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Sample records for analgesia multimodal preventiva

  1. Analgesia preventiva y multimodal con ketamina y dipirona en mastectomía radical por cáncer de mama

    OpenAIRE

    Miladys Justo Hernández; Leticia Fernández Álvarez; Yamila Zayas Nápoles; Alina Pérez Sánchez; Sandra Ramos Rojas

    2015-01-01

    El dolor agudo es frecuente en los pacientes que requieren intervención quirúrgica; su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal y preventiva. Se realizó un estudio longitudinal, prospectivo en 22 pacientes, a los que se les practicó mastectomía radical por cáncer de mama, con el objetivo de describir el uso de la analgesia multimodal y preventiva con ketalar y dipirona en el manejo del dolor posoperatorio de estos pacientes....

  2. Analgesia preventiva y multimodal con ketamina y dipirona en mastectomía radical por cáncer de mama

    Directory of Open Access Journals (Sweden)

    Miladys Justo Hernández

    2015-11-01

    Full Text Available El dolor agudo es frecuente en los pacientes que requieren intervención quirúrgica; su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal y preventiva. Se realizó un estudio longitudinal, prospectivo en 22 pacientes, a los que se les practicó mastectomía radical por cáncer de mama, con el objetivo de describir el uso de la analgesia multimodal y preventiva con ketalar y dipirona en el manejo del dolor posoperatorio de estos pacientes. La técnica anestésica utilizada fue total intravenosa, con propofol y fentanyl, dosis convencional. En el postoperatorio se vigiló la aparición de efectos colaterales. Los datos se colocaron en tablas de contingencia, procesados mediante el sistema de cálculos estadísticos que presenta Microsoft Excel. El análisis se realizó fundamentalmente a través de medidas de resúmenes, porcentaje y media aritmética. Se concluyó que la analgesia multimodal preventiva con ketamina y dipirona fue efectiva y segura en todos los casos, a los que se realizó radical de mama. Predominó el grupo de edad entre 46 y 65 años y ASA II. Las variables hemodinámicas y respiratorias se mantuvieron estables en todos los pacientes. No necesitaron analgesia de rescate. La somnolencia se manifestó en 13,6% de los casos.

  3. Multimodal therapy in perioperative analgesia.

    Science.gov (United States)

    Gritsenko, Karina; Khelemsky, Yury; Kaye, Alan David; Vadivelu, Nalini; Urman, Richard D

    2014-03-01

    This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.

  4. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Steinbrüchel, Daniel Andreas; Wanscher, Michael Jaeger;

    2014-01-01

    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective....... 1, p = 0.31). 30-day mortality was 1 vs. 2, p = 0.54. CONCLUSIONS: In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed...

  5. Preventive local analgesia in orthopedic and Traumatology surgery. Analgesia local preventiva en la cirugía traumatológica y ortopédica.

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    Carlos M. Hernández

    2005-12-01

    posoperatorio es entonces una prioridad de la medicina moderna. Objetivo: Caracterizar los resultados obtenidos con la aplicación de analgesia preventiva infiltrando la herida operatoria sin restringir el uso de otros analgésicos si fuera necesario. Métodos: Estudio prospectivo descriptivo en una serie de 30 pacientes atendidos por del Servicio de Ortopedia del Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos en el período de septiembre de 2004 a marzo de 2005. Se les aplicó una infiltración anestésica en el área quirúrgica una vez finalizada la intervención, con bupivacaína al 0,125 % en un volumen de 20 ml y 2 gotas de epinefrina sin restringir el uso de otros analgésicos. Resultados: Comprobamos que 13 enfermos no presentaron dolor dentro de las primeras 24-48 horas posoperatorias, seguido por otro grupo formado por 9 en que existió alivio entre las 12 y 23 horas. Conclusiones: En la serie de pacientes estudiados se comprobaron los beneficios de la infiltración anestésica en el área quirúrgica con fines analgésicos, al proporcionar ausencia de dolor en un período mayor de 24 horas en gran número de pacientes. La bupivacaína presentó buenos resultados por proporcionar una analgesia posoperatoria y la aplicación temprana de la rehabilitación en buen número de casos.

  6. [Assessment of pain relief in patients receiving different variants of multimodal analgesia after major gynecological surgery].

    Science.gov (United States)

    Timerbaev, V H; Smimova, O V; Genov, P G; Olejnikova, O N; Rebrova, O Yu

    2014-01-01

    The major gynecology surgery generally results in severe postoperative pain. Currently multimodal analgesia concept is widely used for the aim of postoperative pain relief optimization. According to this theory it is worth using the medication with different mechanism in order to increase analgesia qualify, decrease analgesic consumption and avoid adverse reaction. Unfortunately the surveys recently conducted have been pointed out the postoperative analgesia quality is still insufficient despite of using the concept mentioned above. One way to solve the problem is appearing in daily practice nefopam--centrally acting non-opioid analgesic that inhibits reuptake of serotonin, norepinephrine, and dopamine and also mitigates glutamatergic neurotransmission. In this trial we tried to assess the postoperative daily used analgesia quality and potency of preemptive multimodal analgesia model consisted of nefopam, ketoprofen, paracetamol and morphine.

  7. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  8. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: A randomized trial study

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    Valdecy Ferreira de Oliveira Pinheiro

    2015-12-01

    Full Text Available Objective: to assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. Methods: sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. Results: the groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47. The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. Conclusion: the present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious.

  9. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...

  10. Analgesia preemptiva nas cirurgias da coluna lombossacra: estudo prospectivo e randomizado Analgesia preventiva en las cirugías de la columna lumbosacra: estudio prospectivo y aleatorio Preemptive analgesia in lumbosacral spine surgeries: prospective randomized study

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    Augustin Malzac

    2009-06-01

    Full Text Available OBJETIVO: Analisar a eficácia da analgesia preemptiva pelo método da administração de analgésicos antes e após o início do estímulo doloroso operatório, comparando-as. A melhora do quadro doloroso pós-operatório nas cirurgias da coluna vertebral no segmento lombossacro, por via posterior, não tem sido completamente investigada. MÉTODOS: Sessenta e dois pacientes submetidos à microdiscectomia ou microdescompressão, em um único nível, na coluna lombossacra, foram divididos em três grupos, 20 pacientes no primeiro (A não receberam qualquer substância analgésica (controle. Vinte e dois no segundo (B, os quais foram submetidos à injeção epidural, 20 minutos antes da incisão cirúrgica, contendo 10 mL de marcaína e morfina. No terceiro e no último grupo (C com vinte pacientes, foi injetado, com auxílio de um cateter, no espaço epidural, as mesmas drogas do grupo B, através da incisão antes do fechamento da ferida operatória. Os pacientes foram examinados durante as primeiras 24 horas com auxílio da escala verbal de dor. RESULTADOS: Os três grupos foram comparados quanto à idade, sexo, nível e tempo cirúrgico. Os dados não obedeceram a uma distribuição Gaussiana, o teste não paramétrico de Mann-Whitney foi adotado para análise estatística. Desta maneira, os valores da escala verbal de dor, em todos os intervalos de tempo, foram significativamente baixos (pOBJETIVO: analizar la eficacia y comparar la analgesia preventiva por el método de la administración de analgésicos antes y después del inicio del estímulo doloroso operatorio. La mejoría del cuadro doloroso postoperatorio en las cirugías de la columna vertebral en el segmento lumbosacro, por vía posterior, no ha sido completamente investigada. MÉTODOS: sesenta y dos pacientes sometidos a la microdisección o microdescompresión, en un único nivel, en la columna lumbosacra fueron divididos en tres grupos. Veinte pacientes en el primer grupo (A no

  11. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post–cesarean section pain management

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    Adeniji AO

    2013-05-01

    Full Text Available Adetunji Oladeni Adeniji,1 Oluseyi Olaboyede A Atanda21Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; 2Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, NigeriaBackground: Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post–cesarean section pain management.Objective: To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam approach, in the management of post–cesarean section pain.Materials and methods: This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg or tramadol (100 mg as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post–cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.Results: A total of 120 patients were equally and randomly allocated to four study groups – two that received unimodal analgesia (the pentazocine group and the tramadol group and two that received multimodal analgesia (the pentazocine

  12. Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

    Science.gov (United States)

    Lyons, Mary; Montgomery, Robert; Quinlan-Colwell, Ann

    2016-01-01

    Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns. PMID:27828892

  13. Isobolographic analysis of multimodal analgesia in an animal model of visceral acute pain.

    Science.gov (United States)

    Miranda, Hugo F; Prieto, Juan Carlos; Puig, Margarita M; Pinardi, Gianni

    2008-02-01

    Multiple analgesic-drug combinations are commonly used in the management of acute and chronic pain in humans during multimodal or balanced analgesia. At present, these combinations are used empirically in clinical practice and are considered to be beneficial for the patient. Interactions between two antinociceptive drugs have been thoroughly examined, but the nature of interactions between three analgesics has not been studied. The antinociceptive interaction of ketoprofen (K) with a mixture of morphine (M) and paracetamol (P) was evaluated using a model of visceral acute tonic pain, the acetic-acid writhing test in mice. The i.p. administration of the combination M/P+K resulted in a significant potentiation of the antinociception induced either by K or by the synergic two-drug mixtures M/K, P/K and M/P. The effect of opioid, cholinergic, adrenergic and serotonergic antagonists on the analgesic interaction was assessed. The pretreatment of mice with atropine (1 mg/kg) did not produce any change in the synergistic interaction of the triple combination. The pretreatment with naltrexone (1 mg/kg) or tropisetron (1 mg/kg) reduced the intensity of M/P+K synergic interaction, while prazosin (0.1 mg/kg) significantly potentiated the synergy. The findings of this work suggest that the two major pathways of descending inhibitory systems, noradrenergic and serotonergic are significantly involved in the mechanism of the antinociceptive synergy induced by the triple combination. On the other hand, opioid pathways also seem to participate, since pretreatment with naltrexone reduced the synergy. In conclusion, the triple combination M/P+K induced a strong synergistic antinociceptive effect, which could be of interest for optimal multimodal clinical analgesia.

  14. Analgesia preventiva con pregabalina en intervenciones de hernia con malla: Revisión al año Preventive analgesia with pregabalin in mesh hernia repair: Review at 1 year

    Directory of Open Access Journals (Sweden)

    M.P. Acín

    2009-05-01

    Full Text Available Objetivo: La analgesia preventiva consiste en la administración de fármacos para conseguir un estado analgésico previo al trauma quirúrgico que disminuya la respuesta sensitiva periférica y central al dolor, con la cual se intenta interrumpir el círculo inflamacióndolor-hiperalgesia-aumento del estímulo doloroso. Pregabalina es un neuromodulador utilizado en el tratamiento del dolor neuropático; varios trabajos indican que se puede administrar en la prevención del dolor postoperatorio. El objetivo de este trabajo fue realizar un estudio comparativo de dolor postoperatorio en pacientes intervenidos de hernia por cirugía abierta con colocación de malla, tratados con pregabalina o sin ella. Material y métodos: Se realizó un estudio prospectivo, aleatorizado, que incluyó a 140 pacientes intervenidos de hernia inguinal, crural o umbilical con malla, por cirugía abierta, con 112 varones y 28 mujeres. Grupo I: 70 de ellos fueron tratados con pregabalina 75 mg noche durante 3 días antes de la intervención y 75 mg noche durante 12 días después, incluido el día de la intervención. Grupo II: 70 sin pregabalina. No hubo diferencias entre ambos grupos en edad, que estaban comprendidos entre 18-79 años (edad media: 55,47 ± 13,38 años ni tampoco en el grado ASA: entre I-III. La evaluación del dolor se basó en la escala analógica verbal y consumo de pirazolonas. Los controles se realizaron después de 1, 6 y 12 meses de la intervención. Se registraron los efectos adversos, el número de horas de sueño y la mejoría o no en la calidad del sueño. El análisis estadístico se realizó con el test de Kolmogorov-Smirnov del programa Statgraphics. Se consideró significativa una p Objective: Preventive analgesia consists of administrating drugs to achieve an analgesic state that decreases the peripheral and central sensory response to pain prior to surgical injury; thus, the aim is to break the cycle of inflammation

  15. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

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    Anis Dizdarevic

    2016-01-01

    Full Text Available Objective. Primary lateral sclerosis (PLS is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS. Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use.

  16. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Science.gov (United States)

    Fernandes, Anthony

    2016-01-01

    Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use. PMID:27200193

  17. General anaesthesia with multimodal principles versus intrathecal analgesia with conventional principles in total knee arthroplasty

    DEFF Research Database (Denmark)

    Harsten, Andreas; Hjartarson, Hjortur; Werner, Mads Utke;

    2013-01-01

    Postoperative outcomes following major surgery are influenced by surgical and anaesthesiological factors. While techniques of minimal invasive surgery have been associated with improved outcome, the techniques of minimal invasive, multimodal anaesthesia have not been adequately investigated. The ...

  18. 氟比洛芬酯在多模式镇痛中的应用%Application of flurbiprofen in multimodal analgesia

    Institute of Scientific and Technical Information of China (English)

    龙云; 王品; 陈朴; 王浩; 段满林; 赵建生

    2015-01-01

    背景 多模式镇痛(multimodal analgesia,MMA)已经被越来越多的临床医师所认同,且推广前景广阔.目的 探讨氟比洛芬酯在MMA中的应用.内容 从氟比洛芬酯独特的超前镇痛、联合镇痛和靶向镇痛作用方面分别总结分析其在MMA中的应用,总结氟比洛芬酯的应用现状.趋向 氟比洛芬酯在MMA中起着重要作用,临床应用广泛.%Background Multimodal analgesia (MMA) has been more and more recognized by clinicians,and has vast range of prospects.Objective To investigate the application of flurbiprofen in MMA.Content This article summarized the preemptive analgesia,joint pain,targeted analgesic effects of flurbiprofen,were and summarized its application in MMA and the application status of flurbiprofen.Trend Flurbiprofen plays an important role in MMA,and its clinical application is wide.

  19.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne;

    scored mean nine out of possible ten points regarding their satisfaction with the entire stay including LOS. CONCLUSIONS: These results demonstrate, that LOS can be shortened without reducing the quality of the hospital stay. Further studies conducted as randomized controlled trials, including follow-up......  PURPOSE: The purpose of this project was to study the length of the hospital stay (LOS) in relation to a new multimodal pain strategy for patients undergoing elective hip and knee arthroplasty. Usual discharge criteria were used: independence in ambulation and transfers, independence in toileting...... underwent the "Timed Up & Go" test, a test for functional mobility. Patients were discharged according to criteria mentioned above and were asked to evaluate the quality of the hospital stay. EVALUATION: LOS was decreased for the THA patients from an already accelerated track of 3.8 days to 3.1 days...

  20. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam Analgesia pos-operatoria multimodal en cirugía ginecológica videolaparoscópica ambulatorial: comparación entre parecoxib y tenoxican Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Avaliar as características da analgesia pós-operatória em pacientes submetidas à cirurgia ginecológica videolaparoscópica ambulatorial, comparando o efeito de parecoxib e tenoxicam venoso em um estudo duplamente encoberto. MÉTODO: Foram estudadas, prospectivamente, 60 pacientes divididas aleatoriamente em 2 grupos. Todas receberam sedação pré-operatória com midazolam. Um dos grupos (P recebeu, antes de iniciar a cirurgia, 40 mg de parecoxib e o outro (T 20 mg de tenoxicam. Na sala de operação foi feita raquianestesia com bupivacaína e sufentanil. A analgesia pós-operatória foi avaliada mediante a intensidade da dor com escalas verbal e visual, a localização da dor (incisional, visceral, no ombro e o consumo de analgésicos suplementares. Os efeitos colaterais adversos foram registrados. A satisfação da paciente com a técnica foi pesquisada. RESULTADOS: A qualidade analgésica foi excelente, com 76% das pacientes do grupo P e 83% das pacientes do grupo T sem queixa de dor nem uso de analgésicos no pós-operatório. Não houve diferença entre os grupos em todos os critérios e períodos de avaliação analgésica. A incidência de efeitos adversos foi pequena, embora prurido de intensidade leve e curta duração tenha ocorrido freqüentemente. Todas as pacientes ficaram satisfeitas ou muito satisfeitas com a técnica empregada. CONCLUSÕES: Uma técnica de analgesia multimodal, com um componente de anestésico local e opióide por via subaracnóidea associado a AINE venoso, produz analgesia pós-operatória de excelente qualidade com poucos efeitos colaterais adversos em cirurgia videolaparoscópica ginecológica ambulatorial. A escolha do AINE não parece importante para obter estes resultados.JUSTIFICATIVA Y OBJETIVOS: Evaluar las características de la analgesia pos-operatoria en pacientes sometidas a cirugía ginecológica videolaparoscópica ambulatorial, comparando el efecto de parecoxib y

  1. Impact of a Preemptive Multimodal Analgesia plus Femoral Nerve Blockade Protocol on Rehabilitation, Hospital Length of Stay, and Postoperative Analgesia after Primary Total Knee Arthroplasty: A Controlled Clinical Pilot Study

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    Lauren A. Beaupre

    2012-01-01

    Full Text Available Purpose. To compare preemptive multimodal analgesia (PMMA without femoral nerve blocks (FNB to PMMA including FNB following total knee arthroplasty (TKA. Methods. In a prospective, controlled pilot study, subjects with noninflammatory arthritis undergoing TKA and a short postoperative stay received either PMMA + FNB (FNB group; n=19 or PMMA only (PMMA group; n=20. No preoperative group differences were noted. Evaluations occurred in hospital and at 2, 6, and 12 weeks postoperatively. The primary outcome (knee flexion was measured on day two postoperatively. Rehabilitation indices, pain, analgesic use, and length of stay (LOS were also measured. Results. All subjects completed the study. The only significant group differences were quadriceps motor blocks in the FNB group (P<0.001. No significant differences were noted in ROM, pain levels, analgesic use, or hospital LOS. Conclusion. Other than the quadriceps motor block, no group differences were noted; both achieved satisfactory analgesia. Best postoperative pain management strategies when following a short hospital stay program are still unclear.

  2. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    2010-01-01

    on their teaching and learning situations. The choices they make involve e-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very......In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal' communication, which should not be confused with the term ‘multimedia'. While multimedia...... useful for developing pedagogies where a synergy of different symbol systems facilitates new and flexible learning situations that can meet different needs of different learners. The present paper includes an example from a Danish university program...

  3. Effects of comprehensive rehabilitation training in combination with multi-mode analgesia on body function recovery after tumor-type knee replacement

    Science.gov (United States)

    Zhang, Junjuan; Wang, Yahan; Yang, Guangyu; Liu, Jing; Wang, Junjie

    2016-01-01

    Objective: To discuss the significance of comprehensive rehabilitation training combined with multimodal analgesia (MMA) for the early knee function recovery of patients with knee bone tumor who underwent prosthesis replacement operation. Methods: Sixty patients with knee bone tumor who underwent prosthesis replacement operation were selected and randomly divided into two groups according to rehabilitation training and postoperative analgesic methods, namely, observation group and control group, 30 cases in each group. The control group was treated with symptomatic treatment (drugs were given based on pain before and after surgery) and continuous passive motion (CPM) functional training, while the observation group was treated with comprehensive rehabilitation training combined with MMA. The compliance of patients in the two groups was compared and the first-time off-bed activity time was recorded. Recovery conditions of wounds were observed, and recovery conditions of limb functions after operations were evaluated. Results: The compliance of patients in the observation group was significantly higher than that in the control group, and the difference was statistically significant (Pknee (HSS) score and evaluation result of range of motion (ROM) of knees of the observation group were both better than those of the control group in different periods after operation, and the differences were statistically significant (Prehabilitation training combined with MMA can improve the compliance of patients and help patients off bed earlier, and remarkably promote the early recovery of knee functions; hence it deserves to be promoted clinically. PMID:27882029

  4. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    and learning situations. The choices they make involve E-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very useful......In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal’ communication, which should not be confused with the term ‘multimedia’. While multimedia...... for developing pedagogies where a synergy of different symbol systems facilitates new and flexible learning situations that can meet different needs of different learners. The present paper includes an example from a Danish university program....

  5. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk;

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  6. 多模式镇痛在脊柱外科微创手术中的应用①%Application of Multimodal Analgesia in Minimally Invasive Surgery for Patients in Spine Surgery

    Institute of Scientific and Technical Information of China (English)

    杨同文; 王强; 王增春; 白金柱; 洪毅; 张军卫

    2013-01-01

    Objective To apply the multimodal analgesia (MMA) in minimally invasive surgery (MIS) for patients in spine surgery. Methods 21 patients undergoing MIS were selected to be reviewed, including haemodynamics, respiratory parameters, analgesia and seda-tion scale, side effects, satisfaction of operators and patients in the course of the operation. Results All the MIS was successful with excel-lent analgesia, conscious sedation, stable haemodynamics, unsuppressed respiratory function, and satisfaction of operators and patients. Con-clusion Patients under MMA would accept MIS in a comfortable state and the communication between patients and operators would not be inhibited.%  目的探讨多模式镇痛在脊柱外科微创手术中的应用。方法选择21例在多模式镇痛模式下接受脊柱外科微创手术的患者,观察术中血流动力学、呼吸监测指标、镇痛镇静评分、不良反应事件、术者及患者对手术过程满意度评价。结果手术过程顺利,血流动力学稳定,呼吸功能无抑制,患者及术者对手术过程满意。结论多模式镇痛能够使患者在最舒适的环境下接受脊柱外科微创手术,同时不影响术者与患者在术中进行交流。

  7. Genetic Influences of OPRM1, OPRD1 and COMT on Morphine Analgesia in a Multi-Modal, Multi-Tissue Human Experimental Pain Model

    DEFF Research Database (Denmark)

    Nielsen, Lecia Møller; Christrup, Lona Louring; Sato, Hiroe;

    2017-01-01

    Human studies on experimentally induced pain are of value to elucidate the genetic influence on morphine analgesia under controlled conditions. The aim of this study was to investigate if genetic variants of mu, kappa and delta opioid receptor genes (OPRM1, OPRK1 and OPRD1) and catechol...

  8. Analgesia multimodal para el postoperatorio en la enfermedad renal crónica: fentanilo transcutáneo, fentanilo oral transmucosa y metamizol

    Directory of Open Access Journals (Sweden)

    P. Mesa Suárez

    2015-04-01

    Full Text Available La enfermedad renal crónica (ERC es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM y la hipertensión arterial (HTA. Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para brindarles una analgesia postoperatoria de gran calidad. Presentamos el esquema de analgesia postoperatoria de un paciente en fallo renal severo sometido a artroplastia de cadera: metamizol (6 gramos/24 horas en perfusión durante 48 horas, fentanilo transcutáneo TTS 25 microgramos/hora durante 48 horas y fentanilo oral transmucosa 200 microgramos en caso de exacerbación del dolor. Este tratamiento analgésico permitió el control satisfactorio del dolor sin que se presentaran vómitos, prurito ni estreñimiento; la calidad del sueño y el descanso nocturno fueron buenos.

  9. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam Analgesia pos-operatoria multimodal en cirugía ginecológica videolaparoscópica ambulatorial: comparación entre parecoxib y tenoxican Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

    OpenAIRE

    Sérgio D. Belzarena; Mozart T. Alves; Cucco,Máximo L. D.; Vanius D. D'Ávila

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Avaliar as características da analgesia pós-operatória em pacientes submetidas à cirurgia ginecológica videolaparoscópica ambulatorial, comparando o efeito de parecoxib e tenoxicam venoso em um estudo duplamente encoberto. MÉTODO: Foram estudadas, prospectivamente, 60 pacientes divididas aleatoriamente em 2 grupos. Todas receberam sedação pré-operatória com midazolam. Um dos grupos (P) recebeu, antes de iniciar a cirurgia, 40 mg de parecoxib e o outro (T) 20 mg de t...

  10. Analgesia multimodal para el postoperatorio en la enfermedad renal crónica: fentanilo transcutáneo, fentanilo oral transmucosa y metamizol

    OpenAIRE

    P. Mesa Suárez; V. Aceña Fabián; M.J. González Forte; F. Neira Reina; D. Portilla Huerta

    2015-01-01

    La enfermedad renal crónica (ERC) es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM) y la hipertensión arterial (HTA). Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para ...

  11. Perioperative analgesia in total knee replacement:multimodal analgesia schemes and optimal pain management%人工全膝关节置换围术期镇痛方法:多模式方案及最佳疼痛管理

    Institute of Scientific and Technical Information of China (English)

    孙扬; 杨明敏; 李亦梅

    2014-01-01

    , epidural analgesia, peripheral nerve block, joint local analgesia, patient control ed analgesia, cold treatment”in Chinese and English. RESULTS AND CONCLUSION:There were 986 articles after the initial survey. Final y, 55 articles were included according to the inclusion and exclusion criteria. As the technology for total knee arthroplasty, early functional rehabilitation and replacement of pain control has been widely concerned, a large number of literatures about analgesic drugs and analgesic programs emerge. Analgesic drugs include opioids, non-steroidal anti-inflammatory drugs, local anesthetics and N-methyl-aspartate receptor blockers. Analgesic program includes epidural analgesia, peripheral nerve blockage, joint local analgesia, patient-control ed analgesia and cold therapy. These analgesic drugs and methods have their advantages and disadvantages. At present, multimodal analgesia schemes have been recognized, but the optimal pain management scheme remains controversial. Increasing considerations should be paid on the choice of analgesic methods, depending on individual characteristics and existing technology.

  12. Effects of multimodal analgesia with LowDose buprenorphine and meloxicam on fecal glucocorticoid metabolites after surgery in New Zealand white rabbits (Oryctolagus cuniculus).

    Science.gov (United States)

    Goldschlager, Gregg B; Gillespie, Virginia L; Palme, Rupert; Baxter, Mark G

    2013-09-01

    Despite the increasing use of rabbits as companion animals and models for biomedical research, rabbits have not been extensively studied to identify an efficacious postsurgical analgesic that does not cause systemic complications. The synergy of NSAID and systemic opioids is well-documented, and their combined use reduces the amount of either drug required for adequate analgesia. We measured fecal corticosterone metabolites (FCM) in rabbits after a minimally invasive vascular cut-down procedure. Rabbits received buprenorphine (0.03 mg/kg SC every 12 h for 3 d), meloxicam (0.2 mg/kg SC every 24 h for 3 d), buprenorphine-meloxicam (0.01 mg/kg-0.1 mg/kg SC every 24 h for 3 d), or a single dose of 0.5% bupivacaine (0.5 mL) infused locally at the incision site. By day 3 after surgery, buprenorphine, meloxicam, and bupivacaine groups showed elevated FCM levels, which continued to rise until day 7 and then gradually returned to baseline by day 28. In the buprenorphine-meloxicam group, FCM was relatively unchanged until day 3, when treatment was discontinued, and then began to rise. Rabbits in the buprenorphine-meloxicam group gained more weight over the 28-d study than did those in the other 3 treatment groups. This study shows that in rabbits low-dose buprenorphine administered with meloxicam effectively mitigates the FCM response that develops after surgery without the adverse effects associated with higher doses.

  13. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Kristiansen, V B;

    1999-01-01

    Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during laparoscopic cholecystectomy. Therefore, we investigated the effects of a somato-visceral local anesthetic blockade on pain and nausea in patients...... undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3...... postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain...

  14. L'archeologia preventiva nella normativa recente

    Directory of Open Access Journals (Sweden)

    Andrea Fantin

    2013-05-01

    Full Text Available Lo scritto analizza l’attuale normativa sulla c.d. valutazione preventiva di impatto archeologico (ViArch introdotta dall’art. 28, comma 4 del D.Lgs. 42/2004 e successivamente disciplinata, nei suoi aspetti procedurali, dalla L. 109/2005, confluita, oggi, nel D.Lgs. 163/2006 (codice dei contratti pubblici. In particolare, nel presente lavoro, l’attenzione è stata posta sulle diverse fasi del procedimento cercando di evidenziare anche i vantaggi conseguenti all’introduzione di tale normativa.   This work examines the current legislation about Archeological Impact Assessment (AIA regulated at the beginning by article 28 D.Lgs. 42/2004 and, later, regulated by Law n. 109/2005 and D. Lgs. 163/2006 (Code of public contracts about AIA’s. The present report draws attention to different section of the process pointing to the benefits resulting from this new regulation.

  15. As teorias das guerras preventivas e as internacionais

    OpenAIRE

    Palácios Júnior, Alberto Montoya Correa [UNESP

    2009-01-01

    A incorporação do conceito da estratégia preemptiva ao documento de Estratégia de Segurança Nacional dos EUA em 2002, e a suposta aplicação dessa estratégia na Guerra do Iraque em 2003, fez com que os debates teóricos sobre guerras preventivas e preemptivas fossem reabertos. Em termos gerais, as guerras preventivas podem ser entendidas como o “início de uma ação militar em antecipação a ações danosas que não ocorrem no presente nem são iminentes”. A análise da definição de guerras preventivas...

  16. Analgesia regional em cuidados intensivos

    Directory of Open Access Journals (Sweden)

    Luísa Guedes

    2012-10-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A analgesia regional desempenha um papel importante na abordagem multimodal da dor no doente crítico e permite amenizar o desconforto do doente e reduzir os estresses fisiológico e psicológico associados. Ao diminuir as doses de opioides sistêmicos, reduz alguns dos seus efeitos colaterais, como a síndrome de abstinência, possíveis alterações psicológicas e disfunção gastrintestinal. Apesar desses benefícios, seu uso é controverso, uma vez que os doentes em unidades de cuidados intensivos apresentam frequentemente contraindicações, como coagulopatia, instabilidade hemodinâmica e dificuldade na avaliação neurológica e na execução da técnica regional. CONTEÚDO: Os autores apresentam uma revisão sobre analgesia regional em cuidados intensivos, com foco nas principais vantagens e limitações de seu uso no doente crítico, e descrevem as técnicas regionais mais usadas e a sua aplicabilidade nesse contexto.

  17. Fomentar la cultura preventiva entre trabajadores y empresarios

    Directory of Open Access Journals (Sweden)

    José Manuel González Tizón

    2013-01-01

    Full Text Available Desde hace más de una década, la entidad trabaja activamente en la puesta en marcha de acciones preventivas que mejoren las condiciones de seguridad y salud de los trabajadores y empresarios de la zona.

  18. Preemptive analgesia I: physiological pathways and pharmacological modalities.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

  19. Preemptive analgesia II: recent advances and current trends.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

  20. Regional anesthesia and analgesia for oral and dental procedures.

    Science.gov (United States)

    Rochette, Judy

    2005-07-01

    Regional anesthesia and analgesia benefit the client, the patient, and the practitioner, and their use is becoming the standard for care. Familiarity with the processes involved in the generation of pain aids in understanding the benefits of preemptive and multimodal analgesia. Local anesthetic blocks should be a key component of a treatment plan, along with opioids, nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate receptor antagonists, and other therapies. Nerve blocks commonly used for dentistry and oral surgery include the infraorbital, maxillary, mental,and mandibular blocks.

  1. Stellate ganglion blockade for analgesia following upper limb surgery.

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

  2. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam

    OpenAIRE

    Sérgio D. Belzarena; Mozart T. Alves; Cucco,Máximo L. D.; D'Ávila,Vanius D.

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Avaliar as características da analgesia pós-operatória em pacientes submetidas à cirurgia ginecológica videolaparoscópica ambulatorial, comparando o efeito de parecoxib e tenoxicam venoso em um estudo duplamente encoberto. MÉTODO: Foram estudadas, prospectivamente, 60 pacientes divididas aleatoriamente em 2 grupos. Todas receberam sedação pré-operatória com midazolam. Um dos grupos (P) recebeu, antes de iniciar a cirurgia, 40 mg de parecoxib e o outro (T) 20 mg de t...

  3. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme

    DEFF Research Database (Denmark)

    Kehlet, H; Mogensen, T

    1999-01-01

    the results of a multimodal rehabilitation regimen after open sigmoidectomy. METHODS: Sixteen unselected patients scheduled for elective sigmoid resection (median age 71 years) underwent operation under combined spinal-epidural anaesthesia. After operation, epidural analgesia was continued for 48 h...

  4. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes

    Directory of Open Access Journals (Sweden)

    Keith A. Candiotti, MD

    2014-12-01

    Conclusions: Compared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy.

  5. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  6. A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

    Directory of Open Access Journals (Sweden)

    Himanshu A. Shah

    2013-12-01

    Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated. [Int J Basic Clin Pharmacol 2013; 2(6.000: 723-727

  7. Multimodal Afslapning

    Directory of Open Access Journals (Sweden)

    Stephen Palmer

    2012-10-01

    Full Text Available Artiklen beskriver Multimodal Relaxation Method (MRM, fremover Multimodal Afslapningsmetode, somkan anvendes i livs-, ledelses-, virksomheds-, sports- eller sundhedscoaching til at forbedre ydeevnen hos denenkelte og reducere eller håndtere stress. Inden for sports- og sundhedscoaching kan metoden anvendes til atreducere fysiske spændinger og styrke fysiologisk kontrol, fx lavere hjertefrekvens og nedsætte blodtrykket.

  8. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  9. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    clinical trials even when combined with multimodal systemic analgesia. In contrast, LIA may have limited additional analgesic efficacy in THA when combined with a multimodal analgesic regimen. Postoperative administration of local anaesthetic in wound catheters did not provide additional analgesia when......In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...... the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on with TKA...

  10. Early recovery after abdominal rectopexy with multimodal rehabilitation

    DEFF Research Database (Denmark)

    Basse, Linda; Billesbølle, Per; Kehlet, Henrik

    2002-01-01

    PURPOSE: Abdominal rectopexy without sigmoid resection is usually associated with a hospital stay of four to ten days. Recent developments have shown that a multimodal rehabilitation program with epidural analgesia and early oral feeding and mobilization will reduce hospital stay after colonic...... resection. The aim of this study was to describe the results after abdominal rectopexy with a multimodal rehabilitation program. METHODS: Thirty-one consecutive patients with rectal prolapse, median age 69 (range, 24-85) years and including 14 patients of American Society of Anesthesiologists physical...... status III to IV, were scheduled for abdominal rectopexy with a multimodal rehabilitation program including 48 hours thoracic epidural analgesia or patient-controlled anesthesia (3 patients), early oral nutrition and mobilization, and a planned two-day postoperative hospital stay. Follow-up was done...

  11. Inmoralidad de la prisión preventiva

    Directory of Open Access Journals (Sweden)

    Jorge W. Álvarez

    2014-11-01

    Full Text Available El título no me pertenece; por eso lo pongo entre comillas, corno corresponde en rigor gramatical. Lo torné prestado de un precioso trabajo del maestro pisano Francesco Carrara, recién aparecido en una revista de criminología y que manos dilectas pusieron en las mías, conociendo mi vieja pasión por el tema. Y me dije, esto tiene que conocerse por todos los medios posibles para que la voz del viejo maestro resuene con potencia renovada.He aquí, estimado lector, el propósito de esta glosa que hoy pongo a tu consideración.No es el momento ni tampoco tendría mayor interés hacer la historia de la prisión preventiva en este país. Más vale olvidarla por todo lo que tuvo de aborrecible y antijurídica.Sólo cabría apuntar que esa historia, en términos generales, quedó dividida en dos tramos a partir de la sanción de la Ley 15.859 del 31 de marzo de 1987 y por la cual su aplicación se redujo a circunstancias excepcionales, muy pocas por cierto.

  12. CENTRAL MECHANISMS OF ACUPUNCTURE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Eman S. Mansour

    2015-12-01

    Full Text Available Background: Acupuncture is an component of traditional Chinese medicine (TCM that has been used for three thousand years to treat diseases and relieve pain. Pain is found to be the most common reason for people to use acupuncture. Due to recent scientific findings, acupuncture treatment has been accepted worldwide. Numerous trials have been conducted especially in analgesia. The mechanisms of acupuncture analgesia has been widely investigated, however, the underlying mechanism still not clear. This article summarizes the central mechanisms of acupuncture analgesia and reviews recent studies on the topic. Method: We have focused on examining the recent literature on acupuncture analgesia. The central mechanisms of acupuncture analgesia and reviews recent studies on the topic. We focused on the studies related to central mechanisms of acupuncture analgesia from these aspects: (neurophysiology, neurochemistry and neuroanatomy. Result: The result revealed that acupuncture act on various parts of the central nervous system, including the spinal cord, brain stem, cerebral ganglia and cerebral cortex to alleviate pain. The central mechanisms underlying the effects of acupuncture include neurohumors and neurotransmitters, which are involved in analgesia. At spinal level, Spinal opioids, glutamate, norepinephrine and serotonin are the key elements acupuncture-induced analgesia. At brain level, Endogenous opioid peptides, limbic system play essential roles in mediating the analgesia. Conclusion: Acupuncture is an effective approach to pain management. There is good evidence in both experimental and clinical research that supports acupuncture efficacy in management of chronic pain through central nervous system. Acupuncture should be strongly used as a part of pain management plans. This work helps in improving our understanding of the scientific basis underlying acupuncture analgesia.

  13. Multimodal stilistik

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2012-01-01

    socialsemiotiske multimodalitetsteori. Formålet med en sådan multimodal stilistik er således at udvikle et konsistent systematisk analyseapparat, der kan fange og beskrive den multimodale semiosis, der realiseres i romanen såvel som i andre typer tekst. Med nedslag i et udvalg af skandinaviske og oversatte...

  14. 地佐辛及氟比洛芬酯多模式镇痛对食管癌患者术后镇痛效果的比较研究%Effect of multimodal analgesia of dezocine versus flurbiprofen in patients undergoing esophageal caner surgery

    Institute of Scientific and Technical Information of China (English)

    杨普春; 柯伟琪; 王静巍; 杨少辉

    2014-01-01

    Objective To compare the effect of multimodal analgesia between dezocine and flurbiprofen axetil which were used in patients undergoing esophageal caner surgery; to investigate the feasibility of preemptive and postoperative patient-controlled intravenous analgesia (PCIA) in major surgeries.Methods Sixty patients with Americam Society of Anesthesiologists Ⅰ-Ⅱ class and undergoing esophageal caner surgery were randomly divided into dezocine group(n =30) and flurbiprofen axetil group(n =30).The single intravnous injection dezocine (0.1 mg/kg) and flurbiprofen axetil 1 mg/kg were given 5 min before anesthesia started.Anesthesia of both group patients was induced with target controlled infusion of propofol,remifentanyland intermittent cisatracurium.All patients of two groups received PCIA pump after operation according to different PCIA formula:flurbiprofen axetil group received fentanyl 0.5 mg plus dezocine 30 mg; flurbiprofen axetil group received fentanyl 0.5 mg plus flurbiprofen axetil 200 mg; tropisetron 60 mg was also added identicanlly in two groups; total PCIA volume was 100 ml saline with loading volume 2 ml,background volume 2 ml/h,bolus dose 1.5 ml and lockout time was 15 min.The visual analogue scale/score,Prince-henry and Ramsay sedation scale were recorded 1,3,6,12,24 h after surgery.Total PCIA pressing times and the adverse effects were also recorded.Results At 6,12,24 h,compared with those in flurbiprofen axetil group,the scores of Ramsay in dezocine group were significantly increased [6 h:(3.5 ±0.6)scores vs (2.2 ±0.4)scores,12 h:(2.5 ±0.5)scores vs (2.1 ±0.3)scores,24 h:(2.2 ±0.3)scores vs (2.0 ± 0.4) scores,all P < 0.05].Compared with those in flurbiprofen axetil group,the total PCIA pressing times in dezocine group were significantly decreased[(10.8 ± 1.8) times vs (12.1 ± 1.3) times,P < 0.05].All patients had no respiratory depression and abnormal bleeding.Compared with dezocine group,the incidence of adverse reaction in 48 h in

  15. Colpocitologia em ambulatório de ginecologia preventiva

    Directory of Open Access Journals (Sweden)

    MOTTA E.V. DA

    2001-01-01

    Full Text Available OBJETIVOS: Avaliar os resultados de colpocitologia oncótica de mulheres atendidas em ambulatório de ginecologia preventiva (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Foram estudadas 6821 mulheres submetidas a exame clínico e ginecológico com realização de colpocitologia oncótica pela técnica de Papanicolaou. Estas mulheres foram consideradas conforme a faixa etária em três grupos: abaixo de 40 anos, entre 41 e 60 anos e acima de 60 anos. RESULTADOS: Amaioria das mulheres reconhecem tanto a necessidade da colpocitologia como sua periodicidade, principalmente entre as mais jovens. As mulheres acima de 60 anos eram as que mais referiam (54,1% não conhecer a necessidade da colpocitologia oncótica, nem sua periodicidade (58,8%; o grupo que melhor referia conhecimento da necessidade e periodicidade da colpocitologia oncótica foi o de mulheres entre 40 e 60 anos. O material foi considerado insuficiente para análise em 15,1% ou inadequado em 1,1%, sendo os resultados: classe I (21,7%, II (59,9%, III (2,0%, IV (0,1% e V (0,1%. Não houve diferença significativa em relação à distribuição dos casos de neoplasia intraepitelial (NIC entre as faixas etárias. O achado microbiológico mais freqüente foi Gardnerella sp. (8,6%. Presença de papilomavírus humano (HPV foi significativamente menor nas mulheres acima de 60 anos. CONCLUSÕES: O diagnóstico de alterações colpocitológicas relacionadas a neoplasias foi de 2,2% com detecção de Gardnerella sp. como o agente microbiológico mais prevalente por este método. A distribuição de infecção pelo HPV mostrou declínio com o aumento da faixa etária. As mulheres mais velhas foram as que menos apresentavam conhecimento sobre a realização de colpocitologia.

  16. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  17. Estratégias da medicina preventiva de Geoffrey Rose

    Directory of Open Access Journals (Sweden)

    Armando Henrique Norman

    2015-03-01

    Full Text Available Uma das atividades dos profissionais de saúde na prática dos serviços de atenção primária envolve a prevenção de doenças e a promoção da saúde. Essas atividades têm sido fortalecidas atualmente por meio de ações programáticas de saúde e manejo das doenças crônicas não transmissíveis. Esse contexto reforça a importância de se entenderem as bases da prevenção, discutidas no livro Estratégias da Medicina Preventiva de Geoffrey Rose.1 Rose classifica a prevenção de doenças em duas abordagens: a estratégia de alto risco (EAR e a estratégia de amplitude populacional (EAP. A primeira refere-se ao processo de separação entre os indivíduos de alto risco e os demais. A segunda visa abranger a população como um todo. A estratégia de alto risco parte de uma lógica binária de processo decisório que na medicina é denominada diagnose, ou seja, a pessoa tem ou não a condição a ser investigada. Em caso positivo, alguma intervenção lhe é oferecida; em caso negativo, ‘deixa-se a pessoa em paz’. A EAR é muito atrativa e, tradicionalmente, mais lógica e adequada: primeiro, porque faz sentido tanto aos profissionais como aos pacientes, visto que ambos entendem mais facilmente o porquê da intervenção; segundo, por ser custo-efetiva, pois os recursos são direcionados àqueles que mais precisam; finalmente, porque se encaixa mais no cotidiano dos serviços, que geralmente operam na lógica do modelo individual do cuidado às doenças.Existem, no entanto, algumas desvantagens desse tipo de intervenção: (1 tende-se a medicalizar a prevenção; (2 há que se manter o programa indefinidamente, pois não se intervém no problema de base; e (3 é difícil para aquele que recebe a intervenção quantificar seu real benefício, visto que se opera no campo da probabilidade (NNT: número necessário para tratar durante certo tempo para que uma pessoa se beneficie. Qual pessoa irá se beneficiar? Não sabemos. Porém, o

  18. [Systemic analgesia for postoperative pain management in the adult].

    Science.gov (United States)

    Binhas, M; Marty, J

    2009-02-01

    Severe postsurgical pain contributes to prolonged hospital stay and is also believed to be a risk factor for the development of chronic pain. Locoregional anesthesia, which results in faster patient recovery with fewer side effects, is favored wherever feasible, but is not applicable to every patient. Systemic analgesics are the most widely used method for providing pain relief in the postoperative period. Improvements in postoperative systemic analgesia for pain management should be applied and predictive factors for severe postoperative pain should be anticipated in order to control pain while minimizing opioid side effects. Predictive factors for severe postoperative pain include severity of preoperative pain, prior use of opiates, female gender, non-laparoscopic surgery, and surgeries involving the knee and shoulder. Pre- and intraoperative use of small doses of ketamine has a preventive effect on postoperative pain. Multimodal or balanced analgesia (the combined use of various analgesic agents) such as NSAID/morphine, NSAID/nefopam, morphine/ketamine improves analgesia with morphine-sparing effects. Nausea and vomiting, the principle side effects of morphine, can be predicted using Apfel's simplified score; patients with a high Apfel score risk should receive preemptive antiemetic agents aimed at different receptor sites, such as preoperative dexamethasone and intraoperative droperidol. Droperidol can be combined with morphine for postoperative patient-controlled anesthesia (PCA). When PCA is used, dosage parameters should be adjusted every day based on pain evaluation. Patients with presurgical opioid requirements will require preoperative administration of their daily opioid maintenance dose before induction of anesthesia: PCA offers useful options for effective postsurgical analgesia using a basal rate equivalent to the patient's hourly oral usage plus bolus doses as required.

  19. Multimodal perception and simulation

    NARCIS (Netherlands)

    Werkhoven, P.J.; Erp, J.B.F. van

    2013-01-01

    This chapter discusses mechanisms of multimodal perception in the context of multimodal simulators and virtual worlds. We review some notable findings from psychophysical experiments with a focus on what we call touch-inclusive multimodal perception—that is, the sensory integration of the tactile sy

  20. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an interm

  1. Placebo analgesia: understanding the mechanisms.

    Science.gov (United States)

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo analgesic effects. Distinct psychological traits can modulate expectations of analgesia, which facilitate brain pain control mechanisms involved in pain reduction. Many studies have highlighted the importance and clinical relevance of these responses. Gaining deeper understanding of these pain modulatory mechanisms has important implications for personalizing patient pain management.

