245 resultados para DIAZEPAM WITHDRAWAL


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This study's aim was to verify coping strategies among children aged between 7 and 12 years old who will be experiencing surgery and the potential relationship of coping strategies with sociodemographic variables, stress in children and in companions, and the child's prior experience with surgery. A total of 58 children hospitalized and waiting for elective surgeries responded to the Assessment Instrument of Coping to Hospitalization and an instrument to assess stress. The companion received a sociodemographic questionnaire and the Lipp Stress Symptom Inventory. Problem-solving strategies and distraction were the most frequent strategies used, while social withdrawal and opposition were the least frequent. Girls and children of stressful parents used emotion regulation strategies with significantly more frequency. Likewise, greater cognitive restructuring was observed in older children and those with prior experience with surgeries. The results show the need to consider the studied variables when developing pre-operative preparation programs.

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The aims of this study were to evaluate the isoflurane sparing and clinical effects of a constant rate infusion of morphine - lidocaine - ketamine (MLK) in healthy sheep undergoing experimental gastrointestinal surgery. Twelve adult female sheep (Texel breed) were used, weighing 36.5 +/- 8.1 kg. The sheep were anesthetized for the implantation of duodenal cannulas. The sheep were premedicated with 0.3 mg kg(-1) intramuscular (IM) morphine and 20 mu g kg(-1) intravenous (IV) detomidine. After premedication, anesthesia was induced using 5 mg kg(-1) ketamine and 0.5 mg kg(-1) diazepam IV and maintained using isoflurane in 100% oxygen. After the induction of anesthesia, the animals were allocated into two groups (each n=6); the GMLK (MLK group - 10 mg morphine, 150 mg lidocaine, 30 mg de ketamine were added in 500 mL saline) received a 10 mL kg(-1)h(-1) MLK infusion during the maintenance of anesthesia, and GCON (control group) received 10 mL kg(-1)h(-1) of 0.9% sodium chloride. The animals were mechanically ventilated. Cardiopulmonary variables and end-tidal isoflurane concentration (FE'Iso) were measured at baseline (immediately before the surgery) and 15, 30 and 45 minutes after initiation of surgery. In GMLK, there was a decrease in the FE 'Iso at 15, 30 and 45 minutes, a reduction of up to 75.6% during the surgery. The HR was lower in GMLK compared with GCON at 30 minutes, and the MAP was at during baseline in GCON compared with GMLK. The standing time was less in GMLK than in GCON. The use of intravenous MLK was demonstrated to offer great efficiency as part of a balanced anesthesia protocol in sheep, with a 75.6% reduction in the need for isoflurane, providing stability of the cardiovascular parameters and blood gases with a shortened recovery period.

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This article has been withdrawn at the request of the author(s) and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Quality is a variable concept, which involves many factors, depending on the consumer market. In meat production, the concern with environmental aspects, animal welfare and the health and safety of workers is increasing. This work studied the effect of controlled atmosphere stunning of broilers on meat features and biochemical parameters for stress. Cobb broilers were stunned by electrical stunning and by controlled atmosphere with 70% CO2 and 70% CO2 + 30% Argon. After stunning, serum levels of glucose, lactate and corticosterone were compared with those of broilers at rest, immediately before transportation and slaughter and after 12 h of feed withdrawal (control group). At slaughter, blood volume drained during bleeding was not different for the stunning methods tested, ranging from 3.3 to 3.4% birds weight. This finding was important to demonstrate that gas stunning was not responsible for the animals′ death. Final pH in breast (6.1 to 6.2) and thigh (6.3 to 6.5) also did not vary among the different stunning methods (P > 0.05). Lightness (L = 60.55) and redness (a = +8.94) values found for breasts from electrical stunning showed that they were darker and redder (P < 0.05), probably due to changes in blood pressure. Glucose and corticosterone levels were not different between gas stunned birds (302.45 to 315.7 mg/dl and 55.71 to 72.49 ng/ml respectively) and birds at rest (305.95 mg/dl and 50.65 ng/ml) (P > 0.05). These stress indicators were higher (337.65 mg/dl for glucose and 104.13 ng/ml for costicosterone) when electrical stunning was used (P < 0.05). Lactate concentrations were lower (5.4 mmol/l) for birds at rest (P < 0.05) but not different for all stunning methods tested (7.3 to 8.1 mmol/l; P > 0.05). These results show that serum glucose may be used as a stress indicator in birds, with the advantage of being a quick and cheap biochemical test. Gas stunning favored birds′ management during slaughter and so reduced workers′ effort and injury hazard and the amount of feces and dust in the room. To make this method available for a large scale process, adjustments in equipments will be necessary to avoid delays in the processing line.

