiences of cannabis use as a pain killer. Hopefully the results of this study leads to increasing nurses’ understanding towards this group of people and their suffering, doing this will increase caring in healthcare encounters.

Inledning: Forskning visar att smärta vid stora trauman är underbehandlat, vilket kan ge ett förlängt sjukdomsförlopp och leda till komplikationer för patienten. Smärtbedömning är en viktig del i smärtbehandlingen och kan göras med hjälp av observationer av fysisk status och smärtskattningsinstrument. Eftersom ett stort trauma även innebär en psykologisk påfrestning för patienten är det viktigt att lindra både smärtan och det psykiska lidandet. Syfte: Att beskriva ambulanssjuksköterskors uppfattningar om traumapatienters upplevelser av smärta samt beskriva ambulanssjuksköterskors erfarenheter av smärtbehandling och omvårdnadsåtgärder som lindrar lidande hos dessa patienter. Metod: En intervjustudie med elva ambulanssjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Ambulanssjuksköterskans arbete vid smärtlindring vid stort trauma präglades av avvägningar och prioriteringar. Dessa gjordes utifrån ambulanssjuksköterskans egna bedömningar samt de riktlinjer som fanns inom ambulanssjukvården. Omvårdnadsåtgärder var lika viktiga som de farmakologiska åtgärderna, i arbetet för att lindra patientens smärta och lidande. Majoriteten av ambulanssjuksköterskorna upplevde smärtan vid stort trauma som underbehandlad. Detta på grund av otillräckliga läkemedelsdoser men också på grund av prioritering av livsuppehållande åtgärder. Slutsats: Studiens resultat visar att ambulanssjuksköterskans arbete stämmer väl överens med kompetensbeskrivningen. Smärtlindring vid stora trauman är komplext och de upplevda hindren är många. Ambulanssjuksköterskans egen bedömning, med utgångspunkt från gällande riktlinjer, är kärnan i deras arbete med traumapatienter. Smärtlindring vid stora trauman är ett viktigt ämne och ett relativt outforskat område. Det är därför angeläget med vidare forskning. / Introduction: Research shows that pain at major traumas are poorly treated, which can lead to a prolonged course of the disease and lead to complications for the patient. Pain assessment is an important part of pain treatment and can be done either through observations of the patient’s physical status or via pain assessment tools. A major trauma involves also a psychological stress for the patient, therefore it’s important to relieve both the physical pain as well as the mental suffering. Aim: To describe ambulance nurses’ perception regarding trauma patients’ experiences of pain and to describe ambulance nurses’ experiences of pain treatment and nursing care that ease the suffering for these patients. Method: An interview study with eleven ambulance nurses. The interviews were analyzed by using qualitative content analysis. Result: Ambulance nurses’ work with pain relief at major traumas was characterized by balancing decisions and prioritizations. These were made based on the ambulance nurses’ own judgment combined with the guidelines for the ambulance health care. The nursing care was just as important as the medical treatment in the work to ease the patient’s pain and suffering. The majority of the ambulance nurses experienced that pain at major traumas was poorly treated. The reason for this opinion was due to a restricted use off analgesics, but also due to prioritization of life support care. Conclusion: The study´s findings shows that ambulance nurse’s work are in line with the ambulance nurse’s competence description. Pain treatment at major traumas is complex and the perceived difficulties are many. The ambulance nurses’ own evaluations, with the associated guidelines, constitute the core work with trauma patients. Pain relief at major traumas is an important and relatively unexplored area and it is therefore desirable with further research in this area.

