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Sample records for farmacovigilancia del midazolam

  1. Principales resultados del sistema cubano de farmacovigilancia en el año 200

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    Francisco Debesa García

    2003-08-01

    Full Text Available Se describe el funcionamiento y principales resultados del sistema cubano de farmacovigilancia durante el año 2001 en todos los niveles de salud del país. Durante 12 meses, los casos se identificaron mediante el sistema de notificación voluntaria de sospecha de reacciones adversas a medicamentos. Se recibieron en la Unidad Nacional Coordinadora de Farmacovigilancia 16 195 notificaciones de Reacciones Adversas Medicamentosas (RAM que contenían 33 601 sospechas de RAM, para una tasa de notificación de 1 447 reportes x 1 000 000 de habitantes, el 60,2 % de las RAM correspondió al sexo femenino y el 39,8 % al masculino. En cuanto al nivel de asistencia, la atención primaria es la que más notifica con 83,3 %, fueron resultados alentadores que en el año 2001 la relación de reacciones moderadas y graves respecto a leves (59,2 %/40,6 % continua favorable al incremento de notificaciones de mayor severidad. Se reportaron 33 reacciones con desenlace fatal, para un 0,2 %. Las notificaciones recibidas en nuestra unidad nos permitieron cuantificar y caracterizar las RAM, teniendo además un gran valor para generar alertas y vigilar la seguridad de los medicamentos que circulan en nuestro país.The functioning and main results of the Cuban Drug Surveillance System in the year 2001 at all the health care levels throughout the country are described. In that period, cases were identified by the Voluntary Notification of suspected adverse drug reaction System. The National Coordinating Unit of Drug Surveillance received 16 195 notes on Adverse Drug Reactions that included 33 601 suspected adverse drug reactions, for a notification rate of 1 447 reports per 1 000 000 pop.; 62% of adverse drug reactions were reported in females and 39,8% in males. Regarding the level of assistance, primary health care level is the one that presented more reports with 83,3% of the total amount. Results were encouraging in the year 2001 since the ratio of moderate and

  2. Farmacovigilancia hospitalaria

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    Ana Julia García Milián

    Full Text Available En la práctica clínica existen varios factores que dificultan la detección de las reacciones adversas producidas por medicamentos. La farmacovigilancia es utilizada para la prevención de riesgos de los medicamentos en los seres humanos y para evitar los costes económicos asociados a los efectos adversos no esperados. Esta vigilancia en el marco de la práctica habitual se realiza por los sistemas de farmacovigilancia, y se considera necesaria en cada país, ya que hay diferencias entre países (y aún entre regiones en algunos países en la manifestación de reacciones adversas a medicamentos y otros problemas relacionados con estos, lo que puede ocurrir por las diferencias en la producción, la distribución y el uso (por ejemplo: indicaciones, dosis y disponibilidad. Teniendo en cuenta la baja incidencia general de reporte de reacciones adversas procedentes de los hospitales en general y de la especialidad de Oftalmología en particular, debe mantenerse una colaboración multicéntrica para la notificación de las reacciones adversas producidas por fármacos en los servicios de Oftalmología. El desarrollo de un Programa de farmacovigilancia en un hospital exige cumplir con requisitos básicos en el plano técnico, ético y de la coordinación interhospitalaria y general.

  3. Principales resultados del sistema cubano de Farmacovigilancia en el año 2004 Main results of the Cuban system of pharmacological surveillance system in 2004

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    Francisco Debesa García

    2005-12-01

    Full Text Available Se describen los principales resultados alcanzados por el sistema cubano de Farmacovigilancia en el 2004. Durante 12 meses, los casos se identificaron mediante el sistema de notificación voluntaria de sospecha de reacciones adversas a medicamentos. Se recibieron en la Unidad Nacional Coordinadora de Farmacovigilancia 7 063 notificaciones de reacciones adversas medicamentosas (RAM que contenían 13 500 a razón de 1,9 RAM por notificación, de ellas 3 185 fueron “importantes” para el 35,1 % (según criterios para determinar RAM importantes de la UCNFv , en las Normas y procedimientos de trabajo del sistema cubano de Farmacovigilancia. La tasa de notificación anual fue de 628 notificaciones por millón de habitantes. El 64,6 % de las RAM correspondió al sexo femenino y el 35,4 % al masculino. En cuanto al nivel de asistencia, la atención primaria fue la que más notificó con 85 %. La relación de reacciones leves con respecto a las moderadas y graves fue de 48,3/51,4 %, que continúa con un balance muy bueno en relación con el reporte por severidad. Se reportaron 23 reacciones con desenlace fatal, para el 0,3 %. A pesar de la disminución en cuanto al número de notificaciones recibidas en nuestro unidad, con respecto al año anterior, aún se encuentra entre las tasas de notificación más altas de los países miembros del sistema internacional de monitoreo de RAM; por otra parte, dada la calidad de estas permitieron cuantificar y caracterizar las RAM, teniendo además un gran valor para generar alertas y vigilar la seguridad de los medicamentos que circulan en nuestro país.The main results achieved by the Cuban Pharmacological Surveillance System in the year 2004 were described. During these 12 months, the cases were identified by the voluntary notification system of suspected adverse reactions to drugs. The National Coordinating Unit of Pharmacological Surveillance (NCUPs received 7 063 notifications that included 13 500 adverse drug

  4. Efecto sedante del midazolam genérico versus innovador en ratas Wistar

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    Radamés Alemón-Medina

    2015-11-01

    Full Text Available Antecedentes: ocho de cada diez pacientes en Terapia Intensiva del Instituto Nacional de Pediatría no obtienen el mismo efecto ansiolítico y sedante con midazolam genérico (PiSA®, que con el innovador (Dormicum, Roche® a pesar de que su biodisponibilidad es de 100%.  Objetivo: determinar diferencias significativas en el efecto sedante del midazolam genérico y del innovador administrados parenteralmente.  Material y métodos: estudio aleatorizado cruzado en 24 ratas Wistar macho distribuidas en 4 grupos (n=6. A cada individuo se le administró una dosis de 0.5 mg/kg de peso vía intraperitoneal. Se determinaron los grados de sedación mediante la escala de Salamone. Se midió la concentración del fármaco en las ampolletas de ambas marcas por cromatografía líquida de alta resolución. Resultados: el efecto sedante del midazolam apareció al mismo tiempo y tuvo la misma duración, ndependientemente de la marca. El efecto tiende a ser más duradero con el innovador pero sin ser estadísticamente significativo (ANOVA, p ≤ 0.05. Asimismo, la mayoría de los animales llegaron al nivel 3 de sedación con ambas marcas.   Conclusión: tanto el midazolam innovador como el genérico tienen el mismo efecto sedante: aparece al mismo tiempo y tiene la misma duración.

  5. Principales resultados del sistema cubano de Farmacovigilancia en el año 2003 Main results of the Cuban System of Drug Surveillance in 2003

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    Francisco Debesa García

    2004-12-01

    Full Text Available Se describe el funcionamiento y principales resultados del sistema cubano de Farmacovigilancia durante el 2003 en todos los niveles de salud de Cuba. Durante 12 meses, los casos se identificaron mediante el sistema de notificación voluntaria de sospecha de reacciones adversas a medicamentos. Se recibieron en la Unidad Nacional Coordinadora de Farmacovilancia 12 601 notificaciones de reacciones adversas medicamentosas (RAM que contenían 25 348 sospechas de RAM, para una tasa de notificación de 1 119 reportes x 1 000 000 de habitantes. El 66 % de las RAM correspondió al sexo femenino y el 34 % al masculino. En cuanto al nivel de asistencia, la atención primaria es la que más notifica con 83,5 %. Fueron resultados alentadores que en este año la relación de reacciones leves con respecto a las moderadas y graves resultó del 55,3/44,7 %, que continúa con un balance bastante bueno en relación con el reporte por severidad. Se reportaron 54 reacciones con desenlace fatal, para el 0,2 %. Las notificaciones recibidas en nuestro unidad permitieron cuantificar y caracterizar las RAM, teniendo además un gran valor para generar alertas y vigilar la seguridad de los medicamentos que circulan en nuestro país.The functioning and the main results of the Cuban Drug Surveillance System at all the health levels, in 2003, are described. During 12 months, the cases were identified by the volunteer notification system of suspicion of adverse drug reactions. 12 601 notifications of adverse drug reactions (DAR containing 25 348 DAR suspicions were received at the National Coordinating Unit of Drug Surveillance for a notification rate of 1 119 reports x 1 000 000 inhabitants. 66 % of the ADRs corresponded to females and 34 % to males. As regards the assistance level, the primary care level notifies the most with 83.5 %. It was considered as encouraging the fact that the relation of mild adverse reactions with respect to the moderate and severe was 55.3 %/44

  6. Farmacovigilancia: ¿y si notificamos?

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    Tena Trincado T

    2014-06-01

    Full Text Available Introducción: Farmacovigilancia es la actividad de salud pública que tiene como objetivo la identificación, cuantificación, evaluación y prevención de los riesgos del uso de los medicamentos una vez comercializados, permitiendo así el seguimiento de los posibles efectos adversos. Según las últimas estadísticas del Centro Andaluz de Farmacovigilancia las notificaciones por farmacéuticos solo suponen el 9 % de las realizadas por los profesionales sanitarios. A la vista de estos datos se propuso un estudio para conocer los motivos de la falta de notificación y resolver los posibles problemas. Método: Se elaboró un cuestionario ad hoc, que se envió a todos los farmacéuticos de la provincia de Huelva. Resultados: Participaron 66 farmacéuticos. El 91 % conoce la tarjeta amarilla, dispone de ella el 45 %, conoce la vía web el 34 %, ha notificado alguna vez 34 % (7 % lo hace siempre que se encuentra una reacción adversa. El 60 % no ha notificado nunca y un 15 % piensa que no es obligatorio. Los motivos por los que no se notifica son falta de información 44 %, falta de formación 41 %, falta de tiempo 36 % y no disponer de tarjeta amarilla 29 %. Los titulares demandan una mayor información y formación. Los adjuntos ven la falta de tiempo como principal motivo de la no notificación. Discusión: Ante la poca notificación por los farmacéuticos y la importancia de este tema, se propone una campaña de concienciación entre los farmacéuticos de Huelva para mejorar estos resultados. Para ello se enviará a todos los colegiados un díptico formativo con la finalidad de resolver los principales inconvenientes de la notificación.

  7. Programa Nacional de Farmacovigilancia INVIMA

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    Instituto Nacional de Vigilancia de Medicamentos y Alimentos

    2003-03-01

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    Una reacción adversa a medicamento, RAM (adverse drug reactíon, ADR es una respuesta a un medicamento que es inesperada, no intencional y que ocurre a dosis terapéuticas de los medicamentos usados en profilaxis, diagnóstico o terapia de enfermedad, o para lograr modificaciones de funciones fisiológicas.
    La farmacovigilancia (pharmacovi-gilance, drug surveillance es la actividad de las ciencias de salud que permite recolectar información, analizar, tomar decisiones y difundir  información sobre reacciones adversas a medicamentos.
    EI INVIMA (www.invima.gov.co es el lnstituto Nacional de Vigilancia de Medicamentos y Alimentos, y es el ente encargado de realizar dicha actividad Ayúdenos mediante su detección y su reporte oportuno a que los medicamentos y las prescripciones sean de mejor calidad y más seguros cada día. iMañana, usted podría necesitar medicamentos y presentar una reacción adversa!

  8. Farmacovigilancia: Una herramienta poco utilizada Pharmacoepidemiology: An unappreciated tool

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    Walter Vasen

    2006-06-01

    Full Text Available La farmacovigilacia es una herramienta esencial para el control de los fármacos utilizados en nuestro país, el presente artículo muestra una revisión de los elementos más destacados en el tema y un resumen de los sistemas regulatorios vigentes en la Argentina y de la experiencia de la Red de Farmacovigilancia de los hospitales del Gobierno de la Ciudad de Buenos Aires, con el objetivo de informar y estimular a los colegas a la denuncia de los efectos adversos de los medicamentos.Pharmacoepidemiology is an essential tool for controlling drugs used in our country. The present article reveals the most relevant aspects on the topic, summarizes regulatory tools currently used in Argentina and explores the experience of the Pharmacoepidemiology Network in public hospitals of Buenos Aires City. The aim is to inform and stimulate colleagues to report adverse effects of drugs.

  9. Estrategia de trabajo a seguir en Laboratorios Liorad para la farmacovigilancia desde la industria

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    Nancy Burguet Lago

    Full Text Available Introducción: la farmacovigilancia es una responsabilidad que comparten los médicos, la industria farmacéutica, las autoridades sanitarias y los pacientes. En Laboratorios Liorad no estaba definida la implementación de esta actividad. Objetivo: establecer la estrategia de trabajo a seguir por la referida institución para asumir la farmacovigilancia desde la industria. Métodos: se trazaron las estrategias siguientes: seleccionar una persona para asumir la actividad, definir el marco regulatorio que regiría esta, establecer cómo se llevaría a cabo el flujo de la información, definir el sistema documental para obtener evidencia documentada y valorar el diseño para realizar los estudios de poscomercialización. Resultados: se definió un especialista del área de Investigación, Desarrollo e Innovación para la actividad de farmacovigilancia; así como sus funciones de trabajo. El profesional designado recibió capacitación en farmacovigilancia orientada a la industria. Se definió como marco regulatorio las normas que rigen esta acción en Cuba. Se confeccionaron, revisaron y aprobaron los documentos para facilitar la organización y dejar constancia del trabajo realizado. Por último, como diseño fundamental para realizar los estudios de poscomercialización se definió realizar la investigación de eventos adversos raros e inesperados y la detección de aumentos en la incidencia de reacciones adversas conocidas. Conclusiones: al término del trabajo existe una infraestructura organizativa en la empresa que permite asumir esta tarea desde la industria, lo que contribuirá a detectar precozmente manifestaciones inesperadas que pudieran alterar el balance riesgo-beneficio de los medicamentos fabricados en Liorad durante su empleo.

  10. Adecuación de ranelato de estroncio tras alertas de farmacovigilancia en un área de gestión sanitaria

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    M.R. Cantudo-Cuenca

    2016-01-01

    Conclusiones: El número de pacientes con prescripción de ranelato de estroncio ha disminuido considerablemente. Las intervenciones dirigidas a la revisión de la adecuación del tratamiento, en base a las alertas de farmacovigilancia han sido efectivas.

  11. Reacciones adversas graves y mortales a los antimicrobianos. Sistema Cubano de Farmacovigilancia, 2003-2012

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    Ismary Alfonso Orta

    Full Text Available Introducción: las reacciones adversas a los antimicrobianos ocasionan más de 142 000 visitas a las salas de urgencias hospitalarias por año en los Estados Unidos. En Cuba han ocupado el primer lugar en el reporte, por ejemplo, en el año 2008 representaron el 31,4 % del total de las reacciones adversas graves y el 25 % de las reacciones adversas mortales. Objetivo: caracterizar las reacciones adversas graves y mortales a los antimicrobianos notificadas a la Unidad Nacional Coordinadora de Farmacovigilancia, durante el periodo 2003-2012. Métodos: se realizó un estudio de farmacovigilancia, observacional, descriptivo y transversal, utilizando la base de datos nacional de farmacovigilancia durante el periodo 2003-2012. Se trabajó con el total de reportes de reacciones adversas graves y mortales a los antimicrobianos. Las reacciones adversas se clasificaron según tipo de reacción, sistema de órgano afectado, imputabilidad y frecuencia. Se identificaron los principales antimicrobianos sospechosos y se estudiaron los pacientes que presentaron reacciones adversas según sexo y edad. Resultados: se detectaron 631 sospechas de reacciones adversas graves y mortales a los antimicrobianos, de ellas fueron 550 graves y 81 mortales. Predominaron el sexo femenino con 60,1 % y 405 adultos. Las reacciones adversas comprometieron los sistemas: general (30,4 %, respiratorio (25,2 % y cardiovascular (14,9 %. El shock anafiláctico fue la reacción más reportada y la penicilina el fármaco más relacionado con esta. El 73,5 % fueron probables y el 58,9 % ocasionales. Conclusiones: las reacciones adversas graves y mortales predominaron en el sexo femenino y en los adultos. La penicilina fue el fármaco más relacionado. Las reacciones adversas probables y ocasionales fueron la mayoría en el estudio.

  12. Azitromicina y efectos cardiovasculares notificados al Sistema Cubano de Farmacovigilancia, 2003-2012

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    Ismary Alfonso Orta

    Full Text Available Introducción: la azitromicina, es un antibacteriano macrólido semisintético, al cual se han asociado efectos cardiovasculares, como la prolongación del intervalo QT y trastornos del ritmo que pueden ser fatales. La FDA alertó sobre un pequeño aumento de la mortalidad y riesgo de muerte en personas tratadas durante 5 días con este antibacteriano, y en el Centro Internacional de Monitoreo de Uppsala también se han registrado casos. Objetivo: caracterizar las reacciones adversas cardiovasculares a la azitromicina informadas a la Unidad Nacional Coordinadora de Farmacovigilancia durante el periodo 2003-2012. Métodos: estudio observacional, descriptivo y transversal utilizando la base de datos nacional de farmacovigilancia y las notificaciones espontáneas de reacciones adversas. Se trabajó con el universo de pacientes con reacciones adversas a la azitromicina. Las reacciones cardiovasculares se clasificaron según tipo de reacción, severidad, imputabilidad y frecuencia. Se estudiaron los pacientes que presentaron reacciones adversas según sexo y edad. Resultados: se recibieron 1 960 notificaciones de reacciones adversas a la azitromicina en el periodo de estudio, de las cuales 96 se correspondieron con reacciones adversas cardiovasculares para el 4,9 %. Predominaron en el sexo femenino (55,2 % y en los adultos (75 %. Las palpitaciones representaron el 44,8 % (43 pacientes, seguidas de la taquicardia y el dolor torácico. El 67,7 % resultaron moderadas, el 71,9 % probables y el 60,4 % ocasionales. El 31,3 % de las reacciones se pudo haber evitado y el motivo que predominó fue la indicación inadecuada en el 70 %. Conclusiones: aunque no se informan reacciones adversas cardiovasculares con desenlace fatal en personas tratadas con azitromicina, la tercera parte de ellas se podrían haber evitado; por lo se recomienda realizar una vigilancia más proactiva a este medicamento, así como informar todas las reacciones al Sistema Cubano de

  13. Eficacia del midazolam contra la ansiedad en niños de 1-3 años sometidos a cirugía

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    Rosaevelyn Oriolo Estrada

    2014-06-01

    Full Text Available Introducción: cualquier acto quirúrgico crea ansiedad, sobre todo en niños, a lo que se añade la ansiedad parental por separación a la entrada al salón de operaciones. Objetivo: demostrar la eficacia del midazolam jarabe para controlar la ansiedad en niños de 1-3 años que fueron sometidos a cirugía que requería anestesia general en el Hospital Provincial Pediátrico Docente "Pepe Portilla" de Pinar del Río, en el período 2008-2009. Material y método: se realizó estudio de cohorte, longitudinal y prospectivo de casos y controles en niños. Treinta recibieron dosis de 0.5 mg/kg de peso, y 60 controles que no lo recibieron, previo consentimiento informado de los padres. Se midió tiempo de sedación, signos vitales, reacciones adversas y grado de satisfacción de padres y personal del salón de operaciones. Se calcularon frecuencias que fueron comparadas mediante X². Resultados: la muestra resultó homogénea por sexo, edades y el tipo de cirugía a realizarse (p> 0,05. La sedación se obtuvo desde los 10 minutos en (24 niños/30. La bradipnea fue el único efecto adverso observado en 7 niños. Los controles (100% taquipneicos y llorosos. El 76.7 % de los padres y el 100% del personal estuvo satisfecho con los efecto sedativos del midazolam. Conclusiones: es la primera vez que se usa esta droga como premedicación anestésica en niños 1-3 años, y se demuestra la eficacia y efectiva, con escasas reacciones adversas y gran aceptabilidad y satisfacción por padres y personal de salud.

