44 resultados para Cateterisme intravascular


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BackgroundThe success of epidural anaesthesia depends on correct identification of the epidural space. For several decades, the decision of whether to use air or physiological saline during the loss of resistance technique for identification of the epidural space has been governed by the personal experience of the anaesthesiologist. Epidural block remains one of the main regional anaesthesia techniques. It is used for surgical anaesthesia, obstetrical analgesia, postoperative analgesia and treatment of chronic pain and as a complement to general anaesthesia. The sensation felt by the anaesthesiologist from the syringe plunger with loss of resistance is different when air is compared with saline (fluid). Frequently fluid allows a rapid change from resistance to non-resistance and increased movement of the plunger. However, the ideal technique for identification of the epidural space remains unclear.ObjectivesTo evaluate the efficacy and safety of both air and saline in the loss of resistance technique for identification of the epidural space.To evaluate complications related to the air or saline injected.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE, EMBASE and the Latin American and Caribbean Health Science Information Database (LILACS) (from inception to September 2013). We applied no language restrictions. The date of the most recent search was 7 September 2013.Selection criteriaWe included randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) on air and saline in the loss of resistance technique for identification of the epidural space.Data collection and analysisTwo review authors independently assessed trial quality and extracted data.Main resultsWe included in the review seven studies with a total of 852 participants. The methodological quality of the included studies was generally ranked as showing low risk of bias inmost domains, with the exception of one study, which did not mask participants. We were able to include data from 838 participants in the meta-analysis. We found no statistically significant differences between participants receiving air and those given saline in any of the outcomes evaluated: inability to locate the epidural space (three trials, 619 participants) (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.33 to 2.31, low-quality evidence); accidental intravascular catheter placement (two trials, 223 participants) (RR 0.90, 95% CI 0.33 to 2.45, low-quality evidence); accidental subarachnoid catheter placement (four trials, 682 participants) (RR 2.95, 95% CI 0.12 to 71.90, low-quality evidence); combined spinal epidural failure (two trials, 400 participants) (RR 0.98, 95% CI 0.44 to 2.18, low-quality evidence); unblocked segments (five studies, 423 participants) (RR 1.66, 95% CI 0.72 to 3.85); and pain measured by VAS (two studies, 395 participants) (mean difference (MD) -0.09, 95% CI -0.37 to 0.18). With regard to adverse effects, we found no statistically significant differences between participants receiving air and those given saline in the occurrence of paraesthesias (three trials, 572 participants) (RR 0.89, 95% CI 0.69 to 1.15); difficulty in advancing the catheter (two trials, 227 participants) (RR 0.91, 95% CI 0.32 to 2.56); catheter replacement (two trials, 501 participants) (RR 0.69, 95% CI 0.26 to 1.83); and postdural puncture headache (one trial, 110 participants) (RR 0.83, 95% CI 0.12 to 5.71).Authors' conclusionsLow-quality evidence shows that results do not differ between air and saline in terms of the loss of resistance technique for identification of the epidural space and reduction of complications. Applicability might be compromised, as most of the results described in this review were obtained from parturient patients. This review underlines the need to conduct well-designed trials in this field.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Hyphema is an intraocular hemorrhage that can result from many ocular and/or systemic disorders. It is an important clinical sign, since it may appear in the initial stages of some diseases or haematological disorders, acting as an initial marker for early diagnosis. The hematologic disturbances that predispose animals to present hyphema are: Thrombocytopenia, von Willebrand Disease, Scott Syndrome, Disseminated Intravascular Coagulation and Hyperviscosity Syndrome due to Multiple Myeloma. Each of the differential diagnoses due to hematological changes from the appearance of hyphema in dogs shows clinical relevance and particular ocular signs