Syftet med denna studie är att studera ambulanssjuksköterskors upplevelser av att bedöma och vårda barn under tio års ålder med akut smärta i en prehospital kontext.   Metod: Studien utfördes som en kvalitativ empirisk intervjustudie baserad på fem öppna frågor. Tio ambulanssjuksköterskor intervjuades och fick beskriva positiva och negativa upplevelser av att omhänderta barn 0-10 år med akut smärta i prehospital kontext. Materialet analyserades genom en kvalitativ innehållsanalys med en manifest och latent ansats.   Resultat: Upplevelser av det vårdande mötet var en utmaning. Ambulanssjuksköterskan förberedde sig inför smärtbehandling under framkörningen till barnet. En bra smärtlindring var förenad med ett gott omhändertagande men smärtbehandlingen var svår och mångfacetterad. Vikten av stöd och samarbete prehospitalt från kollegorna och andra personalgrupper framkom liksom frustration som följd av kommunikationssvårigheter med barnet. Vikten av att skapa en god kontakt med barnet och dess anhöriga betonades och det fanns en upplevelse av otillräcklighet och utrymme för förbättring kring barn och smärta. Ambulanssjuksköterskan upplevde otillräcklighet i sitt yrkesutövande och mer utbildning önskades. Behovet av alternativa behandlingsprinciper lämpliga för barn där ambulanssjuksköterskan inte behöver sticka barnet efterfrågades.   Slutsats: Den prehospitala vården behöver utvecklas ytterligare på flera områden avseende riktlinjer, metoder för att skatta barns smärta och vid omhändertagandet av de yngsta barnen. Mera utbildning kring barn och smärta är önskvärt samt utveckling kring andra administrationssätt än perifer venkateter. / The purpose of this study is to find out the ambulance nurses experience in assessing and nursing children under the age of ten with acute pain in a prehospital context. Method: The study was conducted as a qualitative empirical interview study based on five open-ended questions. Ten ambulance nurses were interviewed and were asked to describe positive and negative experiences in caring for children 0-10 years old with acute pain in a prehospital context. The material was analyzed through a qualitative content analysis with a manifest and latent approach. Results: Experiences of the caring encounter was a challenge. Ambulance nurses prepare themselves for pain treatment while they drove to the child. A good pain relief was associated with good care but pain treatment was difficult and multifaceted. Importance of support and cooperation from prehospital colleagues and other staff groups was found as frustration due to communication difficulties with the child. The importance of creating a good contact with the child and their family was important and there was a feeling of inadequacy, and room for improvement around children and pain. Ambulance nurses experienced inadequacy in their professional practice and more training was desired. As well as alternative modes of administration where the stick torque is not needed. Summary: The prehospital care need to be developed further in several areas regarding policies, methods to estimate the child's pain and the care of the youngest children. More education about children and pain is desirable as well as development on other alternatives than intravenous drug administration.

Bakgrund: Smärta är ett mångfacetterat begrepp och det vanligaste symtomet inom palliativ vård. Begreppet innefattar såväl fysisk, psykisk, social som existentiell smärta. För att uppnå en individanpassad smärtlindring bör sjuksköterskan ta hänsyn till smärtans alla dimensioner genom såväl subtila tecken som direkta uppmaningar på hjälp. Syfte: Att belysa sjuksköterskors erfarenheter av att vårda patienter med smärta inom palliativ vård. Metod: En litteraturöversikt baserad på elva artiklar har använts. De vetenskapliga artiklarna är hämtade i databasen Cinahl with full text och har granskats och analyserats enligt Fribergs modell (2012). Resultat: Resultatet av analysen presenteras i fyra huvudkategorier. Den första kategorin är Rädsla ett hinder i patientens smärtlindring och belyser en rädsla hos såväl patienter som sjuksköterskor och närstående. I Kunskapens betydelse för tillfredsställande smärtlindring beskrivs en osäkerhet hos sjuksköterskorna vid kunskapsbrist. Den tredje kategorin Sjuksköterskors erfarenheter av att ge en individanpassad smärtlindring visar på svårigheter och hinder vid smärtbedömning och smärtlindring. I Samarbetets betydelse för patientens smärtlindring framkommer sjuksköterskans centrala roll som patientens ombud vid smärtlindring Diskussion: Resultatet knyts an till Travelbees omvårdnadsteori om den mellanmänskliga relationen. Sambandet mellan rädsla och okunskap diskuteras, likaså kommunikationens olika uttryck och betydelse samt vikten av en fungerande vårdrelation.