  14. Presente y futuro de la farmacovigilancia en la Industria Farmacéutica

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    Iván E. Cuevas

    2007-04-01

    Full Text Available Se realizó un estudio sobre los problemas de la vigilancia poscomercialización desde la industria farmacéutica. Las reacciones adversas a medicamentos y vacunas causan un aumento significativo en los costos de la atención sanitaria; las vacunas en particular tienen un beneficio diferido y desconocido y un riesgo inmediato, por lo cual se requiere de mayores estándares de vigilancia. La farmacovigilancia por sí misma tiene obstáculos que pueden ser mayores cuando se enfocan desde la industria farmacéutica. El acompañamiento o apadrinamiento como estrategia permite vencer esos obstáculos y establecer el sistema de vigilancia poscomercialización, lo cual ha sido práctica sistemática del Instituto Finlay y es la concreción de cómo se debe asumir un mayor nivel de responsabilidad en los productos con el ciclo completo. La experiencia en nuestro Instituto con relación al enfoque poscomercialización, donde se observan todos los factores y condiciones que inciden en efectos deseados o no de los productos, es un adelanto para que con la aplicación de herramientas epidemiológicas y farmacoeconómicas, obtener una mejor evaluación del impacto sanitario y económico en la aplicación de nuestras vacunas. La implementación y puesta en marcha de la farmacovigilancia en la industria de medicamentos es un desafío y una necesidad para completar el desarrollo de la industria farmacéutica.

  15. Midazolam por via oral como medicação pré-anestésica em crianças e adolescentes com paralisia cerebral: estudo comparativo das variações do índice bispectral Midazolam por vía oral como medicación preanestésica en niños y adolescentes con parálisis cerebral: estudio comparativo de las variaciones del índice bispectral Oral midazolam as pre-anesthetic medication in children and teenagers with cerebral palsy: a comparative study on the variations of the bispectral index

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    Verônica Vieira da Costa

    2009-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O midazolam é um derivado benzodiazepínico com ação hipnótica e muito utilizado como medicação pré-anestésica em anestesia pediátrica. As crianças com paralisia cerebral (PC também se beneficiam do uso do midazolam, mas seus efeitos são ainda desconhecidos sobre esse grupo de pacientes que apresentam uma série de particularidades, com alterações inclusive no local de ação do midazolam. O objetivo do estudo foi avaliar a ação do midazolam utilizado como medicação pré-anestésica sobre o índice bispectral (EEG-BIS dos pacientes com paralisia cerebral. MÉTODO: Foram avaliados dois grupos de pacientes: um com diagnóstico de PC e outro sem doença do sistema nervoso central (SNC e periférico. Foram registrados valores de EEG-BIS na enfermaria na véspera da operação e no dia da operação, 40 minutos depois da administração de 0,6 mg.kg-1 de midazolam via oral. Foram excluídos pacientes com história de reação paradoxal ao midazolam e pacientes do grupo-controle que estivessem em uso de outra medicação. RESULTADOS: Foram estudados 77 pacientes de ambos os sexos, entre 4 e 18 anos de idade. Não houve diferença entre os valores de EEG-BIS basal entre os grupos estudados. Após o uso do midazolam houve diminuição dos valores do EEG-BIS nos dois grupos estudados, com diferença estatística significativa em cada grupo. Na comparação entre grupos não houve diferença estatística. CONCLUSÕES: O midazolam administrado como medicação pré-anestésica na dose de 0,6 mg.kg-1 diminui os valores basais do EEG-BIS sem caracterizar hipnose e sem diferença estatística nos grupos estudados.JUSTIFICATIVA Y OBJETIVOS: El midazolam es un derivado benzodiazepínico con acción hipnótica y muy utilizado como medicación preanestésica en anestesia pediátrica. Los niños con parálisis cerebral (PC también se benefician del uso del midazolam, pero sus efectos todavía se desconocen sobre ese

  16. Ação do anticonvulsivante isolado e associado ao midazolam como medicação pré-anestésica sobre o índice bispectral (BIS em pacientes com paralisa cerebral Acción del antiepiléptico aislado y asociado al midazolam como medicación preanestésica sobre el índice bispectral (BIS en pacientes con parálisis cerebral Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the bispectral index (BIS in patients with cerebral palsy

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    Verônica Vieira da Costa

    2010-06-01

    ás utilizado como medicación preanestésica y no se conocen sus interacciones medicamentosas en los pacientes con PC. El objetivo de este estudio fue evaluar el midazolam como medicación preanestésica en el BIS de los pacientes con PC en uso crónico de antiepilépticos. MÉTODO: Se evaluaron tres grupos de pacientes: PC sin uso de antiepilépticos, PC en uso de antiepiléptico y otro grupo sin enfermedad y sin uso de medicaciones (grupo control. En la víspera de la cirugía, con los pacientes despiertos y en decúbito dorsal, fue colocado el monitor del BIS y se registraron los valores basales del BIS. Al día siguiente, 40 minutos antes de la cirugía, los pacientes recibieron 0,6 mg.kg-1 de midazolam por vía oral. Antes del inicio de la anestesia fue realizado el mismo procedimiento para registro del BIS, después del uso del midazolam. RESULTADOS: Fueron estudiados 107 pacientes, 39 pacientes del grupo control y 68 con diagnóstico de PC. De ellos, 17 usaban antiepilépticos. Con relación al valor promedio de BIS después del uso del midazolam, no hubo diferencia entres los pacientes del grupo control y del grupo PC que no tomaban antiepiléptico, mientras que los pacientes que usaban antiepilépticos fueron diferentes (p = 0,003. La posibilidad de disminución del BIS después del uso del midazolam, aumenta de acuerdo con el número de antiepiléptico usado por el paciente. CONCLUSIONES: El uso crónico de antiepiléptico asociado al midazolam vía oral como medicación preanestésica, puede conllevar a la disminución de los valores de BIS configurando niveles profundos de hipnosis.BACKGROUND AND OBJECTIVES: Patients with cerebral palsy (CP frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre

  17. Pharmacology of midazolam.

    Science.gov (United States)

    Pieri, L; Schaffner, R; Scherschlicht, R; Polc, P; Sepinwall, J; Davidson, A; Möhler, H; Cumin, R; Da Prada, M; Burkard, W P; Keller, H H; Müller, R K; Gerold, M; Pieri, M; Cook, L; Haefely, W

    1981-01-01

    8-Chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a][1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) is an imidazobenzodiazepine whose salts are soluble and stable in aqueous solution. It has a quick onset and, due to rapid metabolic inactivation, a rather short duration of action in all species studied. Midazolam has a similar pharmacologic potency and broad therapeutic range as diazepam. It produces all the characteristic effects of the benzodiazepine class, i.e., anticonvulsant, anxiolytic, sleep-inducing, muscle relaxant, and "sedative" effects. The magnitude of the anticonflict effect of midazolam is smaller than that of diazepam in rats and squirrel monkeys, probably because a more pronounced sedative component interferes with the increase of punished responses. In rodents, surgical anaesthesia is not attained with midazolam alone even in high i.v. doses, whereas this state is obtained in monkeys. The drug potentiates the effect of various central depressant agents. Midazolam is virtually free of effects on the cardiovascular system in conscious animals and produces only slight decreases in cardiac performance in dogs anaesthetized with barbiturates. No direct effects of the drugs on autonomic functions were found, however, stress-induced autonomic disturbances are prevented, probably by an effect on central regulatory systems. All animal data suggest the usefulness of midazolam as a sleep-inducer and i.v. anaesthetic of rapid onset and short duration.

  18. Farmacovigilancia en pacientes geriátricos con neumonía

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    Dorgerys García Falcón

    Full Text Available Objetivo: evaluar las reacciones adversas detectadas en los tratamientos aplicados a pacientes ancianos con neumonía. Métodos: se realizó un estudio descriptivo, prospectivo, de farmacovigilancia empleando el método de monitoreo intensivo al paciente hospitalizado, en el Servicio de Geriatría del Hospital Provincial Saturnino Lora Torres de Santiago de Cuba, en el período comprendido desde enero a diciembre de 2008. Resultados: se obtuvo que las reacciones adversas más frecuentes fueron atribuidas a los antimicrobianos. Predominaron la nefrotoxicidad y el prurito, y de acuerdo con su causalidad y significación clínica, las reacciones adversas medicamentosas probables y leves, respectivamente. Conclusiones: los pacientes geriátricos tienen una serie de condiciones que los hace más propensos a la aparición de reacciones adversas medicamentosas, de ahí que cobre gran importancia en la actualidad la vigilancia de las sospechas de estas en aras de contribuir a la mejora de su calidad de vida.

  19. Farmacovigilancia de psicofármacos en una farmacia de A Coruña (España

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    Alonso Lovera P.

    2016-03-01

    Full Text Available Objetivos: Realizar una actividad de farmacovigilancia (FV en una farmacia comunitaria, registrando las reacciones adversas (RAM y derivando a los pacientes a su médico si fuese necesario. Material y métodos: Estudio observacional transversal. En un cuestionario ad hoc se recogieron datos demográficos de los pacientes sobre la utilización de los medicamentos, percepción sobre efectividad y seguridad de los fármacos a estudiar. Se seleccionaron cuatro principios activos: duloxetina, venlafaxina, quetiapina y olanzapina por ser de dispensación frecuente en la farmacia y de reciente comercialización. Resultados: 47 pacientes utilizaban uno de los antidepresivos estudiados. 34 (72,3% mujeres y 13 (27,7% hombres. 21 (55,3% tomaban venlafaxina y 26 (44,7% duloxetina. Media de edad 52,9 (DE= 13,7 años (21-80. 36 en tratamiento con los dos antipsicóticos del estudio. 21 (58,3% utilizaban olanzapina y 15 (41,8% quetiapina. Edad media 41,6 (DE=13,4 años (27-70. 174 RAM en los antidepresivos y 120 en los antipsicóticos. Sequedad de boca, temblores, hipersudoración, flatulencia y ansiedad son las más frecuentes en los dos antidepresivos y sequedad de boca, reducción de la libido y aumento de peso en los dos antipsicóticos. Se notificó 1 caso al Centro Gallego de Farmacovigilancia. Se derivaron dos pacientes al médico por problemas relacionados con la medicación (PRM. Conclusiones: Mediante una actividad de FV en una farmacia comunitaria de A Coruña se ha detectado un elevado número de RAM, contribuyendo a un resultado más seguro de la farmacoterapia de los pacientes.

  20. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual

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    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.

  1. Farmacovigilancia en la literatura médica cubana

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    María de los Angeles Peña Machado

    1996-04-01

    Full Text Available Se aborda el tema de la vigilancia farmacológica, para lo cual se seleccionaron las publicaciones que aparecían en 5 revistas médicas cubanas, que sugerían alguna relación con las reacciones adversas de los medicamentos. Se describen las características comunes y diferenciales de dichos artículos, haciendo énfasis en las posibilidades de desarrollo de la farmacovigilancia, que es una necesidad en nuestro país, donde la producción y comercialización de los fármacos es una realidad objetiva. Se sugieren métodos para estimular al personal médico en la pesquisa de reacciones adversas de los medicamentos.The theme of drug surveillance is approached, and for this purpose, publications appeared in five Cuban medical journals were selected; these articles suggested a certain relation with drugs adverse reactions. The common characteristics, and the differences of such articles, are described, emphasizing in the development possibilities of drug surveillance, an item that is a necessity in our country, where drug production and marketing is an objective reality. Methods for the stimulation of the medical staff in search for drugs adverse reactions, are suggested.

  2. Estudio exploratorio de farmacovigilancia en el personal médico

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    María de los Ángeles Peña Machado

    2000-01-01

    Full Text Available La farmacovigilancia es un procedimiento que depende en gran medida del médico, con el objetivo de determinar las posibles causas de la escasa notificación de reacciones adversas de los medicamentos (RAM en nuestro medio. Se aplicó una encuesta anónima a 145 profesionales de la medicina, de 17 especialidades diferentes de los cuales 68 eran de la Atención Primaria (AP y 77 de la Secundaria (AS. En la AP el 40 % eran especialistas y el 68 % residentes, en la AS el 100 % eran especialistas. Se observaron diferencias significativas entre la AP y la AS en la mayoría de las respuestas de las preguntas formuladas. Los resultados nos permiten concluir que los médicos tienen conocimientos y experiencia relacionados con las RAM, pero la divulgación y el mecanismo de notificación deben mejorar de manera que los estimule a reportarlas.Drug surveillance is a procedure that depends greatly on the doctor with the objective of determining the possible causes of the poor notification of the adverse reactions of drugs (ARD in our environment. An anonymous survey was done among 145 medical professionals from 17 different specialities. 68 worked at the primary care level (PCL and 77 at the secondary care level (SCL. At the primary care level 40 % were specialists and 68 % residents, whereas at the secondary level 100 % were specialists. Significant differences were observed between the PCL and the SCL in most of the answeres given to the questions. The results allowed to conclude that doctors have experience and know about the adverse reactions of drugs but that the divulgation and the mechanism of modification should be improved in order to encourage doctors to report them.

  3. Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

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    Mojtaba Vahid Golpayegani

    2012-01-01

    Conclusion: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results.

  4. Ontogeny of midazolam glucuronidation in preterm infants

    NARCIS (Netherlands)

    S.N. de Wildt (Saskia); G.L. Kearns (Greg); D.J. Murry (Darryl); G. Koren (Gideon); J.N. van den Anker (John)

    2010-01-01

    textabstractPurpose: In preterm infants, the biotransformation of midazolam (M) to 1-OH-midazolam (OHM) by cytochrome P450 3A4 (CYP3A4) is developmentally immature, but it is currently unknown whether the glucuronidation of OHM to 1-OH-midazolam glucuronide (OHMG) is also decreased. The aim of our

  5. Estrategia y resultados de la farmacovigilancia de vacunas desde el Instituto Finlay, 2009

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    Iván E. Cuevas-Valdespino

    2010-08-01

    Full Text Available El objetivo de este trabajo fue mostrar la estrategia y los resultados de la farmacovigilancia desde el Instituto Finlay, como titular de registros sanitarios. Se concretó la biografía de los productos en la etapa de poscomercialización y se examinó el balance riesgo/beneficio. Esto fue posible gracias a convenios con instituciones que permitieron el acceso a bases de datos digitales y auditables, donde se encontró la notificación espontánea de eventos adversos y el cumplimiento de las buenas prácticas, reglamentos y regulaciones de la autoridad reguladora. La minería de datos para la búsqueda de la agrupación de eventos raros e inesperados para un mismo lote o de accidentes, la confección de los informes periódicos de seguridad y la práctica sistemática para completar la información de seguridad solicitada en subpoblaciones y grupos especiales permitió actualizar el perfil de seguridad de las vacunas. Se confirmó que la vacuna antileptospirósica trivalente, la antitifoídica Vi y el toxoide tetánico, presentaron una frecuencia de eventos adversos menor de 0,1 reporte por cada 100.000 dosis administradas, mientras las demás vacunas tuvieron valores entre 1 y 10 por cada 10.000 vacunados. Entre el 80% y 95% de las notificaciones fueron relacionadas causalmente con la vacuna, y solo el 0,89% fueron de severidad grave, casi todas en niños menores de un año. Las manifestaciones generales fueron las que predominaron. Los resultados presentados muestran la importancia que tiene la farmacovigilancia desde la industria para obtener una valiosa información de la seguridad en la aplicación de las vacunas.

  6. Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children

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    Sonal S Khatavkar

    2014-01-01

    Full Text Available Background: T his study was done to compare effects of intranasal midazolam and intranasal midazolam with ketamine for premedication of children aged 1-12 yrs undergoing intermediate and major surgeries. Aims: Midazolam and Ketamine have already been used as premedicants in children. Our aim was to find out advantage of combination of midazolam with ketamine over midazolam by nasal route. Methods: Sixty children of age group 1-12 yrs of American Society of Anesthesiologists (ASA grade 1 and 2 were selected. Group A- midazolam (0.2 mg/kg, Group B- midazolam (0.15 mg/kg + ketamine 1 mg/kg. Both groups received drug intranasally 30 min before surgery in recovery room with monitored anesthesia care. Onset of sedation, sedation score, emotional reaction, intravenous cannula acceptance, and mask acceptance were studied. Statistical Analysis: Unpaired t test and chi square test. Results: Sedation score, anxiolysis, attitude, reaction to intravenous cannulation, face mask acceptance, and emotional reaction were significantly better in midazolam with ketamine group. Intra operatively, in both groups, pulse rate, oxygen saturation, and respiratory rate had no significant difference; also, post operatively, no significant difference was observed in above parameters, post operative analgesia was significantly better in midazolam with ketamine group. Conclusions: Intra nasal premedication allows rapid and predictable sedation in children. Midazolam as well as combination of Midazolam with ketamine gives good level of sedation and comfort. But quality of sedation, analgesia, and comfort is significantly better in midazolam with ketamine group. No significant side effects were observed in both groups.

