A multicentre, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis

Background The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and have examined only short-term outcomes, such as clinical scores. Methods We conducted a randomized, double-blind, controlled trial comparing nebulized single-isomer epinephrine with placebo in 194 infants admitted to four hospitals in Queens-land, Australia, with a clinical diagnosis of bronchiolitis. Three 4-ml doses of 1 percent nebulized epinephrine or three 4-ml doses of normal saline were administered at four-hour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after, and 60 minutes after each dose. The primary outcome measures were the length of the hospital stay and the time until the infant was ready for discharge. The secondary outcome measures were the degree of change in the respiratory rate, the heart rate, and the respiratory-effort score and the time that supplemental oxygen was required. Results There were no significant overall differences between the groups in the length of the hospital stay (P=0.16) or the time until the infant was ready for discharge (P=0.86). Among infants who required supplemental oxygen and intravenous fluids, the time until the infant was ready for discharge was significantly longer in the epinephrine group than in the placebo group (P=0.02). The need for supplemental oxygen at admission had the greatest influence on the score for severity of illness and strongly predicted the length of the hospital stay and the time until the infant was ready for discharge (P

Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients

Objective: To investigate the effect of standing with assistance of the tilt table on ventilatory parameters and arterial blood gases in intensive care patients. Design: Consecutive sample. Setting: Tertiary referral hospital. Participants: Fifteen adult patients who had been intubated and mechanically ventilated for more than 5 days (3 subjects successfully weaned, 12 subjects being weaned). Intervention: Passive tilting to 70degrees from the horizontal for 5 minutes using a tilt table. Main Outcome Measures: Minute ventilation (VE), tidal volume (VT), respiratory rate, and arterial partial pressure of oxygen (Pao(2)) and carbon dioxide (Paco(2)). Results: Standing in the tilted position for 5 minutes produced significant increases in VE (P

Pressure support ventilation with the ProSeal (R) laryngeal mask airway. A comparison of sevoflurane, isoflurane and propofol

Background and objective: There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal (R) laryngeal mask airway during pressure support ventilation. Methods: Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 29%, isoflurane end-tidal 1.1% or propofol 6 mg kg(-1) h(-1) in oxygen 33% and air. Pressure support ventilation comprised positive end-expiratory pressure set at 5 cmH(2)O, and pressure support set 5 cmH(2)O above positive end-expiratory pressure. Pressure support was initiated when inspiration produced a 2 cmH(2)O reduction in airway pressure. A blinded observer recorded cardiorespiratory variables (heart rate, mean blood pressure, oxygen saturation, air-way occlusion pressure, respiratory rate, expired tidal volume, expired minute volume and end-tidal CO2), adverse events and emergence times. Results: Respiratory rate and minute volume were 10-21% lower, and end-tidal CO2 6-11% higher with the propofol group compared with the sevoflurane or isoflurane groups, but otherwise cardiorespiratory variables were similar among groups. No adverse events occurred in any group. Emergence times were longer with the propofol group compared with the sevoflurane or isoflurane groups (10 vs. 7 vs. 7 min). Conclusion: Lung ventilation is less effective and emergence times are longer with propofol than sevoflurane or isoflurane for maintenance of anaesthesia during pressure support ventilation with the ProSeal (R) laryngeal mask airway. However, these differences are small and of doubtful clinical importance.