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Equine neonatal isoerythrolysis is a neonatal foals’ illness. Results from the incompatibility of blood type between the foal and the mare and mediated by maternal antibody absorbed by the colostrum against foal’s red blood cells. Characterized by a type ll hypersensitivity reaction, where the exhibition of the organism to a strange antigen, that it takes the sensitization of the lymphocytes B that after the removal of the antigens by the reticule-endothelial system the production of immunoglobulin is decreased, with the formation of cellular immunological will cause the occurrence of the illness in foal of sensitized mares. The most important clinical signs are severe anemia and jaundice, and this illness should be differentiated of other as: hemolysis induced by bacterial toxins, diseases of the hepatobiliary system, disseminated intravascular coagulation and incompatibility in blood transfusions. Like the sensitization happens during the previous incompatible foal’s birth, most cases occur in foals of multiparous mares. However during the first pregnancy the mare can generate a foal with neonatal 7 isoerythrolysis if she have developed placental anomaly in the beginning of the pregnancy which blood cells in her circulation

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Diabetic ketoacidosis (DKA) is one of the most serious complications of Diabetes Mellitus (DM) in small animals (SILVA, 2006). It is an acute metabolic disorder, potentially fatal, both in humans and in dogs and cats with DM (BRUYETTE, 1997), being related, mostly, to insulin-dependent diabetics (CHASTAIN, 1981; HUME et al., 2006). DKA is a medical emergency characterized by extreme metabolic abnormalities, including hyperglycemia, metabolic acidosis, ketonemia, dehydration and electrolyte loss (MACINTIRE, 2006) and its diagnosis may be established basically by the detection of ketonuria and metabolic acidosis (NELSON, 2009). The primary purposes of the treatment of DKA are intravascular volume restoration, dehydration, acid-base and electrolyte’s imbalances correction and blood glucose concentration reduction (BOYSEN, 2008). The treatment’s success depends of the clinical status at the time of diagnosis and of the introduction of an appropriate therapy to the conditions of each patient (CHASTAIN, 1981)

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Pancreatitis is a predominantly disease of the exocrine pancreas, which occurs commonly in dogs. Acute pandreatitis is reversible, with the removal of the primary cause, whereas chronic pancreatitits is irreversible, with histopathological changes, such as atrophy and fibosis that occurs from persistent inflammation. In dogs, clinicl signs ranging among abdominal pain and anorexia until potential insufficiency of various organs and Disseminated Intravascular Coagulation. In general, dogs with acute illness presents vomiting, anorexia, abdominal pain and several degrees of dehydration, collapse and shock. The caim of this monograph is evaluate ultrassound changes in dogs with panceatitis. Ultrassound is a valuable technique to evaluate exocrine pancreas, with association with another diagnostic modalities will be able to increase the preciosion of the diagnosis

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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O cobre (Cu) é um microelemento essencial aos mamíferos, entretanto, quando ingerido em altas quantidades, num período curto ou prolongado, pode provocar uma intoxicação severa. A habilidade de acumular Cu nos tecidos varia de acordo com as espécies e com as raças dentro da própria espécie, dentre as espécies acometidas, destacam-se a ovina, e em menor escala, canina, suína e bovina. A intoxicação aguda em ovinos é pouco frequente e pode ser decorrente da ingestão oral ou da administração parenteral de cobre. A intoxicação crônica é a principal forma de ocorrência desta enfermidade nesta espécie. A maioria dos ovinos acometidos é proveniente de manejo intensivo, os quais recebem dietas ricas em concentrados energéticos, e a ocorrência mais comum se dá quando estes animais ingerem misturas minerais destinadas a bovinos. A forma crônica caracteriza-se por três fases distintas: pré-hemolítica, hemolítica e pós-hemolítica. O resultado, tanto da forma crônica, como da aguda será a hemólise intravascular. O diagnóstico é realizado por meio do histórico, exame clínico e laboratorial e achados de necropsia. Entre os sinais clínicos destacam-se a icterícia e a hemoglobinúria. A terapia pode ser eficiente se for iniciada precocemente no decorrer do 1º ao 2º dia após o início da hemoglobinúria, sendo utilizado antídoto específico à base de tetratiomolibdato (TTM). O controle em rebanhos ovinos deve ser feito com rígidas medidas dietéticas, evitando-se oferecer rações concentradas em concomitância com sais minerais que contenham altos teores de cobre.

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Pós-graduação em Enfermagem (mestrado profissional) - FMB

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