  7. Comportamiento de las reacciones adversas a los analgésicos y antiinflamatorios no esteroideos notificadas por el Sistema Cubano de Farmacovigilancia en el 2001

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    Giset Jiménez López

    2003-12-01

    Full Text Available Los fármacos analgésicos y antiinflamatorios no esteroideos comparten algunas actividades terapéuticas y efectos colaterales, su mecanismo de acción está mediado por la inhibición de la ciclooxigenasa (COX 1 y 2, enzima encargada de la biosíntesis de prostaglandinas y otros autacoides similares. En la Unidad Coordinadora de Farmacovigilancia se hace un análisis periódico de las sospechas de reacciones adversas notificadas, y en el 2001 se observó que de los 10 fármacos sospechosos de producir mayor número de reacciones adversas el 50 % corresponde al grupo de los analgésicos y antiinflamatorios no esteroideos, que es a su vez uno de los grupos de mayor consumo en el país. Se realiza una descripción del comportamiento de las sospechas de reacciones adversas relacionadas con aspirina, dipirona, indometacina, ibuprofeno, naproxeno, paracetamol y piroxicam, incluyendo severidad, características demográficas y mecanismo fisiopatológico de estas. En el 2001 se recibieron en la Unidad Coordinadora de Farmacovigilancia 16 195 notificaciones que contenían un total de 33 601 reacciones adversas medicamentosas, de las cuales el 21,5 % correspondió a los analgésicos y antiinflamatorios no esteroideos, grupo este más notificado después de los antimicrobianos. Se encontró que las reacciones de mayor gravedad afectaron a los sistemas hematológico, gastrointestinal y cuerpo como un todo; el sexo femenino y el adulto joven fueron los más afectados. Debido a las reacciones notificadas y a la severidad de estas es necesario mantener vigilancia activa sobre dicho grupo farmacológico y realizar una prescripción adecuada por los médicos con el fin de minimizar el riesgo de sufrir reacciones adversas.The analgesics and nonsteroideal antiinflammatory drugs share some therapeutic activities and side effects. Their action mechanism is mediated by the inhibition of cyclooxygenase (COX 1 and 2, an enzime incharge of the biosynthesis of

  8. Aplicación de la minería de datos al Sistema Cubano de Farmacovigilancia Application of data mining to the Cuban Pharmacovigilance System

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    Omar Calzadilla Fernández de Castro

    2007-12-01

    Full Text Available En el año 1999, se crea la Unidad Nacional Coordinadora de Farmacovigilancia, la cual funciona como el órgano técnico-científico que desarrolla la política de vigilancia de seguridad de medicamentos del Ministerio de Salud Pública e integra las actividades de los centros provinciales y de otros programas concertados de farmacovigilancia en un sistema único. Entre sus funciones más relevantes se encuentran la de definir, diseñar y desarrollar los sistemas de información; administrar la base de datos nacional; depurar y validar la información contenida en ella; y realizar y coordinar estudios científicos sobre la seguridad de los medicamentos; así como elaborar informes para las autoridades sanitarias y el Sistema Nacional de Salud. En este sistema existe la necesidad de utilizar herramientas de análisis, por lo que se trazó el objetivo de definir, diseñar y desarrollar los sistemas de tratamiento de la información y administrar la base de datos nacional "VigiBaseCuba". Aplicando una serie de transformaciones, validaciones y la adecuación de la metodología CRISP-DM para la elaboración de proyectos de minería de datos, se conformó la base de datos nacional, en un sistema de gestión de bases de datos relacional con los registros de las notificaciones de sospechas de reacciones adversas a los medicamentos y un proceso de descubrimiento de conocimiento que permite gestionar eficazmente la seguridad de los medicamentos, así como desarrollar aplicaciones para la visualización de las señales de reacciones adversas y su evoluciónIn 1999, The National Coordinating Unit of Pharmacovigilance was created. It works as a scientific and technical agency that develops the drug safety surveillance policy of the Ministry of Public Health, and integrates the activities of the provincial centres and other pharmacovigilance programs in a unique system. Some of its most important functions are to define, design and develop the information

  9. [Midazolam as a premedication for gastroscopy].

    Science.gov (United States)

    Eisner, M

    1984-04-01

    Midazolam (Ro 21-3981; Dormicum ) is a new water-soluble benzodiazepine. Compared with diazepam and flunitrazepam, it has the advantage of a short half-life and good tolerability after intravenous administration. It induces light sleep 1/2 to 2 min after injection, and anterograde amnesia. It has minimal hemodynamic and respiratory effects. We administered midazolam by intravenous injection in a dose of 3-7 mg to 100 patients about to undergo esophago-, gastro-, or duodenoscopy. The patient became quiet and relaxed, falling into a light sleep but remaining capable of following simple instructions. After completion of the endoscopy, the patients were half awake, and listened attentively to the report. They subsequently usually slept for 1-2 h, afterwards remembering nothing of the procedure. Two (at most, 3) hours after injection, the patients were again completely awake and able to go home or back to work. In some cases, concentration was slightly impaired for the rest of the day. Compared with other premedications , midazolam is better suited for use in endoscopy, owing to its rapid onset and short duration of action.

  10. Intravenous sedation for implant surgery: midazolam, butorphanol, and dexmedetomidine versus midazolam, butorphanol, and propofol.

    Science.gov (United States)

    Kawaai, Hiroyoshi; Tomita, Shu; Nakaike, Yoshihiro; Ganzberg, Steven; Yamazaki, Shinya

    2014-02-01

    We compared the amnesic action, recovery process, and satisfaction of patients and surgeons after the use of 2 different sedation regimens for 40 patients undergoing scheduled implant surgery. Butorphanol, midazolam, dexmedetomidine (BMD) was administered to 20 patients who were maintained with continuous infusion of dexmedetomidine after the induction with butorphanol and midazolam, and butorphanol, midazolam, propofol (BMP) was administered to 20 patients who were maintained with continuous infusion of propofol after the induction with butorphanol and midazolam. To assess the amnesic action, the memory of local anesthesia, auditory memory, and visual memory were evaluated. The Trieger Dot Test (TDT) was applied during the recovery process. A questionnaire regarding the patient's feelings of the management of sedation was taken from each patient and was also filled out by the surgeon. The comparison between groups was analyzed by the Mann-Whitney U test. No significant differences in the amnesic action and the TDT were noted. Both methods also satisfied the patients and surgeons, as determined by the questionnaire results. In conclusion, both sedation regimens are appropriate for implant surgery.

  11. Estudo comparativo de midazolam com cetamina S(+ versus midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina Estudio comparativo de midazolam con cetamina S(+ versus midazolam con bloqueo paracervical uterino para aspiración manual intrauterina Comparative study of midazolam with ketamine S(+ versus midazolam with uterine paracervical block for manual intrauterine aspiration

    Directory of Open Access Journals (Sweden)

    Vonaldo Torres de Almeida

    2006-10-01

    . RESULTADOS: Las técnicas se mostraron eficientes en 95% de las pacientes del Grupo MC y 76,7% de las pacientes del grupo MP (p = 0,04. Entre las pacientes del Grupo MC, 67 % no presentaron dolor después de una hora, mientras que en el grupo MP el porcentaje de pacientes sin dolor fue de un 33,3% (p BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy, postoperative analgesia, the degree of satisfaction of the patients submitted to manual intrauterine aspiration, and whether the patient would recommend the technique, by comparing two anesthetic techniques. METHODS: A prospective study was done with 80 patients divided, randomized, in two groups. All of them received IV midazolam. Afterwards, the MC Group received IV Ketamaine S(+ and the MP Group underwent paracervical uterine block. In the operating room, the efficacy of the technique was evaluated by 3 observers (the researcher, the obstetrician, and the obstetrics resident and, after one hour, an observer, who did not know which technique had been used, evaluated the postoperative analgesia, and the degree of satisfaction and whether or not the patient would recommend the technique, using a verbal scale. RESULTS: The techniques were effective in 95% of the patients in the MC group and 76.7% of the patients in the MP group (p = 0.04. Among the patients in the MC group, 67% did not experience pain after 1 hour, while in the MP group the percentage of pain free patients was 33.3% (p < 0.01, and a relative risk = 2. Both groups had a 90% satisfaction rate and 90% would recommend the technique. CONCLUSIONS: We concluded that anesthesia with midazolam and ketamine S(+ was better than the association of midazolam with uterine paracervical block for manual intrauterine aspiration, regarding both efficacy and postoperative analgesia. The index of satisfaction was very high for both techniques.

  12. Could conscious sedation with midazolam for dental procedures be ...

    African Journals Online (AJOL)

    CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures. Materials and Methods: In our study, 58 and 47 American Society of Anesthesiologists (ASA).1 pediatric patients, aged ...

  13. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual Importance of pharmacovigilance in current medical practice

    Directory of Open Access Journals (Sweden)

    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.Adverse drug reactions (ADRs are cause of significant morbi-mortality They are between the fourth and sixth cause of mortality in developed countries and cause nearly 12% of hospitalizations. The objective of this publication was to analyze the incidence of ADRs

  14. Preemptive analgesic effects of midazolam and diclofenac in rat model

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    Antigona Hasani

    2011-05-01

    Full Text Available The aim of the present study was to investigate the preemptive analgesic effects of intraperitoneally administrated midazolam and diclofenac, before acute and inflammatory induced pain in rat model.One hundred twenty-eight (n=8 in each group male Sprague Dawley rats were included in the study. Paw movements in response to thermal stimulation or paw flinching in response to formalin injection were compared after midazolam (0.1, 1, 5 and 10 mg/kg and diclofenac (10 mg/kg, intraperitoneal administration. Saline was used as a control.Preemptive analgesic effect was significant in both tests when diclofenac and midazolam was administrated before the pain stimuli (p<0.01 and p<0.001. Intraperitoneal injection of midazolam in doses 5 and 10 mg/kg, increase the response time in hot plate test and decrease the number of flinches in formalin test (p<0.01 vs. p<0.001. ED50 of midazolam (with diclofenac in hot plate test was 2.02 mg/kg (CI95% =-3.47-5.03 mg; and, 0.9 mg/kg (CI95% =-0.87-4.09 mg in phase I and 0.7 mg/kg (CI95% = 0.48-6.63 mg in phase II, in formalin test.Intraperitoneally administered midazolam and diclofenac had preemptive analgesic effects on acute thermal, and inflammatory induced pain in rats.

  15. Administration order of midazolam/fentanyl for moderate dental sedation.

    Science.gov (United States)

    Lobb, Douglas; Clarke, Alix; Lai, Hollis

    2018-02-01

    The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences. A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group. The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

  16. Comparison of subcutaneous dexmedetomidine-midazolam versus alfaxalone-midazolam sedation in leopard geckos (Eublepharis macularius).

    Science.gov (United States)

    Doss, Grayson A; Fink, Dustin M; Sladky, Kurt K; Mans, Christoph

    2017-09-01

    To compare dexmedetomidine-midazolam with alfaxalone-midazolam for sedation in leopard geckos (Eublepharis macularius). Prospective, randomized, blinded, complete crossover study. Nine healthy adult leopard geckos. Geckos were administered a combination of dexmedetomidine (0.1 mg kg -1 ) and midazolam (1.0 mg kg -1 ; treatment D-M) or alfaxalone (15 mg kg -1 ) and midazolam (1.0 mg kg -1 ; treatment A-M) subcutaneously craniodorsal to a thoracic limb. Heart rate (HR), respiratory rate (f R ), righting reflex, palpebral reflex, superficial and deep pain reflexes, jaw tone and escape response were assessed every 5 minutes until reversal. Conditions for intubation and response to needle prick were evaluated. Antagonist drugs [flumazenil (0.05 mg kg -1 ) ± atipamezole (1.0 mg kg -1 )] were administered subcutaneously, craniodorsal to the contralateral thoracic limb, 45 minutes after initial injection, and animals were monitored until recovery. HR, but not f R , decreased significantly over time in both treatments. HR was significantly lower than baseline at all time points in D-M and for all but the 5 and 10 minute time points in A-M. HR was significantly higher in A-M at all time points after drug administration when compared with D-M. Sedation scores between protocols were similar for most time points. All animals in A-M lost righting reflex compared with seven out of nine (78%) geckos in D-M. Geckos in A-M lost righting reflex for significantly longer time. Mean ± standard deviation time to recovery after antagonist administration was 6.1 ± 2.2 minutes for D-M and 56 ± 29 minutes for A-M, and these times were significantly different. Combination D-M or A-M provided sedation of a level expected to allow physical examinations and venipuncture in leopard geckos. A-M provided a faster onset of sedation compared with D-M. Recovery was significantly faster following antagonist reversal of D-M, compared with A-M. Copyright © 2017 Association of

  17. Role of neurosteroids in the anticonvulsant activity of midazolam.

    Science.gov (United States)

    Dhir, Ashish; Rogawski, Michael A

    2012-04-01

    Midazolam is a short-acting benzodiazepine that is widely used as an i.v. sedative and anticonvulsant. Besides interacting with the benzodiazepine site associated with GABA(A) receptors, some benzodiazepines act as agonists of translocator protein (18 kDa) (TSPO) to enhance the synthesis of steroids, including neurosteroids with positive modulatory actions on GABA(A) receptors. We sought to determine if neurosteroidogenesis induced by midazolam contributes to its anticonvulsant action. Mice were pretreated with neurosteroid synthesis inhibitors and potentiators followed by midazolam or clonazepam, a weak TSPO ligand. Anticonvulsant activity was assessed with the i.v. pentylenetetrazol (PTZ) threshold test. Midazolam (500-5000 µg·kg(-1) , i.p.) caused a dose-dependent increase in seizure threshold. Pretreatment with the neurosteroid synthesis inhibitors finasteride, a 5α-reductase inhibitor, and a functional TSPO antagonist PK 11195, reduced the anticonvulsant action of midazolam. The anticonvulsant action of midazolam was enhanced by the neurosteroidogenic drug metyrapone, an 11β-hydroxylase inhibitor. In contrast, the anticonvulsant action of clonazepam (100 µg·kg(-1) ) was reduced by finasteride but not by PK 11195, indicating a possible contribution of neurosteroids unrelated to TSPO. Enhanced endogenous neurosteroid synthesis, possibly mediated by an interaction with TSPO, contributed to the anticonvulsant action of midazolam. Enhanced neurosteroidogenesis may also be a factor in the actions of other benzodiazepines, even those that only weakly interact with TSPO. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  18. [Sedation with midazolam for ambulatory pediatric dentistry].

    Science.gov (United States)

    Shavlokhova, E A; Ostreĭkov, I F; Korolenkova, M V

    2014-01-01

    To improve the quality of dental treatment in children by using combined anaesthesia technique including local anaesthesia and conscious sedation, and to assess the effectiveness of conscious sedation for younger children undergoing dental treatment. The study included 208 children aged 14-88 months who received dental treatment for tooth decay and its complication under combined anaesthesia. Midazolam was used as sedative medication. Sedation level was assessed by visual scale and BIS-monitoring. ANI-monitoring was also used for pain sensitiveness evaluation. Results All 208 children were successfully treated under combined anaesthesia which showed satisfactory sedation rates both by visual scale and and BIS-monitoring values. While mean patient age was 39 months 20.6% were younger than 24 months. These data are extremely valuable as according to literature review conscious sedation in early infancy remains controversial. Our results proved conscious sedation to be effective in younger children undergoing dental treatment thus representing important alternative for general anaesthesia and providing a basis for later behavior management.

  19. Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children

    Directory of Open Access Journals (Sweden)

    Al-Zahrani A

    2009-03-01

    Full Text Available Aim: To compare the effectiveness of 0.6 mg/kg oral midazolam sedation alone and a combination of 0.6 mg/kg oral midazolam plus nitrous oxide-oxygen inhalation sedation, in controlling the behavior of uncooperative children during dental treatment. Study Design: The study had a crossover design where the same patient received two different sedation regimens, that is, oral midazolam 0.6 mg/kg and oral midazolam 0.6 mg/kg with nitrous oxide-oxygen inhalation during two dental treatment visits. Materials and Methods: Thirty children (17 males and 13 females were randomly selected for the study, with a mean age of 55.07 (± 9.29 months, ranging from 48 - 72 months. A scoring system suggested by Houpt et al. (1985 was utilized for assessment of the children′s behavior. Results : There was no significant (p > 0.05 difference in the overall behavior assessment between the two sedation regimens, that is, oral midazolam alone and oral midazolam plus nitrous oxide-oxygen. However, the combination of midazolam and nitrous oxide-oxygen showed significantly (p < 0.05 superior results as compared to midazolam alone, in terms of controlling movement and crying during local anesthesia administration and restorative procedures. Conclusion: Compared to oral midazolam alone, a combination of oral midazolam and nitrous oxide inhalation sedation appears to provide more comfort to pediatric dental patients and operators during critical stages of dental treatment.

  20. Rectal premedication in pediatric anesthesia: midazolam versus ketamine

    Directory of Open Access Journals (Sweden)

    Moshirian N

    2008-06-01

    Full Text Available Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale. Results: Neither medication showed acceptable sedation (>75%, with no significant difference in sedation score between the two groups (P=0.725. Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively. Ease of parental separation was seen in both groups without significant difference (P=0.288 and no major adverse effects, such as apnea, occurred in either group.Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.

  1. Development of midazolam sublingual tablets: in vitro study.

    Science.gov (United States)

    Odou, P; Barthelemy, C; Robert, H

    1998-01-01

    Midazolam is a benzodiazepine with short elimination half-life, used as induction or continuous agent for general anesthesia. At present, only injectable solution is available from French hospital pharmacies. The aim of the study is the development of 5 mg midazolam sublingual tablets to realize a short general anesthesia without intravenous or intramuscular injection. Incorporation of citric acid in the tablet formulation leads to an increase of dissolution rates of active drug, but a decrease of diffusion through lipid membranes is observed with 10 mg of citric acid when using the Dibbern's Resomat three phases apparatus. One explanation of this result is that midazolam (pKa = 6.1) in presence of 10 mg of citric acid is ionised. The ionised form, more hydrophilic, cannot cross the artificial lipid membrane and therefore the diffusion decreases. On the other hand, the decrease of diffusion's rate, when pH increases, is explained by the precipitation of midazolam at pH higher than 6. A compromise between dissolution and diffusion results leads us to choose the sublingual formulation containing 5 mg of citric acid per tablet.