Ventilatory changes following head-up tilt and standing in healthy subjects

Passive tilting increases ventilation in healthy subjects; however, controversy surrounds the proposed mechanism. This study is aimed to evaluate the possible mechanism for changes to ventilation following passive head-up tilt (HUT) and active standing by comparison of a range of ventilatory, metabolic and mechanical parameters. Ventilatory parameters (V (T), V (E), V (E)/VO2, V (E)/VCO2, f and PetCO(2)), functional residual capacity (FRC), respiratory mechanics with impulse oscillometry; oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in 20 healthy male subjects whilst supine, following HUT to 70 degrees and unsupported standing. Data were analysed using a linear mixed model. HUT to 70 degrees from supine increased minute ventilation (V (E)) (P < 0.001), tidal volume (V (T)) (P=0.001), ventilatory equivalent for O-2 (V (E)/VO2) (P=0.020) and the ventilatory equivalent for CO2 (V (E)/VCO2) (P < 0.001) with no change in f (P=0.488). HUT also increased FRC (P < 0.001) and respiratory system reactance (X5Hz) (P < 0.001) with reduced respiratory system resistance (R5Hz) (P=0.004) and end-tidal carbon dioxide (PetCO(2)) (P < 0.001) compared to supine. Standing increased V (E) (P < 0.001), V (T) (P < 0.001) and V (E)/VCO2 (P=0.020) with no change in respiratory rate (f) (P=0.065), V (E)/VO2 (P=0.543). Similar changes in FRC (P < 0.001), R5Hz (P=0.013), X5Hz (P < 0.001) and PetCO(2) (P < 0.001) compared to HUT were found. In contrast to HUT, standing increased VO2 (P=0.002) and VCO2 (P=0.048). The greater increase in V (E) in standing compared to HUT appears to be related to increased VO2 and VCO2 associated with increased muscle activity in the unsupported standing position. This has implications for exercise prescription and rehabilitation of critically ill patients who have reduced cardiovascular and respiratory reserve.

Anesthesia of captive African wild dogs (Lycaon pictus) using a medetomidine-ketamine-atropine combination

Seven captive male African wild dogs (Lycaon pictus) weighing 25-32 kg each, were anesthetized by i.m. injection via hand syringe with a combination of 1.5 mg/kg ketamine, 40 mu g/kg medetomidine, and 0.05 mg/kg atropine. Following endotracheal intubation, each animal was connected to a bain closed-circuit system that delivered 1.5% isoflurane and 2 L/min oxygen. Atipamezole (0.1 mg/kg i.v.; 0.1 mg/kg i.m.) was given at the end of each procedure (60 min following injection of medetomidine/ketamine/atropine). Time to sternal recumbency was 5-8 min. Times to standing after atipamezole administration were 8-20 min. This anesthetic regimen was repeated on three separate occasions (September 2000, February 2002, and October 2002) on all males to perform electroejaculation procedures. Each procedure was < 80 min from injection to standing. Dogs showed excellent muscle relaxation during the procedures. Arterial blood samples were collected at 10-min intervals for blood gases in one procedure (September 2000). Separate venous samples were taken from each dog during each procedure for hematology and biochemistry. These values were within the normal range for this species. Arterial hemoglobin oxygen saturation (SpO2) and heart rate (HR) were monitored continuously in addition to other anesthesia monitoring procedures (body temperature, respiratory rate [RR], capillary refill time, blink response, pupil position, deep pain perception reflex). All dogs maintained relatively stable SpO2 profiles during monitoring, with a mean (+/- SD) SpO2 of 92% +/- 5.4%. All other physiological variables (HR, RR, body temperature, blood pressure) were within normal limits. Following each procedure, normal behavior was noted in all dogs. All the dogs were reunited into the pack at completion of their anesthetic procedures. An injectable medetomidine-ketamine-atropine combination with maintenance by gaseous isoflurane and oxygen provides an inexpensive, reliable anesthetic for captive African wild dogs.

Physiological and haematological findings and clinical observations in a model of acute systemic anaphylaxis in Dirofilaria immitis-sensitised cats

