Injeção inadvertida de metoclopramida no espaço subaracnóideo: relato de caso

JUSTIFICATIVA E OBJETIVOS: Injeção inadvertida de medicamentos de uso não espinhal nos espaços peridural e subaracnóideo é uma complicação anestésica passível de ocorrer. Este relato apresenta um caso de injeção inadvertida de metoclopramida no espaço subaracnóideo. RELATO do CASO: Paciente do sexo feminino, 17 anos, 69 kg, IMC de 26.2, estado físico ASA I, 36 semanas e 4 dias de gestação, com diagnóstico de sofrimento fetal agudo, e indicação de cesariana. Apresentava freqüência cardíaca de 82 bpm, pressão arterial de 130 x 70 mmHg, SpO2 de 97%, ritmo cardíaco sinusal regular. A anestesia foi por via subaracnóidea com a associação de anestésico local e opióide, 15 mg de bupivacaína hiperbárica a 0,5% e 25 µg de fentanil. Após 5 minutos da instalação do bloqueio, a paciente referiu mal estar inespecífico. Aferidas pressão arterial, 190 x 120 mmHg, freqüência cardíaca, 145 bpm, e SpO2, 95%. Verificando-se as ampolas cujos conteúdos foram administrados encontrou-se uma de bupivacaína e uma de metoclopramida. O quadro se apresentou com cefaléia frontal intensa, visão turva, náuseas, vômitos e agitação inicial, que evoluiu para sonolência e torpor, além de hipertensão arterial e taquicardia. Foram administrados tramadol, dipirona, ondansetron e medidas de suporte. Após 30 minutos, a paciente apresentava-se assintomática, com PA de 150 x 100 mmHg e FC de 120 bpm. Recebeu alta para a enfermaria 140 minutos após permanência na SRPA, com total reversão dos bloqueios motor, sensitivo e autonômico, e normalização dos parâmetros hemodinâmicos. Recebeu alta hospitalar 48 horas após, sem apresentar seqüelas neurológicas, juntamente com o recém-nascido. CONCLUSÕES: Máxima atenção deve ser dada a qualquer medicamento administrado, seja qual for à via utilizada. Padronização de cores de ampolas, e dos locais de depósito, com o intuito de diminuir este tipo de acidente é recomendável.

Desenvolvimento de um método reflectométrico ambientalmente mais amigável para a determinação de metoclopramida em formulações farmacêuticas

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

ACAO ANTIARRITMICA DA METOCLOPRAMIDA (PLASIL®) EM INTOXICACAO DIGITALICA EXPERIMENTAL. COMPARACAO COM A DIFENIL-HIDANTOINA

The antiarrhythmic action of metoclopramide in cardiac arrhythmias caused by toxic doses of desacetyl-lanatoside C and digitoxin was studied in dogs. A comparison was made between the efficacy of metoclopramide and diphenylhydantoin in arrhythmias caused by digitoxin. The results indicate that metoclopramide antagonized the arrhythmias induced by desacetyl-lanatoside C, while causing a transitory reversion of those induced by digitoxin in most of the experiments. Diphenylhydantoin failed to show an arrhythmic effect in the majority of the tested animals.

Nausea e vomito em laparoscopia ginecologica: Efeitos do oxido nitroso e da metoclopramida

Background and Objectives - Gynecological laparoscopy causes high postoperative morbidity, mainly due to occurrences such as nausea and vomiting. They result from a great multiplicity of etiologies and drugs used in anesthesia may function as contributing factors. Both the emetic properties of nitrous oxide and the efficacy of metoclopramide as antiemetic agent are controversial. This study was undertaken to determine the effects of both drugs, when used alone or in combination. Methods - Eighty three physical status ASA I and II women were studied. They were premedicated with midazolam before induction of anesthesia with alfentanil and propofol. Anesthesia was maintained with isoflurane with or without nitrous oxide in oxygen. Muscle relaxation was achieved with atracurium. There were 4 groups of patients: GI: midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GII: midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen; GIII: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GIV: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen. The incidence of nausea and vomiting was assessed both in the recovery room (RR) and in the ward. Results - There were no significant differences as regards age, weight and height of the patients and duration of anesthesia and surgery. Nausea and vomiting were more frequent in patients who received N2O (GII, 50%; GIV, 33%), as compared to those who didn't receive this agent (GI and GII, 9.5% and 14.35%, respectively). Metoclopramide decreased the incidence of nausea and vomiting in the recovery room, in patients who didn't receive N2O (GII). These patients remained in the recovery room for 90 minutes. Conclusions - N2O increases the incidence of nausea and vomiting and metoclopramide is effective in reducing these complications only in the recovery room.

Hemograma e teores séricos de Na, K, Mg, Ca e P de cães hígidos submetidos à administração de cisplatina

Pós-graduação em Cirurgia Veterinária - FCAV

Efeito da alizaprida intravenosa sobre o prurido provocado pela morfina administrada por via subaracnóidea

Pós-graduação em Anestesiologia - FMB

Reprodução induzida e desenvolvimento inicial do Jundiá Leiarius marmoratus (PISCES: SILURIDAE)

Pós-graduação em Ciências Biológicas (Zoologia) - IBB

Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus

The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I - control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively. Ondansetron does not inhibit subarachnoid morphine-induced pruritus.

Desempenho reprodutivo e diferenciação gonadal em piau-três-pintas, Leporinus friderici, Bloch 1794

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)