  2. The effect of intrathecal midazolam on the characteristics of ...

    African Journals Online (AJOL)

    Objectives: The present study was undertaken to determine the onset of sensory block, the time to achieve the maximum level of sensory block and the analgesic efficacy of intrathecal midazolam when given in combination with bupivacaine, and also to observe any undesirable side-effects produced by the ...

  3. Efficacy of intrathecal midazolam versus fentanyl for endoscopic

    African Journals Online (AJOL)

    intrathecal midazolam versus fentanyl as an adjunct to bupivacaine for endoscopic urology surgery. Methods: Sixty adult ASA grade I–II patients undergoing transurethral resection of prostate or bladder tumor under spinal block. Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of ...

  4. Toediening van intraveneuze sedatie met midazolam door tandarts is onveilig

    NARCIS (Netherlands)

    Broers, D L M; Plat, J; de Jongh, A; Zuidgeest, T G M; Blom, H C C M; Kraaijenhagen, A E; Pieterse, C M; Bildt, M M

    2015-01-01

    In the December issue of the Nederlands Tijdschrift voor Tandheelkunde (Dutch Journal of Dentistry) in 2014, an article was devoted to the use of light sedation with midazolam by dentists. A number of dentists who are active in the area of Special Dentistry (anxiety management, care of the disabled)

  5. Farmacovigilancia de la sertralina en pacientes cubanos con episodio de depresión mayor

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    Leslie Pérez Ruiz

    2011-03-01

    Full Text Available En la depresión predominan síntomas como: desinterés, fatiga, sentimientos de inutilidad, desconcentración, deseos de muerte e insomnio. Entre los medicamentos para tratarla se encuentra la sertralina. Con el objetivo de evaluar su seguridad, se revisaron 40 historias clínicas y cuadernos de recogida de datos de los pacientes incluidos en ensayo clínico fase III, aletatorizado, controlado y a doble ciegas: "Uso de sertralina en pacientes con episodio de depresión mayor", pertenecientes al Hospital "Dr. Gustavo Aldereguía Lima". Se obtuvieron datos demográficos, clínicos y eventos adversos, con los cuales se realizó un estudio descriptivo, observacional y transversal que clasifica como un estudio de utilización de medicamentos sobre consecuencias prácticas. La información fue analizada mediante SPSS, versión 13.0 para Windows. De los 40 pacientes incluidos, 24 presentaron eventos adversos para un 60 %; de ellos, 16 (67 % en el grupo tratado con sertralina y 8 (33 % en los tratados con placebo. Los eventos adversos más frecuentes fueron: disminución de peso, sequedad bucal, cefalea, diarreas y náuseas. En su mayoría resultaron de intensidad ligera, causalidad probable y sin necesidad de tratamiento. El uso del fármaco se consideró seguro en el tratamiento de estos pacientes.

  6. Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy.

    Science.gov (United States)

    Brouillette, D E; Leventhal, R; Kumar, S; Berman, D; Kajani, M; Yoo, Y K; Carra, J; Tarter, R; Van Thiel, D H

    1989-08-01

    This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy (EGD) and colonoscopy. Subjects were assessed for their degree of analgesia and amnesia for the procedure, prior experience with endoscopy, and willingness to undergo another similar procedure should such be necessary. The patients were randomized single blind to receive either midazolam or diazepam for their preprocedure sedation. The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech. Prior to receiving either agent, the subjects were shown a standard card containing pictures of 10 common objects, were asked to name and remember them, and were told they would be "quizzed" (at 30 min and 24 hr) after being sedated for their recollection as to the objects pictured on the card. Each subject filled out a questionnaire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure. Sixty-three percent of the midazolam-sedated subjects reported total amnesia for their colonoscopy vs 20% of diazepam-sedated patients (P less than 0.001). Fifty-three percent of midazolam-sedated patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23% of diazepam-sedated subjects (P less than 0.05). The midazolam-sedated subjects reported experiencing less pain with both upper gastrointestinal endoscopy (P less than 0.05) and colonoscopy (P less than 0.001) than did the diazepam-sedated group. Most importantly, the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Effects of midazolam on cerebral blood flow in human volunteers

    International Nuclear Information System (INIS)

    Forster, A.; Juge, O.; Morel, D.

    1982-01-01

    The effects of intravenously administered midazolam on cerebral blood flow were evaluated in eight healthy volunteers using the 133 Xe inhalation technique. Six minutes after an intravenous dose of 0.15 mg/kg midazolam, the cerebral blood flow decreased significantly (P less than 0.001) from a value of 40.6 +/- 3.3 to a value of 27.0 +/- 5.0 ml . 100 g-1 . min-1. Cerebrovascular resistance (CVR) increased from 2.8 +/- 0.2 to 3.9 to 0.6 mmHg/(ml . 100 g-1 . min-1)(P less than 0.001). Mean arterial blood pressure decreased significantly (P less than 0.05) from 117 +/- 8 to 109 +/- 9 mmHg and arterial carbon dioxide tension increased from 33.9 +/- 2.3 to 38.6 +/- 3.2 mmHg (P less than 0.05). Arterial oxygen tension remained stable throughout the study, 484 +/- 95 mmHg before the administration of midazolam and 453 +/- 76 mmHg after. All the subjects slept after the injection of the drug and had anterograde amnesia of 24.5 +/- 5 min. The decrease in mean arterial blood pressure was probably not important since it remained in the physiologic range for cerebral blood flow autoregulation. The increase in arterial carbon dioxide tension observed after the midazolam injection may have partially counteracted the effect of this new benzodiazepine on cerebral blood flow. Our data suggest that midazolam might be a safe agent to use for the induction of anethesia in neurosurgical patients with intracranial hypertension

  8. Midazolam inhibits chondrogenesis via peripheral benzodiazepine receptor in human mesenchymal stem cells.

    Science.gov (United States)

    Chen, Yung-Ching; Wu, King-Chuen; Huang, Bu-Miin; So, Edmund Cheung; Wang, Yang-Kao

    2018-05-01

    Midazolam, a benzodiazepine derivative, is widely used for sedation and surgery. However, previous studies have demonstrated that Midazolam is associated with increased risks of congenital malformations, such as dwarfism, when used during early pregnancy. Recent studies have also demonstrated that Midazolam suppresses osteogenesis of mesenchymal stem cells (MSCs). Given that hypertrophic chondrocytes can differentiate into osteoblast and osteocytes and contribute to endochondral bone formation, the effect of Midazolam on chondrogenesis remains unclear. In this study, we applied a human MSC line, the KP cell, to serve as an in vitro model to study the effect of Midazolam on chondrogenesis. We first successfully established an in vitro chondrogenic model in a micromass culture or a 2D high-density culture performed with TGF-β-driven chondrogenic induction medium. Treatment of the Midazolam dose-dependently inhibited chondrogenesis, examined using Alcian blue-stained glycosaminoglycans and the expression of chondrogenic markers, such as SOX9 and type II collagen. Inhibition of Midazolam by peripheral benzodiazepine receptor (PBR) antagonist PK11195 or small interfering RNA rescued the inhibitory effects of Midazolam on chondrogenesis. In addition, Midazolam suppressed transforming growth factor-β-induced Smad3 phosphorylation, and this inhibitory effect could be rescued using PBR antagonist PK11195. This study provides a possible explanation for Midazolam-induced congenital malformations of the musculoskeletal system through PBR. © 2018 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  9. Comparison Of Oral Premedication With Combination Of Midazolam With Ketamine Vs Midazolam Ketamine Alone In Children Children Medical Center (year 2000

    Directory of Open Access Journals (Sweden)

    Hasani M

    2002-09-01

    Full Text Available Anxiolysis and sedation with oral midazolam are common practice in pediatric anesthesia. Good or excellent results are seen in only 50% to 80% of cases, so we decided to investigate if addition of a low dose of oral ketamine to midazolam (ketamine2.5 mg /kg ^midazolam 0.25 mg/kg resulted in better premedication compared with oral midazolam 0.5 mg/kg or ketamine 6 mg/kg alone."nMethods and Materials: in a prospective, randomized ,double -blind study we study 105 children (mean age 6 ,range 2-10 yr. undergoing non thoracic and non cardiac surgery of more than 30 min duration. The patients were in ASA 1, 2. After oral premedication the child's condition was evaluated by assigning 1-4 point to the quality of anxiolysis, sedation, and separation from parents in the induction room .The groups were similar in sex, age, weight, intervention and duration of anaesthesia."nResults: The score of sedation before transfer to the operation room was significantly better in the ketamine, midazolam combination group than in the ketamine or midazolam group. Success rates for anxiolysis and behavior at separation were grater than 90%with the combination, approximately 80% with midazolam and 70% with ketamine alone .The incidence of salivation, excitation, nausea and vomiting was grater in the ketamine group but were very low in other groups. During recovery there were no difference in sedation or time of possible discharge."nConclusion: In summery, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children than with midazolam or ketamine alone. Duration of action and side effects of the combination was similar to those of midazolam.

  10. Pharmacokinetic evaluation of novel midazolam gel formulations following buccal administration to healthy dogs.

    Science.gov (United States)

    Aldawsari, Mohammed F; Lau, Vivian W; Babu, Ramapuram J; Arnold, Robert D; Platt, Simon R

    2018-01-01

    OBJECTIVE To determine the physiochemical properties and pharmacokinetics of 3 midazolam gel formulations following buccal administration to dogs. ANIMALS 5 healthy adult hounds. PROCEDURES In phase 1 of a 2-phase study, 2 gel formulations were developed that contained 1% midazolam in a poloxamer 407 (P1) or hydroxypropyl methylcellulose (H1) base and underwent rheological and in vitro release analyses. Each formulation was buccally administered to 5 dogs such that 0.3 mg of midazolam/kg was delivered. Each dog also received midazolam hydrochloride (0.3 mg/kg, IV). There was a 3-day interval between treatments. Blood samples were collected immediately before and at predetermined times for 8 hours after drug administration for determination of plasma midazolam concentration and pharmacokinetic analysis. During phase 2, a gel containing 2% midazolam in a hydroxypropyl methylcellulose base (H2) was developed on the basis of phase 1 results. That gel was buccally administered such that midazolam doses of 0.3 and 0.6 mg/kg were delivered. Each dog also received midazolam (0.3 mg/kg, IV). All posttreatment procedures were the same as those for phase 1. RESULTS The H1 and H2 formulations had lower viscosity, greater bioavailability, and peak plasma midazolam concentrations that were approximately 2-fold as high, compared with those for the P1 formulation. The mean peak plasma midazolam concentration for the H2 formulation was 187.0 and 106.3 ng/mL when the midazolam dose administered was 0.6 and 0.3 mg/kg, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that buccal administration of gel formulations might be a viable alternative for midazolam administration to dogs.

  11. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    OpenAIRE

    Yen-Hsuan Hsu; Feng-Sheng Lin; Chi-Cheng Yang; Chih-Peng Lin; Mau-Sun Hua; Wei-Zen Sun

    2015-01-01

    Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. Methods: We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of ...

  12. Effect of midazolam on memory: a study of process dissociation procedure and functional magnetic resonance imaging.

    Science.gov (United States)

    Tian, S Y; Zou, L; Quan, X; Zhang, Y; Xue, F S; Ye, T H

    2010-06-01

    To assess the effects of midazolam on explicit and implicit memories, 12 volunteers were randomly divided into the two groups: one with an Observer's Assessment of Alertness/Sedation score of 3 (mild sedation) and one with a score of 1 (deep sedation). Blood oxygen-level-dependent functional magnetic resonance imaging was measured before and during an auditory stimulus, then with midazolam sedation, and then during a second auditory stimulus with continuous midazolam sedation. After 4 h, explicit and implicit memories were assessed. There was no evidence of explicit memory at the two levels of midazolam sedation. Implicit memory was retained at a mild level of midazolam sedation but absent at a deep level of midazolam sedation. At a mild level of midazolam sedation, activation of all brain areas by auditory stimulus (as measured by functional magnetic resonance imaging) was uninhibited. However, a deep level of midazolam sedation depressed activation of the superior temporal gyrus by auditory stimulus. We conclude that midazolam does not abolish implicit memory at a mild sedation level, but can abolish both explicit and implicit memories at a deep sedation level. The superior temporal gyrus may be one of the target areas.

  13. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial

    OpenAIRE

    Katayoun Salem; Shaqayegh Kamranzadeh; Maryam Kousha; Shahnaz Shaeghi; Fatemeh AbdollahGorgi

    2015-01-01

    Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF))” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and e...

  14. Midazolam intranasal para la sedación preanestésica pediátrica

    Directory of Open Access Journals (Sweden)

    Joaquín L. de la Lastra Rodríguez

    1995-12-01

    Full Text Available El ingreso hospitalario y un tratamiento quirúrgico pueden crear en los niños temor, ansiedad y trastornos emocionales al abandonar la atmósfera de seguridad y confianza del hogar y estar en el ambiente desconocido del hospital. La medicación preanestésica logra la reducción de la ansiedad y disminuye su respuesta. En el presente trabajo se utilizó con este fin el midazolam al 0,5 % (dormicum en dosis de 0,2 a 0,3 mg por kg de peso corporal administrado por vía intranasal, con la finalidad de observar las ventajas de este método en 30 niños menores de 5 años de edad. Se logró una sedación rápida y de corta duración y no se observó ninguna complicación.

  15. Effects of midazolam and morphine on cerebral oxygenation and hemodynamics in ventilated premature infants.

    NARCIS (Netherlands)

    Velden, A.A.E.M. van der; Hopman, J.C.W.; Klaessens, J.H.G.M.; Feuth, A.B.; Sengers, R.C.A.; Liem, K.D.

    2006-01-01

    BACKGROUND: Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. OBJECTIVES: To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. METHODS: 11 patients (GA 26.6-33.0 weeks, BW

  16. Effect of midazolam on memory during fiberoptic gastroscopy under conscious sedation.

    Science.gov (United States)

    Hong, Yun Jeong; Jang, Eun Hye; Hwang, Jihye; Roh, Jee Hoon; Kwon, Miseon; Lee, Don; Lee, Jae-Hong

    2015-01-01

    As the fiberoptic gastroscopy using midazolam is being in widespread use, the exact nature of midazolam on memory should be clarified. We intended to examine whether midazolam causes selective anterograde amnesia and what impact it has on other aspects of memory and general cognitive function. We recruited healthy subjects undergoing fiberoptic gastroscopy under conscious sedation. At baseline, history taking for retrograde amnesia and the Korean version of the Montreal Cognitive Assessment were performed. A man's name and address were given immediately after intravenous midazolam administration. After gastroscopy, the subjects were asked to recall those items. By the time they had fully recovered consciousness, the same test was repeated along with the Korean version of the Montreal Cognitive Assessment and a test for retrograde amnesia. A total of 30 subjects were enrolled in this study. Subjects with high-dose midazolam showed lower scores in the immediate and delayed recall of "a man's name and address" compared with those with low-dose midazolam. The midazolam dose was inversely correlated with the delayed recall scores of "a man's name and address." On full recovery of consciousness, the subjects did not exhibit any of anterograde or retrograde amnesia. These findings suggest that midazolam causes transient selective anterograde amnesia in a dose-dependent manner.

  17. Study of Preinduction Sedation with Intranasal Midazolam in Children

    Directory of Open Access Journals (Sweden)

    A. Rostaminejad

    2010-04-01

    Full Text Available Introduction & Objectives: Surgical procedures are the most stressful expreiences in life, specially in children. Different methods are used before operation to decrease the stress. Intranasal midazolam is an effective way of preparing before operation and to prevent the separation irritability.Materials & Methods: In a double blind experimental trial study , 60 patients aged 2-6 years with ASAI who had no elective surgery in the past were randomly chosen and divided into two groups.For the patients in group I intranasal midazolam 0.2 mg/kg was administerated and for the patients in group II the equal volume of normal saline was used. The patients’ crying was considered as mild, moderate, and severe. The irritability of their hands shaking during IV canula insertion,consciousness before the induction of anesthesia and cooperation during the mask ventilation were also evaluated.Results: The result of our study determined that 93.3% of the children in group I didn’t cry or they did mildly when separated from their parents but 90% of the children of group II cried moderately and some severely and 90% of the patients in group I cooperated well when separated from their parents. The resistance in group II was moderate or severe in 76.6%. Before induction of anesthesia 73.4% of group I were asleep but woke up with stimulation. 93.3% of the patients in group II were awake and irritated.90% of group I shook their hands steadily during iv cannula insertion but their hands shaking increased in 83.3% of group II..100% of group I cooperated well during face mask ventilation but 76.6% of group II did not. Conclusion: The above mentioned experiences showed that the intranasal midazolam is an effective way of preinduction sedation in children.

  18. Disruption of cortical integration during midazolam-induced light sedation.

    Science.gov (United States)

    Liang, Peipeng; Zhang, Han; Xu, Yachao; Jia, Wenbin; Zang, Yufeng; Li, Kuncheng

    2015-11-01

    This work examines the effect of midazolam-induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double-blind, placebo-controlled, cross-over, within-subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting-state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower-level functional networks and higher-order functions related ones. Independent component analysis (ICA) was used to identify these resting-state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam-induced light sedation while the higher-order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower-level networks was maintained, while that of the higher-level networks was significantly disrupted by light sedation. The within-network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher-order cognitive functions including memory, attention, executive function, and language were impaired prior to lower-level sensory responses during sedation. Our result also lends support to the information integration model of consciousness. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

  19. Cardiovascular effects of midazolam in levomepromazine premedicated dogs

    Directory of Open Access Journals (Sweden)

    Gladys Bastos de Castro

    1992-12-01

    Full Text Available Experiments were performed on ten mongrel dogs with 10-18 kg body weight. They received levomepromazine 1.0 mg/kg body weight, I.V. as premedication, and 15 minutes later, midazolam was given in dosage of 2.0 mg/kg body weight intravenously. The result showed moderat increase on respiratory rate and decrease heart rate after 15 minutes and increase heart rate after 30 minutes. Mean and sistolic arterial pressure decreased significantly (p<0.05 but without clinical importance, remained in the physiologic range. Hipnosis duration was less than 20 minutes and at 30 minutes the dogs awaked and they tried to walk.