Objective This study aims to understand the pathophysiology of anaphylaxis in Dirofflaria immitis-sensitised cats by analysing objective physiological and haematological measurements after challenge. Design Nineteen healthy D immitis-naive cats were sensitised using weekly injections of aluminium hydroxide-adjuvanted D immitis antigen, administered subcutaneously over 6 weeks. After sensitisation, cats (n = 16) were anaesthetised and challenged with intravenous D immitis antigen. A control group (n = 3) was sham-challenged using intravenous sterile 0.9% saline. Systolic blood pressure (measured non-invasively/indirectly), respiratory rate, degree of dyspnoea, blood 0, saturation, expired CO2, and heart rate and were measured immediately before and at 10 to 15 min intervals after challenge until terminal apnoea occurred or euthanasia at 140 mins post-challenge. Blood was collected for complete blood count immediately before and at 10, 20 and 35 mins after challenge. Clinical observations were recorded as they occurred. Results Antigen-challenged cats were divided into two groups: acute (apnoea occurred within 25 mins of challenge) and subacute (breathing at 25 mins after challenge). In both groups, the degree of dyspnoea increased and blood O-2 saturation and blood pressure decreased. Respiratory rate increased in the subacute group. Expired CO2 decreased in both Ag-challenged and control groups. Haematocrit increased in the subacute group. Neutrophil count decreased in the acute group and platelet count decreased in the subacute group. Eosinophil count decreased in the subacute and control groups. Sustained dyspnoea and gastrointestinal signs were the most common clinical manifestations of anaphylaxis in the antigen-challenged cats. Conclusions Intravenous challenge with D immitis antigen in sensitised cats results in dyspnoea, hypoxaemia and systemic hypotension accompanied by haemoconcentration.

INTERVENÇÕES FISIOTERAPÊUTICAS NUM CONTEXTO LÚDICO JUNTO A CRIANÇAS COM DOENÇAS RESPIRATÓRIAS CRÔNICAS

Verifica-se hoje em dia o aumento da incidência de problemas pulmonares que ocasiona internações hospitalares infantis com maior freqüência. Este projeto baseia-se na visão biopsicossocial da Psicologia da Saúde e leva em conta a valorização de atividades do cotidiano da criança, como o brincar, para sua recuperação. Tem por objetivo principal investigar se a utilização de técnicas interventivas lúdicas em fisioterapia contribui para a melhora dos níveis de oxigenação de crianças asmáticas e por objetivos específicos traçar um breve perfil clínico da criança que procura o Ambulatório de Alergia e Imunologia da Faculdade de Medicina do ABC e verificar a adesão da criança com problemas respiratórios a uma intervenção fisioterapêutica lúdica da criança. A análise qualitativa da intervenção lúdica registra grande envolvimento e participação prazerosa das crianças e ampla aceitação dos pais. Estes resultados sugerem que novas pesquisas sejam realizadas a respeito de intervenções lúdicas em fisioterapia. Utiliza-se de método avaliativo-interventivo quase-experimental. Seus participantes são 58 crianças de ambos os sexos com idade de quatro a 11 anos com as patologias de asma brônquica, bronquite e rinite alérgica, sem a presença da crise. Desenvolve-se por meio de sessão única com cada paciente, com avaliação antes e após da intervenção fisioterápica lúdica por meio das aferições dos sinais vitais, (PA, FC, FR,T°C, incluindo oximetria de pulso e PFE) técnicas de aquecimento, alongamento torácico, fortalecimento abdominal e expansão torácica. Realiza análise qualitativa da responsividade das crianças às técnicas interventivas empregadas no contexto lúdico. Os resultados a respeito do perfil clinico indicam maior incidência de Asma, com 44 casos (75,8620 %), para 11 casos de Rinite (18,9655 %) e apenas três de Bronquite (5,1724 %). Os dados relativos a PA, FC, FR,T°C e ao PFE mostram-se dentro da normalidade. Este estudo não constata diferença significativa em relação ao nível de saturação de O2 após a intervenção lúdica. Quanto à adesão, 55,2 % dos participantes aderiram, sendo que a não adesão deu-se por motivos particulares alegados pelos responsáveis ou indisposição da criança, de dor de cabeça, sonolência e/ou vômito. A análise qualitativa da intervenção lúdica registra grande envolvimento e participação prazerosa das crianças e ampla aceitação dos pais. Estes resultados sugerem que novas pesquisas sejam realizadas a respeito de intervenções lúdicas em fisioterapia.(AU)

Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

Predictability of unplanned extubations

Acute life threatening events such as cardiac/respiratory arrests are often predictable in adults and children. However critical events such as unplanned extubations are considered as not predictable. This paper seeks to evaluate the ability of automated prediction systems based on feature space embedding and time series methods to predict unplanned extubations in paediatric intensive care patients. We try to exploit the trends in the physiological signals such as Heart Rate, Respiratory Rate, Systolic Blood Pressure and Oxygen saturation levels in the blood using signal processing aspects of a frame-based approach of expanding signals using a nonorthogonal basis derived from the data. We investigate the significance of the trends in a computerised prediction system. The results are compared with clinical observations of predictability. We will conclude by investigating whether the prediction capability of the system could be exploited to prevent future unplanned extubations. © 2014 IEEE.

