Rev Assoc Med Bras
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The increasing use of opioids by patients suffering from chronic pain caused by different etiologies, and the possible effects of those substances on everyday activities, require careful evaluation of their effects. For this purpose, a systematic review was developed to assess the influence of opioids on the cognitive function in patients with chronic pain. ⋯ These results must be confirmed by additional randomized trials including a greater number of patients with chronic pain.
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Comparative Study
Comparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients.
to compare the ability of the APACHE II score and three different abbreviated APACHE II scores: simplified APACHE II (s-APACHE II), Rapid Acute Physiology score (RAPS) and Rapid Emergency Medicine score to evaluate in-hospital mortality of trauma patients at the emergency department (ED). ⋯ abbreviated APACHE II scores have similar ability to evaluate in-hospital mortality of emergency trauma patients in comparison to APACHE II score.
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This article focused on verifying if hyperglycemia in critically ill pediatric patients is a risk factor for increased morbidity and mortality and carried out a critical analysis of the articles in pediatrics and neonatology. ⋯ Analysis of these cohort studies supported the conclusion that hyperglycemia, isolated or persistent during stay in PICU, increases morbidity, mortality and length-of-stay in PICU of critically ill children. However, these studies disclosed methodological issues such as lack of protocols for glucose measurement, design (most of them retrospective cohorts) and many articles did not confirm hyperglycemia as a single predictor of morbidity and mortality in pediatrics; therefore further prospective studies are necessary.
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Randomized Controlled Trial
Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial.
The objective of this study was to compare maternal satisfaction with childbirth according to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. ⋯ The use of CSE was associated with a significant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.
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Pulmonary aspiration of gastric contents, despite its infrequent occurrence, demands special preventive care. Decreased oesophageal sphincter function and protective airway reflexes caused by depression of consciousness, predispose patients to this severe complication. Recently developed preoperative fasting guidelines suggest shorter fasting periods, especially for liquids, providing more comfort to patients and less risk of hypoglycemia and dehydration, without increasing incidence of perioperative pulmonary aspiration. ⋯ Tracheal intubation after rapid sequence induction of anesthesia is indicated for patients at risk of gastric content aspiration without suspicion of difficult intubation. Adequate indication of the technique, its judicious application and rational use of available drugs may promote excellent intubation conditions, with fast onset, early return to consciousness and spontaneous breathing should tracheal intubation fail. This review intends to discuss methods recently used to control volume and pH of the gastric content, protect the airways during the intubation maneuver and to decrease the gastroesophageal reflux.