  20. Stability of midazolam in syrspend SF and syrspend SF cherry.

    Science.gov (United States)

    Geiger, Christine M; Sorenson, Bridget; Whaley, Paul A

    2013-01-01

    Midazolam is a short-acting benzodiazepine central nervous system depressant available as an injection, tablet, or oral syrup. The need for alternative dosage form options for patients unable to take tablets and shortages of other forms of the drug have led compounding pharmacies to seek alternatives, mainly solutions and suspensions. Additionally, some patients are unable to use suspending agents containing alcohol or sorbitol. The objective of this study was to determine the stability of midazolam in sorbitol-free, alcohol-free SyrSpend SF and SyrSpend SF Cherry suspending agents. The studied samples were compounded into a 1-mg/mL suspension and stored in low-actinic plastic bottles at temperatures between 2 degrees C to 8 degrees C and at room temperature conditions. Six samples were assayed at each time point out to 58 days by a stability-indicating high-performance liquid chromatography method. The method was validated for its specificity through forced-degradation studies. The samples remained within 90% to 110% of the initial concentration throughout the course of the study. Based on the data collected, the beyond-use date of these preparations is at least 58 days when protected from light at both refrigerated and room temperature storage conditions.

  1. COMPARISON OF INTRAMUSCULAR FENTANYL-MIDAZOLAM, FENTANYL-MIDAZOLAM-KETAMINE, AND KETAMINE-MEDETOMIDINE FOR IMMOBILIZATION OF JAPANESE MACAQUES ( MACACA FUSCATA).

    Science.gov (United States)

    Ølberg, Rolf-Arne; Sinclair, Melissa; Barker, Ian K; Crawshaw, Graham

    2018-03-01

    The combination of fentanyl and midazolam is commonly used as a sedative in humans. The objective of this study was to evaluate the sedative properties and physiological effects of fentanyl-midazolam and fentanyl-midazolam-ketamine compared with medetomidine-ketamine given intramuscularly in Japanese macaques ( Macaca fuscata). In a randomized crossover design, eight Japanese macaques were hand-injected with either 30 μg/kg fentanyl + 0.3 mg/kg midazolam (FM), 15 μg/kg fentanyl + 0.3 mg/kg midazolam + 5.0 mg/kg ketamine (FMK), or 0.05 mg/kg medetomidine + 5.0 mg/kg ketamine (MedK). Heart rate; indirect systolic, mean, and diastolic arterial pressure; respiratory rate; blood gas concentrations; rectal temperature; and duration of immobilization were recorded. Mixed linear models were used to evaluate the effects of drug treatment on all continuous variables, with a significance level of P < 0.05. Only three of seven animals receiving FM were successfully immobilized. All eight animals in both the FMK and MedK treatment groups had a rapid, smooth induction and were successfully immobilized. Both FMK and MedK treatments resulted in significant hypoxia and the animals required supplemental oxygen via face mask. The mean duration of FMK immobilization was 42 ± 10 min, significantly shorter than the 65 ± 14 min for the animals receiving MedK. Immobilization with MedK resulted in significantly lower heart rates, and significantly higher arterial pressure compared with FMK. Hypoventilation was significantly more pronounced in FMK-treated animals compared with MedK treatments. Immobilization with FMK resulted in a gradual, slow recovery whereas MedK-treated animals woke up more rapidly. Fentanyl-midazolam alone is not a useful sedative in Japanese macaques. A combination of fentanyl and midazolam with ketamine can be used as an alternative to medetomidine-ketamine in this species.

  2. Dexmedetomidine, ketamine, and midazolam for oral rehabilitation: a case report.

    Science.gov (United States)

    Kim, Bill W S; Peskin, Robert M

    2015-01-01

    Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.

  3. Phenobarbital and midazolam increase neonatal seizure-associated neuronal injury.

    Science.gov (United States)

    Torolira, Daniel; Suchomelova, Lucie; Wasterlain, Claude G; Niquet, Jerome

    2017-07-01

    Status epilepticus is common in neonates and infants, and is associated with neuronal injury and adverse developmental outcomes. γ-Aminobutyric acidergic (GABAergic) drugs, the standard treatment for neonatal seizures, can have excitatory effects in the neonatal brain, which may worsen the seizures and their effects. Using a recently developed model of status epilepticus in postnatal day 7 rat pups that results in widespread neuronal injury, we found that the GABA A agonists phenobarbital and midazolam significantly increased status epilepticus-associated neuronal injury in various brain regions. Our results suggest that more research is needed into the possible deleterious effects of GABAergic drugs on neonatal seizures and on excitotoxic neuronal injury in the immature brain. Ann Neurol 2017;82:115-120. © 2017 American Neurological Association.

  4. Voltammetric behavior of sedative drug midazolam at glassy carbon electrode in solubilized systems

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    Rajeev Jain

    2012-04-01

    Full Text Available Redox behavior of midazolam was studied at a glassy carbon electrode in various buffer systems, supporting electrolytes and pH using differential pulse, square-wave and cyclic voltammetry. Based on its reduction behavior, a direct differential pulse voltammetric method has been developed and validated for the determination of midazolam in parenteral dosage. Three well-defined peaks were observed in 0.1% SLS, Britton–Robinson (BR buffer of pH 2.5. The effect of surfactants like sodium lauryl sulfate (SLS, cetyl trimethyl ammonium bromide (CTAB and Tween 20 was studied. Among these surfactants SLS showed significant enhancement in reduction peak. The cathodic peak currents were directly proportional to the concentration of midazolam with correlation coefficient of 0.99. Keywords: Midazolam, Voltammetry, Surfactant, Glassy carbon electrode, Parenteral dosage form

  5. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

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    Yen-Hsuan Hsu

    2015-06-01

    Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

  6. A Comparative Study between Intramuscular Midazolam and Oral Clonidine As A Premedication For General Anesthesia

    OpenAIRE

    Jignasa J Patel; Kalpana A Desai

    2015-01-01

    Background: Most anesthesiologists agree on the need for efficient pre-medication. The pattern of desired effects of a pre-medication is however, complex and includes relief of anxiety, sedation and relaxation of the patient. The present study was undertaken to compare the effects of Midazolam and clonidine as premedication. Methodology: A comparative study between midazolam and clonidine as a premedication for general anesthesia was conducted. Patients were divided in two groups: Group I: In...

  7. INTRANASAL DEXMEDETOMIDINE VS. INTRANASAL MIDAZOLAM FOR PREMEDICATION OF PAEDIATRIC SURGERY PATIENTS

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    Revi N

    2016-06-01

    Full Text Available AIM Preoperative anxiety is one of the most common problems faced by anyone practising paediatric anaesthesia. Various drugs have been used in various routes to get a calm but cooperative child before induction of anaesthesia. Midazolam and dexmedetomidine have already proved their value in paediatric premedication. This study was conducted to compare the effects of these two drugs given intranasally. MATERIALS AND METHODS 100 children falling under the inclusion criteria were assigned to groups of 50 each. They received either intranasal midazolam 0.2 mg/kg (group M or intranasal dexmedetomidine 2 mcg/kg (Group D as premedication. They were compared with regards to the sedation status, anxiety levels and cardiovascular status every 10 minutes, at parental separation and at face mask application. RESULTS The mean sedation score obtained at all-time intervals, at parental separation and more importantly at mask induction were much lower for the midazolam group compared to the dexmedetomidine group. The mean anxiety levels, in general, were lower in the midazolam group, but they attained statistical significance only at 10 minutes and at mask induction. The heart rate measured up to 20 minutes after drug administration did not show much difference between both groups, but at 30 minutes, 40 minutes and at parental separation, heart rate was found to be lower in the dexmedetomidine group. CONCLUSION Intranasal dexmedetomidine and intranasal midazolam are equally effective in providing satisfactory parental separation, but intranasal midazolam produced superior conditions for mask acceptance than intranasal dexmedetomidine.

  8. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy.

    Science.gov (United States)

    Hsu, Yen-Hsuan; Lin, Feng-Sheng; Yang, Chi-Cheng; Lin, Chih-Peng; Hua, Mau-Sun; Sun, Wei-Zen

    2015-06-01

    Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state. Copyright © 2013. Published by Elsevier B.V.

  9. Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

    International Nuclear Information System (INIS)

    Stokland, E.; Jacobsson, B.; Ljung, B.; Andreasson, S.; Jodal, U.

    2003-01-01

    Background: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. Objective: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. Materials and methods: The study was prospective, randomized and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. Results: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group (P < 0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo (NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. Conclusions: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination. (orig.)

  10. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial

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    Katayoun Salem

    2015-01-01

    Full Text Available Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup.

  11. [No inhibition of intestinal motility following ketamine-midazolam anesthesia. A comparison of anesthesia with enflurane and fentanyl/midazolam].

    Science.gov (United States)

    Freye, E; Knüfermann, V

    1994-02-01

    Postoperative intestinal atonia is a complication which is likely to occur in patients predisposed for constipation and in patients after intra-abdominal operations. The postoperative delay of bowel movement, however, is often also related to the type of anaesthesia being used. In order to evaluate the magnitude of an anaesthetic-induced postoperative delay of bowel movement, two types of intravenous-based anaesthesia using fentanyl/midazolam (1 mg/25 mg; dosage 0.1 ml/kg/h), and ketamine/midazolam (250 mg/25 mg; dosage 0.1 ml/kg/h) respectively were compared with a volatile anaesthetic technique (enflurane; mean concentration 1.5 vol%). METHODS. In three groups of patients (each n = 15) undergoing elective surgery of the lower extremities, induction of anaesthesia was accomplished with methohexital (1-1.5 mg/kg) to facilitate intubation. For the maintenance of muscle relaxation vecuronium bromide was used. All patients were given droperidol to prevent postoperative emesis, and they were artificially ventilated with N2O/O2 (60:40) to normal end-expiratory CO2 concentrations. No anticholinergic agents were used at the end of operation since they are known to interfere with bowel motility. In order to determine gastro-intestinal motility, the H2 exhalation test was used. For this purpose 40 g lactulose in 100 ml of water was given to all patients via a gastral tube shortly before extubation. Lactulose is broken down by bacteria once it enters the colon, and H2 is released, taken up by the vascular system and exhaled. Postoperatively, patients were asked to exhale into a 20-ml syringe every 10 min. The content was analysed for hydrogen (ppm), using an electrochemical sensor (GMI exhaled hydrogen monitor). From the time of lactulose instillation to a threefold increase in end-expiratory hydrogen concentration (compared to the preoperative value), gastro-coecal transit time was computed. RESULTS. All three groups of patients were comparable in age, height and body

  12. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department.

    Science.gov (United States)

    Jamal, S M; Fathil, S M; Nidzwani, M M; Ismail, A K; Yatim, F M

    2011-08-01

    The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.

  13. Interaction between repeated restraint stress and concomitant midazolam administration on sweet food ingestion in rats

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    Silveira P.P.

    2000-01-01

    Full Text Available Emotional changes can influence feeding behavior. Previous studies have shown that chronically stressed animals present increased ingestion of sweet food, an effect reversed by a single dose of diazepam administered before testing the animals. The aim of the present study was to evaluate the response of animals chronically treated with midazolam and/or submitted to repeated restraint stress upon the ingestion of sweet food. Male adult Wistar rats were divided into two groups: controls and exposed to restraint 1 h/day, 5 days/week for 40 days. Both groups were subdivided into two other groups treated or not with midazolam (0.06 mg/ml in their drinking water during the 40-day treatment. The animals were placed in a lighted area in the presence of 10 pellets of sweet food (Froot loops®. The number of ingested pellets was measured during a period of 3 min, in the presence or absence of fasting. The group chronically treated with midazolam alone presented increased ingestion when compared to control animals (control group: 2.0 ± 0.44 pellets and midazolam group: 3.60 ± 0.57 pellets. The group submitted to restraint stress presented an increased ingestion compared to controls (control group: 2.0 ± 0.44 pellets and stressed group: 4.18 ± 0.58 pellets. Chronically administered midazolam reduced the ingestion in stressed animals (stressed/water group: 4.18 ± 0.58 pellets; stressed/midazolam group: 3.2 ± 0.49 pellets. Thus, repeated stress increases appetite for sweet food independently of hunger and chronic administration of midazolam can decrease this behavioral effect.

  14. Dreaming in sedation during spinal anesthesia: a comparison of propofol and midazolam infusion.

    Science.gov (United States)

    Kim, Duk-Kyung; Joo, Young; Sung, Tae-Yun; Kim, Sung-Yun; Shin, Hwa-Yong

    2011-05-01

    Although sedation is often performed during spinal anesthesia, the details of intraoperative dreaming have not been reported. We designed this prospective study to compare 2 different IV sedation protocols (propofol and midazolam infusion) with respect to dreaming during sedation. Two hundred twenty adult patients were randomly assigned to 2 groups and received IV infusion of propofol or midazolam for deep sedation during spinal anesthesia. Patients were interviewed on emergence and 30 minutes later to determine the incidence, content, and nature of their dreams. Postoperatively, patient satisfaction with the sedation was also evaluated. Two hundred fifteen patients (108 and 107 in the propofol and midazolam groups, respectively) were included in the final analysis. The proportion of dreamers was 39.8% (43/108) in the propofol group and 12.1% (13/107) in the midazolam group (odds ratio=4.78; 95% confidence interval: 2.38 to 9.60). Dreams of the patients receiving propofol were more memorable and visually vivid than were those of the patients receiving midazolam infusion. The majority of dreams (36 of 56 dreamers, 64.3%) were simple, pleasant ruminations about everyday life. A similarly high level of satisfaction with the sedation was observed in both groups. In cases of spinal anesthesia with deep sedation, dreaming was almost 5 times more common in patients receiving propofol infusion than in those receiving midazolam, although this did not influence satisfaction with the sedation. Thus, one does not need to consider intraoperative dreaming when choosing propofol or midazolam as a sedative drug in patients undergoing spinal anesthesia. © 2011 International Anesthesia Research Society

  15. Administration of midazolam in infancy does not affect learning and memory of adult mice.

    Science.gov (United States)

    Xu, Hua; Liu, Zhi-Qiang; Liu, Yi; Zhang, Wei-Shi; Xu, Bo; Xiong, Yuan-Chang; Deng, Xiao-Ming

    2009-12-01

    1. Midazolam is a common fast-acting GABA(A) receptor agonist. Recent data suggest that exposure to midazolam in early life may cause long-term effects on brain function through stable epigenetic reprogramming. The aim of the present study was to determine whether the administration of midazolam to infant mice would affect their learning and memory in adulthood. 2. An open-field test was conducted before and then 3, 24, 48 and 72 h after administration of midazolam (50 mg/kg, i.p.) to infant mice. Saline control mice received an equal volume of saline i.p. 3 h before the open-field test. Total movements, total movement time, total movement distance and velocity were analysed. Novel object recognition (NOR), Morris water-maze and passive avoidance tests were performed when the treated mice grew to adulthood (105 days of age). 3. The results of open-field test showed that midazolam significantly reduced locomotor activity (total movements, total movement time, total movement distance and velocity) in infant mice 3 and 24 h after drug administration and that these effects had disappeared by 72 h after drug administration. The results of the water-maze, NOR and passive avoidance tests in adulthood (at 105 days of age) indicated that administration of midazolam in infancy had no long-term effects on the learning and memory behaviours of adult mice compared with the saline control. 4. Acute midazolam administration to infant mice affected spontaneous locomotor activity for approximately 2 days, but did not seem to have any significant impact on cognitive functioning that lasted into adulthood.

  16. Epileptic manifestations induced by midazolam in the neonatal period Manifestações epilépticas induzidas por midazolam no período neonatal

    Directory of Open Access Journals (Sweden)

    Maria Augusta Montenegro

    2001-06-01

    Full Text Available Antiepileptic drugs may cause worsening of epilepsy by aggravating pre-existing seizures or by triggering new seizure types. There are several reports of adverse effects related to midazolam, but only a few authors reported epileptic manifestations. We report four newborns seen at the Neonatal Intensive Care Unit of our University Hospital, who developed seizures a few seconds after the administration of midazolam. It is difficult to identify the patients at risk, but it is important to be aware and recognize this situation.Drogas antiepilépticas podem piorar o controle da epilepsia por agravar crises epilépticas pre-existentes ou por desencadear novos tipos de crises. Existem vários relatos de eventos adversos relacionados ao midazolam; entretanto, poucos autores referem manifestações epilépticas. Neste estudo relatamos a ocorrência de crises epilépticas poucos segundos após a administração de midazolam, em quatro neonatos atendidos na Unidade de Terapia Intensiva do nosso hospital universitário. É difícil determinar quais pacientes estão em risco, mas é importante estar atento e reconhecer esta situação.

  17. Prophylactic antiemetic effects of midazolam, dexamethasone, and its combination after middle ear surgery

    International Nuclear Information System (INIS)

    Makhdoom, Naeem K; Farid, Magdy F

    2009-01-01

    To evaluate and compare the efficacy of the combination of midazolam and dexamethasone, with midazolam and dexamethasone alone, for the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing middle ear surgery. A prospective, randomized, double-blind, placebo-controlled study in 80 female patients (mean age 32.6 years), undergoing middle ear surgery with general anesthesia at Ohud Hospital, Madina, Kingdom of Saudi Arabia from May 2007 to May 2008. Patients were classified into 4 groups. They received intravenous normal saline (S group), midazolam 0.075 mg/kg (M group), or dexamethasone 10 mg (D group), or a combination of midazolam and dexamethasone (MD group), before the induction of anesthesia. Postoperatively for 24 hours observation and assessment of nausea, vomiting, rescue anti-emetics, and side effects of the study drugs such as headache and drowsiness were carried out. There was a significant difference between the 4 groups. The MD group was the least to develop PONV compared to other groups (p<0.01). Regarding nausea, there was a non-significant difference between the 4 groups, although the MD group developed the least symptoms among the 4 groups, there were no significant differences in pain intensity and side effects such as, headache, dizziness, and drowsiness between the 4 groups. The combination of midazolam 0.075 mg/kg and dexamethasone 10 mg intravenously is better than either drug alone in reducing the incidence of PONV in female patients after middle ear surgery. (author)

  18. Conscious sedation by oral administration of midazolam in paediatric dental treatment.

    Science.gov (United States)

    Erlandsson, A L; Bäckman, B; Stenström, A; Stecksén-Blicks, C

    2001-01-01

    Midazolam is a short-acting benzodiazepine with rapid onset, short duration of action and minimal side effects. The aim of this study was to evaluate the oral administration of midazolam as pre-operative sedation in the dental treatment of uncooperative pediatric patients. Included in the study were 160 children with a mean age of 6.7 +/- 2.6 years (1-14 years), 83 boys and 77 girls. All the patients had been referred for specialist treatment due to behavioral management problems. Treatment was performed in 250 sessions. All the children received an oral dose of 0.2 mg/kg body weight of midazolam. Acceptance of treatment was evaluated according to Rud & Kisling. Local anesthesia followed by restorative treatment and/or extractions constituted more than 90% of the performed treatments. Of the 250 sessions, 63% were performed with total acceptance and 30% with doubtful acceptance. In 7%, no treatment could be performed. No serious complications were registered during or after treatment. All the children were able to leave the clinic one hour after treatment. In conclusion, we consider oral administration of midazolam a safe form of premedication. The route of administration, the short waiting-time and half-life, in combination with a level of sedation that allows treatment to be performed, are the principal advantages of conscious sedation with orally administered midazolam.