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Stress is an environmental factor that may predispose individuals to depression. Benzodiazepines have been prescribed as effective drugs in these situations. The purpose of this study was histological evaluate of the effect of chronic stress and benzodiazepine drugs on bone healing. Bone cavities were created in both tibias of 40 male rats were divided into two groups: Control and Treaty. In this, the stressor stimulus was applied 40 days pre-operative and all post-operative days until sacrifice in the morning for 2 hours, by immobilizing restraint. These animals also received diazepam benzodiazepine group, daily, at a concentration of 5mg/Kg/peso body within 15 days of preoperative. In groups of five animals were sacrificed at 7, 14, 30 and 60 days post-surgery. At 7 days postoperatively, while the control group exhibited tissue rich in fibroblasts, the treated group showed newly formed tissue with few fibroblasts and capillaries along with lymphocytes and macrophages. At 14 days postsurgery, the control group showed newly formed trabecular bone while the treated group progressed to thin trabecular bone with numerous osteoblasts on their borders. At 30 days post-operative bone healing is complete in both groups. At 60 days post-operative characteristics observed in the treated and control groups are similar to the previous period, but with more advanced osteogenesis.

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The status epilepticus (SE) is characterized by a series of crises which occur without recovery of consciousness or a single seizure lasting more than 30 minutes and can damage the central nervous system and systemic. The duration and frequency of attacks are directly related to patient prognosis. Whether seizures occur often and are longer, increase the risk of neurological and systemic complications. Child population has a higher frequency of seizures and it is associated with a lower threshold of immature brain to trigger these episodes. Aim: To determine the safest drugs prescribed for children in SE, their doses and schedules. A bibliographic survey was performed in electronic databases. Methods: The scientific health descriptors used for search was: “status epilecticus” and “anticonvulsivants” and “child”. Results: This strategy identified 396 manuscripts, of whom four were considered eligible for the study, after the assessment by floating reading and criteria. Of these, two were randomized trials and two descriptive. The studies address the use of oral midazolam, rectal diazepam and intravenous lorazepam. Conclusions: All investigated drugs were effective in treat in status epilepticus. Lorazepam is highlight, since it has fewer secondary effects and, as an alternative to the intravenous, oral midazolam. However, there is a need for further studies to demonstrate the efficacy and safety in the use of drugs in children.

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Aim: To report a possible case of tremor fluoxetine-induced treated as Parkinson’s disease in an elderly female patient noncompliant with the pharmacotherapy, with uncontrolled hypertension and using fluoxetine to treat depression. Presentation of Case: Patient complained of sleepiness in the morning, agitation, anxiety, insomnia and mental confusion. Her greatest concern was about bilateral hand tremors which, in her view became, worse after biperiden was prescribed. Therefore, she stopped taking it. The initial medication was: omeprazole, losartan, biperiden, fluoxetine, atenolol + chlorthalidone, acetylsalicylic acid, atorvastatin and diazepam. Pharmacotherapeutic follow up was performed in order to check the necessity, safety and effectiveness of treatment. Discussion: During the analysis of pharmacotherapy, the patient showed uncontrolled blood pressure and had difficulty complying with the treatment. Thus, in view of the complaints expressed by the patient, our first hypothesis was a possible serotonin syndrome related to fluoxetine use. We proposed a change in the fluoxetine regime and discontinuation of biperiden. As tremors persisted, we suggested the replacement of fluoxetine by sertraline, since a possible tremor fluoxetine-induced could explain the complaint. This approach solved the drug-related problem identified. Conclusion: Tremors reported by the patient was identified as an iatrogenic event related to fluoxetine, which was solved by management of serotonin-reuptake inhibitors.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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