  2. SE ENCUENTRA VIGENTE LA DETENCIÓN PREVENTIVA ADMINISTRATIVA? (CAPTURA ADMINISTRATIVA

    Directory of Open Access Journals (Sweden)

    Saúl de Jesús Uribe García

    2011-01-01

    Full Text Available La libertad personal es un derecho fundamental, no absoluto, puesto que puede limitarse con sujeción estricta a los requisitos constitucionales y legales. El derecho a la libertad personal puede limitarse por orden de autoridad judicial competente, y para esos efectos, la autoridad judicial competente es el juez con función de control de garantías, el juez de conocimiento o de maneraexcepcional la Fiscalía General de la Nación. La flagrancia es una excepción a esa orden de autoridad judicial competente para limitar la libertad personal, pero en el artículo 28, inciso segundo de la Constitución Política, existe la llamada Detención Preventiva Administrativa, cuyos lineamientos para su aplicación, fueron trazados por la Corte Constitucional, sin que se requiriera orden de autoridad judicial competente para privar de la libertad personal a una persona. Posteriormente, con la vigencia del Sistema Penal de corte Acusatorio, dicha figura fue cuestionada y se tornó dudosa su aplicación conforme los lineamientos trazados por la Corte Constitucional.Posteriormente, la Corte Constitucional retoma el tema de la Detención Preventiva Administrativa, retira del ordenamiento jurídico la interpretación anterior y concluye que la Detención preventiva Administrativa procede siempre que exista orden de captura proferida por una autoridad judicial competente. Posteriormente, la Corte Suprema de Justicia, Sala de Casación Penal, en algunas decisiones de habeas corpus, parece revivir la figura de la Detención Preventiva Administrativa.

  3. Fundamentos de la detención preventiva en el procedimiento penal colombiano

    OpenAIRE

    Leonardo Cruz Bolívar

    2012-01-01

    La contribución se ocupa de analizar en concreto los principios que rigen la privación preventiva de la libertad en el procedimiento penal, desde el punto de vista constitucional, legal y de instrumentos internacionales, buscando armonizar los criterios que utilizan los jueces de garantías al momento de resolver la solicitud del fiscal en esta materia. El principio de proporcionalidad constitucional, los elementos desarrollados legalmente y los pronunciamientos del sistema interamericano de d...

  4. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  5. Pharmacogenomic considerations in opioid analgesia

    Directory of Open Access Journals (Sweden)

    Vuilleumier PH

    2012-08-01

    Full Text Available Pascal H Vuilleumier,1 Ulrike M Stamer,1 Ruth Landau21Klinik für Anästhesiologie und Schmerztherapie, Inselspital Universität Bern, Switzerland; 2Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USAAbstract: Translating pharmacogenetics to clinical practice has been particularly challenging in the context of pain, due to the complexity of this multifaceted phenotype and the overall subjective nature of pain perception and response to analgesia. Overall, numerous genes involved with the pharmacokinetics and dynamics of opioids response are candidate genes in the context of opioid analgesia. The clinical relevance of CYP2D6 genotyping to predict analgesic outcomes is still relatively unknown; the two extremes in CYP2D6 genotype (ultrarapid and poor metabolism seem to predict pain response and/or adverse effects. Overall, the level of evidence linking genetic variability (CYP2D6 and CYP3A4 to oxycodone response and phenotype (altered biotransformation of oxycodone into oxymorphone and overall clearance of oxycodone and oxymorphone is strong; however, there has been no randomized clinical trial on the benefits of genetic testing prior to oxycodone therapy. On the other hand, predicting the analgesic response to morphine based on pharmacogenetic testing is more complex; though there was hope that simple genetic testing would allow tailoring morphine doses to provide optimal analgesia, this is unlikely to occur. A variety of polymorphisms clearly influence pain perception and behavior in response to pain. However, the response to analgesics also differs depending on the pain modality and the potential for repeated noxious stimuli, the opioid prescribed, and even its route of administration.Keywords: pain perception, opioid analgesia, genetic variation, pharmacogenetics

  6. Placebo analgesia: understanding the mechanisms

    OpenAIRE

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

  7. The Intersection of Multimodality and Critical Perspective: Multimodality as Subversion

    Science.gov (United States)

    Huang, Shin-ying

    2015-01-01

    This study explores the relevance of multimodality to critical media literacy. It is based on the understanding that communication is intrinsically multimodal and multimodal communication is inherently social and ideological. By analysing two English-language learners' multimodal ensembles, the study reports on how multimodality contributes to a…

  8. Refining analgesia strategies using lasers.

    Science.gov (United States)

    Hampshire, Victoria

    2015-08-01

    Sound programs for the humane care and use of animals within research facilities incorporate experimental refinements such as multimodal approaches for pain management. These approaches can include non-traditional strategies along with more established ones. The use of lasers for pain relief is growing in popularity among companion animal veterinary practitioners and technologists. Therefore, its application in the research sector warrants closer consideration.

  9. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  10. Towards Multimodal Content Representation

    CERN Document Server

    Bunt, Harry

    2009-01-01

    Multimodal interfaces, combining the use of speech, graphics, gestures, and facial expressions in input and output, promise to provide new possibilities to deal with information in more effective and efficient ways, supporting for instance: - the understanding of possibly imprecise, partial or ambiguous multimodal input; - the generation of coordinated, cohesive, and coherent multimodal presentations; - the management of multimodal interaction (e.g., task completion, adapting the interface, error prevention) by representing and exploiting models of the user, the domain, the task, the interactive context, and the media (e.g. text, audio, video). The present document is intended to support the discussion on multimodal content representation, its possible objectives and basic constraints, and how the definition of a generic representation framework for multimodal content representation may be approached. It takes into account the results of the Dagstuhl workshop, in particular those of the informal working group...

  11. Proposta preventiva de la disfonia infantil a través de la dansa

    OpenAIRE

    Ligero Tienda, Aida

    2016-01-01

    Aquest article és un projecte professional sobre la disfonia i la seva prevenció en infants, amb l'objectiu de dissenyar una proposta preventiva a través d'una classe de ball. Per això s'ha consultat una extensa bibliografia sobre disfonia, el seu tractament en infants, postura i hàbits posturals, així com articles sobre la producció de la veu. This article is a professional project on the prevention and dysphonia in children, with the aim of designing a proposal prevention through a dance...

  12. LAS MEDIDAS PREVENTIVAS AMBIENTALES, UNA APROXIMACIÓN DESDE EL DERECHO ADMINISTRATIVO.

    Directory of Open Access Journals (Sweden)

    Iván Andrés Páez Páez

    2013-05-01

    Full Text Available Las medidas preventivas previstas en el régimen sancionatorio ambiental sonuna especie de las medidas cautelares consagradas en el ordenamiento jurídicocolombiano, aunque con algunas particularidades propias de su ámbito deaplicación, que es el derecho ambiental. El artículo realiza una aproximaciónrespecto al contenido, alcance, antecedentes y justificación de las medidaspreventivas ambientales desde la óptica del derecho administrativo y comomanifestación de una de las funciones del ejecutivo, cual es el mantenimientodel orden público.

  13. LAS MEDIDAS PREVENTIVAS AMBIENTALES, UNA APROXIMACIÓN DESDE EL DERECHO ADMINISTRATIVO.

    OpenAIRE

    Iván Andrés Páez Páez; Gloria Amparo Rodríguez

    2013-01-01

    Las medidas preventivas previstas en el régimen sancionatorio ambiental sonuna especie de las medidas cautelares consagradas en el ordenamiento jurídicocolombiano, aunque con algunas particularidades propias de su ámbito deaplicación, que es el derecho ambiental. El artículo realiza una aproximaciónrespecto al contenido, alcance, antecedentes y justificación de las medidaspreventivas ambientales desde la óptica del derecho administrativo y comomanifestación de una de las funciones del ejecuti...

  14. Odontología preventiva en el paciente geriátrico

    OpenAIRE

    Velasco-Ortega, Eugenio; Machuca-Portillo, Guillermo; Martinez-Sahuquillo Marquez, Angel; Ríos-Santos, J.V.; Bullon, Pedro

    1995-01-01

    El incremento de la población mayor de 65 años y sus necesidades crecientes de tratamiento oral, está modificando el desarrollo de una filosofía preventiva odontológica para los pacientes de edad avanzada. Si queremos que los ancianos gocen de un buen estado de salud oral en la senectud, deben beneficiarse de los medios preventivos orales, actualmente a nuestro alcance. Debe prevenirse el edentulismo mediante un tratamiento integral y restaurador de las enfermedades dentales más frecuentes (c...

  15. Partial reinforcement, extinction, and placebo analgesia.

    Science.gov (United States)

    Au Yeung, Siu Tsin; Colagiuri, Ben; Lovibond, Peter F; Colloca, Luana

    2014-06-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electrocutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) under the guise of an analgesic trial. The participants were randomly allocated to different conditioning schedules, namely continuous reinforcement (CRF), partial reinforcement (PRF), or control (no conditioning). Conditioning was achieved by surreptitiously reducing pain intensity during training when the placebo was activated compared with when it was inactive. For the CRF group, the placebo was always followed by a surreptitious reduction in pain during training. For the PRF group, the placebo was followed by a reduction in pain stimulation on 62.5% of trials only. In the test phase, pain stimulation was equivalent across placebo and no placebo trials. Both CRF and PRF produced placebo analgesia, with the magnitude of initial analgesia being larger after CRF. However, although the placebo analgesia established under CRF extinguished during test phase, the placebo analgesia established under PRF did not. These findings indicate that PRF can induce placebo analgesia and that these effects are more resistant to extinction than those established via CRF. PRF may therefore reflect a novel way of enhancing clinical outcomes via the placebo effect.

  16. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  17. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention.

  18. Critical Analysis of Multimodal Discourse

    DEFF Research Database (Denmark)

    van Leeuwen, Theo

    2013-01-01

    This is an encyclopaedia article which defines the fields of critical discourse analysis and multimodality studies, argues that within critical discourse analysis more attention should be paid to multimodality, and within multimodality to critical analysis, and ends reviewing a few examples...... of recent work in the critical analysis of multimodal discourse....

  19. Informe de Producción y Cobertura de Prestaciones Preventivas 2014 SIS-MINSA Perú

    OpenAIRE

    Seguro Integral de Salud

    2016-01-01

    El presente informe tiene como ámbito todas las atenciones preventivas realizadas en el año 2014 (como periodo de atención) a nivel nacional y en IPRESS de todo nivel de atención.El SIS considera que el ámbito preventivo-promocional en la gestión de la Salud y Políticas Públicas por resultados es un pilar fundamental en base a la evidencia acumulada que demuestra la alta costo-efectividad de las actividades preventivas individuales y colectivas para reducir el gasto sanitario dire...

  20. Intranasal sufentanil/ketamine analgesia in children

    DEFF Research Database (Denmark)

    Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne;

    2014-01-01

    The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking.......The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

  1. Analgesia pós-operatória Postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Betina Sílvia Beozzo Bassanezi

    2006-04-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A dor sempre foi uma das maiores preocupações do homem, entretanto, apesar dos progressos da ciência, ainda existem várias barreiras ao seu adequado tratamento, incluindo a falta de conhecimento por parte da equipe médica, sobre o mecanismo das diversas drogas e técnicas empregadas. O objetivo deste trabalho é abordar as principais drogas e técnicas empregadas no controle da dor pós-operatória, visando estimular o interesse sobre o assunto bem como aumentar a eficácia do tratamento dado aos pacientes. CONTEÚDO: Está ressaltada neste artigo, a importância da adequada analgesia pós-operatória, considerando as principais drogas e técnicas utilizadas no controle da dor, seus mecanismos de ação, posologias, vias de administração e efeitos colaterais, bem como a importância da integração de toda a equipe envolvida nos cuidados do paciente para o sucesso do tratamento. O tratamento inadequado da dor no pós-operatório não se justifica, pois há um arsenal considerável de drogas e técnicas analgésicas. O que se faz necessário, portanto, é que toda equipe, anestesistas, cirurgiões, e enfermeiros tenham conhecimento e estejam integrados na utilização deste arsenal.BACKGROUND AND OBJECTIVES: Pain has been one of the men's biggest worries. Despite of scientific progress there still exist many barriers in an adequate treatment of pain including the lack of knowledge of many drugs and pain management techniques. The objective of this study is to discuss the main drugs and analgesics process in an effort to stimulate our colleague interest about the subject and thus increasing treatment efficiency of our patients. CONTENTS: It is emphasized in this study the importance of an adequate postoperative analgesia discussing the main drugs and techniques used in pain management, their mechanism of action, dose, administration route and side effects of each drug. It is also pointed out the great importance

  2. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2015-01-01

    Full Text Available Background: The transverse abdominis plane (TAP block, a regional block provides effective analgesia after lower abdominal surgeries if used as part of multimodal analgesia. In this prospective, randomized double-blind study, we determined the efficacy of TAP block in patients undergoing cesarean section. Materials and Methods: Totally, 62 parturients undergoing cesarean section were randomized in a double-blind manner to receive either bilateral TAP block at the end of surgery with 20 ml of 0.25% bupivacaine or no TAP block, in addition to standard analgesic comprising 75 mg diclofenac 8 hourly and intravenous patient-controlled analgesia (PCA tramadol. Each patient was assessed at 0, 4, 8, 12, 24, 36, and 48 h after surgery by an independent observer for pain at rest and on movement using numeric rating scale of 0-10, time of 1 st demand for tramadol, total consumption of PCA tramadol, satisfaction with pain management and side effects. Results: Use of tramadol was reduced in patients given TAP block by 50% compared to patients given no block during 48 h after surgery (P < 0.001. Pain scores were lower both on rest and activity at each time point for 24 h in study group (P < 0.001, time of first analgesia was significantly longer, satisfaction was higher, and side effects were less in study group compared to control group. Conclusion: Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 48 h after cesarean section when used as adjunctive to standard analgesia.

  3. Hypno-analgesia and acupuncture analgesia: a neurophysiological reality?

    Science.gov (United States)

    Saletu, B; Saletu, M; Brown, M; Stern, J; Sletten, I; Ulett, G

    1975-01-01

    The effects of hypnosis, acupuncture and analgesic drugs on the subjective experience of pain and on objective neurophysiological parameters were investigated. Pain was produced by brief electric stimuli on the wrist. Pain challengers were: hypnosis (induced by two different video tapes), acupuncture (at specific and unspecific loci, with and without electrical stimulation of the needles), morphine and ketamine. Evaluation of clinical parameters included the subjective experience of pain intensity, blood pressure, puls, temperature, psychosomatic symptoms and side effects. Neurophysiological parameters consisted of the quantitatively analyzed EEG and somatosensory evlked potential (SEP). Pain was significantly reduced by hypnosis, morphine and ketamine, but not during the control seesion. Of the four acupuncture techniques, only electro-acupuncture at specific loci significantly decreased pain. The EEG changes during hypnosis were dependent on the wording of the suggestion and were characterized by an increase of slow and a decrease of fast waves. Acupuncture induced just the opposite changes, which were most significant when needles were inserted at traditional specific sites and stimulated electrically. The evoked potential findings suggested that ketamine attenuates pain in the thalamo-cortical pathways, while hypnosis, acupuncture and morphine induce analgesia at the later CNS stage of stimulus processing. Finally some clinical-neurophysiological correlations were explored.

  4. EVALUACIÓN DE RIESGOS Y PLANIFICACIÓN PREVENTIVA DE UN PUNTO LIMPIO

    OpenAIRE

    Saavedra-Ferro, Alicia

    2013-01-01

    La actividad empresarial escogida para la realización del trabajo es una organización dedicada a la gestión de residuos, concretamente se realizará la Evaluación Inicial de Riesgos Laborales y la Planificación de la actividad preventiva de un Punto Limpio que es gestionado por dicha empresa. La justificación de la elección de esta actividad empresarial se debe a la realización del módulo de prácticas externas en el seno de una empresa de estas características y por interés pers...

  5. Comportamento suicida: fatores de risco e intervenções preventivas

    OpenAIRE

    Kelly Piacheski de Abreu; Maria Alice Dias da Silva Lima; Eglê Kohlrausch; Joannie Fachinelli Soares

    2010-01-01

    As taxas de suicídio evidenciam um problema de saúde pública, e ações preventivas são necessárias. O objetivo deste artigo de atualização é discorrer sobre fatores de risco para o comportamento suicida e as possíveis intervenções utilizadas para sua prevenção na atenção primária à saúde. Os fatores de risco mais importantes para comportamento suicida são: transtornos mentais, antecedentes familiares, sexo, idade, relações familiares, abuso de substâncias,problemas físicos e situação social de...

  6. Fundamentos de la detención preventiva en el procedimiento penal colombiano

    Directory of Open Access Journals (Sweden)

    Leonardo Cruz Bolívar

    2012-12-01

    Full Text Available La contribución se ocupa de analizar en concreto los principios que rigen la privación preventiva de la libertad en el procedimiento penal, desde el punto de vista constitucional, legal y de instrumentos internacionales, buscando armonizar los criterios que utilizan los jueces de garantías al momento de resolver la solicitud del fiscal en esta materia. El principio de proporcionalidad constitucional, los elementos desarrollados legalmente y los pronunciamientos del sistema interamericano de derechos humanos dan base a las interpretaciones que se proponen en el artículo, buscando proteger la libertad, sin renunciar a las necesidades básicas de la justicia y la sociedad que requieren un proceso penal eficiente y que responda a la realidad nacional.

  7. Estados Unidos-Medio Oriente: de la contención a la guerra preventiva

    OpenAIRE

    Zeraoui, Zidane

    2009-01-01

    La política norteamericana hacia el Medio Oriente ha transitado desde la doctrina de la contención, aplicada por el presidente Truman a partir de 1948 para detener la supuesta expansión comunista, y vigente hasta la caída de la Unión Soviética, a la guerra preventiva iniciada por el presidente George W. Bush a partir de septiembre de 2002. Entre estas dos políticas, durante la década de los años noventa, Washington ha elaborado la doctrina de la doble contención, específicamente en relación a...

  8. Comportamento suicida: fatores de risco e intervenções preventivas

    Directory of Open Access Journals (Sweden)

    Kelly Piacheski de Abreu

    2010-03-01

    Full Text Available As taxas de suicídio evidenciam um problema de saúde pública, e ações preventivas são necessárias. O objetivo deste artigo de atualização é discorrer sobre fatores de risco para o comportamento suicida e as possíveis intervenções utilizadas para sua prevenção na atenção primária à saúde. Os fatores de risco mais importantes para comportamento suicida são: transtornos mentais, antecedentes familiares, sexo, idade, relações familiares, abuso de substâncias,problemas físicos e situação social desfavorável. Considerando que os usuários com comportamento suicida tendem a procurar auxílio nos serviços de atenção primária antes de morrer, é possível identificar a presença desse comportamento. O foco de implementação do cuidado deve ser direcionado àqueles que se enquadram em situaçõesde agravos que predisponham às tentativas de suicídio. Por isso, o conhecimento dos fatores de risco e intervenções preventivas para o comportamento suicida pode trazer benefícios para a comunidade e profissionais de saúde, garantindo um cuidado seguro e tecnicamente orientado. Para isso é necessária a sensibilização dos profissionais de saúde para o uso de tecnologias relacionais, bem como estratégias de acolhimento e vínculo para a identificação dos fatores de risco, bem como a estruturação de ações em saúde mental para serem desenvolvidas com suas comunidades e escolas.

  9. Resolving the Brainstem Contributions to Attentional Analgesia

    Science.gov (United States)

    Brooks, Jonathan C.W.; Davies, Wendy-Elizabeth

    2017-01-01

    Previous human imaging studies manipulating attention or expectancy have identified the periaqueductal gray (PAG) as a key brainstem structure implicated in endogenous analgesia. However, animal studies indicate that PAG analgesia is mediated largely via caudal brainstem structures, such as the rostral ventromedial medulla (RVM) and locus coeruleus (LC). To identify their involvement in endogenous analgesia, we used brainstem optimized, whole-brain imaging to record responses to concurrent thermal stimulation (left forearm) and visual attention tasks of titrated difficulty in 20 healthy subjects. The PAG, LC, and RVM were anatomically discriminated using a probabilistic atlas. Pain ratings disclosed the anticipated analgesic interaction between task difficulty and pain intensity (p pain intensity. Intersubject analgesia scores correlated to activity within a distinct region of the RVM alone. These results identify distinct roles for a brainstem triumvirate in attentional analgesia: with the PAG activated by attentional load; specific RVM regions showing pronociceptive and antinociceptive processes (in line with previous animal studies); and the LC showing lateralized activity during conflicting attentional demands. SIGNIFICANCE STATEMENT Attention modulates pain intensity, and human studies have identified roles for a network of forebrain structures plus the periaqueductal gray (PAG). Animal data indicate that the PAG acts via caudal brainstem structures to control nociception. We investigated this issue within an attentional analgesia paradigm with brainstem-optimized fMRI and analysis using a probabilistic brainstem atlas. We find pain intensity encoding in several forebrain structures, including the insula and attentional activation of the PAG. Discrete regions of the rostral ventromedial medulla bidirectionally influence pain perception, and locus coeruleus activity mirrors the interaction between attention and nociception. This approach has enabled the

  10. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  11. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  12. Involvement of connexin 43 in acupuncture analgesia

    Institute of Scientific and Technical Information of China (English)

    HUANG Guang-ying; ZHENG Cui-hong; YU Wei-chang; TIAN Dai-shi; WANG Wei

    2009-01-01

    Background Connexin 43 (Cx43) is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli (ST36) acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia. Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

  13. Effect of Oxycodone on multimodality postoperative analgesia and the quality of awakening in panhys-terectomy%羟考酮用于全子宫切除术后多模式镇痛的效果及对苏醒质量的影响

    Institute of Scientific and Technical Information of China (English)

    王冰; 杨海慧; 李长科

    2016-01-01

    Objective To observe the effect of Fentanyl combing with oxycodone to cure postoperative analgesia and the quality of awakening in hysterectomy and compare with fentanyl alone. Method 60 patients( ASA Ⅰ ~ Ⅱ )acceptted gyneco-logical laparoscopic hysterectomy were divided into two groups randomly:fentanyl group(F group,n = 30)and the group of oxyc-odone combined with fentanyl(OF group,n = 30). Two groups were given tracheal cannula and intravenous anesthesia. F group was given fentanyl 2μg / kg by intravenous injection,OF group were given oxycodone 0. 1mg / kg and fentanyl 1μg / kg by the same way when beginning sewing skin and the drugs given were diluted to 10 ml in 0. 9% saline. MAP 、HR 、SpO2 before drug and 10 min 、20 min、30 min after drugwere recorded;Recording the time from Discontinuation to spontaneous breathing recovery, to orientation recovery and to extubation. Scales of VAS and RASS of 1 h、2 h、4 h、8 h after operation were recorded. And degree of satisfaction and adverse reactions were recorded too. Results MAP,HR,SpO2 were no significant difference in two groups(P> 0. 05). Scales of VAS and RASS of OF group was significantly lower than that in F group(P > 0. 05),Adverse reactions were no significant difference in two groups(P > 0. 05). Degree of satisfaction in OF group were significantly higher than that in F group. Conclusion Fentanyl combined with oxycodone for postoperative analgesia of laparoscopic hysterectomy are safe and effec-tive,the degree of satisfaction of patients was higher than fentanyl.%目的:观察羟考酮联合芬太尼用于妇科腔镜下行全子宫切除术患者术后镇痛的效果及对苏醒质量的影响,并与单独使用芬太尼比较。方法:选择妇科腔镜下全子宫切除术患者60例,随机平均分为芬太组(F 组)和羟考酮联合芬太尼组(OF 组)。两组均采用气管插管、全凭静脉麻醉。开始缝皮时 F 组静脉滴注芬太尼2μg/ kg,OF

  14. Multimodal Resources in Transnational Adoption

    DEFF Research Database (Denmark)

    Raudaskoski, Pirkko Liisa

    The paper discusses an empirical analysis which highlights the multimodal nature of identity construction. A documentary on transnational adoption provides real life incidents as research material. The incidents involve (or from them emerge) various kinds of multimodal resources and participants...

  15. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    Directory of Open Access Journals (Sweden)

    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  16. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  17. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed......: feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than...

  18. Multimodal sequence learning.

    Science.gov (United States)

    Kemény, Ferenc; Meier, Beat

    2016-02-01

    While sequence learning research models complex phenomena, previous studies have mostly focused on unimodal sequences. The goal of the current experiment is to put implicit sequence learning into a multimodal context: to test whether it can operate across different modalities. We used the Task Sequence Learning paradigm to test whether sequence learning varies across modalities, and whether participants are able to learn multimodal sequences. Our results show that implicit sequence learning is very similar regardless of the source modality. However, the presence of correlated task and response sequences was required for learning to take place. The experiment provides new evidence for implicit sequence learning of abstract conceptual representations. In general, the results suggest that correlated sequences are necessary for implicit sequence learning to occur. Moreover, they show that elements from different modalities can be automatically integrated into one unitary multimodal sequence.

  19. Multimodal Processes Rescheduling

    DEFF Research Database (Denmark)

    Bocewicz, Grzegorz; Banaszak, Zbigniew A.; Nielsen, Peter

    2013-01-01

    Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe-cuted in the......Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe...

  20. Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

    Directory of Open Access Journals (Sweden)

    Gabriela Carvalho Aquilino Santos

    2015-04-01

    Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 mg.kg-1. iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

  1. The effects of maternal labour analgesia on the fetus.

    Science.gov (United States)

    Reynolds, Felicity

    2010-06-01

    Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. Inhalational analgesia using Entonox is more effective and, being rapidly exhaled by the newborn, is less likely to produce lasting depression. Neuraxial analgesia has maternal physiological and biochemical effects, some of which are potentially detrimental and some favourable to the fetus. Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.

  2. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  3. Multimodal emergens via musik

    DEFF Research Database (Denmark)

    Bonde, Anders

    2010-01-01

    I denne artikel præsenteres og argumenteres for en værkanalytisk indfaldsvinkel i forhold til det at undersøge multimodal betydningsdannelse i audiovisuelle medieprodukter såsom reklamefilm og dokumentarfilm, hvor flere forskellige modaliteter eller semiotiske ressourcer samvirker. Som teoretisk...

  4. Multimode geodesic branching components

    Science.gov (United States)

    Schulz, D.; Voges, E.

    1983-01-01

    Geodesic branching components are investigated for multimode guided wave optics. Geodesic structures with particular properties, e.g. focussing star couplers, are derived by a synthesis technique based on a theorem of Toraldo di Francia. Experimentally, the geodesic surfaces are printed on acrylic glass and are spin-coated with organic film waveguides.

  5. Modeling Multimodal Stratification

    DEFF Research Database (Denmark)

    Boeriis, Morten

    2017-01-01

    This article discusses one of the core axioms of social semiotic theory, namely stratification, in the light of developments in multimodality in recent years. The discussion takes a point of departure in the approaches to stratification taken by Hjelmslev, Halliday, and Kress and van Leeuwen...

  6. Decreto y ejecución de las medidas preventivas en el arbitraje

    Directory of Open Access Journals (Sweden)

    Andreína Velasco Pérez

    2014-01-01

    Full Text Available Se ha recogido en estas páginas, la evidencia del afán innovador del legislador patrio y la máxima expresión de libertad en el ordenamiento jurídico venezolano, para con la conducta procesal del árbitro, al estar abierta la posibilidad de incursionar en nuevas interpretaciones que puedan cambiar sustancialmente, la concepción misma de su discrecionalidad, en el decreto de Medidas Cautelares. La ausencia de los límites o el alcance de sus facultades, dentro de la normativa procesal, motiva el planteamiento siguiente, sin otra intención que examinar la autoridad del Juzgador, frente a la norma que la sustenta. Para lograr estas aspiraciones, se ha señalado como objetivo general su análisis, mediante el examen de las exigencias necesarias para su ejercicio, y así, determinar los límites del administrador de justicia ad hoc, en toda su magnitud jurídica, todo bajo la incuestionable influencia del principio de interés social. Al efecto, se apeló a la metodología operatoria del proceso de investigación documental, como instrumento de conocimiento y apoyada en el diseño descriptivo, para darle respuesta a la problemática en cuestión, fundamentada en criterios del Tribunal Supremo de Justicia venezolano, la Constitución Nacional y de procesalistas patrios como Ricardo Henriquez La Roche. Este estudio logró precisar que el decreto de las medidas preventivas por parte del tribunal arbitral, garantiza el derecho a la defensa, por lo que su total aceptación, sería un paso hacia adelante, en la consecución del debido proceso.

  7. Uma chama que se apaga: residência de medicina preventiva e social

    Directory of Open Access Journals (Sweden)

    Adriano Massuda

    Full Text Available O processo de extinção da residência de Medicina Preventiva e Social (RMPS constitui um paradoxo diante da necessidade de médicos com especialização em Saúde Coletiva para atuar no Sistema Único de Saúde. O presente artigo realizou uma revisão do processo histórico de construção das RMPS e investigou a estrutura atual dos programas remanescentes a partir da análise dos cenários de prática e das atividades práticas e teóricas desenvolvidas. Ao final foi possível construir uma tipologia em que se identifica o tipo Generalista em Saúde Coletiva, que aborda as três áreas nucleares da Saúde Coletiva; o tipo da Epidemiologia, no qual o foco é exclusivamente essa área; e o tipo da Saúde Comunitária, que se centra na Atenção Primária em Saúde. Do cruzamento do processo histórico de construção com a realidade atual, pode-se inferir que os fatores que têm contribuído para a extinção da RMPS são principalmente a ausência de políticas de Estado para formação na área, bem como o não comprometimento de sujeitos sociais que se relacionam com essa residência, levando à existência de anacrônicas diretrizes orientadoras para formação profissional

  8. Multimodal eye recognition

    Science.gov (United States)

    Zhou, Zhi; Du, Yingzi; Thomas, N. L.; Delp, Edward J., III

    2010-04-01

    Multimodal biometrics use more than one means of biometric identification to achieve higher recognition accuracy, since sometimes a unimodal biometric is not good enough used to do identification and classification. In this paper, we proposed a multimodal eye recognition system, which can obtain both iris and sclera patterns from one color eye image. Gabor filter and 1-D Log-Gabor filter algorithms have been applied as the iris recognition algorithms. In sclera recognition, we introduced automatic sclera segmentation, sclera pattern enhancement, sclera pattern template generation, and sclera pattern matching. We applied kernelbased matching score fusion to improve the performance of the eye recognition system. The experimental results show that the proposed eye recognition method can achieve better performance compared to unimodal biometric identification, and the accuracy of our proposed kernel-based matching score fusion method is higher than two classic linear matching score fusion methods: Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA).

  9. Programmable Multimode Quantum Networks

    CERN Document Server

    Armstrong, Seiji; Janousek, Jiri; Hage, Boris; Treps, Nicolas; Lam, Ping Koy; Bachor, Hans-A

    2012-01-01

    Entanglement between large numbers of quantum modes is the quintessential resource for quantum information processing and future applications such as the quantum internet. Conventionally the generation of multimode entanglement in optics requires complex layouts of beam-splitters and phase shifters in order to transform the input modes in to entangled modes. These networks need substantial modification for every new set of entangled modes to be generated. Further, the complexity grows rapidly with the number of entangled modes as the number of detectors, phase locks and optical components needs to be increased. Here we report on the highly efficient and versatile generation of various multimode entangled states within one optical beam. By defining our modes to be combinations of different spatial regions of the beam, we may use just one pair of multi-pixel detectors and one local oscillator to measure an orthogonal set of modes. The transformation of this set into a desired set of entangled modes is calculate...

  10. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  11. Remifentanil for labor analgesia: an evidence-based narrative review.

    Science.gov (United States)

    Van de Velde, M; Carvalho, B

    2016-02-01

    This manuscript reviews the available literature on remifentanil patient-controlled intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares favorably to other potent systemic opioids but with fewer opioid-related neonatal effects. However, remifentanil provides modest and short-lasting labor analgesia that is consistently inferior when compared to neuraxial analgesia. The initial analgesic effect provided with remifentanil also diminishes as labor progresses. In several studies, remifentanil induced significant respiratory depressant effects in laboring women with episodes of desaturation, hypoventilation and even apnea. Given the safety concerns, we recommend that remifentanil patient-controlled intravenous analgesia should not be a routine analgesia technique during labor. In cases where neuraxial analgesia is refused or contraindicated and the use of remifentanil justified, continuous and careful monitoring is required to detect respiratory depression to provide safe care of both the pregnant woman and unborn child.

  12. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  13. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    Institute of Scientific and Technical Information of China (English)

    Lorella; Fanti; Pier; Alberto; Testoni

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...

  14. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    OpenAIRE

    Fanti, Lorella; Testoni, Pier Alberto

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures. The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of the examination, the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation. The properties of a model sedat...

  15. Hands-and-knees positioning during labor with epidural analgesia.

    Science.gov (United States)

    Stremler, Robyn; Halpern, Stephen; Weston, Julie; Yee, Jennifer; Hodnett, Ellen

    2009-01-01

    Hands-and-knees position has shown promise as an intervention to improve labor and birth outcomes, but no reports exist that examine its use with women laboring with epidural analgesia. Concerns of safety, effects on analgesia, and acceptability of use may limit use of active positioning during labor with regional analgesia. This article presents a case study series of 13 women who used hands-and-knees position in the first stage of labor.

  16. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  17. Offset analgesia is reduced in older adults.

    Science.gov (United States)

    Naugle, Kelly M; Cruz-Almeida, Yenisel; Fillingim, Roger B; Riley, Joseph L

    2013-11-01

    Recent studies indicate that aging is associated with dysfunctional changes in pain modulatory capacity, potentially contributing to increased incidence of pain in older adults. However, age-related changes in offset analgesia (offset), a form of temporal pain inhibition, remain poorly characterized. The purpose of this study was to investigate age differences in offset analgesia of heat pain in healthy younger and older adults. To explore the peripheral mechanisms underlying offset, an additional aim of the study was to test offset at 2 anatomical sites with known differences in nociceptor innervation. A total of 25 younger adults and 20 older adults completed 6 offset trials in which the experimental heat stimulus was presented to the volar forearm and glabrous skin of the palm. Each trial consisted of 3 continuous phases: an initial 15-second painful stimulus (T1), a slight increase in temperature from T1 for 5 seconds (T2), and a slight decrease back to the initial testing temperature for 10 seconds (T3). During each trial, subjects rated pain intensity continuously using an electronic visual analogue scale (0-100). Older adults demonstrated reduced offset compared to younger adults when tested on the volar forearm. Interestingly, offset analgesia was nonexistent on the palm for all subjects. The reduced offset found in older adults may reflect an age-related decline in endogenous inhibitory systems. However, although the exact mechanisms underlying offset remain unknown, the absence of offset at the palm suggests that peripheral mechanisms may be involved in initiating this phenomenon.

  18. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    Directory of Open Access Journals (Sweden)

    Varaprasad

    2015-07-01

    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  19. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Directory of Open Access Journals (Sweden)

    Florian Chouchou

    Full Text Available The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers. Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1 placebo analgesia improved with REM sleep deprivation; 2 pain relief expectations did not differ between REM sleep deprivation and control groups; and 3 REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  20. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM) sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers). Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1) placebo analgesia improved with REM sleep deprivation; 2) pain relief expectations did not differ between REM sleep deprivation and control groups; and 3) REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  1. Fatores de risco e medidas preventivas das infecções associadas a cateteres venosos centrais

    Directory of Open Access Journals (Sweden)

    Viviane Rosado

    2011-12-01

    Full Text Available OBJETIVO: Rever os fatores de risco para infecção associada a cateteres venosos centrais e as recomendações para a sua prevenção. FONTES DOS DADOS: Foram revisados artigos publicados sobre o tema no PubMed, Cochrane Collaboration e Bireme. Os seguintes critérios de inclusão foram levados em consideração: trabalhos publicados entre 2000 e 2010, delineamento do estudo, população pediátrica hospitalizada com utilização de cateteres venosos centrais e artigos sobre infecção associada a cateteres venosos centrais. Além disso, foram utilizados documentos de referência dos Centers for Disease Control and Prevention e da Agência Nacional de Vigilância Sanitária. SÍNTESE DOS DADOS: Os fatores de risco associados foram: tempo de utilização de acesso central, duração da internação e uso de cateter central de longa permanência, colocação de cateter venoso central em Unidade de Terapia Intensiva, doença cardiovascular não cirúrgica, recebimento de nutrição parenteral e de transfusão de hemoderivados. Entre as medidas preventivas, a literatura recomenda a implementação de protocolos e diretrizes multidisciplinares de cuidados na inserção e manutenção dos cateteres centrais, cuidados com a técnica de inserção dos cateteres venosos centrais, utilização de curativos impregnados com clorexidina, retirada precoce do cateter e adoção de programas de educação continuada para a equipe assistencial. CONCLUSÃO: O controle dos fatores de risco pode levar a uma redução igual ou superior a 40% na incidência dessas infecções. A vigilância do processo de inserção e cuidados com os cateteres vasculares centrais na população pediátrica orienta a padronização de rotinas dos serviços de saúde para a obtenção de taxas de referência para comparação intra e interinstitucionais.

  2. ADESÃO ÀS MEDIDAS PREVENTIVAS DE PNEUMONIA ASSOCIADA À VENTILAÇÃO MECÂNICA

    Directory of Open Access Journals (Sweden)

    Luany Caroline Adamovicz Bork

    2015-07-01

    Full Text Available Justificativa e Objetivos: Ressaltando a relevância da adoção de medidas preventivas de infecção para a realização de uma assistência livre de danos emergiu a necessidade de observar como a equipe de saúde aplica o bundle. Objetivou-se verificar a adesão de medidas preventivas de pneumonia pelos profissionais de saúde, da Unidade de Terapia Intensiva geral adulta de um hospital público, Ponta Grossa-PR. Métodos: Pesquisa transversal, de abordagem quantitativa, prospectiva e observacional, realizada no período de abril a julho de 2013. A amostra constituiu-se de 33 pacientes que estavam em ventilação mecânica, totalizando o registro de 1522 momentos de aplicações das medidas preventivas de pneumonia associada à ventilação mecânica (PAVM. Resultados: Dos 33 pacientes, 13 desenvolveram pneumonia, a média de idade foi de 59,72 anos e a prevalência foi do gênero feminino (44,44%. Verificou-se que os profissionais de saúde atenderam a cabeceira elevada dos leitos em média 69,80%, assim como aderiram à interrupção da sedação em média 66,66%, realizaram a higiene oral com clorexidina 94,61%, mantiveram o cuff do tubo orotraqueal (entre 20 e 25 mmH20 64,44%, adequaram o filtro de nebulizador para ficar dentro da validade 89,50% e em 93,4% das observações deixaram os circuitos livre de condensados. Analisou-se que o valor médio de dias passados em ventilação mecânica dos pacientes que adquiriram infecção foi de 15,85 (DP = 8,65 dias. Conclusão: Revela-se que quando a equipe aplica todas as medidas preventivas ao paciente sob ventilação mecânica há redução do risco de adquirir infecção no trato respiratório. DESCRITORES: Terapia intensiva; Pneumonia associada à ventilação mecânica; Infecção hospitalar; Equipe de assistência ao paciente.

  3. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2012-01-01

    Background: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a res

  4. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

    Directory of Open Access Journals (Sweden)

    Samina Ismail

    2013-01-01

    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  5. Influence of adrenergic and cholinergic mechanisms in baclofen induced analgesia.

    Science.gov (United States)

    Tamayo, L; Rifo, J; Contreras, E

    1988-01-01

    1. Baclofen induced analgesia was confirmed by means of the mouse hot plate test. 2. Physostigmine significantly increased the response to baclofen whilst neostigmine was ineffective. Baclofen analgesia was reduced by atropine. 3. The response to baclofen was increased by the administration of tolazoline, propranolol and nadolol. In contrast, the analgesic response to morphine was attenuated by the antiadrenergic drugs phenoxybenzamine, tolazoline and nadolol.

  6. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  7. Multimodality of Learning Through Anchored Instruction

    Science.gov (United States)

    Love, Mary Susan

    2004-01-01

    Multimodality of learning results from the intertextual relationship between multimodal design and other meaning-making modes. Meaning making is becoming more multimodal because language is continually reshaped by new forms of communication media. This article examines anchored instruction from a multimodal perspective. The first section includes…

  8. Relationship between analgesia and turnover of brain biogenic amines.

    Science.gov (United States)

    Bensemana, D; Gascon, A L

    1978-10-01

    The analgesic activity of morphine, delta9THC, and sodium salicylate was studied concomitantly with changes in brainstem and cortex turnover of dopamine (DA), noradrenaline (NA), and serotonin (5HT). The results show that a correlation exists between the presence of analgesia and the increased turnover rates of the three biogenic amines. Morphine and sodium salicylate induced analgesia is accompanied by an increased turnover rate of all three biogenic amines; delta9THC-induced analgesia is accompanied by an increased turnover rate of DA and 5HT only. There is, however, no consistent relationship between the degree of analgesia and the degree of change in the turnover rates. The existence of the endogenous morphine-like substances, endorphines, may explain why morphine analgesia is distinct from that of delta9THC and sodium salicylate. The possible relationship between this morphine-like substance and biogenic amines is discussed.

  9. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  10. A COMPARISON OF ANALGESIA AND FOETAL OUTCOME IN TERM PARTURIENTS WITH AND WITHOUT LOW DOSE COMBINED SPINAL EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Manjunath

    2015-11-01

    Full Text Available : STUDY OBJECTIVE: We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined ‘low dose’ spinal and epidural (CSE. DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia - ‘GROUP T’ and 60 of who underwent a delivery without labour analgesia -‘GROUP C’. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.

  11. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Sharma Munish

    2010-01-01

    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

  12. Developments in labour analgesia and their use in Australia.

    Science.gov (United States)

    Eley, V A; Callaway, L; van Zundert, A A

    2015-07-01

    Since the introduction of chloroform for labour analgesia in 1847, different methods and medications have been used to relieve the pain of labour. The use of heavy sedative medication in the early 1900s was encouraged by enthusiastic doctors and by women empowered by the women's suffrage movement in America. Nitrous oxide by inhalation has been used in Australia since the 1950s and improved methods of administration have made this method of analgesia safe and practical. Caudal epidural analgesia and lumbar epidural analgesia were first made popular in America and by the 1970s these techniques were more widely available in Australia. In 1847, physicians and the public were unsure whether relieving labour pains was the 'right' thing to do. However, many medical and social changes have occurred thanks to the clinical connection between Australia and the United Kingdom and those first settlers to land on Australian shores. Thanks to this historical connection, in today's Australia there is no question that women should use analgesia as a pain relief if they wish. Currently, the majority of women worldwide use some form of analgesia during labour and different methods are widely available. This paper discusses the four milestones of the development of obstetric analgesia and how they were introduced into patient care in Australia.

  13. Intracortical modulation, and not spinal inhibition, mediates placebo analgesia.

    Science.gov (United States)

    Martini, M; Lee, M C H; Valentini, E; Iannetti, G D

    2015-02-01

    Suppression of spinal responses to noxious stimulation has been detected using spinal fMRI during placebo analgesia, which is therefore increasingly considered a phenomenon caused by descending inhibition of spinal activity. However, spinal fMRI is technically challenging and prone to false-positive results. Here we recorded laser-evoked potentials (LEPs) during placebo analgesia in humans. LEPs allow neural activity to be measured directly and with high enough temporal resolution to capture the sequence of cortical areas activated by nociceptive stimuli. If placebo analgesia is mediated by inhibition at spinal level, this would result in a general suppression of LEPs rather than in a selective reduction of their late components. LEPs and subjective pain ratings were obtained in two groups of healthy volunteers - one was conditioned for placebo analgesia while the other served as unconditioned control. Laser stimuli at three suprathreshold energies were delivered to the right hand dorsum. Placebo analgesia was associated with a significant reduction of the amplitude of the late P2 component. In contrast, the early N1 component, reflecting the arrival of the nociceptive input to the primary somatosensory cortex (SI), was only affected by stimulus energy. This selective suppression of late LEPs indicates that placebo analgesia is mediated by direct intracortical modulation rather than inhibition of the nociceptive input at spinal level. The observed cortical modulation occurs after the responses elicited by the nociceptive stimulus in the SI, suggesting that higher order sensory processes are modulated during placebo analgesia.

  14. Organización y actividades preventivas en el sector del transporte de mercancías por carretera

    Directory of Open Access Journals (Sweden)

    Elena Ordaz Castillo

    2008-09-01

    Full Text Available Objetivos: Identificar los recursos y actividades preventivas más prevalentes en el sector del transporte de mercancías por carretera y los hechos diferenciales con el resto de la población trabajadora española. Metodología: Estudio descriptivo de los datos de la Encuesta de Salud y Condiciones de Trabajo del sector del transporte y estudio comparativo con el resto de la población trabajadora a través de la V-Encuesta Nacional de Condiciones de Trabajo. Para el análisis estadístico se ha aplicado el ji cuadrado y la t-student. Resultados: El 77% de las empresas de este sector tienen menos de 50 trabajadores. El 41% de los conductores señala que en su empresa no existe Delegado de Prevención y un 25% no dispone de ningún Recurso Preventivo. Destaca el alto desconocimiento existente entre los conductores de los recursos preventivos en su empresa (34,3%. La modalidad preventiva más frecuentemente instaurada en el sector es la asunción de la prevención por parte del empresario (13,6% a diferencia del resto de sectores donde predomina el SP. Ajeno (43%. Conclusiones: Predominio de la pequeña empresa en el Sector del transporte asociado a un escaso desarrollo del tejido preventivo en comparación con la población de referencia. Ambas características pueden ser determinantes de la menor actividad preventiva, más baja que la observada en la población de referencia. El acceso a actividades preventivas entre los conductores se relaciona con una mejor salud percibida.Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T

  15. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  16. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Harsimran Singh

    2013-01-01

    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  17. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  18. Post operatory analgesia in caesarean surgery.