  19. The effects of concurrent atorvastatin therapy on the pharmacokinetics of intravenous midazolam.

    LENUS (Irish Health Repository)

    Mc Donnell, C G

    2012-02-03

    Midazolam is a commonly used anaesthetic agent and is metabolised by the 3A4 isoform of the cytochrome P450 enzyme system. Atorvastatin is also metabolised by cytochrome P450 3A4 and, in vitro, atorvastatin inhibits the cytochrome P450 3A4-mediated metabolism of mexazolam. We hypothesised that concurrent administration of atorvastatin and midazolam would result in altered midazolam pharmacokinetics. Fourteen patients scheduled to undergo general anaesthesia for elective surgery were recruited in a matched pair design to receive intravenous midazolam (0.15 mg.kg-1). Of these patients, seven were taking long-term atorvastatin. Atorvastatin patients demonstrated a greater area under the curve (889.4 (standard deviation 388.6) ng-h.ml-1) vs. control patients (629.1 (standard deviation 197.2) ng-h.ml-1) (p < 0.05). Patients taking atorvastatin also demonstrated a decreased clearance (0.18 (standard deviation 0.08) l-kg. h-1) vs. control patients (0.27 (standard deviation 0.08) l-kg.h-1) (p < 0.05). This study suggests that chronically administered atorvastatin decreases the clearance of intravenously administered midazolam.

  20. The use of temazepam elixir in surgical dental sedation: a comparison with intravenous midazolam.

    Science.gov (United States)

    Skelly, A M; Girdler, N M; File, S E

    1992-02-22

    Out-patients attending for removal of at least one lower third molar were randomly allocated to treatment with temazepam elixir (n = 7) or intravenous midazolam (n = 8), as well as local analgesia. Patients were tested prior to drug administration and at the end of surgery. Both drugs increased heart rate and midazolam also decreased diastolic blood pressure. The two drugs caused significant, equal increases in ratings of sedation, but the reduction of anxiety was significant only for midazolam. There was significant amnesia for material presented after drug administration, as well as for dental events and this was significantly greater for midazolam. The effects of these drugs in dental patients were compared with those in normal volunteers treated in an identical manner, but without oral surgery. The drugs had similar significant cardiovascular and amnesic effects in the volunteers and the same effects on mood ratings, even though volunteers and patients differed in their pretreatment levels of anxiety and discontent. The dentist's ratings of the sedation and operating conditions were excellent in both cases. Thus temazepam elixir provided a useful sedative for oral surgery, avoiding the complications of intravenous administration. However, for equivalent levels of sedation, midazolam had greater anxiolytic and amnesic effects than temazepam.

  1. Effects of midazolam on explicit vs implicit memory in a pediatric surgery setting.

    Science.gov (United States)

    Stewart, Sherry H; Buffett-Jerrott, Susan E; Finley, G Allen; Wright, Kristi D; Valois Gomez, Teresa

    2006-11-01

    Placebo-controlled studies show that midazolam impairs explicit memory in children undergoing surgery (Buffett-Jerrott et al., Psychopharmacology 168:377-386, 2003; Kain et al., Anesthesiology 93:676-684, 2000). A recent within-subjects study showed that midazolam impaired explicit memory while leaving implicit memory intact in a sample of older children undergoing painful medical procedures (Pringle et al., Health Psychol 22:263-269, 2003). We attempted to replicate and extend these findings in a randomized, placebo-controlled design with younger children undergoing surgery. Children aged 3-6 years who were undergoing ear tube (myringotomy) surgery were randomly assigned to receive midazolam (n = 12) or placebo (n = 11). After surgery, they were tested on explicit (recognition) and implicit (priming) memory for pictures encoded before surgery. Relative to placebo, the midazolam-treated children showed poorer recognition memory on the explicit task but equivalent priming on the implicit task. Overall, it appears that midazolam induces a dissociation between explicit and implicit memory in young children in the pediatric surgery setting. Theoretical and clinical implications of the findings are discussed along with directions for future research.

  2. Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

    Energy Technology Data Exchange (ETDEWEB)

    Tschirch, Frank T.C.; Goepfert, Kerstin; Brunner, Genevieve; Weishaupt, Dominik [University Hospital Zuerich, Institute of Diagnostic Radiology, Zuerich (Switzerland); Froehlich, Johannes M. [Klus-Apotheke, Zuerich (Switzerland)

    2007-06-15

    The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (p<0.001). Low-dose intranasal midazolam is an effective and patient-friendly solution to overcome anxiety in claustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form. (orig.)

  3. [Sedation with intravenous midazolam during upper gastrointestinal endoscopy--changes in hemodynamics, oxygen saturation and memory].

    Science.gov (United States)

    Mizuno, Ju; Matsuki, Michiko; Gouda, Yoshinori; Nishiyama, Tomoki; Hanaoka, Kazuo

    2003-09-01

    Cardiorespiratory adverse effects are often observed in patients undergoing upper gastrointestinal endoscopy with sedation. In this study, we examined hemodynamics, oxygen saturation and memory during upper gastrointestinal endoscopy under sedation with intravenous midazolam. Eight healthy outpatients without any obvious complications received intravenous midazolam 5 mg for sedation for upper gastrointestinal endoscopy. Blood pressure, heart rate and percutaneous arterial oxygen saturation (SpO2) were measured before, during and after endoscopy. After the arousal by intravenous flumazenil, we inquired the patients about the level of memory during the endoscopy. Blood pressure decreased significantly two minutes after midazolam administration, but increased significantly after the insertion of an endoscope which was not different from the control value. Heart rate increased significantly one and three minutes after the insertion of the endoscope. SpO2 decreased significantly after midazolam administration and stayed at around 95%. No patients remembered the procedure. Sedation with intravenous midazolam during upper gastrointestinal endoscopy is useful to control the cardiovascular responses, and to obtain amnesia. However, a decrease in SpO2 should be watched carefully.

  4. Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients

    Directory of Open Access Journals (Sweden)

    Chandni Sinha

    2012-01-01

    Full Text Available Background: To compare oral midazolam (0.5 mg/kg with oral butorphanol (0.2 mg/kg as a premedication in 60 pediatric patients with regards to sedation, anxiolysis, rescue analgesic requirement, and recovery profile. Materials and Methods: In a double blinded study design, 60 pediatric patients belonging to ASA class I and II between the age group of 2-12 years scheduled for elective surgery were randomized to receive either oral midazolam (group I or oral butorphanol (group II 30 min before induction of anesthesia. The children were evaluated for levels of sedation and anxiety at the time of separation from the parents, venepuncture, and at the time of facemask application for induction of anesthesia. Rescue analgesic requirement, postoperative recovery, and complications were also recorded. Results: Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents. Midazolam proved to be a better anxiolytic during venepuncture and facemask application. Butorphanol reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea, vomiting, or unpleasant postoperative recovery. Conclusion: Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties. It does not increase side effects significantly.

  5. Efficacy of midazolam as oral premedication in children in comparison to triclofos sodium

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    Kolathu Parambil Radhika

    2016-01-01

    Full Text Available Background and Aims: The perioperative behavioural studies demonstrate that children are at greater risk of experiencing turbulent anaesthetic induction and adverse behavioural sequelae. We aimed to compare the efficacy of midazolam 0.5 mg/kg with triclofos sodium 100 mg/kg as oral premedication in children undergoing elective surgery. Methods: In this prospective, randomised and double-blind study, sixty children posted for elective lower abdominal surgery were enrolled. The patients were randomly divided into midazolam group (Group M and triclofos sodium group (Group T of thirty each. Group M received oral midazolam 0.5 mg/kg 30 min before induction, and Group T received oral triclofos sodium 100 mg/kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. Mann–Whitney U-test was used for comparing the grade of sedation, ease of separation and acceptance of face mask. Results: Oral midazolam produced adequate sedation in children after premedication in comparison to oral triclofos (P = 0.002. Both drugs produced successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. Conclusions: Oral midazolam is superior to triclofos sodium as a sedative anxiolytic in paediatric population.

  6. A comparison of midazolam and clonidine as an oral premedication in pediatric patients

    Directory of Open Access Journals (Sweden)

    Sequeira Trevor

    2012-01-01

    Full Text Available Background: To compare oral midazolam (0.5 mg/kg versus oral clonidine (4 μg/kg as a premedication in pediatric patients aged between 2-12 years with regard to sedation and anxiolysis. Methods: Sixty pediatric patients belonging to the American Society of Anesthesiologists class I and II between the age group of 2-12 years scheduled for elective surgery were randomly allocated to receive either oral midazolam (group I 30 min before induction or oral clonidine (group II 90 min before induction of anesthesia. The children were evaluated for levels of sedation and anxiety at the time of separation from the parents, venepuncture, and at the time of mask application for induction of anesthesia. Results: After premedication, the percentage of children who were sedated and calm increased in both the groups. The overall level of sedation was better in the children in the clonidine group, but children in the midazolam group had a greater degree of anxiolysis at times of venepuncture and mask application. In addition, midazolam did not cause significant changes in hemodynamics unlike clonidine where a significant fall in blood pressure was noted, after premedication, but preinduction. Conclusion: We conclude that under the conditions of the study, oral midazolam is superior to clonidine as an anxiolytic in pediatric population. Clonidine with its sedative action especially at the time of separation from parents along with its other perioperative benefits cannot be discounted.

  7. Studies on thiopentone and midazolam hemodynamic response during induction of anesthesia in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    mohammad Sofiabadi

    2005-08-01

    Conclusions: Hemodynamic effects of midazolam is similar to thiopentone. Midazolam is a water-soluble, safe and effective inductive anesthetic with short- term effects, much lesser venous irritation, and it can be used instead of thiopentone in patients with cardiac diseases or those patients which thiopentone is contraindicated for whom.

  8. The effects of Andrographis paniculata (Burm.f. Nees on the pharmacokinetics and pharmacodynamics of midazolam in healthy volunteers

    Directory of Open Access Journals (Sweden)

    Malinee Wongnawa

    2012-11-01

    Full Text Available Andrographis paniculata (Burm.f. Nees has been widely used for centuries in Asia for the treatment of common coldand diarrhea. Although it was previously reported to inhibit cytochrome P450 in vitro, the potential to cause herb-druginteraction has been questioned. The purpose of this study was to evaluate the effects of A. paniculata on the pharmacokineticsand pharmacodynamics of midazolam, a CYP3A4 probe drug, in normal healthy volunteers. The study was anopen-label, randomized, 2-phase crossover design with a 2-weeks washout period. Twelve healthy male volunteers received4 capsules of 250 mg A. paniculata 3 times a day orally for 7 days. Midazolam plasma concentration time profiles werecharacterized after a single oral dose of 7.5 mg midazolam on the day before and after A. paniculata medication. Pharmacodynamicsof midazolam were also evaluated. The results demonstrated that pretreatment with A. paniculata did not changemean pharmacokinetic parameters (Cmax, Tmax, AUC0-12, AUC0-”, T1/2, Cl/F of oral midazolam. Since midazolam is the mostsensitive substrate for CYP3A4, thus, herb-drug interaction caused by CYP3A4 inhibition after A. paniculata in healthyvolunteers was considered not clinically relevant. However, A. paniculata potentiated the effect of midazolam in loweringblood pressure and pulse rate. Therefore, co-administration of A. paniculata with midazolam should be warranted.

  9. Sedation and physiologic response to manual restraint after intranasal administration of midazolam in Hispaniolan Amazon parrots (Amazona ventralis).

    Science.gov (United States)

    Mans, Christoph; Guzman, David Sanchez-Migallon; Lahner, Lesanna L; Paul-Murphy, Joanne; Sladky, Kurt K

    2012-09-01

    Administration of intranasal midazolam (2 mg/kg) was evaluated for sedation and effects on cloacal temperature, respiratory rate, and heart rate in manually restrained Hispaniolan Amazon parrots (Amazona ventralis). Adult parrots (n=9) were administered either midazolam (2 mg/kg) or an equal volume of saline solution intranasally before a 15-minute manual restraint in a complete crossover study. Respiratory rate and sedation scores were recorded before and during capture and during and after 15 minutes of manual restraint. Heart rate and cloacal temperature were recorded during manual restraint. After restraint, the parrots received intranasal flumazenil (0.05 mg/kg) or an equal volume of saline solution, and the recovery time was recorded. In those birds that received midazolam, sedation was observed within 3 minutes of administration, and vocalization, flight, and defense responses were significantly reduced during capture. During manual restraint, the mean rate of cloacal temperature increase was significantly slower and remained significantly lower in birds that received midazolam compared with controls. Mean respiratory rates were significantly lower for up to 12 minutes in parrots that received midazolam compared with those receiving saline solution. Flumazenil antagonized the effects of midazolam within 10 minutes. No overt clinical adverse effects to intranasal midazolam and flumazenil administration were observed. Further studies on the safety of intranasal midazolam and flumazenil in this species are warranted.

  10. Plasma concentrations of midazolam during continuous subcutaneous administration in palliative care.

    Science.gov (United States)

    Bleasel, M D; Peterson, G M; Dunne, P F

    1994-01-01

    We have investigated the steady-state plasma concentrations of midazolam during continuous subcutaneous administration in palliative care. Using a sensitive gas chromatography with electron capture detector assay, plasma concentrations of midazolam were measured in 11 patients (median age 68 years; range 47-82 years; six females) receiving the drug by continuous subcutaneous infusion (median rate 20 mg/day; range 10-60 mg/day). While not significant, the infusion rate tended to decrease with increasing age of the patient (Spearman's p = -0.51; p = 0.11). The steady-state plasma concentration range was 10-147 ng/ml, with a median of 30 ng/ml. Infusion rates and plasma concentrations of midazolam were correlated (Spearman's p = 0.71; p < 0.05). No other significant relationships were found between plasma concentrations and the variables of age, sex and liver function.

  11. Voltammetric behavior of sedative drug midazolam at glassy carbon electrode in solubilized systems.

    Science.gov (United States)

    Jain, Rajeev; Yadav, Rajeev Kumar

    2012-04-01

    Redox behavior of midazolam was studied at a glassy carbon electrode in various buffer systems, supporting electrolytes and pH using differential pulse, square-wave and cyclic voltammetry. Based on its reduction behavior, a direct differential pulse voltammetric method has been developed and validated for the determination of midazolam in parenteral dosage. Three well-defined peaks were observed in 0.1% SLS, Britton-Robinson (BR) buffer of pH 2.5. The effect of surfactants like sodium lauryl sulfate (SLS), cetyl trimethyl ammonium bromide (CTAB) and Tween 20 was studied. Among these surfactants SLS showed significant enhancement in reduction peak. The cathodic peak currents were directly proportional to the concentration of midazolam with correlation coefficient of 0.99.

  12. Midazolam administration at a department of pediatric radiology: Conscious sedation for diagnostic imaging studies

    International Nuclear Information System (INIS)

    Madzik, J.; Marcinski, A.; Brzewski, M.; Jakubowska, A.; Roik, D.; Majkowska, Z.; Biejat, A.; Krzemien, G.

    2006-01-01

    The aims of the study were to evaluate the usefulness of midazolam administration for sedation prior to some diagnostic examinations in children and to present the requirements and rules for sedation in departments of pediatric radiology. From Oct. 2001 to Aug. 2005, two hundred children were investigated after conscious sedation with midazolam. The examinations were: voiding cystourethrography (129), voiding sonocystography (64), barium enema (3), ultrasonography (1), urography (1), X-ray of facial bone (1), and brain CT (1). The children's age-range was 4 months to 13 years 9 months. The decision for sedation was based on conversation with the child and/or parents, their experience with previous examinations, emotional status of the child, and exclusion of contraindications (renal insufficiency, hepatic failure, respiratory/circulatory insufficiency, allergy to benzodiazepines in anamnesis). Midazolam was given orally in a dose of 0.5 mg/kg body weight, 15-20 minutes before examination (already at the department of pediatric radiology). The parents were informed of the possible side effects and what to do after the procedure. All diagnostic procedures with conscious sedation were well tolerated by the children and accepted by the parents. The parents with experience from previous diagnostic procedures indicated that they would want their child to have midazolam again if the examination needed to be repeated. No significant complications were observed in the children receiving midazolam and few adverse effect on voiding during cystourethrography. In three children (2.5, 3, and 5 years old), paradoxical reactions occurred (psychomotor agitation) which disappeared spontaneously after some minutes and had no influence on the procedure. Application of midazolam for conscious sedation diminished anxiety and discomfort from diagnostic procedures and short anterograde amnesia protected the child's mind from painful experience. Conscious sedation should be widely used in

  13. Reacciones adversas a medicamentos notificadas por pacientes del policlínico Gustavo Aldereguía

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    Adbel Abad Hechavarría Espinosa

    2014-12-01

    Full Text Available Las reacciones adversas a medicamentos son el resultado de una interacción entre el medicamento administrado y algunas características inherentes o adquiridas del paciente y que determinan el patrón individual de respuesta. Se realizó un estudio, donde se describen los principales resultados obtenidos en el sistema de la farmacovigilancia del policlínico “Dr. Gustavo Aldereguía Lima”, en el período comprendido entre enero y diciembre de 2012. Los casos se reportaron a través del modelo 33-36-1, para el reporte de sospecha de reacciones adversas a medicamentos. La muestra estuvo constituida por 242 pacientes notificados con reacciones adversas a medicamentos (RAM, obteniéndose como resultados más relevantes que el 67,3 % eran pacientes del sexo femenino; los meses de abril y mayo fueron los de mayor cantidad de reportes; el 90,9 % fueron reportados por médicos; los grupos farmacológicos que mayor incidencia tuvieron, en el orden siguiente, fueron los antibacterianos, los antihipertensivos y las vacunas; las reacciones más frecuentes fueron el eritema, la fiebre y el prurito, siendo la piel el órgano más reportado; el 30,1 % fueron importantes (según criterios para determinar RAM importantes, descritos en las normas y procedimientos de trabajo del sistema cubano de farmacovigilancia. Según la causalidad, el 95,4 % fueron probables y el 63,2 % frecuentes. El 19,0 % requirió atención de urgencia

  14. Intestinal first pass metabolism of midazolam in liver cirrhosis --effect of grapefruit juice

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Pedersen, Natalie; Larsen, Niels-Erik

    2002-01-01

    Grapefruit juice inhibits CYP3A4 in the intestinal wall leading to a reduced intestinal first pass metabolism and thereby an increased oral bioavailability of certain drugs. For example, it has been shown that the oral bioavailability of midazolam, a CYP3A4 substrate, increased by 52% in healthy...... subjects after ingestion of grapefruit juice. However, this interaction has not been studied in patients with impaired liver function. Accordingly, the effect of grapefruit juice on the AUC of midazolam and the metabolite alpha-hydroxymidazolam was studied in patients with cirrhosis of the liver....