Väntetiden för patienter som ådragit sig höftfraktur till operation är ofta lång och kan uppgå till över ett dygn. I första delen av vårdkedjan är det ambulanssjuksköterskan som möter patienter som ådragit sig höftfraktur och omhändertagandet där smärtbehandling ingår genomförs med stöd av upprättade vårdriktlinjer. Ambulanssjuksköterskan har ett ansvar enligt svensk lag att den prehospitala akutsjukvården som genomförs ska vara evidensbaserad. Syftet med denna studie var att undersöka specialistutbildade ambulanssjuksköterskors uppfattningar om möjligheten att bedriva evidensbaserad vård vid prehospital smärtbehandling av patienter med höftfraktur. Detta är en kvalitativ studie med beskrivande design. Resultatet visade att den specialistutbildade ambulanssjuksköterskan uppfattade generellt att vårdriktlinjerna var tydliga och lätta att förhålla sig till. De uppfattade att smärtbehandling var väl fungerande och evidensbaserad. Vårdriktlinjerna var tydliga och lätta att förhålla sig till och informanterna uppfattade att smärtbehandlingen var väl fungerande och evidensbaserad. / The waiting time for patients that sustain hip fractures is often long and can be more than twenty-four hours. The Ambulance nurse provides the first care for those whom sustain a hip fracture.  These patients receive pain management care from the ambulance nurse as recommended by given guidelines.  The ambulance nurse has a responsibility by Swedish law to administer care in an evidence based care, prehospital in the emergency care. The intention of this study was to investigate the specialist educated ambulance nurses current opinions of the possibility to give evidence based care, during prehospital pain management to patients who have a hip fracture. This is a qualitative study with descriptive design. The outcome of this study shows that the specialist educated ambulance nurses believe that the guidelines are clear and easy to follow in general.  Their opinion was that the pain management was functional and evidence based. The guidelines were clear and easy to relate to and the informants experienced the pain management as evidence based.

Pesquisa piloto de intervenção com dados prospectivos, grupo único de intervenção, cujo desfecho é a medida da dor de mulheres em trabalho de parto. Apresenta como objetivo discutir os efeitos da crioterapia no alívio da dor das parturientes. Como referencial teórico este trabalho apresentou o descrito por Soares e Low, onde se encontra que os mecanismos de ação do gelo para alívio da dor propiciam o decréscimo da transmissão das fibras de dor, a diminuição da excitabilidade nas terminações livres, a redução no metabolismo tecidual aumentando o limiar das fibras de dor e a liberação de endorfinas. Baseou-se ainda nos princípios da desmedicalização e do emprego de tecnologias não-invasivas de cuidado de enfermagem obstétrica conforme descritos por Vargens e Progianti. A pesquisa foi realizada no Centro Obstétrico do Hospital Municipal Maternidade Carmela Dutra, no Rio de Janeiro de abril a agosto de 2011. O gelo foi aplicado, utilizando-se para tal uma bolsa-cinta ajustável à região tóraco-lombar de 36 gestantes. A bolsa/cinta é descartável, de tecido TNT, com abertura na parte superior para introdução de gelo picado envolto em plástico. As aplicações se deram aos cinco centímetros de dilatação do colo uterino; e/ou aos sete centímetros de dilatação do colo uterino; e/ou aos nove centímetros de dilatação uterina, totalizando ao final das três aplicações um tempo de 60 minutos, que corresponde ao somatório de 20 minutos para cada uma. O gelo foi produzido em fôrma exclusiva para o projeto, em freezer da unidade. Os dados referentes à avaliação da dor foram coletados através de entrevista estruturada guiada por formulário previamente elaborado. Os resultados evidenciaram que a crioterapia produziu extinção ou alívio da dor quando aplicada na região tóraco-lombar das parturientes aos cinco, sete ou nove centímetros de dilatação do colo uterino, dando-lhes maiores condições de vivenciar o seu trabalho de parto; produziu um relaxamento geral e local (na região lombar) das parturientes; não interferiu na dinâmica uterina e, não causou dano ao binômio mãe-filho. Concluiu-se que a crioterapia, na forma como descrita no presente estudo, pode ser considerada uma tecnologia não-invasiva de cuidado de enfermagem obstétrica para alivio da dor no trabalho de parto. / This pilot intervention study, with prospective data and a single intervention group, the outcome of which was the pain measured in women in labour, was designed to discuss the pain relief effects of cryotherapy in childbirth. The theoretical framework for this study was as described by Soares & Low, in which the mechanisms of the pain-relief action of ice foster decreased pain fibre transmission, reduced free nerve ending excitability, reduced tissue metabolism, increased pain fibre threshold and release of endorphins. It also drew on the principles of de-medicalisation and non-invasive obstetric nursing techniques as described by Vargens & Progianti. The study was conducted at the Obstetrics Centre of the Carmela Dutra Municipal Maternity Hospital, in Rio de Janeiro, from April to August 2011. Ice was applied using an adjustable belt-bag to the lumbar/thoracic region of 36 expectant mothers. The disposable TNT fabric belt-bag has an opening at the top for introducing