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    Bárbara Lucía Cabezas Poblet

    2003-12-01

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  19. Proinflammatory cytokines oppose opioid induced acute and chronic analgesia

    OpenAIRE

    Hutchinson, Mark R.; Coats, Benjamen D; Lewis, Susannah S.; Zhang, Yingning; Sprunger, David B.; Rezvani, Niloofar; Baker, Eric M.; Jekich, Brian M.; Wieseler, Julie L.; Somogyi, Andrew A; Martin, David; Poole, Stephen; Judd, Charles M.; Steven F. Maier; Watkins, Linda R.

    2008-01-01

    Spinal proinflammatory cytokines are powerful pain-enhancing signals that contribute to pain following peripheral nerve injury (neuropathic pain). Recently, one proinflammatory cytokine, interleukin-1, was also implicated in the loss of analgesia upon repeated morphine exposure (tolerance). In contrast to prior literature, we demonstrate that the action of several spinal proinflammatory cytokines oppose systemic and intrathecal opioid analgesia, causing reduced pain suppression. In vitro morp...

  20. Stability of piritramide in patient-controlled analgesia (PCA) solutions.

    Science.gov (United States)

    Remane, D; Scriba, G; Meissner, W; Hartmann, M

    2009-06-01

    For patient controlled analgesia, syringes with solutions of 1.5 mg/ml piritramide in 0.9% aqueous sodium chloride are used. The physical and chemical stability for dilutions of the commercially available preparation of piritramide is limited up to 72 hours by the manufacturer. Since application duration for patient-controlled analgesia can exceed that limited time, stability was investigated by HPLC. Our results show that these solutions are chemically stable over a time period of 60 days.

  1. COMPLEX INTRAVENOUS OR LOCAL OZONE AND LOW-INTENSE LASER THERAPY IN CORRECTION OF MALIGNANT TUMORS MULTIMODAL TREATMENT COMPLICATIONS

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    V. A. Titova

    2009-01-01

    Full Text Available Multmodal programs are the perspective trend in different malignant tumors treatment but increasing risk of combined complications may influence negatively on the results. Ozone therapy and low-intense laser therapy are perspective methods for complication treatment and prevention as they show their own antibacterial, analgesia and detoxing activity in experiment.To form the algorhythm and to evaluate the results of intravenous and local ozone applications plus low-intense laser (LILT therapeutic complex used in treatment and prevention of malignant tumors multimodal treatment complications.

  2. Vector-Resonance-Multimode Instability

    Science.gov (United States)

    Sergeyev, S. V.; Kbashi, H.; Tarasov, N.; Loiko, Yu.; Kolpakov, S. A.

    2017-01-01

    The modulation and multimode instabilities are the main mechanisms which drive spontaneous spatial and temporal pattern formation in a vast number of nonlinear systems ranging from biology to laser physics. Using an Er-doped fiber laser as a test bed, here for the first time we demonstrate both experimentally and theoretically a new type of a low-threshold vector-resonance-multimode instability which inherits features of multimode and modulation instabilities. The same as for the multimode instability, a large number of longitudinal modes can be excited without mode synchronization. To enable modulation instability, we modulate the state of polarization of the lasing signal with the period of the beat length by an adjustment of the in-cavity birefringence and the state of polarization of the pump wave. As a result, we show the regime's tunability from complex oscillatory to periodic with longitudinal mode synchronization in the case of resonance matching between the beat and cavity lengths. Apart from the interest in laser physics for unlocking the tunability and stability of dynamic regimes, the proposed mechanism of the vector-resonance-multimode instability can be of fundamental interest for the nonlinear dynamics of various distributed systems.

  3. Multimodal Friction Ignition Tester

    Science.gov (United States)

    Davis, Eddie; Howard, Bill; Herald, Stephen

    2009-01-01

    The multimodal friction ignition tester (MFIT) is a testbed for experiments on the thermal and mechanical effects of friction on material specimens in pressurized, oxygen-rich atmospheres. In simplest terms, a test involves recording sensory data while rubbing two specimens against each other at a controlled normal force, with either a random stroke or a sinusoidal stroke having controlled amplitude and frequency. The term multimodal in the full name of the apparatus refers to a capability for imposing any combination of widely ranging values of the atmospheric pressure, atmospheric oxygen content, stroke length, stroke frequency, and normal force. The MFIT was designed especially for studying the tendency toward heating and combustion of nonmetallic composite materials and the fretting of metals subjected to dynamic (vibrational) friction forces in the presence of liquid oxygen or pressurized gaseous oxygen test conditions approximating conditions expected to be encountered in proposed composite material oxygen tanks aboard aircraft and spacecraft in flight. The MFIT includes a stainless-steel pressure vessel capable of retaining the required test atmosphere. Mounted atop the vessel is a pneumatic cylinder containing a piston for exerting the specified normal force between the two specimens. Through a shaft seal, the piston shaft extends downward into the vessel. One of the specimens is mounted on a block, denoted the pressure block, at the lower end of the piston shaft. This specimen is pressed down against the other specimen, which is mounted in a recess in another block, denoted the slip block, that can be moved horizontally but not vertically. The slip block is driven in reciprocating horizontal motion by an electrodynamic vibration exciter outside the pressure vessel. The armature of the electrodynamic exciter is connected to the slip block via a horizontal shaft that extends into the pressure vessel via a second shaft seal. The reciprocating horizontal

  4. Analgesia invasiva domiciliaria en el manejo del dolor postoperatorio en cirugía mayor ambulatoria mediante bombas elastoméricas intravenosas Home invasive analgesia in the management of postoperative pain alter outpatient major surgery using intravenous elastomeric pumps

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    R. Rodríguez de la Torre

    2011-06-01

    Full Text Available Introducción: el dolor postoperatorio moderado-severo sigue siendo un problema en cirugía ambulatoria, ya que provoca problemas de flujo de pacientes, retrasando el alta de los pacientes, siendo uno de los principales motivos de reingreso en los hospitales, y por tanto un importante indicador de calidad de estas Unidades. El empleo de técnicas analgésicas invasivas domiciliarias, en todos sus regímenes, puede controlar el dolor postoperatorio en estas intervenciones y permitir incluirlas en los programas de cirugía ambulatoria. Objetivos: el objetivo de nuestro estudio es valorar la viabilidad y la seguridad de la utilización de bombas de perfusión continua elastoméricas para la administración de analgesia endovenosa continua domiciliaria, a la vez que valorar la eficacia analgésica y el grado de satisfacción de los pacientes intervenidos en régimen ambulatorio. Material y métodos: estudio retrospectivo de 463 pacientes. Una vez intervenidos bajo estrategia de analgesia multimodal, se les coloca dos tipos diferentes de bombas elastoméricas endovenosas (elastómero de dexketoprofeno o de metamizol. La intensidad del dolor, para evaluar la necesidad de analgesia de rescate, se cuantifica con la escala visual analógica o con la escala verbal simple. En el domicilio (24 horas tras la cirugía, la Unidad de Atención Domiciliaria revisa los efectos secundarios, alteraciones del sueño, intensidad del dolor, necesidad de analgesia de rescate y grado de satisfacción. Resultados: un 69% de los pacientes presentaron dolor de carácter leve o ausencia de dolor tras la intervención y únicamente 16 de los 463 pacientes presentaron dolor de carácter severo. El 27% de los pacientes necesitaron analgesia de rescate y un 9% de los pacientes presentaron efectos secundarios atribuibles a los fármacos analgésicos (4% vómitos, 2% mareos, 2,5% somnolencia y 0,5% insomnio. Ningún paciente tuvo que ser reingresado después del alta. Un 83% de

  5. Peripheral morphine analgesia in dental surgery.

    Science.gov (United States)

    Likar, R; Sittl, R; Gragger, K; Pipam, W; Blatnig, H; Breschan, C; Schalk, H V; Stein, C; Schäfer, M

    1998-05-01

    The recent identification of opioid receptors on peripheral nerve endings of primary afferent neurons and the expression of their mRNA in dorsal root ganglia support earlier experimental data about peripheral analgesic effects of locally applied opioids. These effects are most prominent under localized inflammatory conditions. The clinical use of such peripheral analgesic effects of opioids was soon investigated in numerous controlled clinical trials. The majority of these have tested the local, intraarticular administration of morphine in knee surgery and have demonstrated potent and long-lasting postoperative analgesia. As the direct application of morphine into the pain-generating site of injury and inflammation appears most promising, we examined direct morphine infiltration of the surgical site in a unique clinical model of inflammatory tooth pain. Forty-four patients undergoing dental surgery entered into this prospective, randomized, double-blind study. Before surgery they received, together with a standard local anesthetic solution (articaine plus epinephrine) a submucous injection of either 1 mg of morphine (group A) or saline (group B). Postoperative pain intensity was assessed using the visual analog scale (VAS) and numeric rating scale (NRS) at 2, 4, 6, 8, 10, 12, 16, 20 and 24 h after surgery. In addition, patients recorded the occurrence of side effects and the supplemental consumption of diclofenac tablets. Results of 27 patients were analyzed (group A: n=14, group B: n=13). Pain scores which were moderate to severe preoperatively were reduced to a similar extent in both groups up to 8 h postoperatively. Thereafter, pain scores in group A were significantly lower than those in group B for up to 24 h, demonstrating the analgesic efficacy of additional morphine. The time to first analgesic intake and the total amount of supplemental diclofenac were less in group A than in group B. No serious side effects were reported. Our results show that 1 mg of

  6. Meningitis tras anestesia y analgesia espinal

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    M. Robles Romero

    2013-08-01

    Full Text Available El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius

  7. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

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    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  8. Multimodal Aspects of Corporate Social Responsibility Communication

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    Carmen Daniela Maier

    2014-12-01

    Full Text Available This article addresses how the multimodal persuasive strategies of corporate social responsibility communication can highlight a company’s commitment to gender empowerment and environmental protection while advertising simultaneously its products. Drawing on an interdisciplinary methodological framework related to CSR communication, multimodal discourse analysis and gender theory, the article proposes a multimodal analysis model through which it is possible to map and explain the multimodal persuasive strategies employed by Coca-Cola company in their community-related films. By examining the semiotic modes’ interconnectivity and functional differentiation, this analytical endeavour expands the existing research work as the usual textual focus is extended to a multimodal one.

  9. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  10. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  11. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  12. Newborn Analgesia Mediated by Oxytocin during Delivery.

    Science.gov (United States)

    Mazzuca, Michel; Minlebaev, Marat; Shakirzyanova, Anastasia; Tyzio, Roman; Taccola, Giuliano; Janackova, Sona; Gataullina, Svetlana; Ben-Ari, Yehezkel; Giniatullin, Rashid; Khazipov, Rustem

    2011-01-01

    The mechanisms controlling pain in newborns during delivery are poorly understood. We explored the hypothesis that oxytocin, an essential hormone for labor and a powerful neuromodulator, exerts analgesic actions on newborns during delivery. Using a thermal tail-flick assay, we report that pain sensitivity is two-fold lower in rat pups immediately after birth than 2 days later. Oxytocin receptor antagonists strongly enhanced pain sensitivity in newborn, but not in 2-day-old rats, whereas oxytocin reduced pain at both ages suggesting an endogenous analgesia by oxytocin during delivery. Similar analgesic effects of oxytocin, measured as attenuation of pain-vocalization induced by electrical whisker pad stimulation, were also observed in decerebrated newborns. Oxytocin reduced GABA-evoked calcium responses and depolarizing GABA driving force in isolated neonatal trigeminal neurons suggesting that oxytocin effects are mediated by alterations of intracellular chloride. Unlike GABA signaling, oxytocin did not affect responses mediated by P2X3 and TRPV1 receptors. In keeping with a GABAergic mechanism, reduction of intracellular chloride by the diuretic NKCC1 chloride co-transporter antagonist bumetanide mimicked the analgesic actions of oxytocin and its effects on GABA responses in nociceptive neurons. Therefore, endogenous oxytocin exerts an analgesic action in newborn pups that involves a reduction of the depolarizing action of GABA on nociceptive neurons. Therefore, the same hormone that triggers delivery also acts as a natural pain killer revealing a novel facet of the protective actions of oxytocin in the fetus at birth.

  13. A review of perioperative anesthesia and analgesia for infants: updates and trends to watch

    Science.gov (United States)

    Martin, Lizabeth D; Jimenez, Nathalia; Lynn, Anne M

    2017-01-01

    This review focuses on pharmacokinetics and pharmacodynamics of opioid and non-opioid analgesics in neonates and infants. The unique physiology of this population differs from that of adults and impacts drug handling. Morphine and remifentanil are described as examples of older versus recently developed opiates to compare and contrast pharmacokinetics and pharmacodynamics in infants. Exploration of genetics affecting both pharmacokinetics and pharmacodynamics of opiates is an area of active research, as is the investigation of a new class of mu-opiate-binding agents which seem selective for analgesic pathways while having less activity in pathways linked to side effects. The kinetics of acetaminophen and of ketorolac as examples of parenteral non-steroidal analgesics in infants are also discussed. The growth in regional anesthesia for peri-operative analgesia in infants can fill an important role minimizing intra-operative anesthetic exposure to opioids and transitioning to post-operative care. Use of multi-modal techniques is recommended to decrease undesirable opiate-related side effects in this vulnerable population. PMID:28232869

  14. Efficacy of the Bilateral Ilioinguinal-Iliohypogastric Block with Intrathecal Morphine for Postoperative Cesarean Delivery Analgesia

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    Manuel C. Vallejo

    2012-01-01

    Full Text Available The ilioinguinal-iliohypogastric (IIIH block is frequently used as multimodal analgesia for lower abdominal surgeries. The aim of this study is to compare the efficacy of IIIH block using ultrasound visualization for reducing postoperative pain after caesarean delivery (CD in patients receiving intrathecal morphine (ITM under spinal anesthesia. Participants were randomly assigned to 1 of 3 treatment groups for the bilateral IIIH block: Group A = 10 mL of 0.5% bupivacaine, Group B = 10 mL of 0.5% bupivacaine on one side and 10 mL of a normal saline (NSS placebo block on the opposite side, and Group C = 10 mL of NSS placebo per side. Pain and nausea scores, treatment for pain and nausea, and patient satisfaction were recorded for 48 hours after CD. No differences were noted with respect to pain scores or treatment for pain over the 48 hours. There were no differences to the presence of nausea (P=0.64, treatment for nausea (P=0.21, pruritus (P=0.39, emesis (P=0.35, or patient satisfaction (P=0.29. There were no differences in pain and nausea scores over the measured time periods (MANOVA, P>0.05. In parturients receiving ITM for elective CD, IIIH block offers no additional postoperative benefit for up to 48 hours.

  15. Contribuciones de la Medicina Psicosomática a la Medicina Clínica y Preventiva

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    Carmen Berrocal

    Full Text Available El trabajo ofrece una revisión actualizada de las principales contribuciones de la Medicina Psicosomática a la medicina clínica y preventiva. Su contenido se basa en los resultados de revisiones sistemáticas, meta-análisis y estudios controlados. La evidencia acumulada indica que la perspectiva psicosomática podría contribuir significativamente a mejorar los resultados de la atención sanitaria, mediante una práctica clínica holística, la evaluación de los factores psicosociales implicados en la vulnerabilidad individual y la integración de intervenciones psicológicas en medicina. Dicha evidencia constituye el terreno ideal para afrontar necesidades emergentes en sanidad, como la gestión de enfermedades crónicas y de síntomas inexplicables, el paciente como productor activo de salud, la prevención temprana y una valoración de resultados que supere el reduccionismo biomédico.

  16. MEDIDAS PREVENTIVAS DE SALUD A FINALES DEL SIGLO XIX EN LA CIUDAD DE MEXICO: UNA EVIDENCIA ARQUEOLÓGICA

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    Alfredo Feria C.

    2013-01-01

    Full Text Available En la época prehispánica, en México, por la ignorancia, la falta de medidas sanitarias y la falta de medicamentos específicos, prevalecían un sinnúmero de enfermedades entre la población. Las más importantes eran las enfermedades infecciosas y parasitarias que, en forma de epidemias, determinaban la muerte de un gran número de pobladores, principalmente niños, jóvenes y mujeres en edad reproductiva. Muy pocas personas llegaban a edad avanzada, por lo que eran consideradas como sabias y de especial jerarquía. Esto no fue muy diferente en la época de la conquista y los siglos subsecuentes, principalmente en las zonas perimetrales de la Ciudad de México, en los llamados “cinturones de miseria”. En el convento que funcionó en la orden de los Betlemitas, perteneciente al Banco de México y considerado como uno de los edificios históricos más representativos del Siglo XVIII se encontraron numerosas y muy valiosas evidencias que han permitido llegar a extraordinarias conclusiones en materia de estilos de vida, condiciones sanitarias, enfermedades prevalentes, medidas preventivas y procedimientos terapéuticos durante la época prehispánica y en los siglos XVII al XX.

  17. A Multimodal Approach to Post-Operative Pain Relief in Children Undergoing Ambulatory Eye Surgery

    Directory of Open Access Journals (Sweden)

    V V Jaichandran

    2008-01-01

    Full Text Available This study was carried to assess the efficacy of multimodal analgesia using ketorolac and fentanyl, for post-operative pain relief in children undergoing ambulatory eye surgery. Total of 161 children, aged 1 to 5 years, were randomly stratified to three different analgesic regimens: Group A Ketorolac 0.75 mg.kg -1 I.M. , Group B Fentanyl 0.75 µg.kg -1 I.V. and Group C Ketorolac 0.50mg.kg -1 I.M. and Fentanyl 0.50µg.kg -1 I.V. Ketorolac I.M. was given 45 minutes before extubation and fentanyl I.V. was given soon after extubation in the respective groups. Post-operative pain was assessed in a double blinded manner using Children′s Hospital of Eastern Onatario Pain Scale (CHEOPS scoring system and by recording the heart rate at 10, 30 and 60 minutes. If the score was above 8, the child was left with the parents. In case the score did not improve and persisted to be greater than 8, fentanyl 0.50µg.kg -1 I.V. was given as the rescue analgesia. The incidence of nausea, vomiting, sleep disturbances or any other complaints were recorded by a staff nurse 24 hours post operatively. Mean CHEOPS score at 10, 30 and 60 minutes and mean heart rate at 10 and 30 minutes were significantly higher for Group A compared with Group C. Mean pain score emerged significantly higher for Group B compared with Group C at 30 and 60 minutes, (P< 0.01. Rescue analgesia required was significantly higher in Group A compared to Groups B and C, (P< 0.0001. Post-operatively, significant incidence of drowsiness was reported in children in Group B compared to Groups A and C, (P< 0.01. A multimodal approach using both ketorolac and fentanyl at low doses produce effective and safe analgesia in children undergoing ambula-tory eye surgery.

  18. Poder para prever: pronósticos y uso de la prisión preventiva en la provincia de Buenos Aires

    Directory of Open Access Journals (Sweden)

    Ezequiel R. Kostenwein

    2014-06-01

    Full Text Available En este trabajo se analizará, a partir del uso de la prisión preventiva, la relación que existe entre los peligros procesales que pueden justificarla y los pronósticos a partir de los cuales se los anticipa. Junto a esto, describiremos desde 1998 -año en que se reformó estructuralmente el Código Procesal Penal de la provincia de Buenos Aires- los cambios que se han dado respecto a la regulación de la prisión preventiva y las excarcelaciones. Por último, exhibiremos los testimonios de los actores judiciales sobre ambos temas, para enriquecer el análisis sobre la aplicación de la medida cautelar. 

  19. Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia.

    Science.gov (United States)

    Honigman, Liat; Yarnitsky, David; Sprecher, Elliot; Weissman-Fogel, Irit

    2013-08-01

    The endogenous analgesia (EA) system is psychophysically evaluated using various paradigms, including conditioned pain modulation (CPM) and offset analgesia (OA) testing, respectively, the spatial and temporal filtering processes of noxious information. Though both paradigms assess the function of the EA system, it is still unknown whether they reflect the same aspects of EA and consequently whether they provide additive or equivalent data. Twenty-nine healthy volunteers (15 males) underwent 5 trials of different stimulation conditions in random order including: (1) the classic OA three-temperature stimulus train ('OA'); (2) a three-temperature stimulus train as control for the OA ('OAcon'); (3) a constant temperature stimulus ('constant'); (4) the classic parallel CPM ('CPM'); and (5) a combination of OA and CPM ('OA + CPM'). We found that in males, the pain reduction during the OA + CPM condition was greater than during the OA (P = 0.003) and CPM (P = 0.07) conditions. Furthermore, a correlation was found between OA and CPM (r = 0.62, P = 0.01) at the time of maximum OA effect. The additive effect found suggests that the two paradigms represent at least partially different aspects of EA. The moderate association between the CPM and OA magnitudes indicates, on the other hand, some commonality of their underlying mechanisms.

  20. A Learning Algorithm for Multimodal Grammar Inference.

    Science.gov (United States)

    D'Ulizia, A; Ferri, F; Grifoni, P

    2011-12-01

    The high costs of development and maintenance of multimodal grammars in integrating and understanding input in multimodal interfaces lead to the investigation of novel algorithmic solutions in automating grammar generation and in updating processes. Many algorithms for context-free grammar inference have been developed in the natural language processing literature. An extension of these algorithms toward the inference of multimodal grammars is necessary for multimodal input processing. In this paper, we propose a novel grammar inference mechanism that allows us to learn a multimodal grammar from its positive samples of multimodal sentences. The algorithm first generates the multimodal grammar that is able to parse the positive samples of sentences and, afterward, makes use of two learning operators and the minimum description length metrics in improving the grammar description and in avoiding the over-generalization problem. The experimental results highlight the acceptable performances of the algorithm proposed in this paper since it has a very high probability of parsing valid sentences.

  1. Integrated processing in multimodal argumentation

    NARCIS (Netherlands)

    Hoven, P.J. van den; Jiang, W.

    2011-01-01

    The question addressed in this paper is simple. If the argumentative function of a multimodal narrative text requires the integration of the information from different modes, among which verbal ones, what model for the order of processing and the integration of information do we need to adopt? Using

  2. Multimodal approach to postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2009-01-01

    PURPOSE OF REVIEW: To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). RECENT FINDINGS: The value of the fast-track methodology to improve recovery and decrease hospital stay...

  3. Multi-Modality Phantom Development

    Energy Technology Data Exchange (ETDEWEB)

    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

    2009-03-20

    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  4. SESAMO: UN ESTUDIO SOBRE LOS DISCURSOS LEGITIMANTES DE LA PRISIÓN PREVENTIVA Y UN ANÁLISIS SOBRE SU CONSTITUCIONALIDAD

    Directory of Open Access Journals (Sweden)

    Jonathan Ariel Polansky

    2015-09-01

    Full Text Available Motivado por el alarmante número de personas que se encuentran privadas de su libertad sin contar con una sentencia condenatoria efectiva, este trabajo tiene por objeto realizar un análisis de los discursos que tienden a legitimar la posibilidad de aplicación del instituto de la prisión preventiva, a fin de determinar si sus formulaciones son respetuosas de las garantías constitucionales que deben observarse en el proceso penal.

  5. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia

    DEFF Research Database (Denmark)

    Joshi, G.P.; Bonnet, F.; Shah, R.;

    2008-01-01

    BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evide...

  6. LA CAUSAL DE PROLONGACIÓN DEL PROCESO ESTABLECIDA EN LA LEY N° 30076 Y SU INCIDENCIA EN EL PLAZO RAZONABLE DE LA MEDIDA DE PRISIÓN PREVENTIVA: SU CONSTITUCIONALIDAD. MÓDULO PENAL DE CAMANÁ, 2014

    OpenAIRE

    DE ROMAÑA VELARDE, HUGO

    2016-01-01

    LA CAUSAL DE PROLONGACIÓN DEL PROCESO ESTABLECIDA EN LA LEY N° 30076 INTRODUCCION AL CODIGO PROCESAL PENAL DE 2004 MEDIDAS DE COERCION PROCESAL MODELOS DE COERCION PROCESAL CARACTERISTICAS DE LAS MEDIDAS DE COERCION PROCESAL LA PRISION PREVENTIVA PRESUPUESTOS DE LA PRISION PREVENTIVA QUE EL IMPUTADO, EN RAZÓN A SUS ANTECEDENTES Y OTRAS CIRCUNSTANCIAS DEL CASO PARTICULAR, PERMITA COREGIR RAZONABLEMENTE QUE TRATARÁ DE OBSTACULIZAR LA AVERIGUACION DE LA VERDAD (PELIGRO DE OBSTACULIZACION)...

  7. Effect of sufentanil combined with different concentrations of ropivacaine for labor analgesia on maternal

    Institute of Scientific and Technical Information of China (English)

    Han-He Wang; Min-Jia Jiang; Wan-Dong Liao

    2016-01-01

    Objective:To study the effect of sufentanil combined with different concentration of ropivacaine for stepped analgesia on stage of labor, stress indexes and blood coagulation function.Methods:A total of 178 cases of full-term singleton primiparas who awaited delivery and received epidural labor analgesia in our hospital from January 2015 to June 2016 were selected and randomly divided into stepped analgesia group and routine analgesia group, and the stage of labor, levels of stress hormones and pain mediators during childbirth and blood coagulation function indexes after childbirth were observed between two groups.Results: The duration of latent phase of labor of stepped analgesia group was shorter than that of routine analgesia group while the duration of active phase of labor, the duration of second stage of labor and the duration of third stage of labor were not significantly different from those of routine analgesia group; serum PRL level of stepped analgesia group was significantly higher than that of routine analgesia group while PA, NE, E, DYN,β-EP, SP, PGE2, 5-HT, TF, TFPI, FPA, AT-III and DD levels were not significantly different from those of routine analgesia group.Conclusions: Sufentanil combined with different concentration of ropivacaine for stepped analgesia is with equivalent effect to routine analgesia, and can shorten the latent phase of labor and reduce the inhibitory effect of pain on prolactin without affecting the degree of stress during childbirth and the blood coagulation function after childbirth.

  8. Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?

    Science.gov (United States)

    Staud, Roland

    2007-12-01

    Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.

  9. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    Intravenous patient-controlled therapy is used routinely in postoperative care in much of the developed world. Intravenous patient-controlled analgesia results in higher patient satisfaction than conventional administration of analgesics, although it appears to have no advantage over conventional...... analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...... consideration. For example, opioid-tolerant patients need higher postoperative opioid doses to achieve satisfactory analgesic effect. In patients with renal or hepatic insufficiency, the elimination of some opioids may be substantially impaired, and the optimal opioid should be selected based on its...

  10. Classical conditioning and pain: conditioned analgesia and hyperalgesia.

    Science.gov (United States)

    Miguez, Gonzalo; Laborda, Mario A; Miller, Ralph R

    2014-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

  11. Multimode-singlemode-multimode fiber sensor for alcohol sensing application

    Science.gov (United States)

    Rofi'ah, Iftihatur; Hatta, A. M.; Sekartedjo, Sekartedjo

    2016-11-01

    Alcohol is volatile and flammable liquid which is soluble substances both on polar and non polar substances that has been used in some industrial sectors. Alcohol detection method now widely used one of them is the optical fiber sensor. In this paper used fiber optic sensor based on Multimode-Single-mode-Multimode (MSM) to detect alcohol solution at a concentration range of 0-3%. The working principle of sensor utilizes the modal interference between the core modes and the cladding modes, thus make the sensor sensitive to environmental changes. The result showed that characteristic of the sensor not affect the length of the single-mode fiber (SMF). We obtain that the sensor with a length of 5 mm of single-mode can sensing the alcohol with a sensitivity of 0.107 dB/v%.

  12. Remifentanil em analgesia para o trabalho de parto Remifentanil en analgesia para el trabajo de parto Remifentanil as analgesia for labor

    Directory of Open Access Journals (Sweden)

    Eliane C S Soares

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas neuroaxiais representam atualmente os métodos mais efetivos para controle da dor durante o trabalho de parto e a analgesia peridural utilizando soluções anestésicas ultradiluídas é considerada o padrão ouro, promovendo alívio adequado da dor com mínimos efeitos colaterais. Em algumas situações, no entanto, o emprego dessas técnicas é limitado pela existência de contraindicações maternas ou obstáculos estruturais e materiais. Nestes casos, as opções alternativas ainda são precárias e escassas, oferecendo resultados pouco otimistas e de eficácia questionável. CONTEÚDO: Este artigo apresenta, com base em uma revisão da literatura, as informações disponíveis relacionadas ao emprego do remifentanil como técnica alternativa para a analgesia de parto discutindo aspectos farmacocinéticos, farmacodinâmicos, eficácia analgésica, satisfação materna e efeitos colaterais maternos e fetais. CONCLUSÕES: Os dados iniciais apontam o remifentanil como uma opção promissora a ser empregada nas situações em que a gestante não quer ou não pode receber a analgesia neuroaxial.JUSTIFICATIVA Y OBJETIVOS: Las técnicas neuroaxiales representan actualmente los métodos más efectivos para el control del dolor durante el trabajo de parto, y la analgesia epidural utilizando soluciones anestésicas ultradiluidas se considera el estándar oro, promoviendo el alivio correcto del dolor con los mínimos efectos colaterales. En algunas situaciones, sin embargo, el uso de esas técnicas queda limitado por la existencia de contraindicaciones maternas u obstáculos estructurales y materiales. En esos casos, las alternativas todavía son precarias y escasas, ofreciendo resultados poco optimistas y de una eficacia cuestionable. CONTENIDO: Con base en una revisión de la literatura, este artículo muestra que las informaciones disponibles relacionadas a lo empleo de lo remifetanil como técnica alternativa

  13. Effects of hypnotic focused analgesia on dental pain threshold.

    Science.gov (United States)

    Facco, Enrico; Casiglia, Edoardo; Masiero, Serena; Tikhonoff, Valery; Giacomello, Margherita; Zanette, Gastone

    2011-01-01

    The rate, intensity, and selectivity of hypnotic focused analgesia (HFA) were tested with dental pulp stimulation. Thirty-one healthy subjects were hypnotized, and hypnotic suggestions were given for anesthesia of the right mandibular arch. A posthypnotic suggestion of persisting analgesia was also given. The pain threshold of the first premolar was bilaterally measured before, during, and after hypnosis using a pulp tester. During hypnosis, the pain threshold increased significantly (p < .0001) for both sides. The posthypnotic right pain threshold was also significantly (p < .0015) higher than in the basal condition.

  14. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... the epidural to the birth, and the relationship to the midwife. Place of origin: The labor ward, Aalborg Sygehus Nord, Aalborg. The homes of the women. Method: Field study and interviews. Nine women were observed from the establishment of the epidural until birth. They were interviewed the day after the birth...

  15. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

  16. La sinergia farmacológica aplicada a la analgesia: revisión de la combinación de ibuprofeno con codeína Pharmacological synergy applied to analgesia: review of the combination of ibuprofen with codeine

    Directory of Open Access Journals (Sweden)

    J.R. González-Escalada

    2010-02-01

    Full Text Available La analgesia multimodal que participa actualmente en todos los protocolos de analgesia postoperatoria también se utiliza por los especialistas en dolor crónico que manejan la combinación de fármacos como una rutina para optimizar la eficacia de la analgesia; la combinación de fármacos es una práctica bien conocida y muy extendida, gracias a su demostrada rentabilidad terapéutica, y habitualmente se utiliza tanto en anestesia como en analgesia. El concepto del balance adecuado entre efectividad y seguridad es primordial, y aunque la calidad del tratamiento aplicado se mide según el alivio conseguido, el confort se evalúa teniendo en cuenta la combinación entre eficacia analgésica y la ausencia o mínima presencia de efectos secundarios, siendo primordial en el tratamiento del paciente con dolor. En este sentido, parece claro que la búsqueda de las dosis mínimas eficaces de cada fármaco es una premisa necesaria para plantear la combinación de dosis idónea. La búsqueda de los fármacos que deben componer una combinación y las dosis a emplear debe ser fruto de la investigación, pero debe ser corroborada por la experiencia clínica, la opinión de los expertos y las evidencias publicadas. En este trabajo, se realiza una extensa revisión de la experiencia clínica existente con la combinación de ibuprofeno con codeína, haciendo un análisis de los antecedentes históricos que llevaron a su uso, los trabajos que permitieron demostrar su sinergia y compatibilidad farmacocinética y los trabajos pioneros de investigación clínica que permitieron concluir que la dosis fija idónea de esta combinación es la mezcla de 400 mg de ibuprofeno con 30 mg de codeína. Es difícil sacar conclusiones acerca de la efectividad analgésica de los diferentes antiinflamatorios no esteroideos, pero no cabe duda que según los datos acumulados hasta la actualidad, el ibuprofeno se sitúa entre los más efectivos y es una buena opción para

  17. A multimodal approach to management of suspected neuropathic pain in a prairie falcon (Falco mexicanus).

    Science.gov (United States)

    Shaver, Stephanie L; Robinson, Narda G; Wright, Bonnie D; Kratz, Gail E; Johnston, Matthew S

    2009-09-01

    An adult male prairie falcon (Falco mexicanus) was presented for evaluation and treatment of self-inflicted wounds along the right proximal patagium. The bird had started self-traumatizing approximately 1 month after fracturing the right metacarpus, although the fracture had stabilized, surface wounds had healed completely, and treatment with a nonsteroidal antiinflammatory drug had been administered. The bird was treated with gabapentin (11 mg/kg p.o. q12h), ketamine (0.5 mg/kg i.m. q24h), and low level laser therapy (LLLT) (fracture site, then the original LLLT protocol was applied once daily. After 2.5 months, the wounds healed completely and no further mutilation took place. Once deemed ready for release, the falcon was returned to the wild after 181 days in captivity. This is the first reported application of successful multimodal analgesia in a raptor with uncontrolled neuropathic pain.

  18. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime

    DEFF Research Database (Denmark)

    Jensen, Kenneth; Kehlet, Henrik; Lund, Claus M

    2009-01-01

    BACKGROUND AND OBJECTIVE: To evaluate the applicability, effectiveness, immediate postoperative complaints and requirements for a postanaesthesia care unit stay after elective abdominal hysterectomy under a well defined, multimodal anaesthetic regime. METHODS: Observational study of 145 consecutive...... patients scheduled for the procedure at a major university hospital in Denmark. Perioperative treatments and postoperative complaints were recorded continuously until discharge from the postanaesthesia care unit. Main outcome measures were treatment regimen adherence, pain, nausea and vomiting, respiratory...... epidural analgesia (bupivacaine, morphine) was feasible in more than 90% of all patients. In the postanaesthesia care unit, 64% did not require opioids, but 25% experienced severe pain. Mean length of stay was 2 h with a mean discharge readiness of 80 min. Half the patients required supplemental oxygen...

  19. Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

    Science.gov (United States)

    Won, Young Ju; Lim, Byung Gun; Lee, So Hyun; Park, Sangwoo; Kim, Heezoo; Lee, Il Ok; Kong, Myoung Hoon

    2016-01-01

    Abstract Background: The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy. Methods: Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores. Results: Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit. Conclusions: SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy. PMID:27583920

  20. Inorganic Nanoparticles for Multimodal Molecular Imaging

    Directory of Open Access Journals (Sweden)

    Magdalena Swierczewska

    2011-01-01

    Full Text Available Multimodal molecular imaging can offer a synergistic improvement of diagnostic ability over a single imaging modality. Recent development of hybrid imaging systems has profoundly impacted the pool of available multimodal imaging probes. In particular, much interest has been focused on biocompatible, inorganic nanoparticle-based multimodal probes. Inorganic nanoparticles offer exceptional advantages to the field of multimodal imaging owing to their unique characteristics, such as nanometer dimensions, tunable imaging properties, and multifunctionality. Nanoparticles mainly based on iron oxide, quantum dots, gold, and silica have been applied to various imaging modalities to characterize and image specific biologic processes on a molecular level. A combination of nanoparticles and other materials such as biomolecules, polymers, and radiometals continue to increase functionality for in vivo multimodal imaging and therapeutic agents. In this review, we discuss the unique concepts, characteristics, and applications of the various multimodal imaging probes based on inorganic nanoparticles.

  1. Cognitive Principles in Robust Multimodal Interpretation

    CERN Document Server

    Chai, J Y; Qu, S; 10.1613/jair.1936

    2011-01-01

    Multimodal conversational interfaces provide a natural means for users to communicate with computer systems through multiple modalities such as speech and gesture. To build effective multimodal interfaces, automated interpretation of user multimodal inputs is important. Inspired by the previous investigation on cognitive status in multimodal human machine interaction, we have developed a greedy algorithm for interpreting user referring expressions (i.e., multimodal reference resolution). This algorithm incorporates the cognitive principles of Conversational Implicature and Givenness Hierarchy and applies constraints from various sources (e.g., temporal, semantic, and contextual) to resolve references. Our empirical results have shown the advantage of this algorithm in efficiently resolving a variety of user references. Because of its simplicity and generality, this approach has the potential to improve the robustness of multimodal input interpretation.

  2. Multimodal Biometrics using Feature Fusion

    Directory of Open Access Journals (Sweden)

    K. Krishneswari

    2012-01-01

    Full Text Available Problem statement: Biometrics is a unique, measurable physiological or behavioural characteristic of a person and finds extensive applications in authentication and authorization. Fingerprint, palm print, iris, voice, are some of the most widely used biometrics for personal identification. To reduce the error rates and enhance the usability of biometric system, multimodal biometric systems are used where more than one biometric characteristics are used. Approach: In this study it is proposed to investigate the performance of multimodal biometrics using palm print and fingerprint. Features are extracted using Discrete Cosine Transform (DCT and attributes selected using Information Gain (IG. Results and Conclusion: The proposed technique shows an average improvement of 8.52% compared to using palmprint technique alone. The processing time does not increase for verification compared to palm print techniques.

  3. Continuous verification using multimodal biometrics.

    Science.gov (United States)

    Sim, Terence; Zhang, Sheng; Janakiraman, Rajkumar; Kumar, Sandeep

    2007-04-01

    Conventional verification systems, such as those controlling access to a secure room, do not usually require the user to reauthenticate himself for continued access to the protected resource. This may not be sufficient for high-security environments in which the protected resource needs to be continuously monitored for unauthorized use. In such cases, continuous verification is needed. In this paper, we present the theory, architecture, implementation, and performance of a multimodal biometrics verification system that continuously verifies the presence of a logged-in user. Two modalities are currently used--face and fingerprint--but our theory can be readily extended to include more modalities. We show that continuous verification imposes additional requirements on multimodal fusion when compared to conventional verification systems. We also argue that the usual performance metrics of false accept and false reject rates are insufficient yardsticks for continuous verification and propose new metrics against which we benchmark our system.

  4. Robustness of multimodal processes itineraries

    DEFF Research Database (Denmark)

    Bocewicz, G.; Banaszak, Z.; Nielsen, Izabela Ewa

    2013-01-01

    determining stream-like moving transportation means, a problem of an alternative itinerary selection for an origin–destination (O-D) trip in the context of emergency relief is considered. Emergency relief dealing with the contingency events and deciding on MTS robustness can be evaluated in terms of feasible...... of multimodal processes driven itinerary planning problem is our main contribution. Illustrative examples providing alternative itineraries in some cases of MTS malfunction are presented.......This paper concerns multimodal transport systems (MTS) represented by a supernetworks in which several unimodal networks are connected by transfer links and focuses on the scheduling problems encountered in these systems. Assuming unimodal networks are modeled as cyclic lines, i.e. the routes...

  5. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA? Should epidural analgesia still be a routine technique in pain units?

    Directory of Open Access Journals (Sweden)

    F. Caba

    2010-05-01

    .Epidural analgesia has become a routine process in the peri-operative management of surgical patients which has been extended from the operating rooms and high dependency units to hospital wards. The irruption into this new scenario has improved post-surgical analgesia with acceptable safety margins, and has secured a predominant place in the analgesia guidelines of Acute Pain Units (APU. Epidural analgesia with local anaesthetics and opioids, compared to systemic with opioids, has historically been more effective, with a decrease in complications due to the reduction in surgical stress and the improved cardiorespiratory function. However, as well as these these advantages, epidural analgesia also has some disadvantages such as lowering of blood pressure or urinary retention, along with potentially serious ones arising from neurological damage caused by epidural haematoma, infection or direct injury of the nerve tissue. Although its advantages have been consistent and solid, it does seem to be the case today. The advances made in minimally invasive surgery, with earlier hospital discharge, together with multimodal strategies, are leading to the re-establishment of the use of techniques such as epidural and a re-evaluation of its indications. The latest evidence leads us to believe that epidural analgesia has reached its limit in the treatment of post-surgical pain and will begin to lose ground with the introduction of equally effective techniques, with less complications and secondary effects. This will be a slow process in which it must be assured that the alternative analgesics really give better results as regards efficacy, safety, tolerability and quality of recovery from the perspective of the patient.

  6. The Theme in the Multimodality

    Institute of Scientific and Technical Information of China (English)

    Liu; Xiaolin

    2014-01-01

    <正>1.Systemic Functional Linguistic(SFL)and Multimodality The theoretical foundation for this analysis is mainly extrapolated from the approach of language as a social semiotic process(Halliday 1978,2004).SFL deals with the way texts are articulated to be appropriate for particular situations of use.Halliday develops a Systemic Functional approach in relation to verbal language and offers a set of grammatical systems which realize the three metafunctions of language.In them,the clause

  7. Evaluation of multimodal ground cues

    DEFF Research Database (Denmark)

    Nordahl, Rolf; Lecuyer, Anatole; Serafin, Stefania

    2012-01-01

    This chapter presents an array of results on the perception of ground surfaces via multiple sensory modalities,with special attention to non visual perceptual cues, notably those arising from audition and haptics, as well as interactions between them. It also reviews approaches to combining synth...... synthetic multimodal cues, from vision, haptics, and audition, in order to realize virtual experiences of walking on simulated ground surfaces or other features....

  8. Multimodal CT in stroke imaging: new concepts.

    Science.gov (United States)

    Ledezma, Carlos J; Wintermark, Max

    2009-01-01

    A multimodal CT protocol provides a comprehensive noninvasive survey of acute stroke patients with accurate demonstration of the site of arterial occlusion and its hemodynamic tissue status. It combines widespread availability with the ability to provide functional characterization of cerebral ischemia, and could potentially allow more accurate selection of candidates for acute stroke reperfusion therapy. This article discusses the individual components of multimodal CT and addresses the potential role of a combined multimodal CT stroke protocol in acute stroke therapy.

  9. Multi-Mode Broadband Patch Antenna

    Science.gov (United States)

    Romanofsky, Robert R. (Inventor)

    2001-01-01

    A multi-mode broad band patch antenna is provided that allows for the same aperture to be used at independent frequencies such as reception at 19 GHz and transmission at 29 GHz. Furthermore, the multi-mode broadband patch antenna provides a ferroelectric film that allows for tuning capability of the multi-mode broadband patch antenna over a relatively large tuning range. The alternative use of a semiconductor substrate permits reduced control voltages since the semiconductor functions as a counter electrode.

  10. Multimodal Diversity of Postmodernist Fiction Text

    Directory of Open Access Journals (Sweden)

    U. I. Tykha

    2016-12-01

    Full Text Available The article is devoted to the analysis of structural and functional manifestations of multimodal diversity in postmodernist fiction texts. Multimodality is defined as the coexistence of more than one semiotic mode within a certain context. Multimodal texts feature a diversity of semiotic modes in the communication and development of their narrative. Such experimental texts subvert conventional patterns by introducing various semiotic resources – verbal or non-verbal.

  11. Advances in multimodality molecular imaging

    Directory of Open Access Journals (Sweden)

    Zaidi Habib

    2009-01-01

    Full Text Available Multimodality molecular imaging using high resolution positron emission tomography (PET combined with other modalities is now playing a pivotal role in basic and clinical research. The introduction of combined PET/CT systems in clinical setting has revolutionized the practice of diagnostic imaging. The complementarity between the intrinsically aligned anatomic (CT and functional or metabolic (PET information provided in a "one-stop shop" and the possibility to use CT images for attenuation correction of the PET data has been the driving force behind the success of this technology. On the other hand, combining PET with Magnetic Resonance Imaging (MRI in a single gantry is technically more challenging owing to the strong magnetic fields. Nevertheless, significant progress has been made resulting in the design of few preclinical PET systems and one human prototype dedicated for simultaneous PET/MR brain imaging. This paper discusses recent advances in PET instrumentation and the advantages and challenges of multimodality imaging systems. Future opportunities and the challenges facing the adoption of multimodality imaging instrumentation will also be addressed.

  12. Multimodality imaging of pulmonary infarction

    Energy Technology Data Exchange (ETDEWEB)

    Bray, T.J.P., E-mail: timothyjpbray@gmail.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: mortensen@doctors.org.uk [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)

    2014-12-15

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  13. Mechanisms of acupuncture analgesia for clinical and experimental pain.