Non-invasive monitoring of changes in exhaled markers of airway inflammation in Thoroughbred racehorses

Exhaled breath (EB) and exhaled breath condensate (EBC) contain numerous volatile gases and a wide-array of non-volatile compounds, several of which have been investigated as markers of lower airway inflammation in human and veterinary medicine and have been used to diagnose and monitor diseases associated with pulmonary inflammation. The identification of reliable biomarkers within EB and EBC is an active research focus with the common goal of establishing non-invasive and repeatable assessment of respiratory health and disease in mammals. The application of EB and EBC analysis holds considerable appeal in the investigation of respiratory disease in Thoroughbred racehorses, as inflammatory airway disease (IAD) is a common cause for poor performance in this population of animals. This study documented that EB and EBC samples can be safely collected from Thoroughbred racehorses in their own environment, without adverse effect or interference with the horse’s training regimen. The use of off-line collection and analysis of exhaled gases via chemiluminescence is suitable for the measurement of exhaled carbon monoxide, but is not appropriate for analyzing exhaled nitric oxide in horses. Significant changes in the concentration of exhaled CO and the pH of EBC occurred in response to strenuous exercise and when exercising in different environmental temperatures. Exhaled CO was associated with tracheal mucus score (and the number of neutrophils in the mucus) and EBC pH was significantly different in horses with evidence of neutrophilic IAD compared to horses without IAD. Numerous physiological and environmental variables were identified as confounding factors in the assessment of both exhaled CO and EBC pH, with respiratory rate prior to EB collection, and during EBC collection, consistently identified as an explanatory variable influencing the concentration of exhaled biomarkers. Further studies in EB and EBC analysis in horses need to focus on objectively accounting for key respiratory dynamics during sample collection.

Effect of environmental variables on buffaloes physiology

The objective of this work was to evaluate the effect of environmental variables on dairy buffaloes physiology in two different places after milking, shaded plus artificial ventilation and another one non-shaded, in Ribeira Valley, São Paulo State, Brazil. Data on the respiratory rate (RR) and the surface temperature (ST) at udder, neckmiddle, forehead, back middle and rump were collected in 12 dairy buffaloes at autumn. In the same way, it were recorded the black globe temperature in the sun (GTS) and in the shade (GTNS), air temperature and wind speed at padronized height of 1.60 meters. All data were collected at 10:30am and 1:30pm. The results showed statistical difference among black globe temperature, wind speed, RR and ST (P<0.01) in two treatments.The results showed the necessity of protection against the solar radiation in the buffaloes, even in periods of warm climates.

Pazienteen bihotz eta arnasketa maiztasunen monitorizazioa burmuineko infragorri hurbileko espektroskopia seinaleak erabiliz