plastic-wrapped ground ice. Applications were given at five centimetres cervical dilation; and/or at seven centimetres cervical dilation; and/or at nine centimetres cervical dilation: to a total of three applications over a 60-minute timespan, corresponding to the sum of 20 minutes each. The ice was produced exclusively for the project in the units freezer. Pain assessment data were collected by structured interview guided by a previously prepared script. The results provided evidence that cryotherapy produced extinction or relief of pain when applied to the lumbar-thoracic region of women in labour at five, seven or nine centimetres cervical dilation, affording them better conditions in which to experience their labour; it produced relaxation (both overall and locally, in the lumbar-thoracic region) in the women in labour; and it neither interfered in the dynamics of the uterus nor caused harm to the mother and child. It was concluded that cryotherapy, as described in this study, can be considered a non-invasive obstetric nursing technology for pain relief in labour.

Pesquisa piloto de intervenção com dados prospectivos, grupo único de intervenção, cujo desfecho é a medida da dor de mulheres em trabalho de parto. Apresenta como objetivo discutir os efeitos da crioterapia no alívio da dor das parturientes. Como referencial teórico este trabalho apresentou o descrito por Soares e Low, onde se encontra que os mecanismos de ação do gelo para alívio da dor propiciam o decréscimo da transmissão das fibras de dor, a diminuição da excitabilidade nas terminações livres, a redução no metabolismo tecidual aumentando o limiar das fibras de dor e a liberação de endorfinas. Baseou-se ainda nos princípios da desmedicalização e do emprego de tecnologias não-invasivas de cuidado de enfermagem obstétrica conforme descritos por Vargens e Progianti. A pesquisa foi realizada no Centro Obstétrico do Hospital Municipal Maternidade Carmela Dutra, no Rio de Janeiro de abril a agosto de 2011. O gelo foi aplicado, utilizando-se para tal uma bolsa-cinta ajustável à região tóraco-lombar de 36 gestantes. A bolsa/cinta é descartável, de tecido TNT, com abertura na parte superior para introdução de gelo picado envolto em plástico. As aplicações se deram aos cinco centímetros de dilatação do colo uterino; e/ou aos sete centímetros de dilatação do colo uterino; e/ou aos nove centímetros de dilatação uterina, totalizando ao final das três aplicações um tempo de 60 minutos, que corresponde ao somatório de 20 minutos para cada uma. O gelo foi produzido em fôrma exclusiva para o projeto, em freezer da unidade. Os dados referentes à avaliação da dor foram coletados através de entrevista estruturada guiada por formulário previamente elaborado. Os resultados evidenciaram que a crioterapia produziu extinção ou alívio da dor quando aplicada na região tóraco-lombar das parturientes aos cinco, sete ou nove centímetros de dilatação do colo uterino, dando-lhes maiores condições de vivenciar o seu trabalho de parto; produziu um relaxamento geral e local (na região lombar) das parturientes; não interferiu na dinâmica uterina e, não causou dano ao binômio mãe-filho. Concluiu-se que a crioterapia, na forma como descrita no presente estudo, pode ser considerada uma tecnologia não-invasiva de cuidado de enfermagem obstétrica para alivio da dor no trabalho de parto. / This pilot intervention study, with prospective data and a single intervention group, the outcome of which was the pain measured in women in labour, was designed to discuss the pain relief effects of cryotherapy in childbirth. The theoretical framework for this study was as described by Soares & Low, in which the mechanisms of the pain-relief action of ice foster decreased pain fibre transmission, reduced free nerve ending excitability, reduced tissue metabolism, increased pain fibre threshold and release of endorphins. It also drew on the principles of de-medicalisation and non-invasive obstetric nursing techniques as described by Vargens & Progianti. The study was conducted at the Obstetrics Centre of the Carmela Dutra Municipal Maternity Hospital, in Rio de Janeiro, from April to August 2011. Ice was applied using an adjustable belt-bag to the lumbar/thoracic region of 36 expectant mothers. The disposable TNT fabric belt-bag has an opening at the top for introducing plastic-wrapped ground ice. Applications were given at five centimetres cervical dilation; and/or at seven centimetres cervical dilation; and/or at nine centimetres cervical dilation: to a total of three applications over a 60-minute timespan, corresponding to the sum of 20 minutes each. The ice was produced exclusively for the project in the units freezer. Pain assessment data were collected by structured interview guided by a previously prepared script. The results provided evidence that cryotherapy produced extinction or relief of pain when applied to the lumbar-thoracic region of women in labour at five, seven or nine centimetres cervical dilation, affording them better conditions in which to experience their labour; it produced relaxation (both overall and locally, in the lumbar-thoracic region) in the women in labour; and it neither interfered in the dynamics of the uterus nor caused harm to the mother and child. It was concluded that cryotherapy, as described in this study, can be considered a non-invasive obstetric nursing technology for pain relief in labour.

Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-26Bitstream added on 2014-06-13T20:25:56Z : No. of bitstreams: 1 beier_sl_dr_botfm.pdf: 734284 bytes, checksum: e0f92127c23e69cafc4ceab245c23376 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Os modernos sistemas de infusao alvo-controlada (TCI), usados para a inducao e manutencao da anestesia, permitem que a velocidade de infusao seja ajustada atraves da utilizacao de avancados softwares alimentados com parametros farmacocineticos, de modo a assegurar uma adequada profundidade da anestesia e uma rapida e eficiente recuperacao. O objetivo inicial deste estudo foi determinar a concentracao plasmatica calculada de propofol (Cpcalculada) determinada por meio de estimulacao eletrica (50V, 50 Hz e 10 ms). Na segunda fase, o objetivo foi investigar a performance do uso de um sistema de infusao alvo-controlada de propofol usado isoladamente ou associado ao remifentanil. Paralelamente foram avaliados as respostas hemodinamicas e o periodo de recuperacao. A Performance e determinada pela Mediana da Performance do erro (MDPE), e a Mediana Absoluta da Performance do erro (MDAPE), sendo considerada clinicamente aceitavel uma MDPE de ate 20% e a MDAPE de ate 40%. Seis caes adultos saudaveis (26,6} 3,6kg) foram alocados aleatoriamente em 2 grupos com um intervalo de uma semana entre os experimentos. GI = TCI de propofol e G II = TCI de propofol + remifentanil. Os resultados foram analisados estatisticamente atraves da analise de variancia seguida pelo teste gt-Studenth. Foi considerado como significante um p<0,05. Houve uma reducao na frequencia cardiaca e indice cardiaco em GII, enquanto a pressao venosa central e a pressao de oclusao da arteria pulmonar aumentaram significativamente em GII comparado a GI. Os resultados obtidos para o grupo propofol foram de MDPE = 16,3% e MDAPE = 32,1% e para o grupo propofol+remifentanil foram de MDPE = 6,8% e MDAPE = 36,5%. A Cp50calculada foi de 2,0Êg.ml-1 (GI) e de 0,9Êg.ml-1 (GII)... / The target-controlled infusion systems (TCI), designed to keep the drug concentration in the bloodstream constant, are controlled by state-of-art software based upon pharmacokinetic models. These models have been designed for each species to produce an adequate anesthetic depth and fast and efficient recover. The aim of this study was to establish the predicted plasmatic concentration (Cppredicted) based upon electric stimulus (50V, 50 Hz and 10 ms). In a second phase, the aim was to investigate the anesthetic performance of the TCI of propofol used alone and associated with remifentanil. Moreover, haemodynamic parameters and anesthesia recovery time were evaluated. The performance was established based on the Median Performance error (MDPE < 20%) and Absolute Median Performance error (MDAPE < 40%). Six clinically normal dogs (26.6 l 3.6 kg) were randomly divided in 2 groups with at least one week between experiments. G1 = TCI of propofol alone; G2 = TCI of propofol + remifentanil. The statistical analysis was based on Student's t-distribution test, with alpha set at 0.05. Heart rate (HR) and cardiac index (CI) were significantly decreased after propofol + remifentanil (G2) infusion administration until the end, while central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were significantly increased. The G1 group demonstrated MDPE of 16.3% and MDAPE of 32.1%, whereas the G2 group had MDPE of 6.8% and MDAPE of 36.5%. The average Cp50predict for G1 was 2,0ìg.ml-1 and for G2 was 0,9ìg.ml-1. The evaluation of these parameters and the control of the anesthetic depth suggested that the TCI stanpump could be considered clinically acceptable in dogs. The remifentanil enhances the propofol's CPpredict in an average of 56.7%; however, haemodynamic side effects were detected.