    Science.gov (United States)

    Staud, Roland; Price, Donald D

    2006-05-01

    There is convincing evidence that acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting, as well as postoperative dental pain. Less convincing data support AP's efficacy for chronic pain conditions, including headache, fibromyalgia and low back pain. There is no evidence that AP is effective in treating addiction, insomnia, obesity, asthma or stroke deficits. AP seems to be efficacious for alleviating experimental pain by increasing pain thresholds in human subjects and it appears to activate analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes some time to develop and to resolve. Furthermore, repetitive use of AP analgesia can result in tolerance that demonstrates cross-tolerance with morphine. However, it appears that not all forms of AP are equally effective for providing analgesia. In particular, electro-AP seems to best deliver stimuli that activate powerful opioid and nonopioid analgesic mechanisms. Thus, future carefully controlled clinical trials using adequate electro-AP may be able to provide the necessary evidence for relevant analgesia in chronic pain conditions, such as headache, fibromyalgia, irritable bowel syndrome and low back pain.

  14. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...... should aim at including physical rehabilitation programs in the pain treatment regimen....

  15. Bayesian prediction of placebo analgesia in an instrumental learning model

    Science.gov (United States)

    Jung, Won-Mo; Lee, Ye-Seul; Wallraven, Christian; Chae, Younbyoung

    2017-01-01

    Placebo analgesia can be primarily explained by the Pavlovian conditioning paradigm in which a passively applied cue becomes associated with less pain. In contrast, instrumental conditioning employs an active paradigm that might be more similar to clinical settings. In the present study, an instrumental conditioning paradigm involving a modified trust game in a simulated clinical situation was used to induce placebo analgesia. Additionally, Bayesian modeling was applied to predict the placebo responses of individuals based on their choices. Twenty-four participants engaged in a medical trust game in which decisions to receive treatment from either a doctor (more effective with high cost) or a pharmacy (less effective with low cost) were made after receiving a reference pain stimulus. In the conditioning session, the participants received lower levels of pain following both choices, while high pain stimuli were administered in the test session even after making the decision. The choice-dependent pain in the conditioning session was modulated in terms of both intensity and uncertainty. Participants reported significantly less pain when they chose the doctor or the pharmacy for treatment compared to the control trials. The predicted pain ratings based on Bayesian modeling showed significant correlations with the actual reports from participants for both of the choice categories. The instrumental conditioning paradigm allowed for the active choice of optional cues and was able to induce the placebo analgesia effect. Additionally, Bayesian modeling successfully predicted pain ratings in a simulated clinical situation that fits well with placebo analgesia induced by instrumental conditioning. PMID:28225816

  16. Inhaled analgesia for pain management in labour (Review)

    NARCIS (Netherlands)

    Klomp, T.; Poppel, M. van; Jones, L.; Lazet, J.; Nisio, M. Di; Lagro-Janssen, A.L.M.

    2012-01-01

    BACKGROUND: Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains a

  17. Analgesia in the horse, assessing and treating pain in equines

    NARCIS (Netherlands)

    Loon, Thijs van

    2012-01-01

    This review focuses on pain and nociception in horses and is based on the PhD thesis “Analgesia in the Horse, various approaches for assessment and treatment of pain and nociception in equines” by J.P.A.M. van Loon. Apart from a scientific review of the related literature, a multi-disciplinary appro

  18. Information Models of Acupuncture Analgesia and Meridian Channels

    Directory of Open Access Journals (Sweden)

    Chang Hua Zou

    2010-12-01

    Full Text Available Acupuncture and meridian channels have been major components of Chinese and Eastern Asian medicine—especially for analgesia—for over 2000 years. In recent decades, electroacupuncture (EA analgesia has been applied clinically and experimentally. However, there were controversial results between different treatment frequencies, or between the active and the placebo treatments; and the mechanisms of the treatments and the related meridian channels are still unknown. In this study, we propose a new term of infophysics therapy and develop information models of acupuncture (or EA analgesia and meridian channels, to understand the mechanisms and to explain the controversial results, based on Western theories of information, trigonometry and Fourier series, and physics, as well as published biomedical data. We are trying to build a bridge between Chinese medicine and Western medicine by investigating the Eastern acupuncture analgesia and meridian channels with Western sciences; we model the meridians as a physiological system that is mostly constructed with interstices in or between other physiological systems; we consider frequencies, amplitudes and wave numbers of electric field intensity (EFI as information data. Our modeling results demonstrate that information regulated with acupuncture (or EA is different from pain information, we provide answers to explain the controversial published results, and suggest that mechanisms of acupuncture (or EA analgesia could be mostly involved in information regulation of frequencies and amplitudes of EFI as well as neuronal transmitters such as endorphins.

  19. Side effects of pain and analgesia in animal experimentation.

    Science.gov (United States)

    Jirkof, Paulin

    2017-03-22

    This review highlights selected effects of untreated pain and of widely used analgesics such as opioids, non-steroid anti-inflammatory drugs and antipyretics, to illustrate the relevance of carefully planned, appropriate and controlled analgesia for greater reproducibility in animal experiments involving laboratory rodents.

  20. Analgesia and anesthesia for neonates : Study design and ethical issues

    NARCIS (Netherlands)

    Anand, KJS; Aranda, JV; Berde, CB; Buckman, S; Capparelli, EV; Carlo, WA; Hummel, P; Lantos, P; Johnston, CC; Lehr, VT; Lynn, AM; Oberlander, TF; Raju, TNK; Soriano, SG; Taddio, A; Walco, GA; Maxwell, L.G.

    2005-01-01

    Objective: The purpose of this article is to summarize the clinical, methodologic, and ethical considerations for researchers interested in designing future trials in neonatal analgesia and anesthesia, hopefully stimulating additional research in this field. Methods: The MEDLINE, PubMed, EMBASE, and

  1. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  2. EFFECT OF INTRATHECAL CLONIDINE ON DURATION OF SPINAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sourabh

    2015-06-01

    Full Text Available BACKGROUND: Clonidine is an α 2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 μg and 75 μg on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS : A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group received 3ml hyperbaric bupivacaine, Group II (n=25 3ml hyperbar ic bupivacaine + 37.5 μg clonidine and Group III (n=25 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD dura tion of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05. It shows that 37.5  g & 75  g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by abo ut 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 μg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5  g & 75  g as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects

  3. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes.

    Science.gov (United States)

    Devin, Clinton J; McGirt, Matthew J

    2015-06-01

    Multimodal approaches to pain management have arisen with the goal of improving postoperative pain and reducing opioid analgesic use. We performed a comprehensive literature review to determine grades of recommendation for commonly used agents in multimodal pain management and provide a best practice guideline. To evaluate common drugs used in multimodal treatment of pain, a search was performed on English language publications on Medline (PubMed; National Library of Medicine, Bethesda, MD, USA). Manuscripts were rated as Level I-V according to the North American Spine Society's (NASS) standardized levels of evidence tables. Grades of recommendation were assigned for each drug based on the NASS Clinical Guidelines for Multidisciplinary Spine Care. There is good (Grade A) evidence gabapentinoids, acetaminophen, neuraxial blockade and extended-release local anesthetics reduce postoperative pain and narcotic requirements. There is fair (Grade B) evidence that preemptive analgesia and nonsteroidal anti-inflammatory drugs (NSAID) result in reduced postoperative pain. There is insufficient and/or conflicting (Grade I) evidence that muscle relaxants and ketamine provide a significant reduction in postoperative pain or narcotic usage. There is fair (Grade B) evidence that short-term use of NSAID result in no long-term reduction in bone healing or fusion rates. Comprehensive assessment of the effectiveness of perioperative pain control can be accomplished through the use of validated measures. Multimodal pain management protocols have consistently been demonstrated to allow for improved pain control with less reliance on opioids. There is good quality evidence that supports many of the common agents utilized in multimodal therapy, however, there is a lack of evidence regarding optimal postoperative protocols or pathways.

  4. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

    Directory of Open Access Journals (Sweden)

    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

  5. PERSPECTIVAS DEL TRIBUNAL CONSTITUCIONAL SOBRE LA PRISIÓN PREVENTIVA FRENTE A LA AFECTACIÓN DE LA TUTELA JURISDICCIONAL EFECTIVA EN EL PERIODO 2010 AL 2012

    OpenAIRE

    VERA TORRES, MANFRED HONORIO

    2014-01-01

    EL TRIBUNAL CONSTITUCIONAL Y LA PROTECCIÓN DE LA TUTELA JURISDICCIONAL EFECTIVA LA TUTELA JURISDICCIONAL EFECTIVA NATURALEZA JURÍDICA COMO PRINCIPIO ORGANIZADOR DEL ESTADO APUNTE SOBRE SU RELACIÓN CON EL DEBIDO PROCESO COMO CATEGORÍA JURÍDICA AL SERVICIO DE LAS PARTES DEL PROCESO PENAL EL TRIBUNAL CONSTITUCIONAL NATURALEZA JURÍDICA FINALIDAD IMPORTANCIA DE SUS RESOLUCIONES EN LA TUTELA EFECTIVA DE LOS DERECHOS FUNDAMENTALES DE AMBAS PARTES DEL PROCESO PENAL LA PRISIÓN PREVENTIVA COMO MEDIDA C...

  6. Exame clínico pediátrico: aquisição de habilidades na disciplina Pediatria Preventiva Social, FAMEB - UFBA

    OpenAIRE

    Ribeiro, Leonardo Antonio Pereira; Dias, Camila Pereira Fernandes; Jesuíno, Fernanda Azevedo; Alcântara, Taiana Quéssia Neves de; Figueiredo, Isis C.; Sá, Ana Carolina S.; Bastos, Clara Maia; Suñé, Roberta Sampaio; Belitardo, Priscila Machado M.; Oliveira, Cindy S.; Santana, Mariana C.; Casqueiro, Janine B.; Lopes, Daisy Milena C.; Adan, Luís Fernando Fernandes; Silva, Luciana Rodrigues

    2007-01-01

    p. 63-68 O estudo analisa as principais dificuldades referidas e as habilidades adquiridas pelos estudantes de Medicina na prática ambulatorial da disciplina Pediatria Preventiva Social, da Faculdade de Medicina da Universidade Federal da Bahia, em seu primeiro contato com a clínica pediátrica. Através de um questionário, os estudantes foram inquiridos, em dois momentos distintos (início e término da disciplina) acerca dos aspectos com maior dificuldade de superação e progressos ...

  7. Multimodal Literacies in the Secondary English Classroom

    Science.gov (United States)

    Sewell, William C.; Denton, Shawn

    2011-01-01

    To provide insight into the issue of multimodal literacy instruction, the authors explore presentation techniques and instructional activities employed in their secondary language arts classes. They collaborate on assignments that focus students on "anchored media instruction" and engage them in producing multimodal, technology-infused projects,…

  8. Evaluating Multimodal Literacies in Student Blogs

    Science.gov (United States)

    O'Byrne, Barbara; Murrell, Stacey

    2014-01-01

    This research presents ways in which high school students used the multimodal and interactive affordances of blogs to create, organize, communicate and participate on an educational blog. Their actions demonstrated how plural modes of literacy are infiltrating digital environments and reshaping literacy and learning. Multimodal blogging practices…

  9. A cuckoo search algorithm for multimodal optimization.

    Science.gov (United States)

    Cuevas, Erik; Reyna-Orta, Adolfo

    2014-01-01

    Interest in multimodal optimization is expanding rapidly, since many practical engineering problems demand the localization of multiple optima within a search space. On the other hand, the cuckoo search (CS) algorithm is a simple and effective global optimization algorithm which can not be directly applied to solve multimodal optimization problems. This paper proposes a new multimodal optimization algorithm called the multimodal cuckoo search (MCS). Under MCS, the original CS is enhanced with multimodal capacities by means of (1) the incorporation of a memory mechanism to efficiently register potential local optima according to their fitness value and the distance to other potential solutions, (2) the modification of the original CS individual selection strategy to accelerate the detection process of new local minima, and (3) the inclusion of a depuration procedure to cyclically eliminate duplicated memory elements. The performance of the proposed approach is compared to several state-of-the-art multimodal optimization algorithms considering a benchmark suite of fourteen multimodal problems. Experimental results indicate that the proposed strategy is capable of providing better and even a more consistent performance over existing well-known multimodal algorithms for the majority of test problems yet avoiding any serious computational deterioration.

  10. Multimode optical fibers: steady state mode exciter.

    Science.gov (United States)

    Ikeda, M; Sugimura, A; Ikegami, T

    1976-09-01

    The steady state mode power distribution of the multimode graded index fiber was measured. A simple and effective steady state mode exciter was fabricated by an etching technique. Its insertion loss was 0.5 dB for an injection laser. Deviation in transmission characteristics of multimode graded index fibers can be avoided by using the steady state mode exciter.

  11. Multimodal Pedagogies for Teacher Education in TESOL

    Science.gov (United States)

    Yi, Youngjoo; Angay-Crowder, Tuba

    2016-01-01

    As a growing number of English language learners (ELLs) engage in digital and multimodal literacy practices in their daily lives, teachers are starting to incorporate multimodal approaches into their instruction. However, anecdotal and empirical evidence shows that teachers often feel unprepared for integrating such practices into their curricula…

  12. Multimodal Narrative Inquiry: Six Teacher Candidates Respond

    Science.gov (United States)

    Morawski, Cynthia M.; Rottmann, Jennifer

    2016-01-01

    In this paper we present findings of a study on the implementation of a multimodal teacher narrative inquiry component, theoretically grounded by Rosenblatt's theory of transaction analysis, methodologically supported by action research and practically enacted by narrative inquiry and multimodal learning. In particular, the component offered…

  13. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model: a double-blind, randomized, placebo-controlled, five-arm crossover study

    Directory of Open Access Journals (Sweden)

    Ravn P

    2013-01-01

    Full Text Available Pernille Ravn,1 Erik L Secher,2 Ulrik Skram,3 Trine Therkildsen,1 Lona L Christrup,1 Mads U Werner41Department of Drug Design and Pharmacology, University of Copenhagen, 2Department of Anesthesiology, Juliane Marie Center, Rigshospitalet, Copenhagen University Hospitals, 3Department of Intensive Care, Gentofte Hospital, Copenhagen University Hospitals, 4Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, DenmarkPurpose: Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than µ-opioid receptor agonists. The primary outcome of this study was therefore to investigate relative differences in antihyperalgesia and analgesia effects between morphine and buprenorphine in an inflammatory pain model in volunteers. The secondary outcome was to examine the relationship between pain sensitivity and opioid-induced effects on analgesia, antihyperalgesia, and descending pain modulation.Subjects and methods: Twenty-eight healthy subjects were included. The study was a double-blind, randomized, placebo-controlled, five-arm crossover study with a multimodal (electrical, mechanical, and thermal stimuli testing technique. After baseline assessments, intravenous infusions of morphine (10/20 mg, buprenorphine (0.3/0.6 mg, or placebo (normal saline were administered over a 210-minute period, during which a cold pressor test, heat injury (47°C, 7 minutes, 12.5 cm2, and the first postburn assessment were done. After completion of the drug infusions, two additional postburn assessments were done. The subjects were monitored during each 8-hour session by an anesthesiologist.Results: For nearly all tested variables, significant dose-dependent analgesic effects were demonstrated. The median antihyperalgesia/analgesia ratio (secondary hyperalgesia

  14. Multifuel multimodal network design; Projeto de redes multicombustiveis multimodal

    Energy Technology Data Exchange (ETDEWEB)

    Lage, Carolina; Dias, Gustavo; Bahiense, Laura; Ferreira Filho, Virgilio J.M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia de Producao

    2008-07-01

    The objective of the Multi commodity Multimodal Network Project is the development of modeling tools and methodologies for the optimal sizing of production networks and multimodal distribution of multiple fuel and its incomes, considering investments and transportation costs. Given the inherently non-linear combinatory nature of the problem, the resolution of real instances by the complete model, in an exact way, becomes computationally intractable. Thus, the strategy for resolution should contain a combination of exacts and heuristics methods, that must be applied to subdivisions of the original problem. This paper deals with one of these subdivisions, tackling the problem of modeling a network of pipelines in order to drain the production of ethanol away from the producing plants. The objective consists in defining the best network topology, minimizing investment and operational costs, and attending the total demand. In order to do that, the network was considered a tree, where the nodes are the center of producing regions and the edges are the pipelines, trough where the ethanol produced by plants must be drained away. The main objective also includes the decision over the optimal diameter of each pipeline and the optimal size of the bombs, in order to minimize the pumping costs. (author)

  15. The Multimodal Possibilities of Online Instructions

    DEFF Research Database (Denmark)

    Kampf, Constance

    2006-01-01

    The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi......-modal analysis tools help us understand the impact of multimodal channels used in instructions?  This paper looks at Kress and VanLeewan's questions of "how narrative is shaped in a specific mode and how it is reshaped when it appears in different modes?" (2001:128)  In addition, the intersection of linguistics...... and rhetoric is explored as a means of understanding the multimodal possibilities for technical communication genres such as instructions....

  16. Multimodal Treatment of Chronic Pain.

    Science.gov (United States)

    Dale, Rebecca; Stacey, Brett

    2016-01-01

    Most patients with chronic pain receive multimodal treatment. There is scant literature to guide us, but when approaching combination pharmacotherapy, the practitioner and patient must weigh the benefits with the side effects; many medications have modest effect yet carry significant side effects that can be additive. Chronic pain often leads to depression, anxiety, and deconditioning, which are targets for treatment. Structured interdisciplinary programs are beneficial but costly. Interventions have their place in the treatment of chronic pain and should be a part of a multidisciplinary treatment plan. Further research is needed to validate many common combination treatments.

  17. Metawidgets in the multimodal interface

    Energy Technology Data Exchange (ETDEWEB)

    Blattner, M.M. (Lawrence Livermore National Lab., CA (United States) Anderson (M.D.) Cancer Center, Houston, TX (United States)); Glinert, E.P.; Jorge, J.A.; Ormsby, G.R. (Rensselaer Polytechnic Inst., Troy, NY (United States). Dept. of Computer Science)

    1991-01-01

    We analyze two intertwined and fundamental issues concerning computer-to-human communication in the multimodal interfaces: the interplay between sound and graphics, and the role of object persistence. Our observations lead us to introduce metawidgets as abstract entities capable of manifesting themselves to users as image, as sound, or as various combinations and/or sequences of the two media. We show examples of metawidgets in action, and discuss mechanisms for choosing among alternative media for metawidget instantiation. Finally, we describe a couple of experimental microworlds we have implemented to test out some of our ideas. 17 refs., 7 figs.

  18. Estratégias de rastreamento e intervenções breves como possibilidades para a prática preventiva do enfermeiro

    Directory of Open Access Journals (Sweden)

    Angélica Martins de Souza Gonçalves

    2011-06-01

    Full Text Available O rastreamento e as intervenções breves podem ser considerados recursos efetivos para a prática em saúde. O presente estudo teve como objetivo realizar uma reflexão sobre a aplicação dessas estratégias e a sua utilização pelo enfermeiro. Para isso, foram elencados os elementos que fundamentam as intervenções breves, a atuação do enfermeiro em relação à prática preventiva para o uso do álcool e os potenciais benefícios decorrentes de sua implementação. Neste sentido, as atribuições da enfermagem no âmbito da Atenção Primária à Saúde são estratégicas para reduzir os danos causados pelo uso do álcool. Porém, diversos fatores limitam a atuação destes enfermeiros, sendo necessário centrar esforços para dar ao tema um tratamento realista e pragmático. Portanto, é fundamental a difusão de treinamentos e cursos de capacitação com o objetivo de habilitar o enfermeiro a abordar, de maneira sistematizada, a questão do álcool numa perspectiva preventiva.

  19. "Tem mulher, tem preventivo": sentidos das práticas preventivas do câncer do colo do útero entre mulheres de Salvador, Bahia, Brasil

    Directory of Open Access Journals (Sweden)

    Ana María Rico

    2013-09-01

    Full Text Available O objetivo deste trabalho foi compreender os significados das práticas preventivas do câncer do colo do útero entre mulheres de bairros populares de Salvador, Bahia, Brasil. Trata-se de estudo qualitativo, baseado na análise de conteúdo de entrevistas semiestruturadas com 15 mulheres entre 24 e 68 anos. Os resultados evidenciam alta valorização do Papanicolaou, que é realizado como parte de exames de rotina, sem, no entanto, sustentar-se no conhecimento biomédico sobre as suas funções. Além da acessibilidade aos serviços de saúde e da qualidade destes, outros fatores interferem na forma como essas mulheres significam a prevenção do câncer do colo do útero. Valores morais associados à sexualidade e ao gênero interferem na percepção de risco, na adoção de práticas preventivas e na interpretação dos resultados da citologia cervical. A realização continuada do Papanicolaou faz parte da construção da feminilidade, que é associada com maturidade e responsabilidade pessoal pelo cuidado de si em um contexto de medicalização do corpo feminino.

  20. Cardiac imaging. A multimodality approach

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, Manfred [Johannes Gutenberg University Hospital, Mainz (Germany); Erbel, Raimund [University Hospital Essen (Germany). Dept. of Cardiology; Kreitner, Karl-Friedrich [Johannes Gutenberg University Hospital, Mainz (Germany). Clinic and Polyclinic for Diagnostic and Interventional Radiology; Barkhausen, Joerg (eds.) [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Radiology and Nuclear Medicine

    2009-07-01

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  1. Untangled modes in multimode waveguides

    Science.gov (United States)

    Plöschner, Martin; Tyc, TomáÅ.¡; Čižmár, TomáÅ.¡

    2016-03-01

    Small, fibre-based endoscopes have already improved our ability to image deep within the human body. A novel approach introduced recently utilised disordered light within a standard multimode optical fibre for lensless imaging. Importantly, this approach brought very significant reduction of the instruments footprint to dimensions below 100 μm. The most important limitations of this exciting technology is the lack of bending flexibility - imaging is only possible as long as the fibre remains stationary. The only route to allow flexibility of such endoscopes is in trading-in all the knowledge about the optical system we have, particularly the cylindrical symmetry of refractive index distribution. In perfect straight step-index cylindrical waveguides we can find optical modes that do not change their spatial distribution as they propagate through. In this paper we present a theoretical background that provides description of such modes in more realistic model of real-life step-index multimode fibre taking into account common deviations in distribution of the refractive index from its ideal step-index profile. Separately, we discuss how to include the influence of fibre bending.

  2. Preemptive analgesia: the prevention of neurogenous orofacial pain.

    OpenAIRE

    Foreman, P. A.

    1995-01-01

    Chronic neurogenous pain is often an extremely difficult condition to manage. In the orofacial region, trauma from injury or dental procedures may lead to the development of severe neuralgic pains and major distress to the patient. Clinical and experimental evidence suggests that the use of adequate preemptive regional anesthesia, systemic analgesia, and the avoidance of repeated, painful stimuli may reduce the incidence of this problem.

  3. The Neuroanatomy of Sexual Dimorphism in Opioid Analgesia

    Science.gov (United States)

    2014-04-13

    nociception , morphine antinociception and reproductive indices in male and female rats. Pain 103 (3), 285–302. van Bockstaele, E.J., Aston-Jones, G...Review The neuroanatomy of sexual dimorphism in opioid analgesia Dayna R. Loyd a, Anne Z. Murphy b,⁎ a Pain Management Research Area, United States...online 13 April 2014 Keywords: Pain Periaqueductal gray Morphine Mu opioid receptor The influence of sex has been neglected in clinical studies on pain

  4. Intrapartum analgesia as a condition of human satisfaction at hospital

    Directory of Open Access Journals (Sweden)

    Concetta Polizzi

    2013-06-01

    Full Text Available The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia called the A group, and the control group (women who refused it called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

  5. Clinical study of diffusion hypoxia after nitrous oxide analgesia.

    OpenAIRE

    Quarnstrom, F. C.; Milgrom, P.; Bishop, M. J.; DeRouen, T. A.

    1991-01-01

    In order to estimate the incidence of diffusion hypoxia, arterial oxygen saturation was measured in 104 healthy adult dental patients who were administered nitrous oxide-oxygen analgesia and who did not receive postcessation oxygen. Pretreatment saturation levels as determined by pulse oximetry ranged from 93% to 100%. When the nitrous oxide-oxygen administration ceased, the saturation levels were from 95% to 100%. The mean saturation dropped about 2% over the next 4 min and then stabilized. ...

  6. Effects of block analgesia on attenuating intraoperative stress responses during oral surgery.

    OpenAIRE

    Mamiya, H.; Ichinohe, T.; Kaneko, Y

    1997-01-01

    Surgical intervention affects cardiorespiratory function and deteriorates the homeostatic mechanisms. The aim of this study was to evaluate the effect of block analgesia, which may minimize the intraoperative stress responses during oral surgery. In addition, we evaluated whether block analgesia could lessen the anesthetic requirements. Twenty-eight operative patients were randomly allocated to one of four groups: group 1, 1.3MAC without block analgesia; group 2, 1.6MAC without block analgesi...

  7. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Vivian P. Kamphuis

    2015-01-01

    Full Text Available We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy.

  8. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  9. Effects of hypnotic analgesia and hypnotizability on experimental ischemic pain.

    Science.gov (United States)

    DeBenedittis, G; Panerai, A A; Villamira, M A

    1989-01-01

    Mechanisms of hypnotic analgesia are still poorly understood and conflicting data are reported regarding the underlying neurochemical correlates. The present study was designed to investigate the effects of hypnotically induced analgesia and hypnotizability on experimental ischemic pain, taking into account pain and distress tolerance as well as the neurochemical correlates. 11 high hypnotizable Ss and 10 low hypnotizable Ss, as determined by scores on the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1962), were administered an ischemic pain test in both waking and hypnotic conditions. The following variables were measured: (a) pain and distress tolerance, (b) anxiety levels, and (c) plasma concentrations of beta-endorphin and adrenocorticotropic hormone (ACTH). Results confirmed significant increases of pain and distress tolerance during hypnosis as compared to the waking state, with positive correlations between pain and distress relief and hypnotizability. Moreover, a hypnotically induced dissociation between the sensory-discriminative and the affective-motivational dimensions of pain experience was found, but only in high hypnotizable Ss. Hypnotic analgesia was unrelated to anxiety reduction and was not mediated either by endorphins or by ACTH.

  10. A compression bandage improves local infiltration analgesia in total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse; Husted, Henrik; Otte, Niels Kristian Stahl Kri;

    2008-01-01

    BACKGROUND: High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated. METHODS: 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0...... with compression bandage than in those with non-compression bandage and with a similar low use of oxycodone. Mean hospital stay was similar (2.8 days and 3.3 days, respectively). INTERPRETATION: A compression bandage is recommended to improve analgesia after high-volume local infiltration analgesia in total knee...... arthroplasty Udgivelsesdato: 2008/12...

  11. Tibial cortical lesions: A multimodality pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Tyler, P.A., E-mail: philippa.tyler@rnoh.nhs.uk [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Mohaghegh, P., E-mail: pegah1000@gmail.com [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Foley, J., E-mail: jfoley1@nhs.net [Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES (United Kingdom); Isaac, A., E-mail: amandaisaac@doctors.org.uk [Department of Radiology, King' s College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Zavareh, A., E-mail: ali.zavareh@gmail.com [Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE (United Kingdom); Thorning, C., E-mail: cthorning@doctors.org.uk [Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH (United Kingdom); Kirwadi, A., E-mail: anandkirwadi@gmail.com [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Pressney, I., E-mail: ipressney@hotmail.com [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Amary, F., E-mail: fernanda.amary@rnoh.nhs.uk [Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Rajeswaran, G., E-mail: grajeswaran@gmail.com [Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH (United Kingdom)

    2015-01-15

    Highlights: • Multimodality imaging plays an important role in the investigation and diagnosis of shin pain. • We review the multimodality imaging findings of common cortically based tibial lesions. • We also describe the rarer pathologies of tibial cortical lesions. - Abstract: Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.

  12. Mediating multimodal environmental knowledge across animation techniques

    DEFF Research Database (Denmark)

    Maier, Carmen Daniela

    2011-01-01

    in the technology- mediated discourse of short animation films. This is done by employing the model of multimodal discourse analysis proposed by Van Leeuwen (2008) and Machin and Van Leeuwen (2007) to the analysis of a series of animation films focused on environmental problems. These films are united under......://www.sustainlane.com/. The multimodal discourse analysis is meant to reveal how selection and representation of environmental knowledge about social actors, social actions, resources, time and space are influenced by animation techniques. Furthermore, in the context of this multimodal discourse analysis, their influence upon...

  13. Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2009-01-01

    Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ìg.ml-1 of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

  14. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik;

    2011-01-01

    was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...... (range 2-7) days. Interpretation Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib...

  15. Patient controlled intravenous analgesia with tramadol for labor pain relief

    Institute of Scientific and Technical Information of China (English)

    龙健晶; 岳云

    2003-01-01

    Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA)+ patient controlled epidural analgesia (PCEA). Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ-Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n=30) received no analgesia; group A (n=30) received spinal administration with ropivacaine 2.5 mg and fentanyl 5 μg, then with PCEA; group B (n=20) received 1 mg/kg tramadol loading dose I.v.. PCIA with 0.75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS). Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P<0.01). In comparison with group B, the VAS pain scores decreased in group A (P<0.05). The onset times of analgesia in group A were shorter than those in group B (P<0.05). Apgar scores in group B were lower than those in group A (P<0.05). The periods of second stage of labor in group A were longer than those in the control group and group B (P<0.05). The cesarean delivery rate was significantly higher in the control group (16.7%) than in group A (3.3%) and group B (5.0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups. Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.

  16. Multimodal integration in statistical learning

    DEFF Research Database (Denmark)

    Mitchell, Aaron; Christiansen, Morten Hyllekvist; Weiss, Dan

    2014-01-01

    Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study......, we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker’s face. In the critical condition, the visual (e.g., /gi/) and auditory (e.g., /mi/) signals were occasionally...... incongruent, which we predicted would produce the McGurk illusion, resulting in the perception of an audiovisual syllable (e.g., /ni/). In this way, we used the McGurk illusion to manipulate the underlying statistical structure of the speech streams, such that perception of these illusory syllables...

  17. Photon correlations in multimode waveguides

    Energy Technology Data Exchange (ETDEWEB)

    Poem, Eilon; Silberberg, Yaron [Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot 76100 (Israel)

    2011-10-15

    We consider the propagation of classical and nonclassical light in multimode optical waveguides. We focus on the evolution of the few-photon correlation functions, which, much as the light-intensity distribution in such systems, evolve in a periodic manner, culminating in the ''revival'' of the initial correlation pattern at the end of each period. It is found that when the input state possesses nontrivial symmetries, the correlation revival period can be longer than that of the intensity, and thus the same intensity pattern can display different correlation patterns. We experimentally demonstrate this effect for classical, pseudothermal light, and compare the results with the predictions for nonclassical, quantum light.

  18. Multimode waveguide based directional coupler

    Science.gov (United States)

    Ahmed, Rajib; Rifat, Ahmmed A.; Sabouri, Aydin; Al-Qattan, Bader; Essa, Khamis; Butt, Haider

    2016-07-01

    The Silicon-on-Insulator (SOI) based platform overcomes limitations of the previous copper and fiber based technologies. Due to its high index difference, SOI waveguide (WG) and directional couplers (DC) are widely used for high speed optical networks and hybrid Electro-Optical inter-connections; TE00-TE01, TE00-TE00 and TM00-TM00 SOI direction couplers are designed with symmetrical and asymmetrical configurations to couple with TE00, TE01 and TM00 in a multi-mode semi-triangular ring-resonator configuration which will be applicable for multi-analyte sensing. Couplers are designed with effective index method and their structural parameters are optimized with consideration to coupler length, wavelength and polarization dependence. Lastly, performance of the couplers are analyzed in terms of cross-talk, mode overlap factor, coupling length and coupling efficiency.

  19. Intervenciones preventivas de la violencia interna en el trabajo: políticas de buenas prácticas y gestión de conflictos

    Directory of Open Access Journals (Sweden)

    Antonia Bernat Jiménez

    Full Text Available La violencia interna en el lugar de trabajo es la que tiene lugar entre los trabajadores, incluidos mandos y directivos. Incluye la violencia física, el acoso sexual y el acoso psicológico, abarcando también otras conductas de violencia psicológica diferenciadas de éste. Debe ser considerada como un riesgo psicosocial, que supone un peligro importante para la salud y seguridad de las personas, y tiene repercusiones organizacionales a través de costes directos e indirectos. Considerar la violencia interna con este enfoque de riesgo laboral, supone que su abordaje se ha de realizar aplicando los principios de la acción preventiva, a la vez que permite adoptar estrategias de actuación dirigidas a la prevención del fenómeno. Las principales organizaciones a nivel mundial y nacional proponen la implementación de una política de prevención de la violencia en el lugar de trabajo. Este artículo trata sobre la conveniencia del desarrollo e implementación en las organizaciones de una política de prevención de la violencia interna, de carácter integral e integrado, que involucre a toda la organización, orientada a lograr entornos de trabajo más saludables y con un enfoque centrado en los factores organizativos y psicosociales. En el artículo se contemplan las premisas esenciales de esa política preventiva de la violencia interna, abordándose también los momentos básicos de la estrategia preventiva: - La evaluación de riesgo psicosociales. - La política de buenas prácticas. - Los procedimientos de gestión de conflictos y acoso psicológico en el trabajo. - Las estrategias de comunicación organizacional y las acciones formativas. Para conseguir auténtica efectividad, las políticas de prevención de la violencia interna deben incorporarse al Sistema de Gestión de la Prevención de la organización, que, a su vez, estará integrado en todos los sistemas de gestión restantes de la empresa.

  20. El error judicial en el uso de la prisión preventiva: Personas en prisión que nunca llegan a ser condenadas.

    Directory of Open Access Journals (Sweden)

    Nuria Sánchez

    2017-01-01

    Full Text Available Resumen Spanish correctional institutions admitted in 2014 more than 8000 people in pretrial detention. Some of them will be absolved after an inquiry and they will be found innocent having spent time in prison. The present study examines cases in which the State, in the interest of public safety, deprives innocent people of freedom. The ultimate purpose of this study is to analyze the possible presence of bias or judicial heuristics in decision-making. To this end, 70 sentences later compensated for wrongful detention and 136 convictions after pretrial detention have been systematically analyzed. The results showed that there were no significant differences in the age, the sex, the nationality, or the criminal records of the innocent and convicts. Nevertheless, differences in the type of crime have been observed. Serious crimes (murder or sexual assault have been significantly more frequent in compensatory judgments, while the prisoners have been convicted of minor offenses (theft or crimes against road safety. Finally, we discuss the need to conduct research that is generalizable to a target ecology. This will allow study of wrongful convictions both in general and in the application of undue pretrial detention. Abstract Las prisiones españolas acogían en 2014 a más de 8000 personas en situación de prisión preventiva. A tenor de los antecedentes, muchos de ellos serán absueltos tras la instrucción, y habrán sufrido una pena de prisión siendo inocentes. Este trabajo analiza casos en los que el Estado, en aras de la seguridad ciudadana, priva de libertad a inocentes. El propósito último de este estudio es analizar la posible presencia de sesgos o heurísticos judiciales en la toma de decisiones. Para ello, se han analizado sistemáticamente 70 sentencias indemnizatorias y 136 condenatorias tras prisión preventiva. Los resultados mostraron que no existían diferencias significativas en la edad, el sexo, la nacionalidad, o los

  1. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study

    DEFF Research Database (Denmark)

    Rasmussen, Michael; Mathiesen, Ole; Dierking, Gerd

    2010-01-01

    It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared...... with paracetamol and ketorolac alone after hip arthroplasty....

  2. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study

    DEFF Research Database (Denmark)

    2010-01-01

    It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared...

  3. Multi-Modal Treatment of Nocturnal Enuresis.

    Science.gov (United States)

    Mohr, Caroline; Sharpley, Christopher F.

    1988-01-01

    The article reports a multimodal treatment of nocturnal enuresis and anxious behavior in a mildly mentally retarded woman. Behavioral treatment and removal of caffeine from the subject's diet eliminated both nocturnal enuresis and anxious behavior. (Author/DB)

  4. Intelligent Multimodal Signal Adaptation System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Micro Analysis and Design (MA&D) is pleased to submit this proposal to design an Intelligent Multimodal Signal Adaptation System. This system will dynamically...

  5. Histology image search using multimodal fusion.

    Science.gov (United States)

    Caicedo, Juan C; Vanegas, Jorge A; Páez, Fabian; González, Fabio A

    2014-10-01

    This work proposes a histology image indexing strategy based on multimodal representations obtained from the combination of visual features and associated semantic annotations. Both data modalities are complementary information sources for an image retrieval system, since visual features lack explicit semantic information and semantic terms do not usually describe the visual appearance of images. The paper proposes a novel strategy to build a fused image representation using matrix factorization algorithms and data reconstruction principles to generate a set of multimodal features. The methodology can seamlessly recover the multimodal representation of images without semantic annotations, allowing us to index new images using visual features only, and also accepting single example images as queries. Experimental evaluations on three different histology image data sets show that our strategy is a simple, yet effective approach to building multimodal representations for histology image search, and outperforms the response of the popular late fusion approach to combine information.

  6. Esthesioneuroblastoma: Multimodal management and review of literature

    Science.gov (United States)

    Kumar, Ritesh

    2015-01-01

    Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the olfactory neuroepithelium. ENB constitutes only 3% of all malignant intranasal neoplasm. Because of the rarity, the number of patients of ENB treated in individual departments is small. Most of these patients presents in locally advanced stages and require multimodality treatment in form of surgery, chemotherapy and radiotherapy. Multimodality approach with a risk-adapted strategy is required to achieve good control rates while minimizing treatment related toxicity. PMID:26380824

  7. Engineering gestures for multimodal user interfaces

    OpenAIRE

    Echtler, Florian; Kammer, Dietrich; Vanacken, Davy; Hoste, Lode; Signer, Beat

    2014-01-01

    Despite increased presence of gestural and multimodal user interfaces in research as well as daily life, development of such systems still mostly relies on programming concepts which have emerged from classic WIMP user interfaces. This workshop proposes to explore the gap between attempts to formalize and structure development for multimodal interfaces in the research community on the one hand and the lack of adoption of these formal languages and frameworks by practitioners and other researc...

  8. Quantifying Quality Aspects of Multimodal Interactive Systems

    CERN Document Server

    Kühnel, Christine

    2012-01-01

    This book systematically addresses the quantification of quality aspects of multimodal interactive systems. The conceptual structure is based on a schematic view on human-computer interaction where the user interacts with the system and perceives it via input and output interfaces. Thus, aspects of multimodal interaction are analyzed first, followed by a discussion of the evaluation of output and input and concluding with a view on the evaluation of a complete system.

  9. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    P K Dilesh

    2014-01-01

    Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

  10. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  11. Medidas preventivas contra a AIDS e outras doenças sexualmente transmissíveis conhecidas por universitários da área de saúde Medidas preventivas contra SIDA y otras enfermedades sexualmente transmisibles conocidas por universitarios del campo de la salud Preventive measures against AIDS and other sexually transmitted diseases known by undergraduate health students

    Directory of Open Access Journals (Sweden)

    Elucir Gir

    1999-01-01

    Full Text Available Objetivando identificar as medidas de prevenção conhecidas por universitários da área da saúde, acerca da contaminação pelo HIV e outras Doenças Sexualmente Transmissíveis (essencialmente de transmissão sexual e identificar se há diferença significativa entre as citações, considerando-se o sexo dos sujeitos, realizou-se esta investigação. Foi aplicado um questionário estruturado em universitários da área da saúde aleatoriamente selecionados. Os resultados revelaram que a maioria dos itens citados como medidas preventivas para a AIDS e DST se enquadra dentro das medidas importantes para a prevenção das mesmas, no entanto, quando a análise é feita em termos da freqüência citada, ou seja, o número de estudantes que mencionaram medidas corretas, verifica-se que foi aquém do esperado, o que se torna preocupante. Outro aspecto observado nos resultados é que não há diferença, em termos de conhecimentos sobre medidas preventivas, entre estudantes do sexo masculino e feminino. Assim, a análise dos resultados permite evidenciar que os conhecimentos da maioria dos estudantes universitários estudados são precários, o que reforça a necessidade de implementar ações educativas específicas e contínuas.El presente estudio tiene los objetos de identificar las medidas preventivas conocidas por universitarios del campo de la salud, a respecto de la contaminación por HIV y otras enfermedades sexualmente transmisibles, y identificar si hay diferencia significativa entre las respuestas, considerando el sexo de los sujetos. Un cuestionario fue aplicado en universitarios del campo de la salud, los cuales fueron aleatoriamente seleccionados. Las medidas más frecuentes muestran que las medidas preventivas referidas por los universitarios são importantes, pero no observamos diferencia entre conocimiento de los estudiantes de diferentes sexos. Los universitarios están bien informados sobre medidas preventivas generales contra

  12. Multimodal pain stimulation of the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Asbjφrn Mohr Drewes; Hans Gregersen

    2006-01-01

    Understanding and characterization of pain and other sensory symptoms are among the most important issues in the diagnosis and assessment of patient with gastrointestinal disorders. Methods to evoke and assess experimental pain have recently developed into a new area with the possibility for multimodal stimulation (e.g.,electrical, mechanical, thermal and chemical stimulation)of different nerves and pain pathways in the human gut. Such methods mimic to a high degree the pain experienced in the clinic. Multimodal pain methods have increased our basic understanding of different peripheral receptors in the gut in health and disease. Together with advanced muscle analysis, the methods have increased our understanding of receptors sensitive to mechanical,chemical and temperature stimuli in diseases, such as systemic sclerosis and diabetes. The methods can also be used to unravel central pain mechanisms, such as those involved in allodynia, hyperalgesia and referred pain. Abnormalities in central pain mechanisms are often seen in patients with chronic gut pain and hence methods relying on multimodal pain stimulation may help to understand the symptoms in these patients.Sex differences have been observed in several diseases of the gut, and differences in central pain processing between males and females have been hypothesized using multimodal pain stimulations. Finally, multimodal methods have recently been used to gain more insight into the effect of drugs against pain in the GI tract.Hence, the multimodal methods undoubtedly represents a major step forward in the future characterization and treatment of patients with various diseases of the gut.

  13. Vectores recombinantes basados en el virus modificado de ankara (MVA) como vacunas preventivas y terapéuticas contra el SIDA

    OpenAIRE

    Jonathan L Heeney; Mooij, Petra; Nájera García, José Luis; Jiménez, Victoria; Esteban, Mariano; Gómez, Carmen E.

    2005-01-01

    Vectores Recombinantes basados en el Virus Modificado de Ankara (MVA) como Vacunas Preventivas y Terapéuticas contra el SIDA. Losvirus recombinantes de la invención contienen secuencias que se encuentran insertadas en el mismo sitio de inserción del MVA y permiten la expresión simultánea de varios antígenos, una proteína Env del VIH-I consistente en una proteína gpl20 carente de secuencias correspondientes a la proteína gp41, y una proteína quiméricade fusión de Gag, Pol y Nef. Son virus esta...

  14. Necesidades de accesibilidad para acciones preventivas. Una perspectiva de la población en Monterrey, México en 2005

    Directory of Open Access Journals (Sweden)

    María Eugenia Garza Elizondo

    2008-01-01

    Resultados: El 98,9% de la población estudiada recibió alguna acción preventiva. Los municipios con mayor necesidad de accesibilidad fueron Santa Catarina (Z -6,9, Apodaca (Z -1,5 y Benito Juárez (Z -1,2. San Pedro Garza García se vio más afectado por barreras de acceso geográfico o económico (Z -3.5; Apodaca, por percepción de calidad (Z -4,7; y Santa Catarina, por disponibilidad de recursos físicos, humanos o materiales (Z -4,9. Conclusiones: La mayor necesidad de accesibilidad se presentó en tres de los ocho municipios de la zona estudiada.

  15. TRANSVERSUS ABDOMINIS PLANE BLOCK : A COMPLEMENTARY TECHNIQUE FOR POST OPERATIVE ANALGESIA IN LOWER ABDOMINAL GYNECOLOGICAL CANCER SURGERIES

    Directory of Open Access Journals (Sweden)

    Arathi

    2015-06-01

    scores compared to non - block group , p value being < 0.001. Total requirement of opioids in 24 hours was reduced in the block group , p<0.001. Time to first request for analgesia was delayed in the block gr oup where only 22% patients needed analgesic at 0 hours compared to 72% in non - block group . Incidence of nausea and vomiting was reduced after 4 hours in block group. The non - block group patients were less sedated at 0 and 2 hours probably due to pain . The re were no complications attributable to the block. CONCLUSION : TAP block as a complementary technique to the multimodal analgesia protocol , provided improved quality of analgesia with reduced opioid requirement and their side effects in block group compar ed to non - block group for radical hysterectomy and pelvic lymph node dissection with incision below the umbilicus

  16. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C; Bigler, D;

    1988-01-01

    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

  17. The effect of adding epinephrine to combination of sufentanil and bupivacaine in spinal analgesia during labor

    Directory of Open Access Journals (Sweden)

    Parisa Golfam

    2011-03-01

    Full Text Available Background: Spinal analgesia is one of the effective and rapid methods for labor. It is not commonly used because of short duration of analgesia and motor block, which limits mother's force in labor progression. We attempted to prolong duration and quality of analgesia by adding Epinephrine.Methods: In this quasi-experimental study 90 pregnant women gravid II and III who referred to Motazedi and Imam Reza Educational & Medical Centers were recruited and divided into two groups of case and control (45 subjects in each group. The case group received spinal analgesia using Sufentanil and Bupivacaine, and Epinephrine while the control group received Sufentanil and Bupivacaine. Data including feeling of pain, motor block, duration of analgesia, fetal heart rate, nausea and vomiting, blood pressure was collected and analyzed using chi-square and t test. Results: duration of analgesia and vomiting were significantly increased in the case group. (p=0.001, p=0.01 respectively. Hemodynamic status in mothers and Apgar score of neonates were not significantly different between two groups.Conclusion: It seems that adding Epinephrine to Sufentanil and Bupivacaine could increase analgesia duration without altering in sensory level although could increase nausea and vomiting its recommended in labor analgesia.