Lan honen helburua, burmuineko oxigeno maila neurtzeko NIRS (Near Infrarred Spectroscopy) teknika ez-inbaditzaileaz baliatzen den sistema baten eraginkortasuna neurtzea da, pazientearen parametro fisiologikoak diren bihotz eta arnasketa maiztasunak neurtzerako orduan. Orain arte, pazientearen oxigenazioaren monitorizazioa gauzatzea beharrezkoa den egoeratan, atzamarreko oxigenazio maila neurtzea ahalbidetzen duen PPG (Photoplethysmogram) teknika erabili da. Emergentzia egoeratan, ordea, sistema kardiobaskularrak bizi irauteko nahitaezkoak diren organoei ematen die lehentasuna, garuna eta bihotzari, alegia. Bi organo hauek oxigeno jario jarraituaz hornituak direla egiaztatzeko, ezinbestekoa izango da burmuineko oxigenazio maila neurtzea eta berriki frogatu da NIRS teknikak esparru honetan etorkizun handiko emaitzak eskaini ditzakeela. Hau dela eta, azken urteotan, NIRS teknikak lekua hartu dio orain arte agertoki mediku gehienetan erabilitako PPG teknikari, gaur egun teknika hau aplikazio ugaritan erabiltzen hasia delarik, adibidez kirurgia kardiobaskularraren monitorizazioa edo anestesia orokorraren bitarteko monitorizazioa. NIRS teknikak, garuneko oxigenazio mailaz aparte, pazientearen beste hainbat parametro fisiologikoren neurketa ahalbidetuko balu (arnasketa eta bihotz maiztasuna), agertoki mediku asko erraztuko lituzke, gailu bakar batekin pazientearen bizi-konstante anitzen monitorizazio eramango baitzen aurrera. Tresna hau egingarria dela egiaztatzeko, lehenik eta behin, NIRS seinalea bizi-konstante hauen berri emateko gai dela balioetsi behar da eta hauxe da, hain zuzen, proiektu honen xede nagusia. Azken helburu hau lortzeko, hainbat azpi-helburu proposatzen dira hemen aurkeztuko den proiektuan: lehenik eta behin, NIRS seinaleak eta bizi konstante hauek era fidagarrian lortzea ahalbidetzen duten seinaleak biltegiratzen dituen datu base bat sortuko da. Datu base hau osatzeko, aurreko seinale guztiak aldi berean eskuratuko dituen neurketa sistema sinkrono bat sortzea ezinbestekoa izango da eta azkenik, NIRS seinaleen eraginkortasuna ebaluatzeko, seinaleen prozesaketan oinarritutako hainbat algoritmo garatuko dira.

Avaliação da resposta ao stress de gatas hospitalizadas no período pós-cirúrgico em distintas condições de macroambiente

Dissertação de Mestrado Integrado em Medicina Veterinária

Efficacy and Safety of Orally Administered Intravenous Midazolam Versus a Commercially Prepared Syrup

Background: Among different categories of sedative agents, benzodiazepines have been prescribed for more than three decades to patients of all ages. The effective and predictable sedative and amnestic effects of benzodiazepines support their use in pediatric patients. Midazolam is one of the most extensively used benzodiazepines in this age group. Oral form of drug is the best accepted route of administration in children. Objectives: The purpose of this study was to compare the efficacy and safety of a commercially midazolam syrup versus orally administered IV midazolam in uncooperative dental patients. Second objective was to determine whether differences concerning sedation success can be explained by child‘s behavioral problems and dental fear. Patients and Methods: Eighty eight uncooperative dental patients (Frankl Scales 1,2) aged 3 to 6 years, and ASA I participated in this double blind, parallel randomized, controlled clinical trial. Midazolam was administered in a dose of 0.5 mg/kg for children under the age 5 and 0.2 mg/kg in patients over 5 years of age. Physiologic parameters including heart rate, respiratory rate, oxygen saturation and blood pressure were recorded. Behavior assessment was conducted throughout the course of treatment using Houpt Sedation Rating Scale and at critical moments of treatment (injection and cavity preparation) by North Carolina Scale. Dental fear and behavioral problems were evaluated using Child Fear Schedule Survey-Dental Subscale (CFSS-DS), and Strength and Difficulties Questionnaire (SDQ). Independent t-test, Chi-Square, and Pearson correlation were used for statistical analysis. Results: Acceptable overall sedation ratings were observed in 90% and 86% of syrup and IV/Oral group respectively; Chi-Square P = 0.5. Other domains of Houpt Scale including: sleep, crying and movement were also not significantly different between groups. Physiological parameters remained in normal limits during study without significant difference between groups. Conclusions: “Orally administered IV midazolam” preparation can be used as an alternative for commercially midazolam syrup.