Resumo: Os modernos sistemas de infusao alvo-controlada (TCI), usados para a inducao e manutencao da anestesia, permitem que a velocidade de infusao seja ajustada atraves da utilizacao de avancados softwares alimentados com parametros farmacocineticos, de modo a assegurar uma adequada profundidade da anestesia e uma rapida e eficiente recuperacao. O objetivo inicial deste estudo foi determinar a concentracao plasmatica calculada de propofol (Cpcalculada) determinada por meio de estimulacao eletrica (50V, 50 Hz e 10 ms). Na segunda fase, o objetivo foi investigar a performance do uso de um sistema de infusao alvo-controlada de propofol usado isoladamente ou associado ao remifentanil. Paralelamente foram avaliados as respostas hemodinamicas e o periodo de recuperacao. A Performance e determinada pela Mediana da Performance do erro (MDPE), e a Mediana Absoluta da Performance do erro (MDAPE), sendo considerada clinicamente aceitavel uma MDPE de ate 20% e a MDAPE de ate 40%. Seis caes adultos saudaveis (26,6} 3,6kg) foram alocados aleatoriamente em 2 grupos com um intervalo de uma semana entre os experimentos. GI = TCI de propofol e G II = TCI de propofol + remifentanil. Os resultados foram analisados estatisticamente atraves da analise de variancia seguida pelo teste gt-Studenth. Foi considerado como significante um p<0,05. Houve uma reducao na frequencia cardiaca e indice cardiaco em GII, enquanto a pressao venosa central e a pressao de oclusao da arteria pulmonar aumentaram significativamente em GII comparado a GI. Os resultados obtidos para o grupo propofol foram de MDPE = 16,3% e MDAPE = 32,1% e para o grupo propofol+remifentanil foram de MDPE = 6,8% e MDAPE = 36,5%. A Cp50calculada foi de 2,0Êg.ml-1 (GI) e de 0,9Êg.ml-1 (GII)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The target-controlled infusion systems (TCI), designed to keep the drug concentration in the bloodstream constant, are controlled by state-of-art software based upon pharmacokinetic models. These models have been designed for each species to produce an adequate anesthetic depth and fast and efficient recover. The aim of this study was to establish the predicted plasmatic concentration (Cppredicted) based upon electric stimulus (50V, 50 Hz and 10 ms). In a second phase, the aim was to investigate the anesthetic performance of the TCI of propofol used alone and associated with remifentanil. Moreover, haemodynamic parameters and anesthesia recovery time were evaluated. The performance was established based on the Median Performance error (MDPE < 20%) and Absolute Median Performance error (MDAPE < 40%). Six clinically normal dogs (26.6 l 3.6 kg) were randomly divided in 2 groups with at least one week between experiments. G1 = TCI of propofol alone; G2 = TCI of propofol + remifentanil. The statistical analysis was based on Student's t-distribution test, with alpha set at 0.05. Heart rate (HR) and cardiac index (CI) were significantly decreased after propofol + remifentanil (G2) infusion administration until the end, while central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were significantly increased. The G1 group demonstrated MDPE of 16.3% and MDAPE of 32.1%, whereas the G2 group had MDPE of 6.8% and MDAPE of 36.5%. The average Cp50predict for G1 was 2,0ìg.ml-1 and for G2 was 0,9ìg.ml-1. The evaluation of these parameters and the control of the anesthetic depth suggested that the TCI stanpump could be considered clinically acceptable in dogs. The remifentanil enhances the propofol's CPpredict in an average of 56.7%; however, haemodynamic side effects were detected. / Orientador: Flavio Massone / Coorientador: Pedro Thadeu Galvão Vianna / Banca: Antonio José de Araújo Aguiar / Banca: Francisco José Teixeira Neto / Banca: Aury Nunes de Moraes / Banca: Silvia Renata Gaido Cortopassi / Doutor