  18. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas

    DEFF Research Database (Denmark)

    Eriksen, Lena Mariann; Nøhr, Ellen Aagaard; Kjaergaard, Hanne

    2011-01-01

    Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between...

  19. Generalized modulational instability in multimode fibers: wideband multimode parametric amplification

    CERN Document Server

    Guasoni, M

    2015-01-01

    In this paper intermodal modulational instability (IM-MI) is analyzed in a multimode fiber where several spatial and polarization modes propagate. The coupled nonlinear Schr\\"{o}dinger equations describing the modal evolution in the fiber are linearized and reduced to an eigenvalue problem. As a result, the amplification of each mode can be described by means of the eigenvalues and eigenvectors of a matrix that stores the information about the dispersion properties of the modes and the modal power distribution of the pump. Some useful analytical formulas are also provided that estimate the modal amplification as function of the system parameters. Finally, the impact of third-order dispersion and of absorbtion losses is evaluated, which reveals some surprising phenomena into the IM-MI dynamics. These outcomes generalize previous studies on bimodal-MI, related to the interaction between 2 spatial or polarization modes, to the most general case of $N>2$ interacting modes. Moreover, they pave the way towards the ...

  20. The elusive rat model of conditioned placebo analgesia.

    Science.gov (United States)

    McNabb, Christopher T; White, Michelle M; Harris, Amber L; Fuchs, Perry N

    2014-10-01

    Recent research on human placebo analgesia has suggested the need for rodent models to further elucidate the neural substrates of the placebo effect. This series of 3 experiments therefore was performed in an attempt to develop a model of placebo analgesia in rats. In each study, female Sprague-Dawley rats received an L5 spinal nerve ligation to induce a neuropathic pain condition. Each rat then underwent a 4-day conditioning procedure in which an active analgesic drug or its vehicle (unconditioned stimulus) was associated with the following cues (conditioned stimuli): novel testing room (environmental), vanilla scent cue (olfactory), dim incandescent lighting (visual), restraint procedure/injection (tactile), and time of day and injection-test latency (temporal). The analgesics for each experiment were as follows: Experiment 1 used 90 mg/kg gabapentin, experiment 2 used 3mg/kg loperamide hydrochloride, and experiment 3 used 6 mg/kg morphine sulfate. On the following test day, half of the animals received the opposite treatment, resulting in 4 conditioning manipulations: drug/drug, drug/vehicle, vehicle/drug, and vehicle/vehicle. Nociceptive thresholds were assessed with the mechanical paw withdrawal threshold test each day after the conditioning procedure. In all 3 experiments, no significant differences were detected on test day between control and placebo groups, indicating a lack of a conditioned placebo analgesic response. Our results contrast with prior research that implies the existence of a reliable and robust response to placebo treatment. We conclude that placebo analgesia in rats is not particularly robust and that it is difficult to achieve using conventional procedures and proper experimental design.

  1. The impact of patients controlled analgesia undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Aluane Silva Dias

    2016-06-01

    Full Text Available ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen, and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA and total knee arthroplasty (TKA, thoracolumbar spine arthrodesis (long PVA, cervical spine arthrodesis (cervical AVA and lumbar spine arthrodesis (lumbar PVA. RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03 and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09. CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

  2. INTRAVENOUS DEXMEDETOMIDINE FOR LABOUR ANALGESIA IN WOMEN WITH PREECLAMPSIA

    Directory of Open Access Journals (Sweden)

    Nidhi

    2016-06-01

    Full Text Available BACKGROUND Parenteral opioids and sedatives are the most frequently prescribed agents for women in labour in many poor resource settings. These have shown poor pain relief and a lot of side effects in both the mother and the foetus. In patients with severe pre-eclampsia who are already haemodynamically compromised labour pains and delivery can result in haemodynamic instability, which can compromise both the mother and the neonate. Dexmedetomidine is a highly selective α-2 agonist, which when used in recommended dose in the form of an infusion has several desirable properties like sedation, anxiolysis, sympatholysis, analgesia, decreased anaesthetic requirements, maintains cardiovascular stability and provides a smooth recovery. AIM The aim of this study was to study the haemodynamic effects of intravenous dexmedetomidine when used in patients with severe pre-eclampsia for labour analgesia. MATERIALS AND METHODS The study was conducted in the Department of Obstetrics and Gynaecology of Bundelkhand Medical College, Sagar, between January 2015 and December 2016; 40 labouring patients with severe pre-eclampsia were included in the study; 20 each were allocated to the study and control group. The study group received intravenous Dexmedetomidine in the recommended doses (1 ug/kg loading dose over 10-15 minutes followed by an infusion at 0.2-0.7 ug/kg/hour when in active labour, while the control group received Intravenous Fentanyl. The two groups were compared regarding the duration of labour, the mode of delivery, the neonatal outcome, the onset and duration of analgesia and maternal haemodynamic parameters during labour and delivery. The data obtained in this study was tabulated and analysed using the Chi-square test and the Z test with p value of 0.05 taken as significant. RESULTS It was found out that the group of patients who received Dexmedetomidine were more haemodynamically stable during labour and delivery; there was significant pain relief

  3. Imaging-guided hyperstimulation analgesia in low back pain.

    Science.gov (United States)

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.

  4. Regional anaesthesia and analgesia on the front line.

    Science.gov (United States)

    Scott, D M

    2009-11-01

    Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier

  5. Intravenous regional analgesia in a patient with Glanzmann thrombastenia.

    Science.gov (United States)

    Goksu, Sitki; Gul, Rauf; Ozen, Onder; Yilmaz, Mehmet; Buyukbebeci, Orhan; Oner, Unsal

    2010-02-01

    Glanzmann thrombastenia (GT) is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR. and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27-year-old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia (IVRA). The use of platelet transfusion and the recombinant factor VIIa, are stressed.

  6. Opioid and nonopioid interactions in two forms of stress-induced analgesia.

    Science.gov (United States)

    Grisel, J E; Fleshner, M; Watkins, L R; Maier, S F

    1993-05-01

    Stressful environmental events activate endogenous mechanisms of pain inhibition. Under some circumstances the analgesia is blocked by naloxone/naltrexone ("opioid"), while under others it is not ("nonopioid"). The existence of these two categories of analgesia leads to the question of how they are related. In a collateral inhibition model proposed by Kirshgessner, Bodnar, and Pasternak (1982), opiate and nonopiate mechanisms were viewed as acting in a mutually inhibitory fashion. In the present experiments, rats were exposed to either of two environmental stressors that produce a nonopioid stress-induced analgesia (SIA) following injections of the opiate antagonist naltrexone or agonist morphine. In the presence of naltrexone, SIA produced by either cold water swim (CWS) or social defeat was enhanced. These same SIAs were found to attenuate the analgesic effect of morphine, demonstrating that an activation of opioid systems can inhibit nonopioid analgesias. These results support an inhibitory interaction of opioid and nonopioid mechanisms in some forms of stress-induced analgesia.

  7. [High thoracic epidural analgesia in the postoperative period after correction of congenital heart defects in children].

    Science.gov (United States)

    Slin'ko, S K

    1999-01-01

    The effects and side effects of thoracic epidural analgesia on the respiratory response, awakening time, and cooperation with nurses were studied. Forty children received epidural analgesia after open-heart surgery. Lidocaine was injected in a dose of 1.5-2 mg/kg every 1.5-2 h. Controls (16 pts) received intravenous fentanyl + diazepam analgesia. Respiratory response and awakening were significantly earlier (p < 0.001) in the epidural group. Cooperation with nurses was much better in this group, too. No side effects were observed in the epidural group. Therefore, thoracic epidural analgesia is a safe and effective method of postoperative analgesia for children subjected to open-heart surgery.

  8. Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor

    Directory of Open Access Journals (Sweden)

    Veena Chatrath

    2015-01-01

    Full Text Available Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4. Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes than in Group I (95 ± 7 minutes. Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.

  9. Multimodality Management of Trigeminal Schwannomas.

    Science.gov (United States)

    Niranjan, Ajay; Barnett, Samuel; Anand, Vijay; Agazzi, Siviero

    2016-08-01

    Patients presenting with trigeminal schwannomas require multimodality management by a skull base surgical team that can offer expertise in both transcranial and transnasal approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic symptoms, preservation of cranial nerve function, and control of mass effect are the primary goals of management for trigeminal schwannomas. Complete surgical resection is the treatment of choice but may not be possible in all cases. Radiosurgery is an option as primary management for small- to moderate-sized tumors and can be used for postoperative residuals or recurrences. Planned surgical resection followed by SRS for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic resection is an excellent approach for patients with an extradural tumor or tumors isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based on high-quality imaging can help better estimate the expected outcome from each treatment. An expert skull base team should be able to provide precise counseling for each patient's situation for selecting the best option.

  10. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  11. Squeezing Properties of the Generalized Multimode Squeezed States

    Institute of Scientific and Technical Information of China (English)

    SONGTong-Qiang

    2001-01-01

    By means of the invariance of Weyl ordering under similar transformations we derive the explicit form of the generalized multimode squeezed states.Moreover,the completeness relation and the squeezing properties of the generalized multimode squeezed states are discussed.

  12. Squeezing Properties of the Generalized Multimode Squeezed States

    Institute of Scientific and Technical Information of China (English)

    SONG Tong-Qiang

    2001-01-01

    By means of the invariance of Weyl ordering under similar transformations we derive the explicit form of the generalized multimode squeezed states. Moreover, the completeness relation and the squeezing properties of the generalized multimode squeezed states are discussed.

  13. Update on epidural analgesia during labor and delivery.

    Science.gov (United States)

    Lurie, S; Priscu, V

    1993-05-01

    Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.

  14. CLINICAL OBSERVATION ON ACUPOINT INJECTION ANALGESIA FOR ARTIFICIAL ABORTION

    Institute of Scientific and Technical Information of China (English)

    马民玉; 李红; 等

    2000-01-01

    In the present study,the effect of acupoint injection analgesia for artificial abortion Was observed.40patients were divided at random into2groups:Acupoint injection group(n=20)and control group(n=20).In the former group,bilateral Zusanli(ST36)and Sanyinjiao(SP6)were selected.1-1.5ml diluted analgesic solution was injected into each acupoint respectively about5-10minutes before operation.The blood pressure(BP)and heart rate(HR)of the patients were all moni-tored before and during operation.Results showed that the effective rates of analgesia for uterus aspira-tion and dilation of the uterine cervix were90percent and 85percent respectively.Patients'BP and HR during operation were all stable as compared with those before operation(P>0.05).It indicates that this method has a better effect in relieving abdominalgia and preventing nausea and vomiting dur-ing artificial abortion.It can be developed and used in clinic.

  15. Analgesia PCA por catéter interesternocleidomastoideo frente analgesia PCA intravenosa tras cirugía proximal de húmero Continuous Intersternocleidomastoid PCA analgesia Vs intravenous PCA analgesia after proximal shoulder surgery

    Directory of Open Access Journals (Sweden)

    R. Ortiz de la Tabla

    2008-10-01

    Full Text Available Introducción: Comparar la eficacia analgésica e incidencia de efectos adversos entre el bloqueo interesternocleidomastoideo continuo y una pauta analgésica intravenosa tras cirugía proximal de húmero. Material y Métodos: Estudio prospectivo descriptivo no aleatorizado de pacientes intervenidos de cirugía de hombro bajo anestesia general con fentanilo intravenoso como analgesia intraoperatoria. Al grupo 1 se realizó bloqueo interesternocleidomastoideo con ropivacaína 0,5% 0,4 mL Kg-1 y en URPA se comenzó una perfusión de ropivacaína 0,2% 5mL h-1, con bolos PCA 5 mL y tiempo de cierre de 30 minutos. Al grupo 2, a su llegada a la URPA se administró una dosis carga de metamizol 2 gr, tramadol 100 mgr y ondansetrón 4 mgr, seguido por una perfusión de metamizol 0,16%, tramadol 0,04% y ondansetrón 0,0016% a 1,5 mL h-1 bolos PCA 1 mL y tiempo de cierre 20 minutos. La variable principal fue la valoración del dolor postoperatorio, en reposo y movimiento, mediante escala verbal numérica de 0 (no dolor a 10 (máximo dolor y la aparición de efectos indeseables. Resultados: Se incluyeron 38 pacientes en el grupo 1 y 39 en el 2. La valoración del dolor postoperatorio puso de manifiesto valores más elevados en las primeras 24 horas al movimiento y a las 48 horas, tanto en reposo como al movimiento, en el grupo 2 (pObjectives: We have compared results in postoperative analgesia and incidence of side effects between a continuous intersternocleidotnastoid blockade and intravenous analgesia after proximal shoulder surgery. Methods: In a prospective no randomized study on patients scheduled for unilateral shoulder surgery under general anaesthesia with intravenous fentanil as intraoperative analgesia. In group 1, a continuous intersternocleidomastoid blockade was performed with a bolus of ropivacaine 0,5% 0,4 mL/kg before surgery and a postoperative patient-controlled analgesia (PCA infusión pump of 0,2% ropivacaine (5ml/h, PCA bolus 5 mi / 30

  16. Multimodale trafiknet i GIS (Multimodal Traffic Network in GIS)

    DEFF Research Database (Denmark)

    Kronbak, Jacob; Brems, Camilla Riff

    1996-01-01

    The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example.......The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example....

  17. Single LP(0,n) mode excitation in multimode fibers.

    Science.gov (United States)

    Bhatia, Nitin; Rustagi, Kailash C; John, Joseph

    2014-07-14

    We analyze the transmission of a Single mode - Multimode -Multimode (SMm) fiber structure with the aim of exciting a single radial mode in the second multimode fiber. We show that by appropriate choice of the length of the central multimode fiber one can obtain > 90% of the total core power in a chosen mode. We also discuss methods of removing undesirable cladding and radiation modes and estimate tolerances for practical applications.

  18. Reference resolution in multi-modal interaction: Preliminary observations

    NARCIS (Netherlands)

    Nijholt, A.; González González, G.R.

    2002-01-01

    In this paper we present our research on multimodal interaction in and with virtual environments. The aim of this presentation is to emphasize the necessity to spend more research on reference resolution in multimodal contexts. In multi-modal interaction the human conversational partner can apply mo

  19. [Multimodal pain therapy: principles and indications].

    Science.gov (United States)

    Arnold, B; Brinkschmidt, T; Casser, H-R; Gralow, I; Irnich, D; Klimczyk, K; Müller, G; Nagel, B; Pfingsten, M; Schiltenwolf, M; Sittl, R; Söllner, W

    2009-04-01

    Multimodal pain therapy describes an integrated multidisciplinary treatment in small groups with a closely coordinated therapeutical approach. Somatic and psychotherapeutic procedures cooperate with physical and psychological training programs. For chronic pain syndromes with complex somatic, psychological and social consequences, a therapeutic intensity of at least 100 hours is recommended. Under these conditions multimodal pain therapy has proven to be more effective than other kinds of treatment. If monodisciplinary and/or outpatient therapies fail, health insurance holders have a legitimate claim to this form of therapy.Medical indications are given for patients with chronic pain syndromes, but also if there is an elevated risk of chronic pain in the early stadium of the disease and aiming at delaying the process of chronification. Relative contraindications are a lack of motivation for behavioural change, severe mental disorders or psychopathologies and addiction problems. The availability of multimodal pain treatment centers in Germany is currently insufficient.

  20. Instrumentation challenges in multi-modality imaging

    Energy Technology Data Exchange (ETDEWEB)

    Brasse, D., E-mail: david.brasse@iphc.cnrs.fr [Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, 23 rue du Loess 67037 Strasbourg (France); CNRS, UMR7178, 67037 Strasbourg (France); Boisson, F. [Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, 23 rue du Loess 67037 Strasbourg (France); CNRS, UMR7178, 67037 Strasbourg (France)

    2016-02-11

    Based on different physical principles, imaging procedures currently used in both clinical and preclinical applications present different performance that allow researchers to achieve a large number of studies. However, the relevance of obtaining a maximum of information relating to the same subject is undeniable. The last two decades have thus seen the advent of a full-fledged research axis, the multimodal in vivo imaging. Whether from an instrumentation point of view, for medical research or the development of new probes, all these research works illustrate the growing interest of the scientific community for multimodal imaging, which can be approached with different backgrounds and perspectives from engineers to end-users point of views. In the present review, we discuss the multimodal imaging concept, which focuses not only on PET/CT and PET/MRI instrumentation but also on recent investigations of what could become a possible future in the field.

  1. Multimodality Data Integration in Epilepsy

    Directory of Open Access Journals (Sweden)

    Otto Muzik

    2007-01-01

    Full Text Available An important goal of software development in the medical field is the design of methods which are able to integrate information obtained from various imaging and nonimaging modalities into a cohesive framework in order to understand the results of qualitatively different measurements in a larger context. Moreover, it is essential to assess the various features of the data quantitatively so that relationships in anatomical and functional domains between complementing modalities can be expressed mathematically. This paper presents a clinically feasible software environment for the quantitative assessment of the relationship among biochemical functions as assessed by PET imaging and electrophysiological parameters derived from intracranial EEG. Based on the developed software tools, quantitative results obtained from individual modalities can be merged into a data structure allowing a consistent framework for advanced data mining techniques and 3D visualization. Moreover, an effort was made to derive quantitative variables (such as the spatial proximity index, SPI characterizing the relationship between complementing modalities on a more generic level as a prerequisite for efficient data mining strategies. We describe the implementation of this software environment in twelve children (mean age 5.2±4.3 years with medically intractable partial epilepsy who underwent both high-resolution structural MR and functional PET imaging. Our experiments demonstrate that our approach will lead to a better understanding of the mechanisms of epileptogenesis and might ultimately have an impact on treatment. Moreover, our software environment holds promise to be useful in many other neurological disorders, where integration of multimodality data is crucial for a better understanding of the underlying disease mechanisms.

  2. Naltrexone-sensitive analgesia following exposure of mice to 2450-MHz radiofrequency radiation (RFR)

    Energy Technology Data Exchange (ETDEWEB)

    Maillefer, R.H.; Quock, R.M. (Univ. of Illinois, Rockford (United States))

    1991-03-11

    This study was conducted to determine whether exposure to RFR might induce sufficient thermal stress to activate endogenous opioid mechanisms and induce analgesia. Male Swiss Webster mice, 20-25 g, were exposed to 10, 15 or 20 mV/cm{sup 2} RFR in a 2,450-MHz waveguide system for 10 min, then tested in the abdominal constriction paradigm. Specific absorption rates (SAR) were 23.7 W/kg at 10 mW/cm{sup 2}, 34.6 W/kg at 15 mW/cm{sup 2} and 45.5 W/kg at 20 mW/cm{sup 2}. Confinement in the exposure chamber alone did not appreciably alter body temperature but did appear to induce a stress-associated analgesia that was insensitive to the opioid receptor blocker naltrexone. Exposure of confined mice to RFR elevated body temperature and further increased analgesia in SAR-dependent manner. The high-SAR RFR-induced analgesia, but not the hyperthermia, was reduced by naltrexone. These findings suggest that (1) RFR produces SAR-dependent hyperthermia and analgesia and (2) RFR-induced analgesia is mediated by opioid mechanisms while confinement-induced analgesia involves non-opioid mechanisms.

  3. Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

    Directory of Open Access Journals (Sweden)

    Torvaldsen Siranda

    2010-04-01

    Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

  4. Multimodal surveillance sensors, algorithms, and systems

    CERN Document Server

    Zhu, Zhigang

    2007-01-01

    From front-end sensors to systems and environmental issues, this practical resource guides you through the many facets of multimodal surveillance. The book examines thermal, vibration, video, and audio sensors in a broad context of civilian and military applications. This cutting-edge volume provides an in-depth treatment of data fusion algorithms that takes you to the core of multimodal surveillance, biometrics, and sentient computing. The book discusses such people and activity topics as tracking people and vehicles and identifying individuals by their speech.Systems designers benefit from d

  5. Strategy development management of Multimodal Transport Network

    Directory of Open Access Journals (Sweden)

    Nesterova Natalia S.

    2016-01-01

    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  6. Detecting multimode entanglement by symplectic uncertainty relations

    CERN Document Server

    Serafini, A

    2005-01-01

    Quantities invariant under symplectic (i.e. linear and canonical) transformations are constructed as functions of the second moments of N pairs of bosonic field operators. A general multimode uncertainty relation is derived as a necessary constraint on such symplectic invariants. In turn, necessary conditions for the separability of multimode continuous variable states under (MxN)-mode bipartitions are derived from the uncertainty relation. These conditions are proven to be necessary and sufficient for (1+N)-mode Gaussian states and for (M+N)-mode bisymmetric Gaussian states.

  7. Multimode siloxane polymer components for optical interconnects

    Science.gov (United States)

    Bamiedakis, Nikolaos; Beals, Joseph, IV; Penty, Richard V.; White, Ian H.; DeGroot, Jon v., Jr.; Clapp, Terry V.; De Shazer, David

    2009-02-01

    This paper presents an overview of multimode waveguides and waveguide components formed from siloxane polymer materials which are suitable for use in optical interconnection applications. The components can be cost-effectively integrated onto conventional PCBs and offer increased functionality in optical transmission. The multimode waveguides exhibit low loss (0.04 dB/cm at 850 nm) and low crosstalk (components are briefly presented including a terabit capacity optical backplane, a radio-over-fibre multicasting system and a SCM passive optical network.

  8. PRÁCTICAS PREVENTIVAS DE LOS HABITANTES MAYORES DE 25 AÑOS EN MONTERREY Y SU ZONA METROPOLITANA (MÉXICO

    Directory of Open Access Journals (Sweden)

    Ma. Eugenia Garza

    2004-01-01

    Full Text Available Fundamento: Los padecimientos crónicos y degenerativos son las primeras causas de morbi-mortalidad en México, por lo que el Sector Salud ha implementado acciones de prevención y detección oportuna. El uso de los servicios de salud es una conducta dinámica de la población. Para que la gente utilice estas acciones de prevención es necesario que se reduzcan barreras de acceso. Así, el objetivo del estudio fue determinar la utilización de los servicios de detección de diabetes mellitus, hipertensión arterial, cáncer cérvicouterino y mamario y aplicación del toxoide tetánico diftérico. Métodos: El tamaño de la muestra fue de 254 personas de 25 años y más, que habitaban en Monterrey y su zona metropolitana. En el uso de acciones preventivas se consideró a las personas que las habían usado el año anterior. El análisis consistió en estadística descriptiva y análisis bivariado. Resultados: Más del 60% de la población correspondió al sexo femenino, la edad promedio fue de 42,3 años±14 años y tres cuartas partes de la población contó con seguridad social. Un 37% mencionó haberse realizado la detección de diabetes y un 44,5% de hipertensión, mientras que le aplicaron el toxoide tetánico diftérico a un 31,1%. En las detecciones propias de la mujer, a un 34,3% de la población femenina le practicaron la correspondiente a cáncer cérvicouterino en tanto que a un 29,5%, la de cáncer mamario. No hubo relación entre uso de acciones con antecedentes familiares y percepción de importancia de la detección. Conclusiones: El uso de las acciones preventivas está por debajo de algunos estándares internacionales. Es necesaria la búsqueda de personas expuestas al riesgo para detectar oportunamente cualquier padecimiento crónico.

  9. Connecting multimodality in human communication.

    Science.gov (United States)

    Regenbogen, Christina; Habel, Ute; Kellermann, Thilo

    2013-01-01

    DCM analysis instead showed a pronounced top-down control. Remarkably, all connections from the dmPFC to the three other regions were modulated by the experimental conditions. This observation is in line with the presumed role of the dmPFC in the allocation of attention. In contrary, all incoming connections to the AG were modulated, indicating its key role in integrating multimodal information and supporting comprehension. Notably, the input from the FFG to the AG was enhanced when facial expressions conveyed emotional information. These findings serve as preliminary results in understanding network dynamics in human emotional communication and empathy.

  10. Imaging-guided hyperstimulation analgesia in low back pain

    Directory of Open Access Journals (Sweden)

    Gorenberg M

    2013-06-01

    Full Text Available Miguel Gorenberg,1,2 Kobi Schwartz31Department of Nuclear Medicine, B'nai Zion Medical Center, Haifa, Israel; 2The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; 3Department of Physical Therapy, B'nai Zion Medical Center, Haifa, IsraelAbstract: Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.Keywords: myofascial, noninvasive, electrical, impedance

  11. Intravenous sub-anesthetic ketamine for perioperative analgesia.

    Science.gov (United States)

    Gorlin, Andrew W; Rosenfeld, David M; Ramakrishna, Harish

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  12. Intravenous sub-anesthetic ketamine for perioperative analgesia

    Directory of Open Access Journals (Sweden)

    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  13. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Gabriela R Lauretti

    2013-01-01

    Full Text Available Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml. The control group (CG received saline as IT test drug. The morphine group (MG received IT 200 g morphine, the ketorolac group (KG IT 2 mg ketorolac and the morphine-ketorolac group (MKG 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P < 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively. Both groups were longer when compared to the CG (170 ± 13 min (P < 0.01. The MG and KG had lesser ketoprofen consumption compared to the CG (P < 0.05. The time to first rescue analgesic was longer to the MKG (926 ± 222 min (15 h compared to CG (P < 0.001 and to the MG and the KG (P < 0.01. MKG displayed lesser ketoprofen consumption compared to MG and KG (P < 0.05 and to the CG (P < 0.02. Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.

  14. The Arts, New Literacies, and Multimodality

    Science.gov (United States)

    Albers, Peggy; Harste, Jerome C.

    2007-01-01

    The arts, multimodality, and new literacies studies, each with its own distinct principles, together can redefine literacy and what constitutes being literate. To recognize the roles that each of these fields plays in literacy necessitates a cultural shift in reading, interpreting, creating, and responding to a range of multimedia messages. The…

  15. Visible Quotation : The multimodal expression of viewpoint

    NARCIS (Netherlands)

    Stec, Kashmiri Kristina Mukti

    2016-01-01

    The central theme of this dissertation is multimodal viewpoint – that is, the way that bodily actions work together with spoken language to express the perspective of characters within a narrative. Drawing on research in cognitive linguistics, conversation analysis, gesture studies, and signed langu

  16. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality tra

  17. Multimode waveguide speckle patterns for compressive sensing.

    Science.gov (United States)

    Valley, George C; Sefler, George A; Justin Shaw, T

    2016-06-01

    Compressive sensing (CS) of sparse gigahertz-band RF signals using microwave photonics may achieve better performances with smaller size, weight, and power than electronic CS or conventional Nyquist rate sampling. The critical element in a CS system is the device that produces the CS measurement matrix (MM). We show that passive speckle patterns in multimode waveguides potentially provide excellent MMs for CS. We measure and calculate the MM for a multimode fiber and perform simulations using this MM in a CS system. We show that the speckle MM exhibits the sharp phase transition and coherence properties needed for CS and that these properties are similar to those of a sub-Gaussian MM with the same mean and standard deviation. We calculate the MM for a multimode planar waveguide and find dimensions of the planar guide that give a speckle MM with a performance similar to that of the multimode fiber. The CS simulations show that all measured and calculated speckle MMs exhibit a robust performance with equal amplitude signals that are sparse in time, in frequency, and in wavelets (Haar wavelet transform). The planar waveguide results indicate a path to a microwave photonic integrated circuit for measuring sparse gigahertz-band RF signals using CS.

  18. Love that Book: Multimodal Response to Literature

    Science.gov (United States)

    Dalton, Bridget; Grisham, Dana L.

    2013-01-01

    Composing with different modes--image, sound, video and the written word--to respond to and analyze literary and informational text helps students develop as readers and digital communicators. This article showcases five multimodal strategies for engaging children in rich literature-based learning using digital tools and Internet resources.

  19. Multimode interferometer for guided matter waves.

    Science.gov (United States)

    Andersson, Erika; Calarco, Tommaso; Folman, Ron; Andersson, Mauritz; Hessmo, Björn; Schmiedmayer, Jörg

    2002-03-11

    Atoms can be trapped and guided with electromagnetic fields, using nanofabricated structures. We describe the fundamental features of an interferometer for guided matter waves, built of two combined Y-shaped beam splitters. We find that such a device is expected to exhibit high contrast fringes even in a multimode regime, analogous to a white light interferometer.

  20. Multimodal representations in collaborative history learning

    NARCIS (Netherlands)

    Prangsma, M.E.

    2007-01-01

    This dissertation focuses on the question: How does making and connecting different types of multimodal representations affect the collaborative learning process and the acquisition of a chronological frame of reference in 12 to 14-year olds in pre vocational education? A chronological frame of refe

  1. A Multimodal Interaction Framework for Blended Learning

    DEFF Research Database (Denmark)

    Vidakis, Nikolaos; Kalafatis, Konstantinos; Triantafyllidis, Georgios

    2017-01-01

    Humans interact with each other by utilizing the five basic senses as input modalities, whereas sounds, gestures, facial expressions etc. are utilized as output modalities. Multimodal interaction is also used between humans and their surrounding environment, although enhanced with further senses ...... framework enabling deployment of a vast variety of modalities, tailored appropriately for use in blended learning environment....

  2. Design Options for Multimodal Web Applications

    Science.gov (United States)

    Stanciulescu, Adrian; Vanderdonckt, Jean

    The capabilities of multimodal applications running on the web are well de-lineated since they are mainly constrained by what their underlying standard mark up language offers, as opposed to hand-made multimodal applications. As the experience in developing such multimodal web applications is growing, the need arises to identify and define major design options of such application to pave the way to a structured development life cycle. This paper provides a design space of independent design options for multimodal web applications based on three types of modalities: graphical, vocal, tactile, and combined. On the one hand, these design options may provide designers with some explicit guidance on what to decide or not for their future user interface, while exploring various design alternatives. On the other hand, these design options have been implemented as graph transformations per-formed on a user interface model represented as a graph. Thanks to a transformation engine, it allows designers to play with the different values of each design option, to preview the results of the transformation, and to obtain the corresponding code on-demand

  3. Equilibrium models in multimodal container transport systems

    NARCIS (Netherlands)

    Corman, F.; Viti, F.; Negenborn, R.R.

    2015-01-01

    Optimizing the performance of multimodal freight transport networks involves adequately balancing the interplay between costs, volumes, times of departure and arrival, and times of travel. In order to study this interplay, we propose an assignment model that is able to efficiently determine flows an

  4. Academic Knowledge Construction and Multimodal Curriculum Development

    Science.gov (United States)

    Loveless, Douglas J., Ed.; Griffith, Bryant, Ed.; Bérci, Margaret E., Ed.; Ortlieb, Evan, Ed.; Sullivan, Pamela, Ed.

    2014-01-01

    While incorporating digital technologies into the classroom has offered new ways of teaching and learning into educational processes, it is essential to take a look at how the digital shift impacts teachers, school administration, and curriculum development. "Academic Knowledge Construction and Multimodal Curriculum Development" presents…

  5. Affective multimodal mirror: sensing and eliciting laughter

    NARCIS (Netherlands)

    Melder, W.A.; Truong, K.P.; Uyl, M. den; Leeuwen, D.A. van; Neerincx, M.A.; Loos, L.R.; Stock Plum, B.

    2007-01-01

    In this paper, we present a multimodal affective mirror that senses and elicits laughter. Currently, the mirror contains a vocal and a facial affect-sensing module, a component that fuses the output of these two modules to achieve a user-state assessment, a user state transition model, and a compone

  6. Interactive Multimodal Learning for Venue Recommendation

    NARCIS (Netherlands)

    Zahálka, J.; Rudinac, S.; Worring, M.

    2015-01-01

    In this paper, we propose City Melange, an interactive and multimodal content-based venue explorer. Our framework matches the interacting user to the users of social media platforms exhibiting similar taste. The data collection integrates location-based social networks such as Foursquare with genera

  7. A legalidade da intervanção preventiva e a Carta das Nações Unidas The Legality of Preventive Intervention under the UN Charter

    Directory of Open Access Journals (Sweden)

    Ana Flávia Granja e Barros Platiau

    2006-06-01

    Full Text Available No presente trabalho o objetivo é analisar a legalidade da intervenção preventiva perante a Carta das Nações Unidas. Pretende-se avaliar a questão sob o aspecto jurídico. Ao fazê-lo, serão apresentados casos que ilustram os argumentos favoráveis e contrários ao uso preventivo da força. Será analisada também a questão da responsabilidade de proteger como possibilidade do uso preventivo da força em situações de violações graves dos direitos humanos.This paper aims to analyze the lawfullness of preventive intervention under the United Nations Charter. The objective is to assess a legal perspective. In doing so, case-studies will be presented to illustrate the arguments in favor of and against the preventive use of force. In addition, the 'responsability to protect' will be analized as a possibility of the preventive use of force in situations of serious violation of human rights.

  8. CONDUTAS PREVENTIVAS NA ATENÇÃO BÁSICA E AMPUTAÇÃO DE MEMBROS INFERIORES EM PORTADORES DE PÉ DIABÉTICO

    Directory of Open Access Journals (Sweden)

    ISABEL CRISTINA RAMOS VIEIRA SANTOS

    2008-01-01

    Full Text Available La tarea realizada tiene por objetivo verificar las conductas preventivas ofrecidas por la asistencia básica al portador de pie diabético internado en hospital de gran porte en la ciudad de Recife. Estudio de enfoque epidemiológico descriptivo, cuya población corresponde a los pacientes internados entre agosto de 2006 a agosto de 2007, en la clínica vascular. Se observó una prevalencia del 46% de pacientes mayores de 65 años, sexo masculino, con hasta 4 años de escolaridad y renta de hasta 1 sueldo mínimo. Se encontró asociación entre las ocurrencias de amputaciones y las variables: conocimiento del diagnóstico, modo de conocimiento de la enfermedad, realización de consultas cada año después del diagnóstico de DM, control de glicemia, examen de los pies y orientaciones relativas al cuidado de los pies. Los resultados hallados permiten visualizar la gravedad de la complicación de pie diabético, así como exhiben áreas que precisan más iniciativas en el cuidado ofrecido por la Atención Básica.

  9. Adolescência e aids: avaliação de uma experiência de educação preventiva entre pares

    Directory of Open Access Journals (Sweden)

    José Ricardo de Carvalho Mesquita Ayres

    2003-02-01

    Full Text Available Ações preventivas de HIV/AIDS, orientadas à superação dos limites das intervenções de corte comportamentalista, incorporando preocupações com os determinantes sócio-culturais desses comportamentos, constituem hoje uma necessidade e, ao mesmo tempo, uma lacuna. O presente artigo trata de estudo de prevenção no ambiente escolar baseado em estratégia de redução de vulnerabilidade. Constitui um estudo de caso, de corte quanti-quali, que, no contexto desta estratégia, avalia o trabalho de prevenção de aids desenvolvido por alunos multiplicadores em uma escola estadual de ensino médio na periferia da cidade de São Paulo. Entre os resultados, destacam-se: a efetividade da proposta, com ampla aceitação e favorável aproveitamento pelos alunos da escola; o perfil diversificado do aluno multiplicador voluntário; e a tensão entre modelos cognitivo-comportamentalistas e social-construtivistas nos processos educativos concretamente operados pelos multiplicadores. Conclui-se pela possibilidade e interesse da ação de alunos multiplicadores na perspectiva das estratégias de redução de vulnerabilidade, apontando-se a necessidade de desenvolver mecanismos de captação e capacitação capazes de problematizar e superar a tensão apontada.

  10. [Eutopic parturition: psychoprophylaxis or extradural analgesia. Influence on the endocrine response].

    Science.gov (United States)

    Carrasco, M S; Iglesias, J; Freire, J; Martín, M L; Marín Santana, A; Cobo, I; García Rendón, A

    1989-01-01

    Prolactin, ACTH, cortisol and HGH levels have been studied on 30 pregnant women in three different periods: during the labour, at the delivery and 24 hours later. They were divided into 3 groups depending on the analgesia: I) no analgesia (n = 10); II) psychoprophylaxis (n = 10), and III) extradural analgesia (n = 10). Prolactin levels increased during delivery and 24 hours later. A significant increase of ACTH levels (p less than 0.01) was observed during the delivery in the 3 groups even though they were under hasal values 24 hours later. Cortisol increased 38% (p less than 0.01) and 52% (p less than 0.02) in II and III groups, respectively during the delivery. No difference was found with HGH. Our results suggest that endocrine response modified by labour and delivery doesn't change with different analgesia techniques.

  11. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

    Directory of Open Access Journals (Sweden)

    Elham M. El-Feky

    2015-04-01

    Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

  12. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

    Directory of Open Access Journals (Sweden)

    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  13. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

  14. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV Mujeres com edad igual o superior a 50 años: acciones preventivas de la infección por el VIH The 50-year-old women or older: preventive actions to the HIV infection

    Directory of Open Access Journals (Sweden)

    Daniela Angelo de Lima Rodrigues

    2010-06-01

    Full Text Available Trata-se de pesquisa qualitativa que buscou verificar a adoção de ações preventivas da transmissão do HIV por mulheres com idade igual ou superior a 50 anos, moradoras em uma comunidade de baixa renda e atendidas pelo Programa Saúde da Família, no Município de São Paulo. Adotou-se como referencial teórico a Antropologia Médica e, para o tratamento dos dados, o Discurso do Sujeito Coletivo. Foram entrevistadas 13 mulheres e são apresentados três discursos: valorizando a prevenção; invisibilidade do HIV/aids; e rejeição à adesão ao preservativo. A análise mostrou que o grupo não se percebia em risco à infecção pela via sexual devido à confiança na fidelidade do parceiro. O eventual uso do preservativo foi atribuído somente à curiosidade. As ações preventivas adotadas carecem de embasamento científico. Os resultados alertam para a necessidade do planejamento e da implementação de intervenções culturalmente embasadas direcionadas ao segmento estudado.Se trata de una investigación cualitativa que buscó verificar la adopción de acciones preventivas de la transmisión del VIH por mujeres con edad igual o superior a 50 años, moradoras en una comunidad de baja renta y atendidas por el Programa Salud de la Familia, en el municipio de São Paulo, Brasil. Se adoptó como referencial teórico la Antropología Médica y, para el tratamiento de los datos, el Discurso del Sujeto Colectivo. Se entrevistaron 13 mujeres y son presentados tres discursos: valorar la prevención; invisibilidad del VIH/SIDA; rechazo a la adherencia al preservativo. El análisis apuntó que el grupo no percibió el riesgo a la infección por la vía sexual a causa de la confianza en la fidelidad del compañero. El eventual uso del preservativo fue atribuido solamente a la curiosidad. Las acciones preventivas adoptadas carecen de base científica. Los resultados alertan para la necesidad del planeamiento y de la implantación de intervenciones

  15. Mergulho em águas rasas e lesão medular: uma abordagem educativa e preventiva = Diving in shallow waters and spinal cord injury: a preventive and educational approach

    Directory of Open Access Journals (Sweden)

    Khan, Richard Lester

    2005-01-01

    Conclusão: A lesão medular causada por mergulho em águas rasas tem uma incidência elevada no mundo principalmente no período do verão. Ocorre em indivíduos jovens, sadios, geralmente do sexo masculino apresentando uma forte associação com uso de álcool. Medidas preventivas, educativas são primordiais para a diminuição de novos casos

  16. Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

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    Patrícia Gomes da Silva

    2011-12-01

    Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

  17. [Multimodal rehabilitation in colorectal surgery. On resistance to change in surgery and the demands of society].

    Science.gov (United States)

    Roig, José V; Rodríguez-Carrillo, Rodolfo; García-Armengol, Juan; Villalba, Francisco L; Salvador, Antonio; Sancho, Cristina; Albors, Pilar; Puchades, Francisco; Fuster, Carlos

    2007-06-01

    Perioperative management is one of the fields of surgery most hide bound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. This modality is based on a multidisciplinary approach provided by surgeons, anesthesiologists and other staff and aims to decrease the response to physiopathological changes induced by surgical aggression. There is evidence to support the use of preoperative oral carbohydrate therapy and oral bowel preparation, the avoidance of intraoperative fluid excess, and the maintenance of normothermia on postoperative recovery. Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice.

  18. Continuous postoperative analgesia via quadratus lumborum block - an alternative to transversus abdominis plane block.

    Science.gov (United States)

    Visoiu, Mihaela; Yakovleva, Nataliya

    2013-10-01

    Different transversus abdominis plane blocks techniques cause variations in postoperative analgesia characteristics. We report the use of unilateral quadratus lumborum catheter for analgesia following colostomy closure. The catheter was placed under direct ultrasound visualization and had good outcomes: low pain scores and minimal use of rescue analgesic medication. No complications were reported in this pediatric patient. More studies are needed to evaluate the effectiveness and safety of this regional anesthesia technique.

  19. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient.

    Science.gov (United States)

    Chakraborty, Arunangshu; Goswami, Jyotsna; Patro, Viplab

    2015-02-01

    Quadratus lumborum block is a recently introduced variation of transversus abdominis plane block. In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic.

  20. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

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    Akanksha Lamba

    2016-06-01

    Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1722-1727

  1. Analgesia postoperatoria en cirugía mayor: ¿es hora de cambiar nuestros protocolos?

    Directory of Open Access Journals (Sweden)

    N. Esteve Pérez

    2009-05-01

    Full Text Available La analgesia postoperatoria es uno de los componentes básicos en la recuperación funcional tras una intervención quirúrgica. No obstante, es difícil aislar los efectos de la analgesia postoperatoria de otros aspectos relacionados con la técnica quirúrgica, la práctica clínica, el tipo de seguimiento analgésico o los factores organizativos del equipo quirúrgico. La introducción de la laparoscopia, la toracoscopia y las técnicas quirúrgicas mínimamente invasivas está modificando los protocolos analgésicos clásicos en la cirugía compleja. La analgesia intravenosa controlada por el paciente e incluso los opioides por vía oral están desplazando a la analgesia epidural en este tipo de técnicas. La evaluación del riesgo/beneficio para la selección de cada tipo de analgesia postoperatoria dependerá de la severidad del dolor dinámico y de los potenciales efectos secundarios de las técnicas y los fármacos analgésicos. Es difícil demostrar el impacto de la analgesia postoperatoria en grandes resultados quirúrgicos como la mortalidad, la morbilidad o la estancia media, que dependen de factores múltiples y heterogéneos. El efecto del tipo de analgesia en el proceso quirúrgico debería investigarse sobre otros resultados orientados al paciente, como la calidad analgésica, los efectos adversos o el bienestar postoperatorio. Otras áreas en las que se plantea el posible impacto de la analgesia postoperatoria son la recurrencia oncológica y el dolor crónico postoperatorio.

  2. [Labor epidural analgesia for a woman with a pityriasis versicolor in the lumbar region].

    Science.gov (United States)

    Dubar, G; Omarjee, M; Viguié, C; Barbarot, S; Mignon, A

    2011-01-01

    Epidural analgesia is usually contraindicated in case of infection at the site of needle insertion. Tinea versicolor is a benign superficial cutaneous fungal infection caused by the proliferation of a skin commensal yeast of low pathogenicity. We report the case of a pregnant woman with a tinea versicolor in the lumbar region, who benefited from a labor epidural analgesia, realised with reinforced antiseptic measures. No neurological or infectious complication occurred.

  3. Opioid therapy: a trade-off between opioid-analgesia and opioid-induced respiratory depression

    OpenAIRE

    Boom, Maria Catharina Anna

    2013-01-01

    Conclusions that may be drawn from the data in this thesis: 1. The ideal drug for antagonism of respiratory depression has not yet been found. At present naloxone seems the most appropriate drug although reversal of respiratory depression coincides with loss of analgesia. New reversal agents acting via non-opioidergic pathways are under investigation and are aimed at reversal of opioid-induced respiratory depression without compromising analgesia. 2. Mathematical modelling of the non-steady s...

  4. Analgesia for Older Adults with Abdominal or Back Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Mills, Angela M

    2011-02-01

    Full Text Available Objective: To determine the association between age and analgesia for emergency department (ED patients with abdominal or back pain.Methods: Using a fully electronic medical record, we performed a retrospective cohort study of adults presenting with abdominal or back pain to two urban EDs. To assess differences in analgesia administration and time to analgesia between age groups, we used chi-square and Kruskal-Wallis test respectively. To adjust for potential confounders, we used a generalized linear model with log link and Gaussian error.Results: Of 24,752 subjects (mean age 42 years, 65% female, 69% black, mean triage pain score 7.5, the majority (76% had abdominal pain and 61% received analgesia. The ≥80 years group (n=722; 3%, compared to the 65-79 years group (n=2,080; 8% and to the (n=21,950; 89%, was more often female (71 vs. 61 vs. 65%, black (72 vs. 65 vs. 69%, and had a lower mean pain score (6.6 vs. 7.1 vs. 7.6. Both older groups were less likely to receive any analgesia (48 vs. 59 vs. 62%, p<0.0001 and the oldest group less likely to receive opiates (35 vs. 47 vs. 44%, p<0.0001. Of those who received analgesia, both older groups waited longer for their medication (123 vs. 113 vs. 94 minutes; p<0.0001. After controlling for potential confounders, patients ≥80 years were 17% less likely than the <65 years group to receive analgesia (95% CI 14-20%.Conclusion: Older adults who present to the ED for abdominal or back pain are less likely to receive analgesia and wait significantly longer for pain medication compared to younger adults. [West J Emerg Med. 2011;12(1;43-50.