  15. Voltammetric behavior of sedative drug midazolam at glassy carbon electrode in solubilized systems

    OpenAIRE

    Jain, Rajeev; Yadav, Rajeev Kumar

    2012-01-01

    Redox behavior of midazolam was studied at a glassy carbon electrode in various buffer systems, supporting electrolytes and pH using differential pulse, square-wave and cyclic voltammetry. Based on its reduction behavior, a direct differential pulse voltammetric method has been developed and validated for the determination of midazolam in parenteral dosage. Three well-defined peaks were observed in 0.1% SLS, BrittonâRobinson (BR) buffer of pH 2.5. The effect of surfactants like sodium lauryl ...

  16. Voltammetric behavior of sedative drug midazolam at glassy carbon electrode in solubilized systems

    OpenAIRE

    Jain, Rajeev; Yadav, Rajeev Kumar

    2011-01-01

    Redox behavior of midazolam was studied at a glassy carbon electrode in various buffer systems, supporting electrolytes and pH using differential pulse, square-wave and cyclic voltammetry. Based on its reduction behavior, a direct differential pulse voltammetric method has been developed and validated for the determination of midazolam in parenteral dosage. Three well-defined peaks were observed in 0.1% SLS, Britton–Robinson (BR) buffer of pH 2.5. The effect of surfactants like sodium lauryl ...

  17. Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics

    OpenAIRE

    Bicudo, J.n. [UNIFESP; Souza, N. de [UNIFESP; Mângia, C.m.f. [UNIFESP; Carvalho, Werther Brunow de [UNIFESP

    1999-01-01

    PURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU) in fentanyl use and midazolam METHODS: Evaluation of 36 children interned in PICU of the Hospital São Paulo - Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem) who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determi...

  18. [Examination of the optimal midazolam dose required for loss of puncture memory at the time of spinal anesthesia].

    Science.gov (United States)

    Boku, Aiji; Koyama, Shinichi; Kishimoto, Naotaka; Nakatani, Keiji; Kurita, Satoshi; Nagata, Noboru; Niwa, Hitoshi

    2011-08-01

    We examined midazolam ED50 according to age that was necessary for loss of puncture memory at the time of spinal anesthesia and determined whether we could estimate the presence of puncture memory from the degree of sedation after midazolam administration. We enrolled patients with ASA PS 1 or 2 and patients from 50 to 80 years of age who had been planned for surgery with spinal anesthesia. We divided the patients into groups according to their age--50s, 60s, and 70s as L, M, and H groups, respectively. We evaluated the degree of sedation with six phases of scores after intravenous administration of midazolam and spinal anesthesia was performed. The midazolam dose was based on the ups and downs method. The midazolam ED50s required for the loss of puncture memory in groups L, M, and H were 0.043, 0.035, and 0.026 mg x kg(-1), respectively. We estimated the association between the sedation degree score after midazolam administration and the puncture memory from ROC curve, but AUC was 0.56 for all cases. The midazolam ED50 required for the loss of puncture memory decreased with age but it was difficult to estimate puncture memory from the degree of sedation.

  19. Intra-operative Patient-Controlled Sedation (PCS:Propofol versus Midazolam Supplementation During Epidural Analgesia (Clinical and Hormonal Study

    Directory of Open Access Journals (Sweden)

    Hassan S Al-khayat

    2008-01-01

    Full Text Available This study was done on sixty adult males scheduled to have an epidural analgesia for elective inguinal hernia repair. The study was designed to compare propofol and midazolam with regard to their suitability for the patient-controlled sedation (PCS technique during epidural analgesia. Patients were divided into three equal groups and premedicated with 0.2mg.kg -1 oral midazolam. Group I (G1 served as control. Using PCS technique, the pump was programmed to deliver on demand a bolus dose of 0.5 mg.kg- 1 of propofol in Group II (G2 or 0.1mg.kg -1 midazolam in Group III(G3. Patient′s sedation status was assessed by sedation score, comfort scale and by psychometric testing. The total delivered dose of each tested drug was calculated. Serum concentrations of propfol and midazolam, plasma cortisol and free fatty acids were measured. Propofol and midazolam PCS technique produced excellent and easily controllable sedation. The dose needed to produce steady state sedation was 2.8±1.42 and 0.11±0.6 mg.kg -1 .h- 1 for propofol and midazolam respectively. Propofol was more suitable than midazolam for PCS because of its rapid onset, favorable recovery profile and low side effects. PCS proved to be a stress-free and acceptable technique.

  20. A short-term high fat diet increases exposure to midazolam and omeprazole in healthy subjects

    NARCIS (Netherlands)

    Achterbergh, Roos; Lammers, Laureen A.; van Nierop, Samuel; Klümpen, Heinz-Josef; Soeters, Maarten R.; Mathôt, Ron A. A.; Romijn, Johannes A.

    2016-01-01

    Knowledge of factors contributing to variation in drug metabolism is of vital importance to optimize drug treatment. This study assesses the effects of a short-term hypercaloric high fat diet on metabolism of five oral drugs, which are each specific for a single P450 isoform: midazolam (CYP3A4),

  1. [Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial].

    Science.gov (United States)

    Linares Segovia, B; García Cuevas, M A; Ramírez Casillas, I L; Guerrero Romero, J F; Botello Buenrostro, I; Monroy Torres, R; Ramírez Gómez, X S

    2014-10-01

    Dexmedetomidine is a pharmacological option for sedation in children. In this study, the efficacy of intranasal dexmedetomidine to reduce preoperative anxiety in pediatric patients is compared with that of oral midazolam. A prospective, randomized, double-blind, controlled trial was conducted on children 2-12 years of age, randomly assigned to one of the following two groups: group A received premedication with oral midazolam and intranasal placebo, group B received intranasal dexmedetomidine and oral placebo. Anxiety was assessed with the modified Yale scale, and a risk analysis and number needed to treat was performed. A total of 108 patients were included, 52 (48.1%) treated with dexmedetomidine, and 56 (51.9%) with midazolam. Anxiety was less frequent in the dexmedetomidine group at 60minutes (P=.001), induction (p=.04), and recovery (P=.0001). Risk analysis showed that dexmedetomidine reduced the risk of anxiety by 28% (RAR=0.28, 95% CI; 0.12 to 0.43) and to prevent one case of anxiety, four patients need to be treated with intranasal dexmedetomidine (NNT=4, 95% CI: 3-9).Changes in heart rate, mean arterial pressure, and oxygen saturation, were statistically significant in the dexmedetomidine group, with no clinical consequences. There were no cases of bradycardia, hypotension or oxygen desaturation. Intranasal dexmedetomidine premedication is more effective than oral midazolam to reduce preoperative anxiety in pediatric patients. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  2. Hypoalbuminaemia and decreased midazolam clearance in terminally ill adult patients, an inflammatory effect?

    NARCIS (Netherlands)

    Franken, Linda G.; Masman, Anniek D.; de Winter, Brenda C. M.; Baar, Frans P. M.; Tibboel, Dick; van Gelder, Teun; Koch, Birgit C. P.; Mathot, Ron A. A.

    2017-01-01

    AimsMidazolam is the drug of choice for palliative sedation and is titrated to achieve the desired level of sedation. Because of large inter-individual variability (IIV), however, the time it takes to achieve adequate sedation varies widely. It would therefore greatly improve clinical care if an

  3. The effects of intrathecal midazolam on the duration of analgesia in ...

    African Journals Online (AJOL)

    This study was designed to evaluate the effect of 2 mg preservative-free intrathecal midazolam added to spinal bupivacaine during postoperative analgesia, and the incidence of adverse effects, if any, in patients undergoing knee arthroscopies. Method: Fifty consenting American Society of Anesthesiologists (ASA) physical ...

  4. Implicit transitive inference and the human hippocampus: does intravenous midazolam function as a reversible hippocampal lesion?

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    Greene Anthony J

    2007-09-01

    Full Text Available Abstract Recent advances have led to an understanding that the hippocampus is involved more broadly than explicit or declarative memory alone. Tasks which involve the acquisition of complex associations involve the hippocampus whether the learning is explicit or implicit. One hippocampal-dependent implicit task is transitive inference (TI. Recently it was suggested that implicit transitive inference does not depend upon the hippocampus (Frank, M. J., O'Reilly, R. C., & Curran, T. 2006. When memory fails, intuition reigns: midazolam enhances implicit inference in humans. Psychological Science, 17, 700–707. The authors demonstrated that intravenous midazolam, which is thought to inactivate the hippocampus, may enhance TI performance. Three critical assumptions are required but not met: 1 that deactivations of other regions could not account for the effect 2 that intravenous midazolam does indeed deactivate the hippocampus and 3 that midazolam influences explicit but not implicit memory. Each of these assumptions is seriously flawed. Consequently, the suggestion that implicit TI does not depend upon the hippocampus is unfounded.

  5. Effect of methamphetamine on the pharmacokinetics of dextromethorphan and midazolam in rats.

    Science.gov (United States)

    Dostalek, M; Hadasova, E; Hanesova, M; Pistovcakova, J; Sulcova, A; Jurica, J; Tomandl, J; Linhart, I

    2005-01-01

    Methamphetamine is the fourth most frequently reported compound associated with drug abuse on admission of patients to treatment centres after cocaine, heroin and marijuana. It is metabolized in the organism with a reaction that is catalyzed by cytochrome P450, mainly by the CYP2D and CYP3A subfamily, 4-hydroxyamphetamine and amphetamine being dominant metabolites. The present pharmacokinetic study was undertaken to investigate the possible influence of methamphetamine (10 mg/kg, i.p., once daily for six days) on the pharmacokinetics of dextromethorphane as a model substrate for rat cytochrome P-4502D2 and midazolam as a model substrate for CYP3A1/2. Animals received a single injection of dextromethorphane (10 mg/kg) or midazolam (5 mg/kg) in the tail vein 24 h after the last dose of methamphetamine or administration of placebo. The results of pharmacokinetic analysis showed a significantly increased rate of dextrorphane and 3-hydroxymorphinan formation, and a marked stimulatory effect of methamphetamine on CYP2D2 metabolic activity. Similarly, the kinetics of midazolam's metabolic conversion to hydroxy derivates of midazolam indicated a significant increase in CYP3A1/2 activity. The results showed that the administration of methamphetamine significantly stimulated the metabolic activity of CYP2D2 as well as that of CYP3A1/2. With regard to the high level of homology between human and rat CYP isoforms studied, the results may have a clinical impact on future pharmacotherapy for methamphetamine abuse.

  6. Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Damle S

    2008-09-01

    Full Text Available The safe and effective treatment of uncooperative or combative preschool children with extensive dental needs is one of pediatric dentist′s ongoing challenges. The traditional methods of behavior management are no longer acceptable to parents as they are not ready to spare more time for dental treatment of their children. Keeping this in mind, the present study was designed and carried out to evaluate the sedative effects of oral ketamine and oral midazolam prior to general anesthesia. Twenty uncooperative children in the age-group of 2-6 years were selected after thorough medical examination and investigations. Informed consent was obtained from the parent. This was a randomized double-blind study. An anesthesiologist administered either 0.5 mg/kg midazolam or 5 mg/kg ketamine orally. The heart rate, respiratory rate, and oxygen saturation were recorded at regular intervals. The sedation and anxiolysis scores were also recorded. The parents were asked to answer a questionnaire at the follow-up session the next day on the surgical experience of the parent and the child and side effects experienced, if any. When the data was subjected to statistical analysis, it was observed that both drugs resulted in adequate sedation at the end of 30 min, with oral midazolam providing significantly better anxiolysis. The heart rate and respiratory rate were marginally higher with oral ketamine. The questionnaire revealed a better response with oral midazolam; side effects were more prominent with oral ketamine.

  7. Midazolam induces apoptosis in MA-10 mouse Leydig tumor cells through caspase activation and the involvement of MAPK signaling pathway

    Directory of Open Access Journals (Sweden)

    So EC

    2014-02-01

    Full Text Available Edmund Cheung So,1,2 Yu-Xuan Lin,3 Chi Hao Tseng,1 Bo-Syong Pan,3 Ka-Shun Cheng,2 Kar-Lok Wong,2 Lyh-Jyh Hao,4 Yang-Kao Wang,5 Bu-Miin Huang2 1Department of Anesthesia, Tainan Municipal An Nan Hospital, China Medical University, Tainan, Taiwan; 2Department of Anesthesia, China Medical University, Taichung, Taiwan; 3Department of Cell Biology and Anatomy, National Cheng Kung University, Tainan, Taiwan; 4Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Veteran General Hospital Tainan Branch Tainan, Taiwan; 5Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan Purpose: The present study aims to investigate how midazolam, a sedative drug for clinical use with cytotoxicity on neuronal and peripheral tissues, induced apoptosis in MA-10 mouse Leydig tumor cells. Methods: The apoptotic effect and underlying mechanism of midazolam to MA-10 cells were investigated by flow cytometry assay and Western blotting methods. Results: Data showed that midazolam induced the accumulation of the MA-10 cell population in the sub-G1 phase and a reduction in the G2/M phase in a time- and dose-dependent manner, suggesting an apoptotic phenomenon. Midazolam could also induce the activation of caspase-8, -9, and -3 and poly (ADP-ribose polymerase proteins. There were no changes in the levels of Bax and cytochrome-c, whereas Bid was significantly decreased after midazolam treatment. Moreover, midazolam decreased both pAkt and Akt expression. In addition, midazolam stimulated the phosphorylation of p38 and c-Jun NH2-terminal kinase but not extracellular signal-regulated kinase. Conclusion: Midazolam could induce MA-10 cell apoptosis through the activation of caspase cascade, the inhibition of pAkt pathway, and the induction of p38 and c-Jun NH2-terminal kinase pathways. Keywords: midazolam, apoptosis, MA-10 cell, caspase, Akt, MAPKs

  8. Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration.

    Science.gov (United States)

    Boku, Aiji; Inoue, Mika; Hanamoto, Hiroshi; Oyamaguchi, Aiko; Kudo, Chiho; Sugimura, Mitsutaka; Niwa, Hitoshi

    Intravenous sedation with propofol is often administered to anxious patients in dental practice. Pain on injection of propofol is a common adverse effect. This study aimed to determine the age-adjusted doses of midazolam required to erase memory of vascular pain of propofol administration and assess whether the Ramsay Sedation Scale (RSS) after the pretreatment of midazolam was useful to predict amnesia of the vascular pain of propofol administration. A total of 246 patients with dental phobia requiring dental treatment under intravenous sedation were included. Patients were classified according to their age: 30s, 40s, 50s, and 60s. Three minutes after administration of a predetermined dose of midazolam, propofol was infused continuously. After completion of the dental procedure, patients were interviewed about the memory of any pain or discomfort in the injection site or forearm. The dosage of midazolam was determined using the Dixon up-down method. The first patient was administered 0.03 mg/kg, and if memory of vascular pain remained, the dosage was increased by 0.01 mg/kg for the next patient, and then if the memory was erased, the dosage was decreased by 0.01 mg/kg. The effective dosage of midazolam in 95% of each age group for erasing the memory of propofol vascular pain (ED95) was determined using logistic analysis. The accuracy of RSS to predict the amnesia of injection pain was assessed by receiver operating characteristic (ROC) analysis. The ED95 of midazolam to erase the memory of propofol vascular pain was 0.061 mg/kg in patients in their 30s, 0.049 mg/kg in patients in their 40s, 0.033 mg/kg in patients in their 50s, and 0.033 mg/kg in patients in their 60s. The area under the ROC curve was 0.31. The ED95 of midazolam required to erase the memory of propofol vascular pain demonstrated a downward trend with age. On the other hand, it was impossible to predict the amnesia of propofol vascular pain using the RSS.

  9. Population pharmacodynamic modelling of midazolam induced sedation in terminally ill adult patients

    Science.gov (United States)

    de Winter, Brenda C. M.; Masman, Anniek D.; van Dijk, Monique; Baar, Frans P. M.; Tibboel, Dick; Koch, Birgit C. P.; van Gelder, Teun; Mathot, Ron A. A.