Bakgrund: Postoperativ smärta uppkommer efter operation. En obehandlad akut smärta kan utvecklas till långvarig smärta och detta är den vanligaste orsaken till att patienter söker läkarvård. Sjuksköterskans ansvar är att lindra, bedöma och skatta smärta hos patienter. Ett ömsesidigt förtroende kan underlätta arbetet, emellertid blir enbart hälften av patienterna på en avdelning delaktiga i sin smärtbehandling. Patientens egna uppfattningar, tidigare erfarenheter och beskrivning av smärta bör tas på allvar. Studiens teoretiska referensram är Joyce Travelbees teori där huvudkomponenten innefattar förståelse för vad som händer i interaktionen mellan patienten och sjuksköterskan. Vårdlidande kan uppstå om patienten förlorar kontroll, vilket är vanligt förekommande inom vården. Smärta är ett exempel på en situation när patienten tappar kontroll över situationen. Syfte: Syftet var att beskriva patienters upplevelse av postoperativ smärta.  Metod: Litteraturstudie av kvalitativa artiklar genomförd i databaserna Pubmed, CINAHL, PsycINFO. Totalt inkluderades 10 stycken vetenskapliga artiklar.  Resultat: Generellt upplevde patienter postoperativ smärta fysiskt. Kroppsliga förnimmelser var kopplade till smärtans karaktär, intensitet och varaktighet. Patienterna upplevde att smärtan begränsade vardagliga livet genom svårigheter att utföra aktivitet och sämre sömn. Patientens psykiska upplevelse präglades av rädsla och oro. Patienter upplevde att vårdpersonalens bemötande hade en inverkan på förtroendet. Tidigare erfarenhet och kunskap av smärta påverkade hur patienter hanterade smärta. Den farmakologiska och icke- farmakologiska smärtlindringen upplevdes positivt och negativt. Slutsats:Patienter upplever smärtans karaktär, varaktighet, intensitet och lokalisation individuellt. Förtroendet för vårdpersonal, deras bemötande och attityd har en betydelsefull inverkan på patienternas postoperativa smärtupplevelse. Tidigare erfarenheter av smärtlindring och relationen till vårdpersonal påverkar patienters inställning gentemot analgetika.  Nyckelord: lidande, postoperativ smärta, smärtbedömning, smärtlindring, upplevelse. / Background: Postoperative pain emerge after surgery. Untreated acute pain can develop into chronic pain. It’s the most common cause for patients to seek medical treatment. It’s the nurse's responsibility to ease and evaluate pain among patients. Mutual trust can help make these responsibilities easier, though only half of the patient in a caring unit gets to be involved in their pain-treatment. Patients opinions, earlier experiences and descriptions of pain must be taken seriously. The theoretical reference frame of this study is Joyce Travelbee’s theory, where the main component includes the understanding of the interaction between patients and nurses. Suffering in healthcare can develop if the patient loses control, which is common in health care. Pain is an example of a situation when a patient loses control over of the situation. Aim: To describe patients experiences of postoperative pain. Method: A literature study of 10 qualitative articles, found in Pubmed, CINAHL and PsycINFO. Results: Patients generally experienced their postoperative pain physically. The experience related to the pains character, intensity and durability. The pain was often perceived to restrict everyday-life by bringing difficulties performing exercises and resulted in deficient sleep. The physical experience where tinged by fear and anxiety. The healthcare professional’s treatment towards patients had an impact on the relationships trust-status. Earlier experiences and knowledge about pain affected how patients handled their pain. Pharmacological and nonpharmacological pain treatment were experienced as both positive and negative.  Conclusion: Patients experiences the character of the pain, as well as the intensity and durability, individually varying. Trust towards healthcare staff, their treatment and attitude, had an impact on the postoperative pain experience. Earlier experiences of pharmacological treatments and the relationship with staff impacted patients attitude towards analgesics.  Keywords: Experience, painassessment, pain relief, postoperative pain, suffering.