  5. ANAESTHESIA, POSTOPERATIVE ANALGESIA AND EARLY REHABILITATION FOR UPPER EXTREMITY BONE AND MAJOR JOINTS SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Kurnosov

    2011-01-01

    Full Text Available A new method was developed to perform prolonged brachial plexus block with almost 100% effectiveness. It was also shown in 44 patients to be 33 % safer for local complications and 11,3 % safer for general complications than common used supraclavicular Winnie block (42 patients in control group, received opiates and NSAID for post-operative analgesia. This new method of analgesia allows effective rehabilitation after elbow arthroplasty to be started on the first day after the surgery.

  6. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status

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    Narmada P Gupta

    2008-01-01

    Conclusion: The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.

  7. TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain.

    Science.gov (United States)

    Liu, Boyi; Fan, Lu; Balakrishna, Shrilatha; Sui, Aiwei; Morris, John B; Jordt, Sven-Eric

    2013-10-01

    Menthol, the cooling natural product of peppermint, is widely used in medicinal preparations for the relief of acute and inflammatory pain in sports injuries, arthritis, and other painful conditions. Menthol induces the sensation of cooling by activating TRPM8, an ion channel in cold-sensitive peripheral sensory neurons. Recent studies identified additional targets of menthol, including the irritant receptor, TRPA1, voltage-gated ion channels and neurotransmitter receptors. It remains unclear which of these targets contribute to menthol-induced analgesia, or to the irritating side effects associated with menthol therapy. Here, we use genetic and pharmacological approaches in mice to probe the role of TRPM8 in analgesia induced by L-menthol, the predominant analgesic menthol isomer in medicinal preparations. L-menthol effectively diminished pain behavior elicited by chemical stimuli (capsaicin, acrolein, acetic acid), noxious heat, and inflammation (complete Freund's adjuvant). Genetic deletion of TRPM8 completely abolished analgesia by L-menthol in all these models, although other analgesics (acetaminophen) remained effective. Loss of L-menthol-induced analgesia was recapitulated in mice treated with a selective TRPM8 inhibitor, AMG2850. Selective activation of TRPM8 with WS-12, a menthol derivative that we characterized as a specific TRPM8 agonist in cultured sensory neurons and in vivo, also induced TRPM8-dependent analgesia of acute and inflammatory pain. L-menthol- and WS-12-induced analgesia was blocked by naloxone, suggesting activation of endogenous opioid-dependent analgesic pathways. Our data show that TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain. In contrast to menthol, selective TRPM8 agonists may produce analgesia more effectively, with diminished side effects.

  8. Avaliação de diferentes modalidades de ações preventivas na redução do consumo de substâncias psicotrópicas em estudantes no ambiente escolar: um estudo randomizado

    Directory of Open Access Journals (Sweden)

    Marcelo Oliveira do Nascimento

    2015-08-01

    Full Text Available ResumoEmbora algumas escolas realizem ações preventivas do uso de drogas, pouco se sabe sobre o seu processo de implementação e os resultados. Assim, o presente estudo buscou avaliar, no contexto escolar, o impacto de três diferentes modalidades preventivas na redução do consumo de substâncias entre os estudantes. Fizeram parte deste estudo 1316 estudantes entre o 9° ano do ensino fundamental e 3° ano do ensino médio de 8 escolas da rede pública estadual do Município de Guarulhos-SP. Os estudantes foram aleatoriamente alocados nos grupos de intervenções e controle, e avaliados em dois momentos quanto ao consumo de sustâncias. Os resultados indicaram a efetividade das intervenções feitas pelos educadores, tanto na redução do consumo como na intensidade de problemas. As intervenções feitas por especialistas apresentaram efetividade parcial, pois reduziram o consumo apenas dos usuários experimentais. O resultado da modalidade ‘Palestra única’ indicaram-na contraproducente. Em suma, ações preventivas contextualizadas à realidade do estudante e do ambiente escolar, e que incluam o envolvimento ativo do educador e do aluno, apresentam melhor impacto na redução da prevalência de uso de substâncias e intensidade de problemas.

  9. Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    YUE De-bo; WANG Bai-liang; LIU Kun-peng; GUO Wan-shou

    2013-01-01

    Background Multimodal cocktail periarticular injection (MCPI) with a large volume of low concentration local anesthetics,adrenaline,and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery.This study compares the efficacy of pain control after total knee arthroplasty,using multimodal cocktail periarticular injection with steroid or without steroid.Methods This is a prospective,double-blinded,randomized and control study.Seventy-two patients with osteoarthritis that met clinical criteria for total knee arthroplasty were recruited into the study,and were randomized to receive either multimodal cocktail periarticular injection with steroid or without steroid.Pain was assessed by visual analogue scale (VAS) at preoperative and postoperative at rest,and during activity.The range of motion was recorded preoperatively and postoperatively.The amount of daily and cumulative morphine consumption were measured by patient-controlled analgesia in the first 72 hours postoperatively.The duration of celecoxib usage was also recorded at the last follow-up.Results There were no differences between the non-steroid and steroid groups with regard to VAS at rest and during activity,or range of motion,at any postoperative observation time.The postoperative Knee Society Knee Score in the steroid group improved significantly as compared with that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; P <0.0045),three-month follow-up (90.2±16.3 and 72.5±16.6; P <0.0027),but after postoperative six-month the Knee Society Knee Score showed no significant difference between the groups.There was no significant difference in consumption of the morphine about daily or total consumption within 72 hours between the two groups.The duration of celecoxib usage in patients in the steroid group was significantly shorter than that in the non-steroid group ((7.2±0.7) compared with

  10. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

  11. Clonidine as an adjuvant for propranolol enhances its effect on infiltrative cutaneous analgesia in rats.

    Science.gov (United States)

    Hung, Ching-Hsia; Chiu, Chong-Chi; Liu, Kuo-Sheng; Wang, Jhi-Joung; Chen, Yu-Wen

    2016-03-11

    Clonidine prolongs duration of analgesia when used as an adjunct to local anesthetics for infiltrative cutaneous analgesia, and propranolol produces local anesthesia. The purpose of the experiment was to evaluate clonidine as an adjuvant for propranolol on the quality and duration of cutaneous analgesia. A rat model of cutaneous trunci muscle reflex (CTMR) in response to local skin pinprick was employed to evaluate the cutaneous analgesic effect of propranolol combined with clonidine. The long-lasting local anesthetic bupivacaine was used as control. Cutaneous analgesia elicited by propranolol and bupivacaine was dose-dependent, and both propranolol (9.0μmol) and bupivacaine (1.8μmol) produced 100% nociceptive blockade. On an 50% effective dose (ED50) basis, the relative potency was bupivacaine [0.48 (0.42-0.55) μmol] greater than propranolol [2.27 (1.98-2.54) μmol] (ppropranolol or bupivacaine) at ED50 or ED95 increased the potency and extended the duration at producing cutaneous analgesia. The resulting data demonstrated that propranolol is less potent than bupivacaine as an infiltrative anesthetic. Clonidine as an adjuvant for propranolol or bupivacaine has a significant peripheral action in increasing the depth and duration of action on infiltrative cutaneous analgesia.

  12. Analgesia, sedação e relaxamento neuromuscular no doente ventilado em cuidados intensivos cardíacos: parte I: analgesia

    OpenAIRE

    Vilela, H; D. Ferreira

    2006-01-01

    Neste artigo são revistos aspectos clínicos relevantes relacionados com a sedação, analgesia e relaxamento neuromuscular em Cuidados Intensivos Cardíacos, incluindo métodos de monitorização e opções terapêuticas disponíveis. São ainda abordadas as implicações fisiopatológicas da dor, agitação, ansiedade e delírio no doente ventilado. Apesar de terem sido publicadas recentemente normas de orientação para sedação, analgesia e relaxamento neuromuscular em Cuidados Intensi...

  13. Sedação e analgesia em neonatologia Sedación y analgesia en neonatología Sedation and analgesia in neonatology

    Directory of Open Access Journals (Sweden)

    Yerkes Pereira e Silva

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais. A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.JUSTIFICATIVA Y OBJETIVOS: La importancia del estudio del dolor en neonatología se debe al hecho de que la sensación de dolor y de estrés significa sufrimiento e incomodidad para los recién nacidos y, a pesar de ese conocimiento poco se ha hecho para reducirlo. Dentro de esa revisión se discutieron: la prevención del dolor, las medidas no farmacológicas ye farmacológicas para su tratamiento y la sedación en recién nacidos. CONTENIDO: Varias son las medidas no-farmacológicas que pueden ser tomadas con el objetivo de prevenir el

  14. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  15. A Study of Fetomaternal Outcome of Epidural Analgesia During Labour

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    Shital H Halvadia

    2013-04-01

    Full Text Available Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%, forceps delivery in 4 patients (5%, ventouse in 14 patients (17.5% and caesarean section in 16 patients (20%. At one minute majority of the babies (n 63, 78.75% had Apgar score of more than 7, only 5 babies (6.25% had Apgar score less than 4, and 12 babies (15% had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5% had Apgar score of more than 7, only one baby (1.25% had Apgar score less than 4, and 5 babies (6.25% had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient. [Natl J Med Res 2013; 3(2.000: 184-186

  16. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

    Science.gov (United States)

    Valente, A.; Frassanito, L.; Natale, L.; Draisci, G.

    2012-01-01

    Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications. PMID:22844625

  17. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

    Directory of Open Access Journals (Sweden)

    A. Valente

    2012-01-01

    Full Text Available Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications.

  18. Prevención en salud mental: el Programa de Actividades Preventivas y Promoción de la Salud (mental de la SEMFYC.

    Directory of Open Access Journals (Sweden)

    Jorge Luis Tizón García

    1994-01-01

    Full Text Available Se realiza una breve justificación de la necesidad, eficacia y posible eficiencia de realizar algún tipo de programas preventivos en el campo de la salud mental desde la Atención Primaria de Salud y sus dispositivos actuales. Se valoran como importantes las posibilidades de colaboración entre Equipos de Salud Mental y los Equipos de Atención Primaria que supone el trabajo conjunto en ese campo. A continuación, se exponen los criterios sobre «subprogramas preventivos iniciales» aprobados por el PAPPS (Programa de Actividades Preventivas y de Promoción de la Salud de la Sociedad Española de Medicina de Familia y Comunitaria: los subprogramas de diagnóstico precoz de la depresión y prevención del suicidio, comunes al trabajo con niños y adolescentes y al trabajo con adultos y los otros diez subprogramas elementales básicos: atención a la mujer y el niño durante el embarazo y puerperio, embarazo en la adolescencia, hijos de familias monoparentales, antecedentes de patología psiquiátrica en los padres y retraso escolar/trastornos en el desarrollo del lenguaje en la atención a niños y adolescentes. En la atención a adultos y ancianos el PAPPS valora como prioritarios los subprogramas pérdida de un familiar o allegado, pérdida de funciones psicofísicas importantes, cuidado del paciente terminal y de su familia, jubilación y cambios frecuentes de domicilio en los ancianos. Se realiza una breve descripción de los elementos básicos para practicar dicho subprograma y de la justificación de cada uno.

  19. Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA

    Directory of Open Access Journals (Sweden)

    Alberto L. Hernández-Hernández

    2010-01-01

    Full Text Available El Reclutamiento y la Retención (R&R de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Información, Motivación y Conductas-Español (IIMC-E a un grupo de 26 parejas heterosexuales (52 participantes. En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes. Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes.

  20. Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA

    Science.gov (United States)

    Hernández-Hernández, Alberto L.; Perez-Jimenez, David

    2012-01-01

    Compendio El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes. PMID:23264700

  1. Intervención Familiar Preventiva en Programas Colaboradores del SENAME: La Perspectiva del Profesional Preventive Family Intervention in Collaborating Programs of SENAME: The Worker's Perspective

    Directory of Open Access Journals (Sweden)

    Esteban Gómez

    2008-11-01

    Full Text Available Se aborda la caracterización del usuario y concepción de la intervención, desde la perspectiva de psicólogos y trabajadores sociales de 6 Programas de Intervención Familiar colaboradores del Servicio Nacional de Menores. Se reconstruyeron sus teorías subjetivas mediante un diseño cualitativo basado en la Grounded Theory, con 12 entrevistas semi-estructuradas y 11 episódicas. Los hallazgos revelan familias con múltiples problemas y niños con sus derechos vulnerados, viviendo en contextos de pobreza y exclusión social. La intervención se concibe como un proceso preventivo integral de orientación, apoyo, empoderamiento y reparación familiar. Se concluye analizando el desafío de visualizar integradamente problemas y fortalezas en los usuarios y las limitaciones de una estrategia preventiva desarrollada en un contexto social de serias dificultades y daños.Client's characterization and conception of intervention, from the perspective of psychologists and social workers of 6 family support programs of Child Protection Services of Chile, are analyzed. Subjective theories were reconstructed by means of a qualitative design based on Grounded Theory, with 12 semi-structured and 11 episodic interviews. Findings revealed families with multiple problems and children whose rights had been violated, living in environments of poverty and social exclusion. The intervention is conceived as an integral preventive process of orientation, support, empowerment, and family repair. In the conclusion, the challenge of considering with equal importance clients' problems and strengths is analyzed, showing the limitations of a preventive strategy developed in a social context of serious difficulties and damages.

  2. Digital Landscapes: Rethinking Poetry Interpretation in Multimodal Texts

    Directory of Open Access Journals (Sweden)

    Hessa A. Alghadeer

    2014-03-01

    Full Text Available Regardless of the fact that a great deal of scholarly studies in the field of digital humanities have emphasized implementing various modes of digital literacy, critical perspectives considering the use of multimodal texts in literature, namely poetry, have received scant attention. Beyond the boundaries of printed texts and verbal means, the present study aims to cast some light on how meaning making in poetry into multimodal contexts becomes crucial to poetry interpretation in multimodal contexts. In particular, the study tackles the theory of multimodality in regard to the poetry genre and briefly reviews its significance in relevant studies. The paper then shifts to show how the multimodalities in question enhance the transformation of print-based poetic texts into creative multimodal poetry experiences. Ultimately, the study provides insight into how digital media have altered our perspectives on definitions, interpretations, and appreciation of poetry.

  3. Multimodality imaging in nanomedicine and nanotheranostics

    Institute of Scientific and Technical Information of China (English)

    Xue Li; Xue-Ning Zhang; Xiao-Dong Li; Jin Chang

    2016-01-01

    Accurate diagnosis of tumors needs much detailed information. However, available single imaging modality cannot provide complete or comprehensive data. Nanomedicine is the application of nanotechnology to medicine, and multimodality imaging based on nanoparticles has been receiving extensive attention. This new hybrid imaging technology could provide complementary information from different imaging modalities using only a single injection of contrast agent. In this review, we introduce recent developments in multifunctional nanoparticles and their biomedical applications to multimodal imaging and theragnosis as nanomedicine. Most of the reviewed studies are based on the intrinsic properties of nanoparticles and their application in clinical imaging technology. The imaging techniques include positron emission tomography, single-photon emission computed tomography, computerized tomography, magnetic resonance imaging, optical imaging, and ultrasound imaging.

  4. Multimodal interaction in image and video applications

    CERN Document Server

    Sappa, Angel D

    2013-01-01

    Traditional Pattern Recognition (PR) and Computer Vision (CV) technologies have mainly focused on full automation, even though full automation often proves elusive or unnatural in many applications, where the technology is expected to assist rather than replace the human agents. However, not all the problems can be automatically solved being the human interaction the only way to tackle those applications. Recently, multimodal human interaction has become an important field of increasing interest in the research community. Advanced man-machine interfaces with high cognitive capabilities are a hot research topic that aims at solving challenging problems in image and video applications. Actually, the idea of computer interactive systems was already proposed on the early stages of computer science. Nowadays, the ubiquity of image sensors together with the ever-increasing computing performance has open new and challenging opportunities for research in multimodal human interaction. This book aims to show how existi...

  5. Fock expansion of multimode pure Gaussian states

    Energy Technology Data Exchange (ETDEWEB)

    Cariolaro, Gianfranco; Pierobon, Gianfranco, E-mail: gianfranco.pierobon@unipd.it [Università di Padova, Padova (Italy)

    2015-12-15

    The Fock expansion of multimode pure Gaussian states is derived starting from their representation as displaced and squeezed multimode vacuum states. The approach is new and appears to be simpler and more general than previous ones starting from the phase-space representation given by the characteristic or Wigner function. Fock expansion is performed in terms of easily evaluable two-variable Hermite–Kampé de Fériet polynomials. A relatively simple and compact expression for the joint statistical distribution of the photon numbers in the different modes is obtained. In particular, this result enables one to give a simple characterization of separable and entangled states, as shown for two-mode and three-mode Gaussian states.

  6. An Adaptive Multimodal Biometrics System using PSO

    Directory of Open Access Journals (Sweden)

    Ola M. Aly

    2013-08-01

    Full Text Available Multimodal biometric systems which fuse information from a number of biometrics, are gaining more attentions lately because they are able to overcome limitations in unimodal biometric systems. These systems are suited for high security applications. Most of the proposed multibiometric systems offer one level of security. In this paper a new approach for adaptive combination of multiple biometrics has been proposed to ensure multiple levels of security. The score level fusion rule is adapted using (PSO Particle Swarm Optimization to ensure the desired system performance corresponding to the desired level of security. The experimental results prove that the proposed multimodal biometric system is appropriate for applications that require different levels of security.

  7. A Multimodal Nanocomposite for Biomedical Imaging

    Science.gov (United States)

    Wu, Aiguo; Paunesku, Tatjana; Zhang, Zhuoli; Vogt, Stefan; Lai, Barry; Maser, Jörg; Yaghmai, Vahid; Li, Debiao; Omary, Reed A.; Woloschak, Gayle E.

    2013-01-01

    A multimodal nanocomposite was designed, synthesized with super-paramagnetic core (CoFe2O4), noble metal corona (Au), and semiconductor shell (TiO2). The sizes of core, core-corona, and core-corona-shell particles were determined by TEM. This multimodal nanocrystal showed promise as a contrast agent for two of the most widely used biomedical imaging techniques: magnetic resonance imaging (MRI) and X-ray computed tomography (CT). Finally, these nanocomposites were coated with a peptide SN-50. This led to their ready uptake by the cultured cells and targeted the nanocomposites to the pores of nuclear membrane. Inside cells, this nanocomposite retained its integrity as shown by X-ray fluorescence microscopy (XFM). Inside cells imaged by XFM we found the complex elemental signature of nanoconjugates (Ti-Co-Fe-Au) always co-registered in the 2D elemental map of the cell. PMID:24817775

  8. Digital confocal microscopy through a multimode fiber

    CERN Document Server

    Loterie, Damien; Papadopoulos, Ioannis; Goy, Alexandre; Psaltis, Demetri; Moser, Christophe

    2015-01-01

    Acquiring high-contrast optical images deep inside biological tissues is still a challenging issue. Confocal microscopy is an important tool for biomedical imaging since it improves image quality by rejecting background signals. On the other hand, it suffers from low sensitivities in deep tissues due to light scattering. Recently, multimode fibers have provided a new paradigm for minimally invasive endoscopic imaging by controlling light propagation through them. Here we introduce a combined imaging technique where confocal images of a human epithelial cell are acquired through a multimode fiber. We achieve this by digitally engineering the excitation wavefront and then applying a virtual digital pinhole on the collected signal. In this way, we are able to acquire images through the fiber with significantly increased contrast.

  9. The multimodal argumentation of persuasive counter discourses

    DEFF Research Database (Denmark)

    Maier, Carmen Daniela

    with the characteristics and potential fallacies of the advertising discourse of commercials. The original advertising discourse is deconstructed and reconstructed with additional visual material in front of the viewers’ eyes who are instructed by a voiceover narrator what to look at and how to identify and decode...... and critical participants in the process of message understanding. In this paper, I explore the Media Bites videos that identify and discuss problematic gender issues in commercials advertising various products. I adopt a multimodal approach in my discourse analysis and I establish which semiotic modes...... are given prominence in the argumentation by examining their complex interplay and functional differentiation. The ways in which speech, writing and images articulate the counter discourse occupy a central position in the analysis. A special focus is put on the multimodal configuration of specific...

  10. Performance Enhancement Of Multimodal Biometrics Using Cryptosystem

    Directory of Open Access Journals (Sweden)

    Muskaan,

    2015-06-01

    Full Text Available Multimodal biometrics means the unification of two or more uni modal biometrics so as to make the system more reliable and secure. Such systems promise better security. This study is a blend of iris and fingerprint recognition technique and their fusion at feature level. Our work comprises of two main sections: feature extraction of both modalities and fusing them before matching and finally application of an encryption technique to enhance the security of the fused template.

  11. Multimodal CARS microscopy of structured carbohydrate biopolymers

    OpenAIRE

    Slepkov, Aaron D.; Ridsdale, Andrew; Pegoraro, Adrian F.; Moffatt, Douglas J.; Stolow, Albert

    2010-01-01

    We demonstrate the utility of multimodal coherent anti-Stokes Raman scattering (CARS) microscopy for the study of structured condensed carbohydrate systems. Simultaneous second-harmonic generation (SHG) and spectrally-scanned CARS microscopy was used to elucidate structure, alignment, and density in cellulose cotton fibers and in starch grains undergoing rapid heat-moisture swelling. Our results suggest that CARS response of the O-H stretch region (3000 cm−1–3400 cm−1), together with the comm...

  12. Research Progress on Multimode Interference Switches

    Institute of Scientific and Technical Information of China (English)

    GAO Qing; SHENG Zhi-rui; JIANG Xiao-qing; WANG Ming-hua

    2005-01-01

    Optical switches are key components for constructing optical communication networks, so it is necessary to design optical switches and optical switch arrays with high performance and low cost. As one type of optical switches, the multimode interference(MMI) switches have received considerable attention due to their unique merits. The structures and operation principles of various types of MMI switches are introduced,and the recent progresses of MMI switches are also discussed.

  13. Multi-Modal Interaction for Robotic Mules

    Science.gov (United States)

    2014-02-26

    Multi-Modal Interaction for Robotic Mules Glenn Taylor, Mike Quist , Matt Lanting, Cory Dunham, Patrick Theisen, Paul Muench Abstract...Taylor, Mike Quist , Matt Lanting, Cory Dunham, and Patrick Theisen are with Soar Technology, Inc. (corresponding author: 734-887- 7620; email: glenn...soartech.com; quist @soartech.com; matt.lanting@soartech.com; dunham@soartech.com; patrick.theisen@soartech.com Paul Muench is with US Army TARDEC

  14. Multimode FPGA with Flexible Embedded FPUS

    OpenAIRE

    G.Murugaboopathi; S.Hariharasitaraman; Sankar, G.

    2012-01-01

    The Performance of field-programmable gate arrays used for Floating-point applications are poor due to complexity of floating-point arithmetic. Implementing floating-point units on FPGAs consume a large amount of resources. This makes FPGAs less attractive for use in floating-point intensive applications. There is a need for embedded FPUs in FPGAs. We proposed a flexible multimode embedded FPU for FPGAs that can be configured to perform a wide range of operations. The floatingpoint adder and ...

  15. Multimodal Sensor Fusion for Personnel Detection

    Science.gov (United States)

    2011-07-01

    Multimodal Sensor Fusion for Personnel Detection Xin Jin Shalabh Gupta Asok Ray Department of Mechanical Engineering The Pennsylvania State...have con- sidered relations taken only two at a time, but we propose to explore relations between higher order cliques as future work. D. Feature...detection,” IEEE Transactions on Pattern Analysis and Machine Intelligence, vol. 23, no. 6, pp. 577–589, 2001. [11] A. Ray , “Symbolic dynamic analysis

  16. Automatic Multimodal Cognitive Load Measurement (AMCLM)

    Science.gov (United States)

    2011-06-01

    Final Project Report Grant AOARD-10-4029 Automatic Multimodal Cognitive Load Measurement (AMCLM) June 2011 NICTA DSIM Team...collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 12 AUG 2011 2. REPORT TYPE 3. DATES COVERED 4...human-computer interface, such as air traffic control , in-car safety and electronic games. By quantifying the mental efforts of a person when

  17. Fiber Optic Temperature Sensor Based on Multimode Interference Effects

    Energy Technology Data Exchange (ETDEWEB)

    Aguilar-Soto, J G; Antonio-Lopez, J E; Sanchez-Mondragon, J J [Photonics and Optical Physics Laboratory, Optics Department, INAOE Apdo. Postal 51 and 216, Tonantzintla, Puebla 72000 (Mexico); May-Arrioja, D A, E-mail: darrioja@uat.edu.mx

    2011-01-01

    A novel fiber optic temperature sensor based on multimode interference was designed, fabricated and tested. The sensor is very simple and inexpensive since we only need to splice a section of multimode fiber between two single mode fibers. Using this device a sensing range of 25 deg. C to 375 deg. C is demonstrated. We should also highlight that due to the pass-band filter response of MMI devices, multiplexing is rather simple by just changing the length of the multimode section.

  18. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.

    Science.gov (United States)

    Collis, R E; Baxandall, M L; Srikantharajah, I D; Edge, G; Kadim, M Y; Morgan, B M

    1994-04-01

    Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). The initial dose was given into the subarachnoid space and analgesia maintained via an epidural catheter. A subarachnoid injection of 2.5 mg bupivacaine and 25 mug fentanyl was successfully given in 268 women (89.3%). Completely pain-free contractions within 3 min of this injection occurred in 195 women (65%) and in all 300 within 20 min and there was no associated motor block in 291 (97%). 141 women chose to stand, walk or sit in a rocking chair at some time during labour. Only 38 women (12.6%) were immobile during the first stage of labour. Analgesia was maintained via the epidural catheter with bolus doses of 10-15 ml of 0.1% bupivacaine and 0.0002% fentanyl. The mean bupivacaine requirement was 9.5 mg/h throughout the entire duration of analgesia. The incidence of post lumbar puncture headache was 2.3%. Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.

  19. Differential effects of experimental central sensitization on the time-course and magnitude of offset analgesia.

    Science.gov (United States)

    Martucci, Katherine T; Yelle, Marc D; Coghill, Robert C

    2012-02-01

    Pain perception is temporally altered during states of chronic pain and acute central sensitization; however, the mechanisms contributing to temporal processing of nociceptive information remain poorly understood. Offset analgesia is a phenomenon that reflects the presence of temporal contrast mechanisms for nociceptive information and can provide an end point to study temporal aspects of pain processing. In order to investigate whether offset analgesia is disrupted during sensitized states, 23 healthy volunteers provided real-time continuous visual analogue scale responses to noxious heat stimuli that evoke offset analgesia. Responses to these stimuli were evaluated during capsaicin-heat sensitization (45°C stimulus, capsaicin cream 0.1%) and heat-only sensitization (40°C stimulus, placebo cream). Capsaicin-heat sensitization produced significantly larger regions of secondary mechanical allodynia compared to heat-only sensitization. Although areas of mechanical allodynia were positively related to individual differences in heat pain sensitivity, this relationship was altered at later time points after capsaicin-heat sensitization. Heat hyperalgesia was observed in the secondary region following both capsaicin-heat and heat-only sensitization. Increased latencies to maximal offset analgesia and prolonged aftersensations were observed only in the primary regions directly treated by capsaicin-heat or heat alone. However, contrary to the hypothesis that offset analgesia would be reduced following capsaicin-heat sensitization, the magnitude of offset analgesia remained remarkably intact after both capsaicin-heat and heat-only sensitization in zones of both primary and secondary mechanical allodynia. These data indicate that offset analgesia is a robust phenomenon and engages mechanisms that interact minimally with those supporting acute central sensitization.

  20. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

    Directory of Open Access Journals (Sweden)

    Summayah Fallatah

    2016-01-01

    Full Text Available Background: Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB, which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection. Materials and Methods: Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients or postoperative intravenous PCA with morphine (group M, 20 patients for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded. Results: PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients. Conclusion: Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.

  1. Medical Image Retrieval: A Multimodal Approach.

    Science.gov (United States)

    Cao, Yu; Steffey, Shawn; He, Jianbiao; Xiao, Degui; Tao, Cui; Chen, Ping; Müller, Henning

    2014-01-01

    Medical imaging is becoming a vital component of war on cancer. Tremendous amounts of medical image data are captured and recorded in a digital format during cancer care and cancer research. Facing such an unprecedented volume of image data with heterogeneous image modalities, it is necessary to develop effective and efficient content-based medical image retrieval systems for cancer clinical practice and research. While substantial progress has been made in different areas of content-based image retrieval (CBIR) research, direct applications of existing CBIR techniques to the medical images produced unsatisfactory results, because of the unique characteristics of medical images. In this paper, we develop a new multimodal medical image retrieval approach based on the recent advances in the statistical graphic model and deep learning. Specifically, we first investigate a new extended probabilistic Latent Semantic Analysis model to integrate the visual and textual information from medical images to bridge the semantic gap. We then develop a new deep Boltzmann machine-based multimodal learning model to learn the joint density model from multimodal information in order to derive the missing modality. Experimental results with large volume of real-world medical images have shown that our new approach is a promising solution for the next-generation medical imaging indexing and retrieval system.

  2. The effect of Hegu acupoint stimulation in dental acupuncture analgesia

    Directory of Open Access Journals (Sweden)

    Fransiskus Andrianto

    2007-03-01

    Full Text Available In daily life, dental treatments are often related with oral pain sensation which needs anesthesia procedures. Sometimes local anesthetics can not be used because patients have hypersensitive reaction or systemic diseases which may lead to complications. Stimulating acupoint, such as Hegu activates hypothalamus and pituitary gland to release endogenous opioid peptide substances that reduce pain sensitivity. The aim of the study was to determine Hegu acupoint stimulation effect on the pain sensitivity reduction in maxillary central incisor gingiva. The laboratory experimental research was conducted on 12 healthy male Wistar rats (3 months old, weights 150–200 grams. All rat samples received the same treatments and adapted within 1 month. The research was done in pre and post test control group design. 40-Volt electro-stimulation was done once on the maxillary central incisor gingiva prior to the bilateral Hegu acupoint stimulation, then followed by 3 times electro-stimulation with 3 minutes intervals. The pain scores were obtained based on the samples’ contraction in each electro-stimulation. The responses were categorized into 5 pain scores and statistically analyzed using Wilcoxon Test. The results showed that Hegu acupoint stimulation lowered the pain scores significantly (p < 0.05. Hegu acupoint stimulation could reduce the pain sensitivity in maxillary central incisor gingiva. Therefore, the use of acupuncture analgesia in dental pain management can be considered in the future.

  3. Kin interaction enhances morphine analgesia in male mice.

    Science.gov (United States)

    D'Amato, F R

    1998-07-01

    The additive effect of social and pharmacological treatments was evaluated in pairs of male mice. Ineffective and effective doses of morphine (2.5 and 5.0 mg/kg, i.p.) were tested on pain threshold in dyads of males at different times after pair formation and drug treatment. During the second hour of social interaction after reunion, saline-injected adult sibling male mice showed a decrease in nociception as measured by the tail-flick test. Pairs of unrelated, unfamiliar control mice showed no changes in pain sensitivity during a 2-h social session. An ineffective dose of 2.5 mg/kg of morphine in non-sibling males, significantly increased tail-flick latencies in sibling pairs, before the effect of the social environment (sibling) reached statistical significance. The higher dose of morphine (5.0 mg/kg) produced analgesia in sibling as well as in non-sibling males, but the effect in the latter disappeared 60 min after drug treatment, whereas siblings were still analgesic. These results indicate that an ineffective dose of morphine, combined with the activation of the endogenous opioid system by social factors, can affect nociception.

  4. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  5. Meditative analgesia: the current state of the field.

    Science.gov (United States)

    Grant, Joshua A

    2014-01-01

    Since the first demonstrations that mindfulness-based therapies could have a positive influence on chronic pain patients, numerous studies have been conducted with healthy individuals in an attempt to understand meditative analgesia. This review focuses explicitly on experimental pain studies of meditation and attempts to draw preliminary conclusions based on the work completed in this new field over the past 6 years. Dividing meditative practices into the broad categories of focused attention (FA) and open monitoring (OM) techniques allowed several patterns to emerge. The majority of evidence for FA practices suggests they are not particularly effective in reducing pain. OM, on the other hand, seems to influence both sensory and affective pain ratings depending on the tradition or on whether the practitioners were meditating. The neural pattern underlying pain modulation during OM suggests meditators actively focus on the noxious stimulation while inhibiting other mental processes, consistent with descriptions of mindfulness. A preliminary model is presented for explaining the influence of mindfulness practice on pain. Finally, the potential analgesic effect of the currently unexplored technique of compassion meditation is discussed.

  6. RESULTS OF THE MEGAVERTEBRATE ANALGESIA SURVEY: ELEPHANTS AND RHINO.

    Science.gov (United States)

    Kottwitz, Jack; Boothe, Matthew; Harmon, Roy; Citino, Scott B; Zuba, Jeffery R; Boothe, Dawn M

    2016-03-01

    An online survey utilizing Survey Monkey linked through the American Association of Zoo Veterinarians listserve examined current practices in megavertebrate analgesia. Data collected included drugs administered, dosing regimens, ease of administration, efficacy, and adverse events. Fifty-nine facilities (38 housing elephants, 33 housing rhinoceroses) responded. All facilities administered nonsteroidal anti-inflammatory drugs (NSAIDs), with phenylbutazone (0.25-10 mg/kg) and flunixin meglumine (0.2-4 mg/kg) being most common. Efficacy was reported as "good" to "excellent" for these medications. Opioids were administered to elephants (11 of 38) and rhinoceroses (7 of 33), with tramadol (0.5-3.0 mg/kg) and butorphanol (0.05-1.0 mg/kg) being most common. Tramadol efficacy scores were highly variable in both elephants and rhinoceroses. While drug choices were similar among institutions, substantial variability in dosing regimens and reported efficacy between and within facilities indicates the need for pharmacokinetic studies and standardized methods of analyzing response to treatment to establish dosing regimens and clinical trials to establish efficacy and safety.

  7. Perioperative analgesia and the effects of dietary supplements.

    Science.gov (United States)

    Abe, Andrew; Kaye, Alan David; Gritsenko, Karina; Urman, Richard D; Kaye, Adam Marc

    2014-06-01

    With over 50,000 dietary supplements available, resurgence in consumer interest over the past few decades has resulted in an explosion of use of these agents worldwide. Disillusionment with current medications and belief in "natural medicines" has resulted in a multibillion dollar industry. Active ingredients in a number of herbs are being tested for therapeutic potential, and some are efficacious, so herbal medicines cannot be dismissed. The prevalence of herbology is further encouraged by a relatively relaxed policy of the FDA regarding these compounds, which they consider foods. As herbal products are included in the "supplement" category, there is no existing protocol for standardization of these products. There are numerous examples of herbals that can adversely affect patient recovery and outcomes in anesthesia. The prudent anesthesia provider will make sure to obtain correct information as to accurate herbal usage of each patient and attempt to discontinue these products two to three weeks prior to the delivery of an anesthetic. Postoperative analgesia, bleeding, and level of sedation can be negatively impacted related to herbal products and herbal-drug interactions. Over 90 herbal products are associated with bleeding and this can be a specific problem intraoperatively or when considering placement of a regional anesthetic for postoperative pain management.

  8. Fetal and maternal analgesia/anesthesia for fetal procedures.

    Science.gov (United States)

    Van de Velde, Marc; De Buck, Frederik

    2012-01-01

    For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation.

  9. Preventive local analgesia in orthopedic and Traumatology surgery.

    Directory of Open Access Journals (Sweden)

    Hugo Jiménez Vázquez

    2005-11-01

    Full Text Available Fundament: One of the most important aims of modern surgery is the recovery of the ill patients and heir integration to society. Sometimes, this wish has its limitations because of the persistence of pain after surgery. The development of an effective analgesic for after surgery pain is therefore a priority in modern medicine. Objective: To characterize the results obtained with the application of a preventive analgesic by infiltrating without limitations of the use of any other analgesic if necessary. Method: Prospective-descriptive study in a series of 30 patients assisted at the Orthopaedic Service of the ¨Dr. Gustavo Aldereguía Lima¨ Hospital from Cienfuegos province in the period that covers September 2004- march 2005. Anaesthetic infiltration in the surgical area was applied once the surgery was ended . Bupivacaine 0,125 % in a volume of 20 ml and 2 drops of epinephrine without avoiding the use of any other analgesic. Results: a group of 13 patients presented pain in the first 24-48 hours after surgery followed by another group of 9 patients who alleviated pain in the period between 12 and 23 hours after surgery. Conclusions: In this series of patients it was shown the benefits of anaesthetic infiltration in the surgical area with analgesic purposes, since it causes pain alleviation in a period greater than 24 hours. Bupivacaine shows good results since it causes after surgery analgesia and the early application in the rehabilitation of a great number of patients.

  10. Anesthesia and analgesia for caesaren section in dog

    Directory of Open Access Journals (Sweden)

    Vasiljević Maja

    2014-01-01

    Full Text Available This work presents a case of a pregnant female dog, of English bulldog breed, three years old, which was brought to Belgrade Faculty of Veterinary Medicine because of inability for normal parturition. Cesarean section is an urgent intervention both in human and in veterinary medicine. Anesthesia of a pregnant dog should be carried out very carefully, because of all the physiological changes that appear during pregnancy, as well as the impact of anesthetics on embryos themselves. Anesthetics, analgesics and sedatives pass through blood brain barrier, but also their transport goes through placenta to embryo, so for that reason it is not possible to anesthetize only mother and to avoid anesthesia effects on the embryo. Therefore, anesthetics with short time of action which metabolize quickly and have minimal negative effect on embryos are recommended. When choosing the right analgesics and anesthetics, there should be known that female dogs in which it is necessary to do Cesarean section belong to the group of high risk patients. Pregnant female dogs are exposed to hypoventilation, hypoxia, hypercapnia, intense heart work, vomiting and regurgitation as well. Reversible anesthetics are recommended to provide shorter duration time of anesthesia, and in accordance, inhalation anesthetics doses are minimal. Application of α2- agonist in premedication, propophol in induction, as well as maintaining general inhalation anesthesia with sevofluran, along with local analgesia, proved to be the ideal combination in this case of cesarean section.

  11. Next Generation Multi-mode Remote Sensing Radar Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This effort leverages ESTO and SBIR investments aimed at enabling fully polarimetric digital beamforming multimode radar, high resolution (wideband) measurements,...

  12. Multimodal integration of anatomy and physiology classes: How instructors utilize multimodal teaching in their classrooms

    Science.gov (United States)

    McGraw, Gerald M., Jr.

    Multimodality is the theory of communication as it applies to social and educational semiotics (making meaning through the use of multiple signs and symbols). The term multimodality describes a communication methodology that includes multiple textual, aural, and visual applications (modes) that are woven together to create what is referred to as an artifact. Multimodal teaching methodology attempts to create a deeper meaning to course content by activating the higher cognitive areas of the student's brain, creating a more sustained retention of the information (Murray, 2009). The introduction of multimodality educational methodologies as a means to more optimally engage students has been documented within educational literature. However, studies analyzing the distribution and penetration into basic sciences, more specifically anatomy and physiology, have not been forthcoming. This study used a quantitative survey design to determine the degree to which instructors integrated multimodality teaching practices into their course curricula. The instrument used for the study was designed by the researcher based on evidence found in the literature and sent to members of three associations/societies for anatomy and physiology instructors: the Human Anatomy and Physiology Society; the iTeach Anatomy & Physiology Collaborate; and the American Physiology Society. Respondents totaled 182 instructor members of two- and four-year, private and public higher learning colleges collected from the three organizations collectively with over 13,500 members in over 925 higher learning institutions nationwide. The study concluded that the expansion of multimodal methodologies into anatomy and physiology classrooms is at the beginning of the process and that there is ample opportunity for expansion. Instructors continue to use lecture as their primary means of interaction with students. Email is still the major form of out-of-class communication for full-time instructors. Instructors with

  13. Multimode fiber amplifier with tunable modal gain using a reconfigurable multimode pump.

    Science.gov (United States)

    Bai, Neng; Ip, Ezra; Wang, Ting; Li, Guifang

    2011-08-15

    We propose a method for controlling modal gain in a multimode Erbium-doped fiber amplifier (MM-EDFA) by tuning the mode content of a multimode pump. By adjusting the powers and orientation of input pump modes, modal dependent gain can be tuned over a large dynamic range. Performance impacts due to excitation of undesired pump modes, mode coupling and macro-bending loss within the erbium-doped fiber are also investigated. The MM-EDFA may potentially be a key element for long haul mode-division multiplexed transmission.

  14. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

  15. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Leonhardt, Jane Schwartz; Revald, Peter

    2011-01-01

    Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged...

  16. Combined spinal-epidural analgesia in labour: its effects on delivery outcome

    Directory of Open Access Journals (Sweden)

    Suneet Kaur Sra Charanjit Singh

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

  17. Advances in patient-controlled analgesia: the role of fentanyl ITS

    Directory of Open Access Journals (Sweden)

    Ian Power

    2009-01-01

    Full Text Available Ian Power, Jon G McCormackDepartment of Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Royal Infirmary, Edinburgh, UKAbstract: Effective pain relief is an essential component of a patient’s peri-operative care package. Good analgesia has been shown to reduce the incidence of cardiovascular, respiratory and thrombo-embolic complications following surgery. Satisfactory analgesia facilitates early patient ambulation following surgery, which may reduce in-patient stay. Patient-controlled analgesia (PCA systems are a well established standard therapy for acute post-operative pain; however some practical limitations limit their clinical utility. The fentanyl inotophoretic transdermal system (ITS is a novel self-contained needle-free PCA device, which delivers boluses of fentanyl transdermally. This system has been shown to provide analgesia equivalent to conventional PCA modalities, with unique design features that may confer advantages to patients and staff, including facilitating patient mobilization in the post-operative phase. This review will discuss the technology of iontophoretic systems, the pharmacology of transdermal fentanyl delivery, and some practical implications of the fentanyl ITS.Keywords: iontophoresis, transdermal, patient-controlled analgesia, fentanyl, post-operative pain

  18. Effects of Flurbiprofen Axetil on Postoperative Analgesia and Cytokines in Peripheral Blood of Thoracotomy Patients.

    Science.gov (United States)

    Zhou, Mi; Li, Beiping; Kong, Ming

    2015-06-01

    The objective is to study the effects of flurbiprofen axetil (FA) with fentanyl together in postoperative controlled intravenous analgesia (PCIA) on pain intensity, cytokine levels in peripheral blood and adverse reactions of thoracotomy patients. Fifty thoracotomy patients were divided into a FA and a control group, each with 25 cases. Postoperative analgesia was administered in the two groups using PCIA. The pressing times of analgesia pump, the visual analog scale (VAS) scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery and the incidence of adverse drug reactions were recorded. Levels of IL-1β, IL-6, IL-8, IL-2, and TNF-α in peripheral blood were determined before the administration of FA (T0), and at 24 h (T1), 48 h (T2), 72 h (T3) after surgery. The analgesia pump pressing times in the FA group was less than that of the control group. The VAS scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery, were statistically less than those of control group. The incidence rate of nausea and vomiting was insignificantly different between the two groups. Administration of FA together with PCIA in thoracotomy patients can improve postoperative analgesia.

  19. Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

    Directory of Open Access Journals (Sweden)

    Piedrahíta-Gutiérrez, Dany Leandro

    2016-07-01

    Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

  20. Post operatory analgesia in caesarean surgery. Analgesia posoperatoria en la operación cesárea.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  1. Osteoporosis y climaterio. Medidas preventivas

    OpenAIRE

    Goberna Tricas, Josefina

    2001-01-01

    El climaterio constituye un proceso fisiológico en la vida de la mujer que puede modificar su estado de salud y aumentar la incidencia de algunas enfermedades como consecuencia de la deprivación estrogénica: entre ellas destaca la osteoporosis. Tras analizar su etiología y factores de riesgo, se des­criben detalladamente las diferentes medidas de prevención de dicha enfer­medad: nutrición, ejercicio físico, hábitos de vida saludables, etc.

  2. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

    1996-01-01

    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp...

  3. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.

    NARCIS (Netherlands)

    Galvin, E.; Boesjes, H.; Hol, J.; Ubben, J.F.; Klein-Nulend, J.; Verbrugge, S.J.

    2010-01-01

    BACKGROUND: Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. METHODS: Patients scheduled for extraco

  4. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

    Directory of Open Access Journals (Sweden)

    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  5. Redactando riesgos. El uso de la prisión preventiva en los expedientes dentro de la provincia de Buenos Aires

    Directory of Open Access Journals (Sweden)

    Ezequiel Kostenwein

    2015-07-01

    Full Text Available En este artículo se presenta una introducción a las características del objeto expediente, para indicar la relación entre dicho instrumento y la prisión preventiva (en adelante, PP en la provincia de Buenos Aires (en adelante, PBA. Luego, aparece una serie de informes en los que se ha trabajado, con métodos diferentes, el uso del encierro preventivo a partir del expediente. Tomando dicho instrumento como fuente primaria,se analizan los argumentos que se consignan para justificar la medida cautelar, mediante cuatro gramáticas argumentativas: la primera es un modelo de argumentación con base en la ley, dentro de la cual la PP se solicita y concede respecto a uno —o dos— de los riesgos procesales que exige el Código Procesal Penal. La segunda se realiza con base en un acuerdo tácito, ya que la medida cautelar se pide y se otorga, si bien no se menciona en las justificaciones el peligro de fuga ni el entorpecimiento en la investigación. La tercera se compone de acuerdos en disidencia, a raíz de que los argumentos entre los fiscales y los jueces de garantías no concuerdan, pero la PP es igualmente aplicada. Por último, los argumentos planteados a partir del concepto de la confianza perdida describen una seriede casos que se distinguen de los presentados en los apartados anteriores, dado que se trata de negativas de los jueces ante los pedidos de PP por parte de la fiscalía. Las tres primeras gramáticas pueden concretarse siempre que las presentaciones de los fiscales hayan satisfecho ciertos requisitos para considerarlas viables. Según los expedientes consultados, estas condiciones son dos: la primera, que el fiscal demuestre la existencia del delito, y, la segunda, que el imputado haya participado probablemente en este. Una vez verificadas las condiciones, es posible que surja un acuerdo activo sobre la necesidad de hacer uso de la PP; de lo contrario, surgen argumentos con base en la confianza perdida. En s

  6. Presença da fisioterapia preventiva no contexto escolar: educação e prevenção em saúde

    Directory of Open Access Journals (Sweden)

    Kamila Mohammad Kamal Mansour

    2016-10-01

    Full Text Available Objetivo: este estudo tem por finalidade explicitar as ações da fisioterapia nas escolas, analisando alguns dos dados coletados durante uma das práticas da disciplina, em escola privada do município de Santa Cruz do Sul-RS. Método: estudo de caráter descritivo, foi composto por 206 estudantes, com idades entre 6 e 10 anos, de ambos os sexos, sendo alunos do 1° ao 4º ano do Ensino Fundamental, distribuídos em 11 turmas, de uma escola privada. A abordagem consistiu na “Educação Postural” no ambiente escolar e nas atividades de vida diárias, aplicação de um questionário de múltipla escolha que englobava a avaliação do aspecto biopsicossocial do aluno. Foi feita a avaliação postural estática, assim como da postura de cada escolar frente ao mobiliário em sala de aula, através de análise observacional individual, sendo realizada a pesagem dos alunos, das mochilas e o ajuste das mesmas também foi realizada. Resultados: a amostra foi composta por 206 estudantes do 1º ao 4º ano do Ensino Fundamental, com idade entre seis e 10 anos, de ambos os sexos. Os achados provenientes do questionário nos forneceram informações acerca da realidade de vida de cada aluno avaliado. Em relação às avaliações posturais realizadas, foram evidenciados quatro casos de escoliose em “C” na coluna lombar e um em "S”, já na coluna torácica foram encontrados sete casos de escoliose em “C”. O mobiliário se mostrou inadequado para a maioria dos estudantes e em relação ao peso das mochilas, 148 delas estavam acima dos 10% do peso corporal do aluno. Considerações finais: existe um vasto campo de atuação para a Fisioterapia Preventiva, dentre eles, a avaliação e intervenção na saúde na escola. As metodologias utilizadas na disciplina para esta prática possibilitaram o aprendizado e a [re] significação da prevenção na Fisioterapia, uma profissão fortemente enraizada na reabilitação.

  7. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  8. Intrathecal administration of resiniferatoxin produces analgesia against prostatodynia in rats

    Institute of Scientific and Technical Information of China (English)

    TANG Wei; SONG Bo; ZHOU Zan-song; LU Gen-sheng

    2007-01-01

    Background Prostatodynia remains a difficult clinical problem. Resiniferatoxin (RTX), an ultrapotent vanilloid, can produce a selective and long-lasting desensitization of nociception via C-fiber sensory neurons. Substance P (SP) and calcitonin gene-related peptide (CGRP) released from C-fibers are key neurotransmitters in visceral pain. In this study,we evaluated the analgesic effect of intrathecal RTX on rat prostatodynia.Methods Male Sprague-Dawley rats were divided into 3 groups for different treatment. In group A, sham operation was preformed. In group B, 100 μl complete Freund's adjuvant (CFA) was injected into the rat's bilateral ventral prostate to induce chronic inflammation. In group C, after prostatitis formed, 50 μl 10 nmol/L RTX was injected into the rat's lumbosacral (L5-S2) vertebral canal. SP and CGRP contents in the spinal cord were investigated by immunohistochemistry and radioimmunoassay (RIA). Their transcriptional levels in dorsal root ganglion (DRG) were determined by reverse transcriptase polymerase chain reaction (RT-PCR). In addition, pelvic nerve afferent discharge was recorded to explore the neuro-electrophysiological mechanisms underlying RTX-induced effect.Results SP and CGRP released in the spinal cord and their synthesis in DRG were increased significantly in response to CFA-induced chronic prostatitis, whereas this increase was effectively inhibited by intrathecal RTX. Meanwhile, pelvic nerve afferent electrical activity was enhanced significantly in rats with chronic prostatitis, but it was attenuated markedly in RTX-treated rats paralleled by the change of neuropeptides.Conclusions Intrathecal RTX administration could produce an analgesic effect on rat prostatodynia. Suppression of pelvic nerve afferent electrical activity may be a crucial mechanism underlying RTX-induced analgesia. RTX intrathecal application may present a novel analgesic strategy of prostatodynia.

  9. RELATIONSHIP BETWEEN ACUPUNCTURE ANALGESIA AND MET- ENKEPHALIN OR DYNORPHIN

    Institute of Scientific and Technical Information of China (English)

    TsogoevAlanS; 王一菱; 吴景兰; 金辉

    2001-01-01

    subjective: The effect of 4~5 Hz electroacupuncture (EA) on alterations of both met-enkephalin (MEK) and dynorphin (Dyn) in the patient plasma or mouse spinal cord and its relation with analgesic effect were studied. Methods: In acupuncture clinic 10 patients with acute pain were treated with 4 Hz EA at Zusanli(ST 36) and/or Hegu(LI 4) acupoints for 30 min. 20 BALB/C mice were randomly divided into 2 groups: a. EA group(n=10), treated with 4~5 Hz EA at bilateral "Zusanli"(ST 36) for 15 min; b. control group(n=10) treated with no EA, but also restrained for 15 min. Before and after EA or restraining acupoints, the pain threshold of the patients or mice was detected. 10 μI of the patient plasma before and after EA and each mouse spinal cord suspension, of the 2 groups were blotted onto nitrocellulose membrane (NCM) respectively. The protein dot blot signals were detected by immunoreactivity (IR) and using Shimadu TLC Scanner and analyzed statistically. Results: The results showed that an increase in patient plasma MEK-IR or Dyn-IR and a decrease in mouse spinal MEK-IR or Dyn-IR could be detected, and the alteration of plasma or spinal MEK-IR was more significant than that of plasma or spinal Dyn-IR. There was a positive correlation in alteration between plasma or spinal MEK-IR and plasma or spinal Dyn-IR with respective parallel levels in individuals. The increased plasma MEK-IR or the decreased spinal MEK-IR was positively or negatively correlated with the analgesic effect, while the correlation between plasma or spinal Dyn-IR and analgesic effect was insignificant. Conclusion: The results suggest that under lower frequency EA the met-enkephalin may play an important role in analgesia.

  10. [Locally administered ropivacaine vs. standard analgesia for laparoscopic cholecystectomy].

    Science.gov (United States)

    Chavarría-Pérez, Teresa; Cabrera-Leal, Carlos Fernando; Ramírez-Vargas, Susana; Reynada, José Luis; Arce-Salinas, César Alejandro

    2015-01-01

    Introducción: se desconoce qué modalidad analgésica brinda mejores resultados después de una colecistectomía laparoscópica. El objetivo de este estudio consistió en valuar la eficacia analgésica de la ropivacaína usada localmente contra la dipirona por vía intravenosa en colecistectomía laparoscópica. Métodos: ensayo clínico al azar, de no inferioridad, en 50 pacientes con colecistectomía laparoscópica para comparar el uso de ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y en la fosa vesicular frente a dipirona por vía intravenosa. El desenlace primario fue dolor evaluado mediante escala visual análoga (EVA) en las primeras 24 horas. Resultados: el promedio de las EVA de dolor al término de la cirugía fue de 3.8 frente a 3.56 en el grupo de ropivacaína o de dipirona, mientras que a las 6, 12 y 24 horas fueron 2.64 frente a 2.6, 1.92 frente a 1.88 y 1.28 frente a 1.2, respectivamente. No hubo efectos adversos en ningún grupo y la necesidad de rescates analgésicos con tramadol fue similar entre ambos grupos. Conclusiones: la ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y la fosa vesicular muestra una analgesia similar a la dipirona por vía intravenosa en las primeras 24 horas después de una colecistectomía laparoscópica, sin efectos adversos.

  11. Endogenous opiate analgesia induced by tonic immobility in guinea pigs

    Directory of Open Access Journals (Sweden)

    C.R.A. Leite-Panissi

    2001-02-01

    Full Text Available A function of the endogenous analgesic system is to prevent recuperative behaviors generated by tissue damage, thus preventing the emission of species-specific defensive behaviors. Activation of intrinsic nociception is fundamental for the maintenance of the behavioral strategy adopted. Tonic immobility (TI is an inborn defensive behavior characterized by a temporary state of profound and reversible motor inhibition elicited by some forms of physical restraint. We studied the effect of TI behavior on nociception produced by the formalin and hot-plate tests in guinea pigs. The induction of TI produced a significant decrease in the number of flinches (18 ± 6 and 2 ± 1 in phases 1 and 2 and lickings (6 ± 2 and 1 ± 1 in phases 1 and 2 in the formalin test when compared with control (75 ± 13 and 22 ± 6 flinches in phases 1 and 2; 28 ± 7 and 17 ± 7 lickings in phases 1 and 2. In the hot-plate test our results also showed antinociceptive effects of TI, with an increase in the index of analgesia 30 and 45 min after the induction of TI (0.67 ± 0.1 and 0.53 ± 0.13, respectively when compared with control (-0.10 ± 0.08 at 30 min and -0.09 ± 0.09 at 45 min. These effects were reversed by pretreatment with naloxone (1 mg/kg, ip, suggesting that the hypoalgesia observed after induction of TI behavior, as evaluated by the algesimetric formalin and hot-plate tests, is due to activation of endogenous analgesic mechanisms involving opioid synapses.

  12. Sedation and analgesia in the pediatric intensive care unit.

    Science.gov (United States)

    Tobias, Joseph D

    2005-08-01

    Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. Although the synthetic opioid fentanyl frequently is chosen for use in the PICU setting because of its hemodynamic stability, preliminary data suggest morphine may have a slower development of tolerance and may cause fewer withdrawal symptoms than fentanyl. Morphine's safety profile includes long-term follow-up studies that have demonstrated no adverse central nervous system developmental effects from its use in neonates and infants. In the critically ill infant at risk following surgery for congenital heart disease, clinical experience supports the use of the synthetic opioids, given their ability to modulate PVR and prevent pulmonary hypertensive crisis. Alternatives to the benzodiazepines and opioids include ketamine, pentobarbital, or dexmedetomidine. Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.

  13. [Use of analgesia and sedation in dental implantology in patients with concomitant hypertension].

    Science.gov (United States)

    Sitkin, S I; Davydova, O B; Kostin, I O; Gasparian, A L

    2015-01-01

    Dental implants surgery in patients with hypertension increases the risk of vascular complications. The aim of the study was to examine the effect of analgesia and sedation on blood pressure and postoperative pain in dental implantology. In 76 patients with hypertension implant surgery was performed under local anesthesia only (40 patients) or under local anesthesia with propofol sedation and pre-emptive analgesia with ketorolac (36 patients). Intraoperative systolic blood pressure in the second group was 20% less than in the first group while the intensity of pain in the postoperative period in the second group was three times less than in the first one. Propofol sedation in dental implantology provides hemodynamic stability in patients with concomitant hypertension and preemptive analgesia with ketorolac allows minimizing postoperative pain.

  14. Pulsed Nd: YAG laser induces pulpal analgesia: a randomized clinical trial.

    Science.gov (United States)

    Chan, A; Armati, P; Moorthy, A P

    2012-07-01

    This double-blind, randomized, clinical trial investigated the effectiveness and underlying mechanism of neural inhibition of pulsed Nd:YAG laser induction of pulpal analgesia compared with 5% EMLA anesthetic cream. Forty-four paired premolars from 44 orthodontic patients requiring bilateral premolar extraction from either dental arch were randomly assigned to the 'Laser plus Sham-EMLA' or 'EMLA plus Sham-Laser' treatment group. Analgesia was tested by an Electric Pulp Tester (EPT) and the cutting of a standardized cavity, which was terminated when participants reported sensitivity, and Visual Analogue Scale (VAS) and numbness were recorded. Statistical analyses were done by paired t test, McNemar's test, and a chi-squared test (p analgesia, by suppression of intradental nerve responses to electrical and mechanical stimuli. Such a laser provides an alternative for dental pain management (ANZ-Clinical Trial Registry: N12611001099910).

  15. Understanding Central Mechanisms of Acupuncture Analgesia Using Dynamic Quantitative Sensory Testing: A Review

    Directory of Open Access Journals (Sweden)

    Jiang-Ti Kong

    2013-01-01

    Full Text Available We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS and conditioned pain modulation (CPM are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.

  16. Effect of Age, Adernaline and Operation Site on Duration of Caudal Analgesia in Paediatric Patients

    Directory of Open Access Journals (Sweden)

    Kharirat Mohd., Yasir,G.A.Mir

    2003-04-01

    Full Text Available The effect ofage, operative site and addition of 1: 200,000 adrenaline to bupivacaine was evaluatedon the duration ofpost operative analgesia after caudal block in 200 children between the age groupof 1 year to 14 years. Anaesthesia was induced and maintained on Halothane/N20I02• After thiscaudal block was performed with 0.5 mllkg of0.25% bupivacaine in one group of 100 Children andwith 0.25% bupivacaine with adrenaline 1 : 200,000 in another 100 children. The duration of postoperative analgesia was noted to be significantly longer in young children, in children having penoscrotaloperations and when adrenaline was added to bupivacaine. Conclusion was drawn that durationofpost-operative analgesia depended upon age, site and addition of adrenaline to bupivacaine.

  17. Molecular and cellular mechanisms of the age-dependency of opioid analgesia and tolerance

    Directory of Open Access Journals (Sweden)

    Zhao Jing

    2012-05-01

    Full Text Available Abstract The age-dependency of opioid analgesia and tolerance has been noticed in both clinical observation and laboratory studies. Evidence shows that many molecular and cellular events that play essential roles in opioid analgesia and tolerance are actually age-dependent. For example, the expression and functions of endogenous opioid peptides, multiple types of opioid receptors, G protein subunits that couple to opioid receptors, and regulators of G protein signaling (RGS proteins change with development and age. Other signaling systems that are critical to opioid tolerance development, such as N-methyl-D-aspartic acid (NMDA receptors, also undergo age-related changes. It is plausible that the age-dependent expression and functions of molecules within and related to the opioid signaling pathways, as well as age-dependent cellular activity such as agonist-induced opioid receptor internalization and desensitization, eventually lead to significant age-dependent changes in opioid analgesia and tolerance development.

  18. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg;

    , and reduce fear during birth which in turn may decrease use of pain relief. Few randomised trials have examined the effect of attending antenatal education in small groups on use of epidural analgesia and among these conclusions are conflicting. The objective of this study was therefore to examine the effect......Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour...... on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour...

  19. Composition 2.0: Toward a Multilingual and Multimodal Framework

    Science.gov (United States)

    Fraiberg, Steven

    2010-01-01

    This article argues that tracing multimodal-multilingual literacy practices across official and unofficial spaces is key to moving composition into the twenty-first century. Key to this remixing of the field is a situated framework that locates multimodal-multilingual activities in wider genre, cultural, national, and global ecologies. (Contains 3…

  20. Instantiation of Multimodal Semiotic Systems in Science Classroom Discourse

    Science.gov (United States)

    Tang, Kok-Sing

    2013-01-01

    Science classroom discourse is inherently multimodal in that scientific meanings are made through an integration of multiple semiotic systems (e.g., language, diagrams, equations). Although some studies have described this multimodal nature, few have examined and explained the relationship between the integration of multiple semiotic systems and…

  1. Fracturing Writing Spaces: Multimodal Storytelling Ignites Process Writing

    Science.gov (United States)

    Lenters, Kimberly; Winters, Kari-Lynn

    2013-01-01

    In this paper, we explore the affordances of literature-based, arts-infused and digital media processes for students, as multimodal practices take centre stage in an English Language Arts unit on fractured fairy tales. The study takes up the challenge of addressing multimodal literacy instruction and research in ways that utilize a range of…

  2. Multimodal Teaching and Learning: Creating Spaces for Content Teachers

    Science.gov (United States)

    Thompson, Mary

    2008-01-01

    In this article, the author describes her multimodal teaching practices in her "Adolescent Literacy Methods" course at a graduate university in the United States. By doing so, she highlights content teacher's understanding and use of various multimodal texts to effectively teach adolescents inside the classroom. In lieu of this, she raises…

  3. Multimodal transports in the Unidted States and Europe

    DEFF Research Database (Denmark)

    Ulfbeck, Vibe Garf

    2009-01-01

    Transport law has traditionally been regarded as an international area of the law. The modern multimodal transport, combining different types of transports, has changed this. Multimodal transports are not regulated by any international conventions. In commercial practice, one liability model is p...

  4. Multimodal network design for sustainable household plastic recycling

    NARCIS (Netherlands)

    Bing Xiaoyun, Xiaoyun; Groot, J.J.; Bloemhof, J.M.; Vorst, van der J.G.A.J.

    2013-01-01

    Purpose – This research studies a plastic recycling system from a reverse logistics angle and investigates the potential benefits of a multimodality strategy to the network design of plastic recycling. This research aims to quantify the impact of multimodality on the network, to provide decision sup

  5. Using Multimodal Writing to Motivate Struggling Students to Write

    Science.gov (United States)

    Darrington, Brett; Dousay, Tonia

    2014-01-01

    One of the reasons that many secondary students fail English classes is because they are not motivated to write. This literature review was conducted to look into the use of multimodal works to increase the motivation for struggling students to write. Change theory was used to evaluate the benefits of multimodal works compared to more traditional…

  6. A Multimodal Discourse Analysis of a Yoruba Song-Drama

    Science.gov (United States)

    Olateju, Moji. A.

    2015-01-01

    This paper presents a multimodal discourse analysis of a story that has been turned into a Yoruba song-drama, highlighting the ideational, interpersonal and textual aspects of the song-drama. The data is a short song-drama meant to teach children importunity, determination and hard work through persistence. The multimodal and narrative conventions…

  7. A Multimodal Discourse Analysis of Tmall's Double Eleven Advertisement

    Science.gov (United States)

    Hu, Chunyu; Luo, Mengxi

    2016-01-01

    From the 1990s, the multimodal turn in discourse studies makes multimodal discourse analysis a popular topic in linguistics and communication studies. An important approach to applying Systemic Functional Linguistics to non-verbal modes is Visual Grammar initially proposed by Kress and van Leeuwen (1996). Considering that commercial advertisement…

  8. Composition at Washington State University: Building a Multimodal Bricolage

    Science.gov (United States)

    Ericsson, Patricia; Hunter, Leeann Downing; Macklin, Tialitha Michelle; Edwards, Elizabeth Sue

    2016-01-01

    Multimodal pedagogy is increasingly accepted among composition scholars. However, putting such pedagogy into practice presents significant challenges. In this profile of Washington State University's first-year composition program, we suggest a multi-vocal and multi-theoretical approach to addressing the challenges of multimodal pedagogy. Patricia…

  9. Observation of Multimode Solitons in Few-Mode Fiber

    CERN Document Server

    Zhu, Zimu; Christodoulides, Demetrios N; Wise, Frank W

    2016-01-01

    We experimentally isolate and directly observe multimode solitons in few-mode graded-index fiber. By varying the input energy and modal composition of the launched pulse, we observe a continuous variation of multimode solitons with different spatiotemporal properties. They exhibit an energy-volume relation that is distinct from those of single-mode and fully spatiotemporal solitons.

  10. The semiotics of typography in literary texts. A multimodal approach

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2009-01-01

    to multimodal discourse proposed, for instance, by Kress & Van Leeuwen (2001) and Baldry & Thibault (2006), and, more specifically, the multimodal approach to typography suggested by Van Leeuwen (2005b; 2006), in order to sketch out a methodological framework applicable to the description and analysis...... of the semiotic potential of typography in literary texts....

  11. Generation of a hollow laser beam by a multimode fiber

    Institute of Scientific and Technical Information of China (English)

    Hongyu Ma; Huadong Cheng; Wenzhuo Zhang; Liang Liu; Yuzhu Wang

    2007-01-01

    A simple method to generate a hollow laser beam by multimode fiber is reported. A dark hollow laser beam is generated from a multimode fiber and the dependence of the output beam profile on the incident angle of laser beam is analyzed. The results show that this hollow laser beam can be used to trap and guide cold atoms.

  12. PROSPECTIVE RANDOMISED CONTROL STUDY OF POST OP EPIDURAL ANALGESIA WITH BUPIVACAINE AND FENTANYL VS. BUPIVACAINE AND CLONIDINE

    Directory of Open Access Journals (Sweden)

    Rachana

    2014-07-01

    Full Text Available The aim of the study was to compare the relative potencies and clinical characteristics of epidural Clonidine and Fentanyl with Bupivacaine in lower limb and lower abdominal surgeries using patient-controlled analgesia. In a randomised double-blinded study, 60 ASA I or II patients requiring epidural analgesia for post- operative pain relief were allocated to receive either 0.125% Bupivacaine with Clonidine 1µg/kg or 0.125% Bupivacaine with Fentanyl 1µg/kg via a sterile syringe by trained anaesthesiologists. Analgesia was established with 10-15 ml bolus of study solution. There were significant differences in onset time, duration and quality of analgesia, local anaesthetic consumption, between the two groups. We conclude that 0.125% Bupivacaine with Clonidine 1µg/kg group of patients clinically had better quality of analgesia and for a longer duration in comparison with patients receiving 0.125% Bupivacaine with Fentanyl 1µg/kg.

  13. O uso do apelo do medo em propagandas preventivas sobre drogas e seus efeitos sobre as atitudes e intenções dos pais em diferentes níveis de responsividade.

    OpenAIRE

    Souza, Ovanildo Gonçalves de

    2013-01-01

    O principal objetivo deste estudo foi identificar o efeito do apelo emocional negativo em propagandas preventivas sobre drogas ilícitas, nas atitudes e intenções dos pais em diferentes níveis de responsividade. Diante da problemática do aumento no consumo de drogas por adolescentes e na crença de que os pais são atores importantes no processo educativo e de formação social de seus filhos, entende-se que o marketing, no campo das políticas públicas pode contribuir favoravelmente com a erradica...

  14. Programa educativo dirigido a elevar el nivel de conocimientos sobre enfermedades de la cavidad bucal y medidas preventivas en alumnos del primer grado de la I.E.P seminario de San Carlos y San Marcelo del Distrito de Trujillo

    OpenAIRE

    2015-01-01

    Se realiz?? un estudio con el objetivo de demostrar que el programa educativo denominado Sonrisas , es efectivo en la medida que modifica favorablemente los conocimientos acerca de las principales enfermedades bucales y medidas preventivas en los ni??os de primer grado del I.E.P Seminario de San Carlos y San Marcelo del distrito de Trujillo en el periodo de marzo a junio del 2014 previo consentimiento informado, se evalu?? el conocimiento sobre salud bucal antes y despu??s de la intervenci??n...

  15. Prevalencia de desórdenes musculoesqueléticos y trastornos del sueño en odontólogos de la Región de Murcia : necesidades preventivas

    OpenAIRE

    Martínez del Toro, Berta

    2015-01-01

    Este trabajo estudia la prevalencia de desórdenes musculoesqueléticos y trastornos del sueño en dentistas de nuestro medio; pretende determinar su relación con factores ocupacionales específicos propios de la profesión odontológica, y establecer las necesidades preventivas en nuestro entorno sociodemográfico para esta profesión. Material y método: Se utiliza un cuestionario autoadministrado enviado por correo postal o electrónico, que incluye datos de filiación, preguntas sobre el ambiente la...

  16. Prevalencia de desórdenes musculoesqueléticos y trastornos del sueño en odontçologos de la Región de Murcia : necesidades preventivas

    OpenAIRE

    Martínez del Toro, Berta

    2015-01-01

    Objetivo: Este trabajo estudia la prevalencia de desórdenes musculoesqueléticos y trastornos del sueño en dentistas de nuestro medio; pretende determinar su relación con factores ocupacionales específicos propios de la profesión odontológica, y establecer las necesidades preventivas en nuestro entorno sociodemográfico para esta profesión. Material y método: Se utiliza un cuestionario autoadministrado enviado por correo postal o electrónico, que incluye datos de filiación, preguntas...

  17. Capacidad de agencia de autocuidado en personas con hipertensión arterial de la fundación médico preventiva, san josé de cúcuta, 2004.

    OpenAIRE

    Peñaloza García, Mónica

    2012-01-01

    Estudio novedoso en la región, realizado por Enfermería con la finalidad de describir la Capacidad de Agencia de Autocuidado en personas con hipertensión arterial, pertenecientes al convenio de magisterio e inscritos en el programa de patologías crónicas de la Fundación Médico Preventiva, San José de Cúcuta, año 2004, según Teoría del Autocuidado planteada por Orem en 1993.Iinvestigación tipo descriptivo, abordaje cuantitativo y corte transversal, que obtuvo muestra de 77 individuos cum...

  18. Inhibiting spinal neuron-astrocytic activation correlates with synergistic analgesia of dexmedetomidine and ropivacaine.

    Directory of Open Access Journals (Sweden)

    Huang-Hui Wu

    Full Text Available BACKGROUND: This study aims to identify that intrathecal (i.t. injection of dexmedetomidine (Dex and ropivacaine (Ropi induces synergistic analgesia on chronic inflammatory pain and is accompanied with corresponding "neuron-astrocytic" alterations. METHODS: Male, adult Sprague-Dawley rats were randomly divided into sham, control and i.t. medication groups. The analgesia profiles of i.t. Dex, Ropi, and their combination detected by Hargreaves heat test were investigated on the subcutaneous (s.c. injection of complete Freund adjuvant (CFA induced chronic pain in rat and their synergistic analgesia was confirmed by using isobolographic analysis. During consecutive daily administration, pain behavior was daily recorded, and immunohistochemical staining was applied to investigate the number of Fos-immunoreactive (Fos-ir neurons on hour 2 and day 1, 3 and 7, and the expression of glial fibrillary acidic protein (GFAP within the spinal dorsal horn (SDH on day 1, 3, 5 and 7 after s.c. injection of CFA, respectively, and then Western blot to examine spinal GFAP and β-actin levels on day 3 and 7. RESULTS: i.t. Dex or Ropi displayed a short-term analgesia in a dose-dependent manner, and consecutive daily administrations of their combination showed synergistic analgesia and remarkably down-regulated neuronal and astrocytic activations indicated by decreases in the number of Fos-ir neurons and the GFAP expression within the SDH, respectively. CONCLUSION: i.t. co-delivery of Dex and Ropi shows synergistic analgesia on the chronic inflammatory pain, in which spinal "neuron-astrocytic activation" mechanism may play an important role.

  19. New developments in multimodal clinical multiphoton tomography

    Science.gov (United States)

    König, Karsten

    2011-03-01

    80 years ago, the PhD student Maria Goeppert predicted in her thesis in Goettingen, Germany, two-photon effects. It took 30 years to prove her theory, and another three decades to realize the first two-photon microscope. With the beginning of this millennium, first clinical multiphoton tomographs started operation in research institutions, hospitals, and in the cosmetic industry. The multiphoton tomograph MPTflexTM with its miniaturized flexible scan head became the Prism-Award 2010 winner in the category Life Sciences. Multiphoton tomographs with its superior submicron spatial resolution can be upgraded to 5D imaging tools by adding spectral time-correlated single photon counting units. Furthermore, multimodal hybrid tomographs provide chemical fingerprinting and fast wide-field imaging. The world's first clinical CARS studies have been performed with a hybrid multimodal multiphoton tomograph in spring 2010. In particular, nonfluorescent lipids and water as well as mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen have been imaged in patients with dermatological disorders. Further multimodal approaches include the combination of multiphoton tomographs with low-resolution imaging tools such as ultrasound, optoacoustic, OCT, and dermoscopy systems. Multiphoton tomographs are currently employed in Australia, Japan, the US, and in several European countries for early diagnosis of skin cancer (malignant melanoma), optimization of treatment strategies (wound healing, dermatitis), and cosmetic research including long-term biosafety tests of ZnO sunscreen nanoparticles and the measurement of the stimulated biosynthesis of collagen by anti-ageing products.

  20. Partial order approach to compute shortest paths in multimodal networks

    CERN Document Server

    Ensor, Andrew

    2011-01-01

    Many networked systems involve multiple modes of transport. Such systems are called multimodal, and examples include logistic networks, biomedical phenomena, manufacturing process and telecommunication networks. Existing techniques for determining optimal paths in multimodal networks have either required heuristics or else application-specific constraints to obtain tractable problems, removing the multimodal traits of the network during analysis. In this paper weighted coloured--edge graphs are introduced to model multimodal networks, where colours represent the modes of transportation. Optimal paths are selected using a partial order that compares the weights in each colour, resulting in a Pareto optimal set of shortest paths. This approach is shown to be tractable through experimental analyses for random and real multimodal networks without the need to apply heuristics or constraints.

  1. Percorsi linguistici e semiotici: Critical Multimodal Analysis of Digital Discourse

    Directory of Open Access Journals (Sweden)

    edited by Ilaria Moschini

    2014-12-01

    Full Text Available The language section of LEA - edited by Ilaria Moschini - is dedicated to the Critical Multimodal Analysis of Digital Discourse, an approach that encompasses the linguistic and semiotic detailed investigation of texts within a socio-cultural perspective. It features an interview with Professor Theo van Leeuwen by Ilaria Moschini and four essays: “Retwitting, reposting, repinning; reshaping identities online: Towards a social semiotic multimodal analysis of digital remediation” by Elisabetta Adami; “Multimodal aspects of corporate social responsibility communication” by Carmen Daniela Maier; “Pervasive Technologies and the Paradoxes of Multimodal Digital Communication” by Sandra Petroni and “Can the powerless speak? Linguistic and multimodal corporate media manipulation in digital environments: the case of Malala Yousafzai” by Maria Grazia Sindoni. 

  2. Multimode Hong-Ou-Mandel interference

    CERN Document Server

    Walborn, S P; Pádua, S; Monken, C H

    2003-01-01

    We consider multimode two-photon interference at a beam splitter by photons created by spontaneous parametric down-conversion. The resulting interference pattern is shown to depend upon the transverse spatial symmetry of the pump beam. In an experiment, we employ the first-order Hermite-Gaussian modes in order to show that, by manipulating the pump beam, one can control the resulting two-photon interference behavior. We expect these results to play an important role in the engineering of quantum states of light for use in quantum information processing and quantum imaging.

  3. Multimodal CARS microscopy of structured carbohydrate biopolymers

    Science.gov (United States)

    Slepkov, Aaron D.; Ridsdale, Andrew; Pegoraro, Adrian F.; Moffatt, Douglas J.; Stolow, Albert

    2010-01-01

    We demonstrate the utility of multimodal coherent anti-Stokes Raman scattering (CARS) microscopy for the study of structured condensed carbohydrate systems. Simultaneous second-harmonic generation (SHG) and spectrally-scanned CARS microscopy was used to elucidate structure, alignment, and density in cellulose cotton fibers and in starch grains undergoing rapid heat-moisture swelling. Our results suggest that CARS response of the O-H stretch region (3000 cm−1–3400 cm−1), together with the commonly-measured C-H stretch (2750 cm−1–2970 cm−1) and SHG provide potentially important structural information and contrast in these materials. PMID:21258555

  4. Ultrasonic motors using piezoelectric ceramic multimode vibrators.

    Science.gov (United States)

    Takano, T; Tomikawa, Y; Ogasawara, T; Sugawara, S; Konno, M

    1990-01-01

    The development is reported of an ultrasonic motor using piezoelectric ceramic multimode vibrators consisting of circular or annular plates in which degenerate horizontal vibration modes of the same or different form are used. Two orthogonal nonaxisymmetric vibration modes were used in the same-form case, and the combination of a nonaxisymmetric vibration mode and a radial vibration mode was used in the different-forms case. Some details of the motor design and its experimental characteristics are presented. The ultrasonic motor presented here has a special advantage in its thin construction.

  5. MUVA: a MUltimodal Visceral design Ambient device

    DEFF Research Database (Denmark)

    Kivac, Robert; Klem, Sune Øllgaard; Olsen, Sophus Béneé

    2016-01-01

    This paper presents MUVA (MUltimodal Visceral design Ambient device), a prototype for a storytelling light- and sound-based ambient device. The aim of this device is to encourage social interaction and expand the emotional closeness in families with children where at least one parent has irregular...... work schedule. MUVA differs from the other ambient devices, because it is targeted to children, and it adopts a visceral design approach in order to be appealing to its users. It is a raindrop-shaped lamp, which features audio playing, while its light color is affected by the audio playing. MUVA can...

  6. Multimodal CARS microscopy of structured carbohydrate biopolymers.

    Science.gov (United States)

    Slepkov, Aaron D; Ridsdale, Andrew; Pegoraro, Adrian F; Moffatt, Douglas J; Stolow, Albert

    2010-11-08

    We demonstrate the utility of multimodal coherent anti-Stokes Raman scattering (CARS) microscopy for the study of structured condensed carbohydrate systems. Simultaneous second-harmonic generation (SHG) and spectrally-scanned CARS microscopy was used to elucidate structure, alignment, and density in cellulose cotton fibers and in starch grains undergoing rapid heat-moisture swelling. Our results suggest that CARS response of the O-H stretch region (3000 cm(-1)-3400 cm(-1)), together with the commonly-measured C-H stretch (2750 cm(-1)-2970 cm(-1)) and SHG provide potentially important structural information and contrast in these materials.

  7. Surgical management of complications of multimodal therapy.

    Science.gov (United States)

    Chui, Chan-Hon

    2012-08-01

    Multimodality therapies that include surgery, chemotherapy, radiotherapy, and various newer forms of targeted therapies have been commonly applied in childhood cancers. Such modalities are associated with complications that may adversely affect the outcome of cancer treatment. Acute complications that require surgical management form the focus of our discussion. These patients are often compromised by immunosuppression, thrombocytopenia, and malnutrition. The complications discussed include typhlitis, invasive aspergillosis (IA), pancreatitis, hemorrhagic cystitis, gastrointestinal hemorrhage, necrotizing skin and soft-tissue infections, and perianal infection. Familiarity with the spectrum of complications and their appropriate management approaches will minimize the patients' morbidity.

  8. Multimodal Biometrics Recognition by Dimensionality Diminution Method

    Directory of Open Access Journals (Sweden)

    Suvarnsing Bhable

    2015-12-01

    Full Text Available Multimodal biometric system utilizes two or more character modalities, e.g., face, ear, and fingerprint, Signature, plamprint to improve the recognition accuracy of conventional unimodal methods. We propose a new dimensionality reduction method called Dimension Diminish Projection (DDP in this paper. DDP can not only preserve local information by capturing the intra-modal geometry, but also extract between-class relevant structures for classification effectively. Experimental results show that our proposed method performs better than other algorithms including PCA, LDA and MFA.

  9. Multimodality Imaging of Heart Valve Disease

    Energy Technology Data Exchange (ETDEWEB)

    Rajani, Ronak, E-mail: Dr.R.Rajani@gmail.com [Department of Cardiology, St. Thomas’ Hospital, London (United Kingdom); Khattar, Rajdeep [Department of Cardiology, Royal Brompton Hospital, London (United Kingdom); Chiribiri, Amedeo [Divisions of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London (United Kingdom); Victor, Kelly; Chambers, John [Department of Cardiology, St. Thomas’ Hospital, London (United Kingdom)

    2014-09-15

    Unidentified heart valve disease is associated with a significant morbidity and mortality. It has therefore become important to accurately identify, assess and monitor patients with this condition in order that appropriate and timely intervention can occur. Although echocardiography has emerged as the predominant imaging modality for this purpose, recent advances in cardiac magnetic resonance and cardiac computed tomography indicate that they may have an important contribution to make. The current review describes the assessment of regurgitant and stenotic heart valves by multimodality imaging (echocardiography, cardiac computed tomography and cardiac magnetic resonance) and discusses their relative strengths and weaknesses.

  10. Multimodal neuromonitoring in pediatric cardiac anesthesia

    Directory of Open Access Journals (Sweden)

    Alexander J. C. Mittnacht

    2014-01-01

    Full Text Available Despite significant improvements in overall outcome, neurological injury remains a feared complication following pediatric congenital heart surgery (CHS. Only if adverse events are detected early enough, can effective actions be initiated preventing potentially serious injury. The multifactorial etiology of neurological injury in CHS patients makes it unlikely that one single monitoring modality will be effective in capturing all possible threats. Improving current and developing new technologies and combining them according to the concept of multimodal monitoring may allow for early detection and possible intervention with the goal to further improve neurological outcome in children undergoing CHS.

  11. Confocal microscopy via multimode fibers: fluorescence bandwidth

    Science.gov (United States)

    Loterie, Damien; Psaltis, Demetri; Moser, Christophe

    2016-03-01

    We recently described a method for confocal reflection imaging through fibers, as a way to increase contrast when imaging unstained biological specimens. Using a transmission matrix, focused spots can be created at the distal end of a fiber. The backscattered field coming back from the sample can be filtered using optical correlation to obtain spatial selectivity in the detection. In this proceedings article, we briefly review the working principle of this method, and we discuss how the scheme could be adapted to confocal fluorescence imaging. In particular, we show simulations of the achievable detection bandwidth when using step-index multimode fibers as imaging devices.

  12. Invariant measures on multimode quantum Gaussian states

    Science.gov (United States)

    Lupo, C.; Mancini, S.; De Pasquale, A.; Facchi, P.; Florio, G.; Pascazio, S.

    2012-12-01

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom—the symplectic eigenvalues—which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest for applications in quantum optics and quantum information.

  13. Invariant measures on multimode quantum Gaussian states

    CERN Document Server

    Lupo, C; De Pasquale, A; Facchi, P; Florio, G; Pascazio, S

    2012-01-01

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom -- the symplectic eigenvalues -- which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest or applications in quantum optics and quantum information.

  14. Invariant measures on multimode quantum Gaussian states

    Energy Technology Data Exchange (ETDEWEB)

    Lupo, C. [School of Science and Technology, Universita di Camerino, I-62032 Camerino (Italy); Mancini, S. [School of Science and Technology, Universita di Camerino, I-62032 Camerino (Italy); Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia (Italy); De Pasquale, A. [NEST, Scuola Normale Superiore and Istituto Nanoscienze-CNR, I-56126 Pisa (Italy); Facchi, P. [Dipartimento di Matematica and MECENAS, Universita di Bari, I-70125 Bari (Italy); Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Florio, G. [Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Museo Storico della Fisica e Centro Studi e Ricerche Enrico Fermi, Piazza del Viminale 1, I-00184 Roma (Italy); Dipartimento di Fisica and MECENAS, Universita di Bari, I-70126 Bari (Italy); Pascazio, S. [Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Dipartimento di Fisica and MECENAS, Universita di Bari, I-70126 Bari (Italy)

    2012-12-15

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom-the symplectic eigenvalues-which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest for applications in quantum optics and quantum information.

  15. Multimodality imaging for resuscitated sudden cardiac death.

    Science.gov (United States)

    Chen, Yingming Amy; Deva, Djeven; Kirpalani, Anish; Prabhudesai, Vikram; Marcuzzi, Danny W; Graham, John J; Verma, Subodh; Jimenez-Juan, Laura; Yan, Andrew T

    2015-01-01

    We present a case that elegantly illustrates the utility of two novel noninvasive imaging techniques, computed tomography (CT) coronary angiography and cardiac MRI, in the diagnosis and management of a 27-year-old man with exertion-induced cardiac arrest caused by an anomalous right coronary artery. CT coronary angiography with 3D reformatting delineated the interarterial course of an anomalous right coronary artery compressed between the aorta and pulmonary artery, whereas cardiac MRI showed a small myocardial infarction in the right coronary artery territory not detected on echocardiography. This case highlights the value of novel multimodality imaging techniques in the risk stratification and management of patients with resuscitated cardiac arrest.

  16. [The dispute and prospect of sedation and analgesia treatments in outpatient dental procedures].

    Science.gov (United States)

    Cong, Yu

    2015-12-01

    The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.

  17. Sterile water injection labour analgesia in a parturient with preeclampsia with thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Shivali Panwar

    2017-01-01

    Full Text Available Pregnancy induced hypertension is one of the most common causes of maternal morbidity and mortality. A G2L1A1 female with period of gestation 36 weeks presented in our hospital with early labour pains. She was a known case of pregnancy induced hypertension with thrombocytopenia and had been operated on the lumbar spine for Potts spine. She was administered intradermal sterile water injection labour analgesia every 3 hours. The labour was uneventful and patient had a normal vaginal delivery of a male baby. The postnatal course was uneventful and patient was satisfied with the labour analgesia.

  18. Age-dependency of analgesia elicited by intraoral sucrose in acute and persistent pain models.

    Science.gov (United States)

    Anseloni, Vanessa C Z; Weng, H-R; Terayama, R; Letizia, David; Davis, Barry J; Ren, Ke; Dubner, Ronald; Ennis, Matthew

    2002-05-01

    Treatment of pain in newborns is associated with problematic drug side effects. Previous studies demonstrate that an intraoral infusion of sucrose and other sweet components of mother's milk are effective in alleviating pain in infant rats and humans. These findings are of considerable significance, as sweet tastants are used in pain and stress management in a number of clinical procedures performed in human infants. The ability of sweet stimuli to induce analgesia is absent in adult rats, suggesting that this is a developmentally transient phenomenon. However, the age range over which intraoral sucrose is capable of producing analgesia is not known. We investigated the effects of intraoral sucrose (7.5%) on nocifensive withdrawal responses to thermal and mechanical stimuli in naive and inflamed rats at postnatal days (P) P0-21. In some rats, Complete Freund's adjuvant (CFA) was injected in a fore- or hindpaw to produce inflammation. In non-inflamed animals, for noxious thermal stimuli, sucrose-induced analgesia emerged at P3, peaked at P7-10, then progressively declined and was absent at P17. For mechanical forepaw stimuli, sucrose-induced analgesia emerged, and was maximal at approximately P10, then declined and was absent at P17. By contrast, maximal sucrose-induced analgesia for mechanical hindpaw stimuli was delayed (P13) compared to that for the forepaw, although it was also absent at P17. In inflamed animals, sucrose reduced hyperesthesia and hyperalgesia assessed with mechanical stimuli. Sucrose-induced analgesia in inflamed animals was initially present at P3 for the forepaw and P13 for the hindpaw, and was absent by P17 for both limbs. Intraoral sucrose produced significantly greater effects on responses in fore- and hindpaws in inflamed rats than in naive rats indicating that it reduces hyperalgesia and allodynia beyond its effects on responses in naive animals. These findings support the hypothesis that sucrose has a selective influence on analgesic

  19. Analgesia preemptiva em cirurgias de implantes dentários : estudo comparativo com dexametasona e cetorolaco

    OpenAIRE

    2014-01-01

    A analgesia preemptiva é um regime analgésico instituído previamente ao estímulo nocivo, com o objetivo de prevenir a hiperalgesia inflamatória e o subsequente estímulo que amplifica a dor no sistema nervoso central. Para aplicá-la na clínica cirúrgica odontológica, alguns fármacos com propriedades analgésicas e anti-inflamatórias têm sido avaliados, todavia com resultados ainda conflitantes. Por este motivo, propôs-se investigar, de forma comparativa, a analgesia preemptiva com dexametasona ...

  20. [Effect of met- and leu-enkephalins and their synthetic analog on stimulation and acupunture analgesia].

    Science.gov (United States)

    Ignatov, Iu D; Vasil'ev, Iu N; Kovalenko, V S; Titov, M I

    1981-08-01

    Experiments on unrestrained rats were carried out to study the effect of intraventricularly injected met- and leu-enkephalins and their synthetic analog Tyr-dAla-Cly-Phe-NH2 on analgesia induced by electrical stimulation of the central gray. It was shown that subanalgesic doses of enkephalins and their synthetic analog facilitated the appearance of analgesic action on subthreshold antinociceptive-brain stimulation and potentiated the analgesic effect of threshold central gray stimulation. Subanalgesic and low analgesic doses of the peptides increased antinociceptive effect of electroacupuncture. The data obtained are discussed from the standpoint of the implication of the peptidergic mechanisms in the realization of acupuncture and stimulation analgesia.

  1. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Giane Nakamura

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group. Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination

  2. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty.

    Science.gov (United States)

    Peters, Christopher L; Shirley, Brayton; Erickson, Jill

    2006-09-01

    This study evaluated the effect of a new multimodal perioperative anesthetic and pain management strategy for primary total hip (THA) and total knee arthroplasty (TKA). Two cohorts of 50 consecutive THA and 50 TKA patients from before and after initiation of the new protocol were compared. The protocol involved scheduled oral narcotics, cyclooxygenase-2 inhibitors, no intrathecal narcotics, femoral nerve catheters for TKAs, and local anesthetic wound infiltration. Use of patient-controlled analgesia was discouraged. Physical therapy was attempted on the day of surgery. The demographic data, surgical procedure, and implants were similar. There were statistically significant improvements after the protocol regarding rest-pain scores post-operative day (POD) 1 and 2, total narcotic consumption, distance walked POD 1 and 2, and length of stay. There were no significant differences in complications. Implementation of this new multimodal perioperative protocol combined with early mobilization for TKA and THA patients has shortened length of stay, improved pain control, and accomplished therapy goals sooner with less narcotic consumption.

  3. An Acetazolamide Based Multimodal Analgesic Approach Versus Conventional Pain Management in Patients Undergoing Laparoscopic Living Donor Nephrectomy

    Science.gov (United States)

    Singh, Rupinder; Sen, Indu; Wig, Jyotsna; Minz, M; Sharma, Ashish; Bala, Indu

    2009-01-01

    Summary Choice of an appropriate anaesthetic technique and adequate pain relief during laparoscopic living donor nephrectomy (LDN) is likely to make the procedure more appealing to kidney donors. Various analgesic regimens proposed to relieve pain after laparoscopic surgery include: opioids, non-opioid analgesics followed by opioids for the breakthrough pain and intra-peritoneal normal saline irrigation and instillation of local anaesthetics at surgical sites. Thorough literature review and medline search did not reveal any study where a combination of orogastric acetazolamide along with intraperitoneal saline irrigation and bupivacaine instillation techniques have been tried in these patients. In a prospective, double blind, randomized trial, eighty healthy adults undergoing LDN under general anaesthesia were enrolled to compare the efficacy of an acetazolamide based multimodal analgesic approach (Group A) with conventional pain management (Group B). Donors' demographics, intra-operative variables, early allograft function and recovery characteristics were evaluated for 72 hours. The primary end points were postoperative pain intensity on a visual analog scale and the incidence of shoulder tip pain (STP). The secondary end points included the latency of the rescue analgesia request rate, total analgesic consumption and patient satisfaction. Consistently lower mean pain scores were observed in Group A (p<0.03 for visceral pain). Frequency as well as the total dose of rescue analgesics administered was significantly less in Group A (p=0.001). Twelve patients (30.7%) in Group B complained of STP compared to three (7.5%) in Group A (p=0.025). Shoulder pain also presented earlier (8 hours versus 12 hours) and persisted for longer period in Group B (72 hours versus 48 hours, p 0.025). To conclude, a multimodal analgesic approach consisting a combination of orogastric acetazolamide, intraperito-neal saline irrigation and use of bupivacaine in the operated renal fossa

  4. Postoperative analgesia for cleft lip and palate repair in children

    Directory of Open Access Journals (Sweden)

    Reena

    2016-01-01

    Full Text Available Acute pain such as postoperative pain during infancy was ignored approximately three decades ago due to biases and misconceptions regarding the maturity of the infant′s developing nervous system, their inability to verbally report pain, and their perceived inability to remember pain. More recently, these misconceptions are rarely acknowledged due to enhanced understanding of the developmental neurobiology of infant pain pathways and supraspinal processing. Cleft lip and palate is one of the most common congenital abnormalities requiring surgical treatment in children and is associated with intense postoperative pain. The pain management gets further complicated due to association with postsurgical difficult airway and other congenital anomalies. Orofacial blocks like infraorbital, external nasal, greater/lesser palatine, and nasopalatine nerve blocks have been successively used either alone or in combinations to reduce the postoperative pain. Since in pediatric population, regional anesthesia is essentially performed under general anesthesia, association of these two techniques has dramatically cut down the risks of both procedures particularly those associated with the use of opioids and nonsteroidal anti-inflammatory drugs. Definitive guidelines for postoperative pain management in these patients have not yet been developed. Incorporation of multimodal approach as an institutional protocol can help minimize the confusion around this topic.

  5. Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

    Directory of Open Access Journals (Sweden)

    Marilda Onghero Taffarel

    2009-12-01

    Full Text Available A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se com este trabalho fazer uma breve revisão sobre as aplicações clínicas e os efeitos fisiológicos da acupuntura nos mecanismos da dor, bem como demonstrar os principais pontos de acupuntura utilizados para analgesia em animais. A pesquisa foi realizada em bases de dados eletrônicas por palavra-chave, durante o período de março a dezembro de 2008.Pain is a protective response of the body to harmful stimulus, which results in undesirable effects if not controlled. Analgesia can be achieved with the use of different types of drugs. However, these drugs can cause adverse effects according to species and patient physical condition. Acupuncture has been proved to be an effective analgesic adjuvant, by the capacity to decrease the amount of drug used for pain control, rarely contra-indicated. The aim of this paper was to review the physiological effects of acupuncture on pain mechanisms, and demonstrate the main acupoints used for animal analgesia. The search was done in electronic search database using key words, in 2008.

  6. Multimodal Network Equilibrium with Stochastic Travel Times

    Directory of Open Access Journals (Sweden)

    M. Meng

    2014-01-01

    Full Text Available The private car, unlike public traffic modes (e.g., subway, trolley running along dedicated track-ways, is invariably subject to various uncertainties resulting in travel time variation. A multimodal network equilibrium model is formulated that explicitly considers stochastic link capacity variability in the road network. The travel time of combined-mode trips is accumulated based on the concept of the mean excess travel time (METT which is a summation of estimated buffer time and tardy time. The problem is characterized by an equivalent VI (variational inequality formulation where the mode choice is expressed in a hierarchical logit structure. Specifically, the supernetwork theory and expansion technique are used herein to represent the multimodal transportation network, which completely represents the combined-mode trips as constituting multiple modes within a trip. The method of successive weighted average is adopted for problem solutions. The model and solution method are further applied to study the trip distribution and METT variations caused by the different levels of the road conditions. Results of numerical examples show that travelers prefer to choose the combined travel mode as road capacity decreases. Travelers with different attitudes towards risk are shown to exhibit significant differences when making travel choice decisions.

  7. A multimodal behavioral approach to performance anxiety.

    Science.gov (United States)

    Lazarus, Arnold A; Abramovitz, Arnold

    2004-08-01

    Cognitive-behavior therapy (CBT) stresses a trimodal assessment framework (affect, behavior, and cognition [ABC]), whereas the multimodal approach assesses seven discrete but interactive components--behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biological factors (BASIC I.D.). Only complex or recalcitrant cases call for the entire seven-pronged range of multimodal interventions. Various case illustrations are offered as examples of how a clinician might proceed when confronted with problems that fall under the general heading of performance anxiety. The main example is of a violinist in a symphony orchestra whose career was in serious jeopardy because of his extreme fear of performing in public. He responded very well to a focused but elaborate desensitization procedure. The hierarchy that was eventually constructed contained many dimensions and subhierarchies featuring interlocking elements that evoked his anxiety. In addition to imaginal systematic desensitization, sessions were devoted to his actual performance in the clinical setting. As a homework assignment, he found it helpful to listen to a long-playing record of an actual rehearsal and to play along with the world-renowned orchestra and conductor. The subsequent disclosure by the client of an important sexual problem was dealt with concomitantly by using a fairly conventional counseling procedure. Therapy required 20 sessions over a 3-month period.

  8. ANALYSING SPACE: ADAPTING AND EXTENDING MULTIMODAL SEMIOTICS

    Directory of Open Access Journals (Sweden)

    Louise J. Ravelli

    2015-07-01

    Full Text Available In the field of multimodal discourse analysis, one of the most exciting sites of application is that of 3D space: examining aspects of built environment for its meaningmaking potential. For the built environment – homes, offices, public buildings, parks, etc. – does indeed make meaning. These are spaces which speak – often their meanings are so familiar, we no longer hear what they say; sometimes, new and unusual sites draw attention to their meanings, and they are hotly contested. This chapter will suggest ways of analyzing 3D texts, based on the framework of Kress and van Leeuwen (2006. This framework, developed primarily for the analysis of 2D images, has been successfully extended to a range of other multimodal texts. Extension to the built environment includes Pang (2004, O’Toole (1994, Ravelli (2006, Safeyton (2004, Stenglin (2004 and White (1994, whose studies will inform the analyses presented here. This article will identify some of the key theoretical principles which underline this approach, including the notions of text, context and metafunction, and will describe some of the main areas of analysis for 3D texts. Also, ways of bringing the analyses together will be considered. The analyses will be demonstrated in relation to the Scientia building at the University of New South Wales, Australia.

  9. Multimodal brain monitoring in fulminant hepatic failure.

    Science.gov (United States)

    Paschoal, Fernando Mendes; Nogueira, Ricardo Carvalho; Ronconi, Karla De Almeida Lins; de Lima Oliveira, Marcelo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2016-08-01

    Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

  10. Photonic lantern with multimode fibers embedded

    Science.gov (United States)

    Yu, Hai-Jiao; Yan, Qi; Huang, Zong-Jun; Tian, He; Jiang, Yu; Liu, Yong-Jun; Zhang, Jian-Zhong; Sun, Wei-Min

    2014-08-01

    A photonic lantern is studied which is formed by seven multimode fibers inserted into a pure silica capillary tube. The core of the tapered end has a uniform refractive index because the polymer claddings are removed before the fibers are inserted. Consequently, the light distribution is also uniform. Two theories describing a slowly varying waveguide and multimode coupling are used to analyze the photonic lantern. The transmission loss decreases as the length of the tapered part increases. For a device with a taper length of 3.4 cm, the loss is about 1.06 dB on average for light propagating through the taper from an inserted fiber to the tapered end and 0.99 dB in the reverse direction. For a device with a taper length of 0.7 cm, the two loss values are 2.63 dB and 2.53 dB, respectively. The results show that it is possible to achieve a uniform light distribution with the tapered end and a low-loss transmission in the device if parameters related to the lantern are reasonably defined.

  11. Multimodal Imaging in Hereditary Retinal Diseases

    Directory of Open Access Journals (Sweden)

    Francesco Pichi

    2013-01-01

    Full Text Available Introduction. In this retrospective study we evaluated the multimodal visualization of retinal genetic diseases to better understand their natural course. Material and Methods. We reviewed the charts of 70 consecutive patients with different genetic retinal pathologies who had previously undergone multimodal imaging analyses. Genomic DNA was extracted from peripheral blood and genotyped at the known locus for the different diseases. Results. The medical records of 3 families of a 4-generation pedigree affected by North Carolina macular dystrophy were reviewed. A total of 8 patients with Stargardt disease were evaluated for their two main defining clinical characteristics, yellow subretinal flecks and central atrophy. Nine male patients with a previous diagnosis of choroideremia and eleven female carriers were evaluated. Fourteen patients with Best vitelliform macular dystrophy and 6 family members with autosomal recessive bestrophinopathy were included. Seven patients with enhanced s-cone syndrome were ascertained. Lastly, we included 3 unrelated patients with fundus albipunctatus. Conclusions. In hereditary retinal diseases, clinical examination is often not sufficient for evaluating the patient’s condition. Retinal imaging then becomes important in making the diagnosis, in monitoring the progression of disease, and as a surrogate outcome measure of the efficacy of an intervention.

  12. Fiber Optic Pressure Sensor using Multimode Interference

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz-Perez, V I; Sanchez-Mondragon, J J [INAOE, Apartado Postal 51 y 216, Puebla 72000 (Mexico); Basurto-Pensado, M A [CIICAp, Universidad Autonoma del Estado de Morelos (Mexico); LiKamWa, P [CREOL, University of Central Florida, Orlando, FL 32816 (United States); May-Arrioja, D A, E-mail: iruiz@inaoep.mx, E-mail: mbasurto@uaem.mx, E-mail: delta_dirac@hotmail.com, E-mail: daniel_may_arrioja@hotmail.com [UAT Reynosa Rodhe, Universidad Autonoma de Tamaulipas (Mexico)

    2011-01-01

    Based on the theory of multimode interference (MMI) and self-image formation, we developed a novel intrinsic optical fiber pressure sensor. The sensing element consists of a section of multimode fiber (MMF) without cladding spliced between two single mode fibers (SMF). The MMI pressure sensor is based on the intensity changes that occur in the transmitted light when the effective refractive index of the MMF is changed. Basically, a thick layer of Polydimethylsiloxane (PDMS) is placed in direct contact with the MMF section, such that the contact area between the PDMS and the fiber will change proportionally with the applied pressure, which results in a variation of the transmitted light intensity. Using this configuration, a good correlation between the measured intensity variations and the applied pressure is obtained. The sensitivity of the sensor is 3 {mu}V/psi, for a range of 0-60 psi, and the maximum resolution of our system is 0.25 psi. Good repeatability is also observed with a standard deviation of 0.0019. The key feature of the proposed pressure sensor is its low fabrication cost, since the cost of the MMF is minimal.

  13. Multimodal brain monitoring in fulminant hepatic failure

    Institute of Scientific and Technical Information of China (English)

    Fernando; Mendes; Paschoal; Jr; Ricardo; Carvalho; Nogueira; Karla; De; Almeida; Lins; Ronconi; Marcelo; de; Lima; Oliveira; Manoel; Jacobsen; Teixeira; Edson; Bor-Seng-Shu

    2016-01-01

    Acute liver failure, also known as fulminant hepatic failure(FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

  14. Multimodal pain management after arthroscopic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten

    Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthrosco...... after knee and ankle arthroscopy with the use of oral NSAIDs combined with bupivacaine plus morphine or combined with bupivacaine, morphine plus steroid....... ankle arthroscopy. Oral NSAID reduced time to work from 17 to 14 days after knee arthroscopy. Intra-articular treatment with bupivacaine plus morphine and bupivacaine plus morphine plus steroid after arthroscopic knee meniscectomy reduced time to work from 10 to 5 to 3 days. Intraarticular treatment...... with bupivacaine plus morphine and bupivacaine plus morphine plus steroid after diagnostic knee arthroscopy reduced time to work from 10 to 5 to 2 days. Additional analysis revealed that the surgical trauma and the use of tourniquet influenced recovery. The thesis proves a reduction in the time to return to work...

  15. Elaboración de una herramienta para la vigilancia de indicadores de calidad de la docencia en la formación especializada de Medicina Preventiva y Salud Pública

    Directory of Open Access Journals (Sweden)

    Christian Carlo Gil-Borrelli

    2015-09-01

    Full Text Available En este trabajo se describe el proceso de creación de una herramienta para evaluar la satisfacción con la calidad de la docencia recibida en las rotaciones de la especialidad de Medicina Preventiva y Salud Pública. Para ello se adaptó la Encuesta de Satisfacción de la Formación Especializada por parte de un panel de expertos formado por 23 residentes de nueve comunidades autónomas, que valoraron y adaptaron la encuesta a las rotaciones de la especialidad mediante una escala de Likert de 5 puntos y la inclusión de nuevas dimensiones e ítems. Las dimensiones mejor valoradas fueron la planificación y la consecución de objetivos específicos, la supervisión, la delegación de responsabilidades, los recursos y el ambiente laboral del dispositivo, la valoración personal, el estímulo, el apoyo recibido y la productividad de la rotación. El desarrollo y la utilización de esta herramienta permitirán la elección informada del itinerario formativo de los residentes de Medicina Preventiva y Salud Pública.

  16. Performance Evaluation of Multimodal Multifeature Authentication System Using KNN Classification

    Directory of Open Access Journals (Sweden)

    Gayathri Rajagopal

    2015-01-01

    Full Text Available This research proposes a multimodal multifeature biometric system for human recognition using two traits, that is, palmprint and iris. The purpose of this research is to analyse integration of multimodal and multifeature biometric system using feature level fusion to achieve better performance. The main aim of the proposed system is to increase the recognition accuracy using feature level fusion. The features at the feature level fusion are raw biometric data which contains rich information when compared to decision and matching score level fusion. Hence information fused at the feature level is expected to obtain improved recognition accuracy. However, information fused at feature level has the problem of curse in dimensionality; here PCA (principal component analysis is used to diminish the dimensionality of the feature sets as they are high dimensional. The proposed multimodal results were compared with other multimodal and monomodal approaches. Out of these comparisons, the multimodal multifeature palmprint iris fusion offers significant improvements in the accuracy of the suggested multimodal biometric system. The proposed algorithm is tested using created virtual multimodal database using UPOL iris database and PolyU palmprint database.

  17. Multimodal Task-Driven Dictionary Learning for Image Classification.

    Science.gov (United States)

    Bahrampour, Soheil; Nasrabadi, Nasser M; Ray, Asok; Jenkins, William Kenneth

    2016-01-01

    Dictionary learning algorithms have been successfully used for both reconstructive and discriminative tasks, where an input signal is represented with a sparse linear combination of dictionary atoms. While these methods are mostly developed for single-modality scenarios, recent studies have demonstrated the advantages of feature-level fusion based on the joint sparse representation of the multimodal inputs. In this paper, we propose a multimodal task-driven dictionary learning algorithm under the joint sparsity constraint (prior) to enforce collaborations among multiple homogeneous/heterogeneous sources of information. In this task-driven formulation, the multimodal dictionaries are learned simultaneously with their corresponding classifiers. The resulting multimodal dictionaries can generate discriminative latent features (sparse codes) from the data that are optimized for a given task such as binary or multiclass classification. Moreover, we present an extension of the proposed formulation using a mixed joint and independent sparsity prior, which facilitates more flexible fusion of the modalities at feature level. The efficacy of the proposed algorithms for multimodal classification is illustrated on four different applications--multimodal face recognition, multi-view face recognition, multi-view action recognition, and multimodal biometric recognition. It is also shown that, compared with the counterpart reconstructive-based dictionary learning algorithms, the task-driven formulations are more computationally efficient in the sense that they can be equipped with more compact dictionaries and still achieve superior performance.

  18. Performance evaluation of similarity measures for dense multimodal stereovision

    Science.gov (United States)

    Yaman, Mustafa; Kalkan, Sinan

    2016-05-01

    Multimodal imaging systems have recently been drawing attention in fields such as medical imaging, remote sensing, and video surveillance systems. In such systems, estimating depth has become possible due to the promising progress of multimodal matching techniques. We perform a systematic performance evaluation of similarity measures frequently used in the literature for dense multimodal stereovision. The evaluated measures include mutual information (MI), sum of squared distances, normalized cross-correlation, census transform, local self-similarity (LSS) as well as descriptors adopted to multimodal settings, like scale invariant feature transform (SIFT), speeded-up robust features (SURF), histogram of oriented gradients (HOG), binary robust independent elementary features, and fast retina keypoint (FREAK). We evaluate the measures over datasets we generated, compiled, and provided as a benchmark and compare the performances using the Winner Takes All method. The datasets are (1) synthetically modified four popular pairs from the Middlebury Stereo Dataset (namely, Tsukuba, Venus, Cones, and Teddy) and (2) our own multimodal image pairs acquired using the infrared and the electro-optical cameras of a Kinect device. The results show that MI and HOG provide promising results for multimodal imagery, and FREAK, SURF, SIFT, and LSS can be considered as alternatives depending on the multimodality level and the computational complexity requirements of the intended application.

  19. Towards an intelligent framework for multimodal affective data analysis.

    Science.gov (United States)

    Poria, Soujanya; Cambria, Erik; Hussain, Amir; Huang, Guang-Bin

    2015-03-01

    An increasingly large amount of multimodal content is posted on social media websites such as YouTube and Facebook everyday. In order to cope with the growth of such so much multimodal data, there is an urgent need to develop an intelligent multi-modal analysis framework that can effectively extract information from multiple modalities. In this paper, we propose a novel multimodal information extraction agent, which infers and aggregates the semantic and affective information associated with user-generated multimodal data in contexts such as e-learning, e-health, automatic video content tagging and human-computer interaction. In particular, the developed intelligent agent adopts an ensemble feature extraction approach by exploiting the joint use of tri-modal (text, audio and video) features to enhance the multimodal information extraction process. In preliminary experiments using the eNTERFACE dataset, our proposed multi-modal system is shown to achieve an accuracy of 87.95%, outperforming the best state-of-the-art system by more than 10%, or in relative terms, a 56% reduction in error rate.

  20. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were ra...

  1. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne;

    2005-01-01

    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the e...

  2. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model

    DEFF Research Database (Denmark)

    Ravn, Pernille; Secher, EL; Skram, U

    2013-01-01

    Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than μ-opioid receptor agonists. The primary outcome of this study was therefore to...

  3. Effect of preemptive analgesia with parecoxib sodium on the postoperative pain for gynecological laparoscopy

    Institute of Scientific and Technical Information of China (English)

    Yu-Jing Zhou

    2015-01-01

    Objective:To observe the effect of preemptive analgesia with parecoxib sodium on the postoperative pain and complications for patients undergoing gynecological laparoscopy. Methods:A total of 100 patients with ASA I-II grade who were admitted in our hospital from January, 2013 to February, 2014 and were undergoing gynecological laparoscopy were included in the study and randomized into the observation group and the control group. The patients in the observation group were given parecoxib sodium injection (40 mg) 30 min before operation and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery, while the patients in the control group were givens injections of parecoxib sodium injection (40 mg) and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery. The analgesia and sedation effects 4, 8, 12 h after the operation in the two groups were observed, and the postoperative additional fentanyl dosage and the adverse reactions were recorded.Results: The postoperative VAS score in each timing point and the total dosage of fentanyl in the observation group were significantly lower than those in the control group (P0.05).Conclusions: The preemptive analgesia with parecoxib sodium can reduce the dosage of postoperative analgesia medications with an accurate analgesic effect; therefore, it deserves to be widely recommended in the clinic.

  4. Regional analgesia for video-assisted thoracic surgery – a systematic review

    DEFF Research Database (Denmark)

    Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik;

    2013-01-01

    there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded...

  5. Opioid-Induced Glial Activation: Mechanisms of Activation and Implications for Opioid Analgesia, Dependence, and Reward

    Directory of Open Access Journals (Sweden)

    Mark R. Hutchinson

    2007-01-01

    Full Text Available This review will introduce the concept of toll-like receptor (TLR–mediated glial activation as central to all of the following: neuropathic pain, compromised acute opioid analgesia, and unwanted opioid side effects (tolerance, dependence, and reward. Attenuation of glial activation has previously been demonstrated both to alleviate exaggerated pain states induced by experimental pain models and to reduce the development of opioid tolerance. Here we demonstrate that selective acute antagonism of TLR4 results in reversal of neuropathic pain as well as potentiation of opioid analgesia. Attenuating central nervous system glial activation was also found to reduce the development of opioid dependence, and opioid reward at a behavioral (conditioned place preference and neurochemical (nucleus accumbens microdialysis of morphine-induced elevations in dopamine level of analysis. Moreover, a novel antagonism of TLR4 by (+- and (˗-isomer opioid antagonists has now been characterized, and both antiallodynic and morphine analgesia potentiating activity shown. Opioid agonists were found to also possess TLR4 agonistic activity, predictive of glial activation. Targeting glial activation is a novel and as yet clinically unexploited method for treatment of neuropathic pain. Moreover, these data indicate that attenuation of glial activation, by general or selective TLR antagonistic mechanisms, may also be a clinical method for separating the beneficial (analgesia and unwanted (tolerance, dependence, and reward actions of opioids, thereby improving the safety and efficacy of their use.

  6. PKC-mediated potentiation of morphine analgesia by St. John's Wort in rodents and humans.

    Science.gov (United States)

    Galeotti, Nicoletta; Farzad, Mersedeh; Bianchi, Enrica; Ghelardini, Carla

    2014-01-01

    Our purpose was to combine the use of morphine with clinically available inhibitors of protein kinase C (PKC), finally potentiating morphine analgesia in humans. Thermal tests were performed in rodents and humans previously administered with acute or chronic morphine combined or not with increasing doses of the PKC-blocker St. John's Wort (SJW) or its main component hypericin. Phosphorylation of the γ subunit of PKC enzyme was assayed by western blotting in the periaqueductal grey matter (PAG) from rodents co-administered with morphine and hypericin and was prevented in rodent PAG by SJW or hypericin co-administration with morphine, inducing a potentiation of morphine analgesia in thermal pain. The score of pain assessment in healthy volunteers were decreased by 40% when morphine was co-administered with SJW at a dose largely below those used to obtain an antidepressant or analgesic effect in both rodents and humans. The SJW/hypericin potentiating effect lasted in time and preserved morphine analgesia in tolerant mice. Our findings indicate that, in clinical practice, SJW could reduce the dose of morphine obtaining the same analgesic effect. Therefore, SJW and one of its main components, hypericin, appear ideal to potentiate morphine-induced analgesia.

  7. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study

    Directory of Open Access Journals (Sweden)

    Hossam A. ELShamaa

    2014-04-01

    Conclusion: The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

  8. THE PHARMACOLOGY RESEARCH OF THENORPHINE,A NEW DRUG OF ANALGESIA AND DETOXIFICATION

    Institute of Scientific and Technical Information of China (English)

    GongZe-Hui; YueYong-Juan; CuiMeng-Xun; QinBo-Yi

    2004-01-01

    Thenorphine is a new parrtail agonist of opioid recepter synthesized by our institute of pharmacology and toxicology.There are double effects of agonist and antegonist on opioid recepter. The agonist effect was showed by analgesia. The analgesic properties are stronger efficacy (ED50 1 mg/kg po) ; longer duration (t1/2 9h) and lower dependence (no physiological

  9. Opioid therapy : a trade-off between opioid-analgesia and opioid-induced respiratory depression

    NARCIS (Netherlands)

    Boom, Maria Catharina Anna

    2013-01-01

    Conclusions that may be drawn from the data in this thesis: 1. The ideal drug for antagonism of respiratory depression has not yet been found. At present naloxone seems the most appropriate drug although reversal of respiratory depression coincides with loss of analgesia. New reversal agents acting

  10. Central administration of neuropeptide FF and related peptides attenuate systemic morphine analgesia in mice.

    Science.gov (United States)

    Fang, Quan; Jiang, Tian-nan; Li, Ning; Han, Zheng-lan; Wang, Rui

    2011-04-01

    Neuropeptide FF (NPFF) belongs to an opioid-modulating peptide family. NPFF has been reported to play important roles in the control of pain and analgesia through interactions with the opioid system. However, very few studies examined the effect of supraspinal NPFF system on analgesia induced by opiates administered at the peripheral level. In the present study, intracerebroventricular (i.c.v.) injection of NPFF (1, 3 and 10 nmol) dose-dependently inhibited systemic morphine (0.12 mg, i.p.) analgesia in the mouse tail flick test. Similarly, i.c.v. administration of dNPA and NPVF, two agonists highly selective for NPFF(2) and NPFF(1) receptors, respectively, decreased analgesia induced by i.p. morphine in mice. Furthermore, these anti-opioid activities of NPFF and related peptides were blocked by pretreatment with the NPFF receptors selective antagonist RF9 (10 nmol, i.c.v.). These results demonstrate that activation of central NPFF(1) and NPFF(2) receptors has the similar anti-opioid actions on the antinociceptive effect of systemic morphine.

  11. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  12. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  13. [Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome].

    Science.gov (United States)

    Errando, C L; Sifre, C; López-Alarcón, D

    1998-12-01

    Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

  14. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.; Bakker, S.; Heesterbeek, P.; Van Den Bemt, B.; Scheffer, G.J.; Touw, D.; Stienstra, R.

    2016-01-01

    Background and Aims: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unb

  15. Postoperative analgesia for Enhanced recovery in Joint replacement: Audit of a new electronic prescribing order set.

    Science.gov (United States)

    Wright, Jonathan; Cullinger, Benjamin; Bacarese-Hamilton, Ian

    2015-01-01

    Enhanced recovery in joint replacement has been shown to reduce length of inpatient stay, reduce re-admission rates, and can improve early functional recovery. Postoperative analgesia is an important component of the group of interventions required to form a holistic enhanced recovery protocol. The introduction of electronic prescribing provides the opportunity to introduce some standardisation, where clinically appropriate, in the prescription of an evidence based postoperative analgesia protocol. Enhanced recovery following joint replacement has been used at this institution since 2011. An order set for the postoperative analgesia protocol was introduced to the in house electronic prescribing system in August 2014 (JAC Medicines Management; JAC Computer Services Ltd., Basildon, UK). An audit was performed to follow the effect of the new system on compliance with the postoperative analgesia guidelines. Improvements were seen following introduction of the electronic prescribing protocol in all criteria of the guideline with a demonstrated improvement in overall compliance from 0% to 35% in the first loop, with subsequent audit showing further improvement to 59% compliance. Use of an embedded order set within an electronic prescribing system has demonstrated improved compliance with an enhanced recovery protocol. This ensures that the correct evidence based protocol is available to guide the junior clinician at the point of care, when the medication is being prescribed.

  16. Effect of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on maternal lactation

    Institute of Scientific and Technical Information of China (English)

    Hu Feng; Bao-Xia Chen; Xi Ren; Hong-Xia Zhu

    2016-01-01

    Objective:To observe the effect of application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on the lactation and neonates.Methods:The puerpera who were underwent cesarean section with different analgesia methods were observed. The included puerpera were performed with the cesarean section under combined spinal epidural anesthesia. A total of 30 puerpera who were given ropivacaine in combined with sufentanil epidural analgesia after operation were served as the observation group, while 30 cases who were intermittently given intramuscular injection of pethidine after operation were served as the control group. The postpartum analgesic effects in the two groups were observed. The radioimmunoassay was used to detect the plasma PRL level. The postpartum colostrum time, 24 h lactation number, and NBNA scores in the two groups were compared.Results:The postoperative VAS score in the observation group was significantly lower than that in the control group (P<0.05), while the plasma PRL level was significantly higher than that in the control group (P<0.05). The postoperative colostrum time in the observation group was significantly earlier than that in the control group (P<0.05), while the lactation number was significantly greater than that in the control group (P<0.05).Conclusions:Application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section can effectively alleviate the postoperative pain, and improve the lactation, with no obvious adverse reactions on the neonates and reliable effects.

  17. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

    Directory of Open Access Journals (Sweden)

    Neha Baduni

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM, and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

  18. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  19. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

  20. Enfermeiros com cargos de chefia e medidas preventivas à exposição ocupacional: facilidades e barreiras Enfermeros con cargos de jefe y medidas preventivas a la exposición ocupacional: facilidades y barreras Nurses in leading positions and measures to prevent occupational exposure: facilities and barriers

    Directory of Open Access Journals (Sweden)

    Silmara Elaine Malaguti

    2008-09-01

    Full Text Available Este estudo descritivo teve como objetivo avaliar as facilidades e barreiras enfrentadas por enfermeiros com cargo de chefia quanto às medidas preventivas à exposição ocupacional envolvendo material biológico, tendo como base o Modelo de Crenças em Saúde de Rosenstock. O estudo foi realizado com 87 enfermeiros de um hospital-escola do interior paulista em 2006. Os dados foram coletados através de um roteiro semi-estruturado, com questões abertas e fechadas e analisados pela técnica de Análise de Conteúdo. O equipamento de proteção individual foi citado como a maior facilidade para a prevenção de acidentes, porém a falta de adesão ao uso e o uso incorreto foram referidos como barreiras para a prevenção de acidentes e como os principais motivos para a ocorrência destes. É importante que estes enfermeiros estejam preparados para desenvolver estratégias individualizadas e motivadoras para adesão ao uso do equipamento de proteção individual em seus setores de trabalho.En este estudio descriptivo se tuvo como objetivo evaluar las facilidades y barreras enfrentadas por enfermeros con cargo de jefe en cuanto a las medidas preventivas a la exposición ocupacional que involucre material biológico, teniendo como base el Modelo de Creencias en Salud de Rosenstock. El estudio fue realizado con 87 enfermeros de un hospital escuela del interior de Sao Paulo, en el 2006. Los datos fueron recolectados a través de una guía de entrevista semi-estructurada, con preguntas abiertas y cerradas y analizados con la técnica del Análisis de Contenido. El equipamiento de protección individual fue citado como la mayor facilidad para la prevención de accidentes, no obstante la falta de adhesión al uso y uso incorrecto fueron referidos como barreras para la prevención de accidentes y como los principales motivos para que éstos ocurran. Es importante que estos enfermeros estén preparados para desarrollar estrategias individualizadas y

  1. A COMPARATIVE STUDY BETWEEN INTRATHECAL MORPHINE AND INTRATHECAL BUPRENORPHINE FOR POST - OPERATIVE ANALGESIA FOLLOWING CAESARIAN SECTION UNDER SUB ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Anish M

    2015-05-01

    Full Text Available BACKGROUND: Good pain relief following caesarian section is of great importance and intrathecal opioids provide good quality postoperative analgesia for longer duration. So the following study describes a comparative study between intrathecal morphine and intrathecal buprenorphine for postoperative pain relief following caesarian section (CS under subarachnoid blockade. AIMS: The study was conducted to compare intrathecal morphine and buprenorphine for post of analgesia following CS, to achieve analgesia without seda tion for better maternal child bondage and to popularize intrathecal opioids . MATERIALS AND METHODS: 60 patients posted for CS under SAB were randomly allocated into group A and group B of 30 each, the group A received morphine 0.1 mg and buprenorphine 0 . 0 3 mg was given for group B patients along with the local anaesthetic. Subjective assessment of post - operative analgesia was done by direct questioning of the patient and by a five point pain scores. Duration of analgesia was taken as the time interval betw een the time of injection of intrathecal opiate and the time at which the patient felt pain and requested for additional analgesics. Data’s were analyzed using SPSS 16th version. OBSERVATION AND RESU LTS: The mean duration of post - operative analgesia with i ntrathecal morphine was 24.19+4 . 8 hours and that with buprenorphine was only 11.7+3.28 hours. Over weight patients reported a lower mean duration of analgesia. None of the patients in the study showed any bradycardia, hypotension, desaturation or respirato ry depression. Intrathecal opiates decreased the parenteral opiate requirements. The main side effects noticed were nausea in about 43% of patients in morphine group and 33% of patients in buprenorphine group. CONCLUSIONS: Intrathecal morphine 0 . 1 mg gives good post - operative analgesia of longer duration than buprenorphine 0 . 03mg. The quality of analgesia provided by intrathecal morphine was superior to

  2. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study

    Science.gov (United States)

    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  3. The critical role of spinal 5-HT7 receptors in opioid and non-opioid type stress-induced analgesia.

    Science.gov (United States)

    Yesilyurt, Ozgur; Seyrek, Melik; Tasdemir, Serdar; Kahraman, Serdar; Deveci, Mehmet Salih; Karakus, Emre; Halici, Zekai; Dogrul, Ahmet

    2015-09-05

    The opioid and non-opioid types of stress-induced analgesia have been well defined. One of the non-opioid type involve the endocannabinoid system. We previously reported that the spinal serotonin 7 receptor (5-HT7) blockers inhibit both morphine and cannabinoid-induced analgesia, thus we hypothesized that descending serotonergic pathways-spinal 5-HT7 receptor loop might contribute to stress-induced analgesia. Stress-induced analgesia was induced with warm (32°C) or cold (20°C) water swim stress in male Balb-C mice. The effects of intrathecal injection of a selective 5-HT7 receptor antagonist, SB 269970, of the denervation of serotonergic neurons by intrathecal administration of 5,7-dihydroxytryptamine (5,7-DHT) and of lesions of the dorsolateral funiculus on opioid and non-opioid type stress-induced analgesia were evaluated with the tail-flick and hot plate tests. The expression of 5-HT7 receptors mRNA in the dorsal lumbar region of spinal cord were analyzed by RT-PCR following spinal serotonin depletion or dorsolateral funiculus lesion. The effects of the selective 5-HT7 receptor agonists LP 44 and AS 19 were tested on nociception. Intrathecal SB 269970 blocked both opioid and non-opioid type stress-induced analgesia. Dorsolateral funiculus lesion or denervation of the spinal serotonergic neurons resulted in a marked decrease in 5-HT7 receptor expression in the dorsal lumbar spinal cord, accompanied by inhibition of opioid and non-opioid type stress-induced analgesia. However, the systemic or intrathecal LP 44 and AS 19 alone did not produce analgesia in unstressed mice. These results indicate that descending serotonergic pathways and the spinal 5-HT7 receptor loop play a crucial role in mediating both opioid and non-opioid type stress-induced analgesia.

  4. Multi-modality molecular imaging for gastric cancer research

    Science.gov (United States)

    Liang, Jimin; Chen, Xueli; Liu, Junting; Hu, Hao; Qu, Xiaochao; Wang, Fu; Nie, Yongzhan

    2011-12-01

    Because of the ability of integrating the strengths of different modalities and providing fully integrated information, multi-modality molecular imaging techniques provide an excellent solution to detecting and diagnosing earlier cancer, which remains difficult to achieve by using the existing techniques. In this paper, we present an overview of our research efforts on the development of the optical imaging-centric multi-modality molecular imaging platform, including the development of the imaging system, reconstruction algorithms and preclinical biomedical applications. Primary biomedical results show that the developed optical imaging-centric multi-modality molecular imaging platform may provide great potential in the preclinical biomedical applications and future clinical translation.

  5. Aberrations of the point spread function of a multimode fiber

    CERN Document Server

    Descloux, Adrien; Pinkse, Pepijn W H

    2016-01-01

    We investigate the point spread function of a multimode fiber. The distortion of the focal spot created on the fiber output facet is studied for a variety of the parameters. We develop a theoretical model of wavefront shaping through a multimode fiber and use it to confirm our experimental results and analyze the nature of the focal distortions. We show that aberration-free imaging with a large field of view can be achieved by using an appropriate number of segments on the spatial light modulator during the wavefront-shaping procedure. The results describe aberration limits for imaging with multimode fibers as in, e.g., microendoscopy.

  6. In vivo multimodal nonlinear optical imaging of mucosal tissue

    Science.gov (United States)

    Sun, Ju; Shilagard, Tuya; Bell, Brent; Motamedi, Massoud; Vargas, Gracie

    2004-05-01

    We present a multimodal nonlinear imaging approach to elucidate microstructures and spectroscopic features of oral mucosa and submucosa in vivo. The hamster buccal pouch was imaged using 3-D high resolution multiphoton and second harmonic generation microscopy. The multimodal imaging approach enables colocalization and differentiation of prominent known spectroscopic and structural features such as keratin, epithelial cells, and submucosal collagen at various depths in tissue. Visualization of cellular morphology and epithelial thickness are in excellent agreement with histological observations. These results suggest that multimodal nonlinear optical microscopy can be an effective tool for studying the physiology and pathology of mucosal tissue.

  7. Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

    Directory of Open Access Journals (Sweden)

    Rafael DeRossi

    2012-02-01

    Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

  8. Investigation on a compact in-line multimode-single-mode-multimode fiber structure

    Science.gov (United States)

    Yin, Bin; Li, Yang; Liu, Zhi-bo; Feng, Suchun; Bai, Yunlong; Xu, Yao; Jian, Shuisheng

    2016-06-01

    We carried out a detailed investigation on a compact in-line multimode single-mode multimode (MSM) fiber structure. Both theoretical modal and experimental setup were established to demonstrate the transmission characteristics and the corresponding responses of the applied strain and temperature. The proposed structure simply involves a section of the single-mode fiber (SMF) spliced to two sections of multimode fiber (MMF) and lead-in and lead-out SMFs. The excited environment-sensitive cladding modes together with the fundamental mode in the central SMF form a typical Mach-Zehnder interferometer (MZI). We analyzed the transmission characteristics of the different length of the middle SMF and the MMF in detail. In the experiment, we obtained the extinction ratio of the MSM fiber structure based MZI comb spectrum which was up to 20 dB, and sensitivities of 0.7096 pm/με (0-2000 με) and 44.12 pm/°C (10-70 °C), which proved the potential sensing applications of the proposed fiber structure.

  9. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

    Directory of Open Access Journals (Sweden)

    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  10. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  11. Estudo comparativo entre doses de morfina intratecal para analgesia após cesariana

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    Francisco Amaral Egydio de Carvalho

    2013-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Analgesia após cesarianas é importante, pois puérperas com dor têm dificuldade na movimentação, o que prejudica o aleitamento. Morfina intratecal proporciona analgesia adequada e duradoura após cesarianas. O objetivo deste estudo foi comparar a qualidade da analgesia proporcionada por duas doses de morfina intratecal e seus efeitos colaterais em pacientes submetidas à cesariana. MÉTODO: Participaram do estudo 123 gestantes, com idade gestacional superior a 38 semanas e plano de cesariana eletiva. As gestantes foram alocadas de maneira aleatória em dois grupos que receberam 50 ou 100 µg de morfina intratecal (Grupo 50/Grupo 100. Todas as pacientes foram anestesiadas com 12 mg de bupivacaína 0,5% hiperbárica via intratecal. As pacientes foram avaliadas entre a 9ª e a 11ª horas e entre a 22ª e a 24ª horas após o bloqueio, em relação à qualidade da analgesia, ao consumo de analgésico, aos efeitos colaterais e à principal causa de desconforto nas primeiras 24 horas após a cirurgia. RESULTADOS: Os grupos foram semelhantes em relação aos dados antropométricos e antecedente obstétrico. Não houve diferença estatística na intensidade dolorosa entre os grupos. Nos dois grupos a dor foi maior nas primeiras 12 horas após a anestesia (p < 0,001. O consumo de cloridrato de tramadol e o intervalo até a primeira dose foram semelhantes nos dois grupos. Prurido foi o efeito colateral mais frequente, com incidência estatisticamente maior no Grupo 100 (p = 0,026. CONCLUSÕES: Morfina intratecal em 50 µg tem a mesma qualidade de analgesia que 100 µg, com menor incidência de efeitos colaterais.

  12. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  13. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

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    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

  14. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

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    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  15. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

    Science.gov (United States)

    Şen, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

    Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

  16. Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

    Science.gov (United States)

    Stav, Anatoli; Reytman, Leonid; Sevi, Roger; Stav, Michael Yohay; Powell, Devorah; Dor, Yanai; Dudkiewicz, Mickey; Bayadse, Fuaz; Sternberg, Ahud; Soudry, Michael

    2017-01-01

    Background The PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days. Results A total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the “blocks” groups versus the control group. Morphine consumption was significantly higher in the control group. Conclusions Pain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120) PMID:28178436

  17. Considerações sobre analgesia controlada pelo paciente em hospital universitário Consideraciones sobre analgesia controlada por el paciente en hospital universitario Patient controlled analgesia in a university hospital

    Directory of Open Access Journals (Sweden)

    Guilherme Antônio Moreira de Barros

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O rápido progresso obtido nas técnicas cirúrgicas e anestésicas nos últimos anos proporcionou extraordinário aumento das indicações de procedimentos invasivos. Por outro lado, com o envelhecimento da população, o período de recuperação pós-operatória passou a ser motivo de maior preocupação da equipe de saúde. Para tanto, novas técnicas de analgesia foram criadas e desenvolvidas e, dentre elas, destaca-se a Analgesia Controlada pelo Paciente (ACP. Em nosso país, o Serviço de Dor Aguda (SEDA da Disciplina de Terapia Antálgica e Cuidados Paliativos, do Departamento de Anestesiologia da Faculdade de Medicina de Botucatu - UNESP, utiliza há muitos anos esta técnica de analgesia. Com a finalidade de atestar a qualidade do serviço prestado, a pesquisa objetiva verificar a eficácia e segurança do método, assim como identificar e caracterizar a população atendida. MÉTODO: De modo retrospectivo, foram avaliados 679 pacientes tratados pelo SEDA, exclusivamente com o método de ACP, durante três anos. Os pacientes foram incluídos na análise aleatoriamente, sem restrições quanto à idade, ao sexo, ao tipo de cirurgia e considerando-se unicamente a possibilidade de indicação da ACP. Foram estudados os seguintes atributos: sexo, idade, tipo de cirurgia, intensidade da dor, dias de acompanhamento, analgésicos utilizados, vias de administração, ocorrência de efeitos colaterais e complicações da técnica. RESULTADOS: 3,96% dos pacientes submetidos a cirurgias e 1,64% dos internados no período observado foram acompanhados com técnica ACP. A cirurgia torácica foi a mais freqüentemente atendida, com 25% dos pacientes. A morfina foi o medicamento mais utilizado (54,2%, sendo a via peridural a preferencial (49,5%. A escala numérica verbal média foi de 0,8 (0-10. Os efeitos colaterais ocorreram em 22,4% dos doentes tratados. CONCLUSÕES: Os resultados foram considerados excelentes quanto

  18. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast...... programs, postoperative complications and preoperative patient preparation; and we examined and discussed the articles that were identified to include in this review. This information was supplemented with our own research on the mediators of the stress response in surgical patients, the use of epidural...

  19. Anatomy and efficiency of urban multimodal mobility

    CERN Document Server

    Gallotti, Riccardo

    2014-01-01

    The growth of transportation networks and their increasing interconnections, although positive, has the downside effect of an increasing complexity which make them difficult to use, to assess, and limits their efficiency. On average in the UK, 23% of travel time is lost in connections for trips with more than one mode, and the lack of synchronization decreases very slowly with population size. This lack of synchronization between modes induces differences between the theoretical quickest trip and the `time-respecting' path, which takes into account waiting times at interconnection nodes. We analyse here the statistics of these paths on the multilayer, temporal network of the entire, multimodal british public transportation system. We propose a statistical decomposition -- the `anatomy' -- of trips in urban areas, in terms of riding, waiting and walking times, and which shows how the temporal structure of trips varies with distance and allows us to compare different cities. Weaknesses in systems can be either ...

  20. Multimode directionality in all-dielectric metasurfaces

    CERN Document Server

    Yang, Yuanqing; Kostinski, Sarah V; Odit, Mikhail; Kapitanova, Polina; Qiu, Min; Kivshar, Yuri

    2016-01-01

    All-dielectric resonant nanophotonics has emerged recently as a new direction of research aiming at the manipulation of strong optically-induced electric and magnetic Mie resonances in dielectric nanoparticles with high refractive index, for a design of metadevices with reduced dissipative losses and large resonant enhancement of both electric and magnetic fields. Usually, the geometry of dielectric nanoparticles is considered to be close to either sphere or rod, so the exact Mie solutions of the scattering problem are applied. Here we study nanoparticles with a large aspect ratio (such as nanobars) and describe a novel type of hybrid Mie-Fabry-Perot modes responsible for the existence of multiple magnetic dipole resonances. The multiple magnetic dipoles originate from a combination of a magnetic dipolar mode and a number of standing waves of an elongated anisotropic nanobar. We reveal that these novel hybrid modes can interfere constructively with the induced electric dipoles and thereby lead to multimode un...