    2017-01-01

    Aims Midazolam is the drug of choice for palliative sedation and is titrated to achieve the desired level of sedation. A previous pharmacokinetic (PK) study showed that variability between patients could be partly explained by renal function and inflammatory status. The goal of this study was to combine this PK information with pharmacodynamic (PD) data, to evaluate the variability in response to midazolam and to find clinically relevant covariates that may predict PD response. Method A population PD analysis using nonlinear mixed effect models was performed with data from 43 terminally ill patients. PK profiles were predicted by a previously described PK model and depth of sedation was measured using the Ramsay sedation score. Patient and disease characteristics were evaluated as possible covariates. The final model was evaluated using a visual predictive check. Results The effect of midazolam on the sedation level was best described by a differential odds model including a baseline probability, Emax model and interindividual variability on the overall effect. The EC50 value was 68.7 μg l–1 for a Ramsay score of 3–5 and 117.1 μg l–1 for a Ramsay score of 6. Comedication with haloperidol was the only significant covariate. The visual predictive check of the final model showed good model predictability. Conclusion We were able to describe the clinical response to midazolam accurately. As expected, there was large variability in response to midazolam. The use of haloperidol was associated with a lower probability of sedation. This may be a result of confounding by indication, as haloperidol was used to treat delirium, and deliria has been linked to a more difficult sedation procedure. PMID:28960387

  10. Comparison of Preanesthetic Sedation after Intranasal Administration of Fentanyle, Ketamin and Midazolam

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    F Javaherforoosh

    2006-07-01

    Full Text Available Introduction & Objective: Induction of anesthesia in children can be a challenge for anesthetist. A stormy induction may increase the personality & behavioral changes. Therefore, it is desirable that they enter the operating room sedated. Many drugs are used for preanesthetic medication and there are many routes for administration. One route of administration is nasal mucous. In this study we compared the effect and side effect of three drugs (midazolam, ketamin and fentanyle after intra nasal administration. Materials & Methods: This is a double blind clinical trial. In this study we selected 60 patients (20 patients for every group A, B or C. We used 3 mg/kg ketamin or 3µg/kg fentanyle or 0.3 mg/kg midazolam by intranasal spray. After administration and in 5, 10 and 15 minutes, we observed the SPO2, PR and RR. After 15 min’s we separated children from parents and brought them to the operating room and controlled the acceptance of separation, depth of sedation with Ramsay score, acceptance of mask and tolerance of IV canulation. The data were then analyzed using K2 and kruskal-wallis test. Results: In our study we found that in SPO2 fentanyle had the highest rate of reduction even though none of the children had SPO2 lower than 90%. There were no differences between drugs in RR. In fentanyle group, we had the lowest rate and in ketamin group the highest rate. Midazolam had the medium rate. The rate of sedation for acceptance of separation from parents had no difference between the groups and all drugs with this dosage were effective for this aim. However, in Ramsay score, acceptance of mask and tolerance of IV canulation, the midazolam was more effective than the others. Conclusion: Intranasal administration of midazolam is a safe route for sedation in children in the pre-anesthetic time.

  11. Premedication with benzodiazepines for upper gastrointestinal endoscopy: Comparison between oral midazolam and sublingual alprazolam

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    Vahid Sebghatollahi

    2017-01-01

    Full Text Available Background: Premedication with orally administered benzodiazepines is effective in reducing anxiety and discomfort related to endoscopic procedures. We evaluated the efficacy and safety of oral midazolam in comparison to sublingual alprazolam as premedication for esophagogastroduodenoscopy (EGD. Materials and Methods: Adult candidates for diagnostic EGD received either oral midazolam (7.5 mg in 15 cc apple juice or sublingual alprazolam (0.5 mg 30 min before EGD. Procedural anxiety and pain/discomfort were assessed using 11-point numerical rating scales. Patients' overall tolerance (using a four-point Likert scale and willingness to repeat the EGD, if necessary, were also assessed. Blood pressure, heart rate, and arterial oxygen saturation were monitored from medication to 30 min after the procedure. Results: Patients experienced a similar reduction in procedural anxiety after medication with oral midazolam and sublingual alprazolam; mean (standard deviation [SD] of 1.86 [1.63] and 2.02 [1.99] points, respectively, P = 0.91. Compared to oral midazolam, pain/discomfort scores were lower with sublingual alprazolam; mean (SD of 4.80 (3.01 versus 3.68 (3.28, P = 0.024. There was no significant difference between the two groups in patients' tolerance, willingness to repeat the procedure, or hemodynamic events. Conclusion: Oral midazolam and sublingual alprazolam are equally effective in reducing EGD-related anxiety; however, EGD-related pain/discomfort is lower with alprazolam. Both benzodiazepines are equally safe and can be used as premedication for patients undergoing diagnostic EGD.

  12. Premedication with melatonin vs midazolam: efficacy on anxiety and compliance in paediatric surgical patients.

    Science.gov (United States)

    Impellizzeri, Pietro; Vinci, Enrica; Gugliandolo, Maria Cristina; Cuzzocrea, Francesca; Larcan, Rosalba; Russo, Tiziana; Gravina, Maria Rosaria; Arena, Salvatore; D'Angelo, Gabriella; Gitto, Eloisa; Montalto, Angela Simona; Alibrandi, Angela; Marseglia, Lucia; Romeo, Carmelo

    2017-07-01

    Preoperative anxiety is a major problem in paediatric surgical patients. Melatonin has been used as a premedicant agent and data regarding effectiveness are controversial. The primary outcome of this randomized clinical trial was to evaluate the effectiveness of oral melatonin premedication, in comparison to midazolam, in reducing preoperative anxiety in children undergoing elective surgery. As secondary outcome, compliance to intravenous induction anaesthesia was assessed. There were 80 children undergoing surgery randomly assigned, 40 per group, to receive oral midazolam (0.5 mg/kg, max 20 mg) or oral melatonin (0.5 mg/kg, max 20 mg). Trait anxiety of children and their mothers (State-Trait Anxiety Inventory) at admission, preoperative anxiety and during anaesthesia induction (Modified Yale Pre-operative Anxiety Scale), and children's compliance with anaesthesia induction (Induction Compliance Checklist) were all assessed. Children premedicated with melatonin and midazolam did not show significant differences in preoperative anxiety levels, either in the preoperative room or during anaesthesia induction. Moreover, compliance during anaesthesia induction was similar in both groups. This study adds new encouraging data, further supporting the potential use of melatonin premedication in reducing anxiety and improving compliance to induction of anaesthesia in children undergoing surgery. Nevertheless, further larger controlled clinical trials are needed to confirm the real effectiveness of melatonin as a premedicant agent in paediatric population. What is Known: • Although midazolam represents the preferred treatment as a premedication for children before induction of anaesthesia, it has several side effects. • Melatonin has been successfully used as a premedicant agent in adults, while data regarding effectiveness in children are controversial. What is New: • In this study, melatonin was as effective as midazolam in reducing children's anxiety in both

  13. Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine, and chlorpromazine for pediatric cardiac catheterization.

    Science.gov (United States)

    Auden, S M; Sobczyk, W L; Solinger, R E; Goldsmith, L J

    2000-02-01

    An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. We compared this IM combination to oral (PO) ketamine/midazolam in children having cardiac catheterization. A total of 51 children, ages 9 mo to 10 yr, were enrolled and randomized in this double-blinded study. All children received an IM injection at time zero and PO fluid 15 minutes later. We observed acceptance of medication, onset of sedation and sleep, and sedative efficacy. The cardiorespiratory changes were evaluated. Sedation was supplemented with IV propofol as required. Recovery time, parental satisfaction, and patient amnesia were assessed. Ketamine/midazolam given PO was better tolerated (P < 0.0005), had more rapid onset (P < 0.001), and provided superior sedation (P < 0.005). Respiratory rate decreased after IM DPT only. Heart rate and shortening fraction were stable. Oxygen saturation and mean blood pressure decreased minimally in both groups. Supplemental propofol was more frequently required (P < or = 0.02) and in larger doses (P < 0.05) after IM DPT. Parental satisfaction ratings were higher (P < 0.005) and amnesia was more reliably obtained (P = 0.007) with PO ketamine/midazolam. Two patients needed airway support after the PO medication, as did two other patients when PO ketamine/midazolam was supplemented with IV propofol. Although PO ketamine/midazolam provided superior sedation and amnesia compared to IM DPT, this regimen may require the supervision of an anesthesiologist for safe use. Oral medication can be superior to IM injections for sedating children with congenital heart disease; however, the safety of all medications remains an issue.

  14. Randomized Clinical Trial of Sedation With Oral Midazolam For Voiding Cystourethrography in Children

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    Haji Ghorbann Nooreddini

    2010-08-01

    Full Text Available Background:Voiding Cystourethrography (VCUG is a distressing procedure for children.Conscious sedation with any drug that its dose would not influences the procedure is preferred. The aim of this study was to assess the effectiveness of conscious sedation using oral midazolam in children undergoing VCUG.Methods: From November 2008 to October 2009 period, 93 Patients (68 girls and 25 boys, age ranging from 24 months to 11 years old (mean, 5.8 yearswere double blindly randomized to receive a placebo (water or oral midazolam before the examination. The primary outcome measures were patients' cooperation, facility of the procedure, 48 hours post procedure memory of children, bladder urine residue and detection of Vesocoureteral reflex. The data were analysed by SPSS and categorical variables compared using t-test and continuous variables compared using Chi. Square and Fisher’s exact tests.Results: 93 children were randomizly divided in two groups. In midazolam   group, 44(93.6% patients had good cooperation but in the control group 26(56.5%had bad cooperation and 19 patients (41.3% very bad cooperation (P=0.000. In midazolam group, 36 children (76.6% had easy separation from their parents but in   control group 20 children (43.5% had moderate resistant and 21(45.7% severe resistant. (P=0.000. Eighteen (38 % patients of the study group and twenty patients(43 % of control group had VUR respectively (P=0.65.   Conclusion:According to this study, midazolam is a useful sedation in children undergoing VCUG.  

  15. El Sistema Cubano de Farmacovigilancia: seis años de experiencia en la detección de efectos adversos The Cuban system of drug surveillance: six years of experience in detecting adverse effects

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    Giset Jiménez López

    2006-04-01

    Full Text Available El Centro para el Desarrollo de la Farmacoepidemiología cuenta entre sus principales líneas de trabajo con la investigación, docencia, información de medicamentos, consulta terapéutica, Programa para el Uso Racional de los Medicamentos (PURMED y la farmacovigilancia con su Unidad Nacional Coordinadora. El objetivo de este trabajo es exponer los principales resultados de trabajo en 6 años de creado este sistema de vigilancia. Se realizó un estudio descriptivo retrospectivo para caracterizar los reportes de sospechas de reacciones adversas recibidas en la Unidad Coordinadora Nacional de Farmacovigilancia. Se recibieron en este periodo un total de 89 540 notificaciones de reacciones adversas medicamentosas, lo que da un promedio 17 908 sospechas de notificación/año, y una tasa de reporte de más de 1 000 notificaciones por millón de habitantes. Con estos resultados queda identificado un comportamiento regular en algunos de estos indicadores, como es el predominio de efectos adversos en el sexo femenino, la afectación de la piel y el sistema digestivo entre las reacciones más reportadas y el predominio en todos los años de los antimicrobianos, antiinflamatorios no esteroideos y los antihipertensivos como grupos farmacológicos; de igual modo han aumentado las reacciones adversas de baja frecuencia de aparición y se han seguido los efectos adversos graves. La farmacovigilancia en el mundo sigue siendo una disciplina científica y clínica muy dinámica, la cual resulta imprescindible para afrontar los problemas que pueda plantear un arsenal de medicamentos que no deja de crecer en variedad y potencia. Por ello es tan necesario que, en cuanto surjan efectos adversos o toxicidad -sobre todo si aún no están descritos-, se notifique y analice el episodio y se comunique adecuadamente su importancia a los profesionales sanitariosThe Center for the Development of Pharmacological Epidemiology has several working lines such as research

  16. Evaluation of the safety and efficacy of a nursing-driven midazolam protocol for the management of procedural pain associated with burn injuries.

    Science.gov (United States)

    Bidwell, Katherine L; Miller, Sidney F; Coffey, Rebecca; Calvitti, Kristin; Porter, Kyle; Murphy, Claire V

    2013-01-01

    Burn pain is one of the most excruciating types of pain and can be difficult to manage. Benzodiazepines may be effective in reducing pain by minimizing anxiety associated with dressing changes. This study aimed to evaluate the safety and efficacy of adjunctive midazolam during dressing changes in patients with uncontrolled pain using opioid monotherapy or significant anxiety associated with dressing changes. A retrospective cohort analysis comparing patients who received midazolam during dressing changes with control patients was performed. Each midazolam patient was matched with up to two control patients who did not receive midazolam on the basis of age, sex, TBSA burned, and grafting requirement. The primary endpoint was the oral morphine equivalents required during admission after initiation of midazolam. Thirty-six patients were included for evaluation (14 midazolam and 22 control patients). Baseline characteristics were similar between the two groups, although patients in the midazolam group had higher pain scores and oral morphine equivalent requirements at baseline. When adjusted for baseline pain, day postburn, age, sex, and grafting status, total oral morphine equivalents and mean pain scores during admission were similar between the groups. One midazolam patient experienced oxygen desaturation with midazolam, but did not require flumazenil for reversal. The use of midazolam during burn dressing changes in patients with poorly controlled pain and/or anxiety was not associated with reduced requirements for oral morphine equivalents or lower pain scores during admission. Further research into the role of benzodiazepines in burn pain management is warranted.

  17. Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

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    Mahmoud Hassan Mohamed

    2014-01-01

    Conclusion: We concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.

  18. Changes to the bispectral index and regional cerebral blood flow in a sedative state, caused by midazolam administration

    OpenAIRE

    池田, 淳子; イケダ, ジュンコ; Junko, IKEDA

    2006-01-01

    Psychosedation, as used in the field of dentistry, is intended to provide trouble-free dental care while maintaining a proper level of sedation. One drug used in psychosedation is midazolam, which is known to have a strong amnestic effect. In the current research, I sought to clarify whether the bispectral index (BIS) using EEC analysis can be used for assessment of optimal sedation in psychosedation, and what effects midazolam has on the cerebrum's mechanism of memory. The subjects were 17 h...

  19. Effects of midazolam and morphine on cerebral oxygenation and hemodynamics in ventilated premature infants.

    Science.gov (United States)

    van Alfen-van der Velden, A A E M; Hopman, J C W; Klaessens, J H G M; Feuth, T; Sengers, R C A; Liem, K D

    2006-01-01

    Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. 11 patients (GA 26.6-33.0 weeks, BW 780-2,335 g) were sedated with midazolam (loading dose 0.2 mg/kg, maintenance 0.2 mg/kg/h) and 10 patients (GA 26.4-33.3 weeks, BW 842-1,955 g) were sedated with morphine (loading dose 0.05 mg/kg, maintenance 0.01 mg/kg/h). Changes in oxyhemoglobin (Delta cO2Hb) and deoxyhemoglobin (Delta cHHb) were assessed using near infrared spectrophotometry. Changes in cHbD (= Delta cO(2)Hb - Delta cHHb) reflect changes in cerebral blood oxygenation and changes in concentration of total hemoglobin (Delta ctHb = Delta cO2Hb + Delta cHHb) represent changes in cerebral blood volume (DeltaCBV). Changes in cerebral blood flow velocity (DeltaCBFV) were intermittently measured using Doppler ultrasound. Heart rate (HR), mean arterial blood pressure (MABP), arterial oxygen saturation (saO2) and transcutaneous measured pO2 (tcpO2) and pCO2 (tcpCO2) were continuously registered. Statistical analyses were carried out using linear mixed models to account for the longitudinal character study design. Within 15 min after the loading dose of midazolam, a decrease in saO2, tcpO2 and cHbD was observed in 5/11 infants. In addition, a fall in MABP and CBFV was observed 15 min after midazolam administration. Immediately after morphine infusion a decrease in saO2, tcpO2 and cHbD was observed in 6/10 infants. Furthermore, morphine infusion resulted in a persistent increase in CBV. Administration of midazolam and morphine in ventilated premature infants causes significant changes in cerebral oxygenation and hemodynamics, which might be harmful. Copyright 2006 S. Karger AG, Basel.

  20. Exacerbation of benign familial neonatal epilepsy induced by massive doses of phenobarbital and midazolam.

    Science.gov (United States)

    Maeda, Tomoki; Shimizu, Miki; Sekiguchi, Kazuhito; Ishii, Atsushi; Ihara, Yukiko; Hirose, Shinichi; Izumi, Tatsuro

    2014-08-01

    Barbiturates and benzodiazepines are the first-line anticonvulsants for neonatal seizures. However, in immature brains, those drugs may lead to paradoxical neuronal excitation. A patient with benign familial neonatal epilepsy developed epileptic encephalopathy after massive doses of phenobarbital that were followed by a continuous infusion of midazolam on postnatal day 3. Electroencephalography revealed rhythmic delta activity in clusters with migrating epileptic foci. After discontinuation of both drugs, the patient's consciousness promptly improved and her electroencephalography normalized on postnatal day 5. This baby developed persistent electroencephalographic seizures due to massive doses of phenobarbital and midazolam. Clinicians should be aware of this anticonvulsant-induced paradoxical neuronal excitation and the uncoupling phenomenon, especially in individuals with benign familial neonatal epilepsy, who have low seizure thresholds. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Discomfort during bronchoscopy performed after endobronchial intubation with fentanyl and midazolam: a prospective study.

    Science.gov (United States)

    Minami, Daisuke; Takigawa, Nagio; Kano, Hirohisa; Ninomiya, Takashi; Kubo, Toshio; Ichihara, Eiki; Ohashi, Kadoaki; Sato, Akiko; Hotta, Katsuyuki; Tabata, Masahiro; Tanimoto, Mitsune; Kiura, Katsuyuki

    2017-05-01

    Although endobronchial intubation during a bronchoscopic examination is useful for invasive procedures, it is not routine practice in Japan. The present study evaluated discomfort due to endobronchial intubation using fentanyl and midazolam sedation during bronchoscopy. Thirty-nine patients were enrolled prospectively from November 2014 to September 2015 at Okayama University Hospital. Fentanyl (20 µg) was administered to the patients just before endobronchial intubation, and fentanyl (10 µg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire survey was administered 2 h after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: excellent (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also asked. Predefined parameters (blood pressure, heart rate, oxygen saturation and complications) were recorded. The enrolled patients included 22 males and 17 females; their median age was 70 (range: 28-88) years. The patients received a mean dose of 47.9 µg of fentanyl (range: 30-90 µg) and 2.79 mg of midazolam (range: 1-7 mg). In total, 28 patients (71.7%) agreed to undergo a second bronchoscopic examination; the mean levels of discomfort and for the re-examination were 2.07 points each. About 41% of the patients remembered the bronchoscopic examination. No severe complications were reported. Endobronchial intubation using fentanyl and midazolam sedation during an invasive bronchoscopic procedure might be recommended. UMIN000015578 in the UMIN Clinical Trials Registry. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  2. Bronchoscopic diagnosis of peripheral pulmonary lung cancer employing sedation with fentanyl and midazolam.

    Science.gov (United States)

    Minami, Daisuke; Nakasuka, Takamasa; Ando, Chihiro; Iwamoto Md, Yoshitaka; Sato, Ken; Fujiwara, Keiichi; Shibayama, Takuo; Yonei Md PhD, Toshirou; Sato, Toshio

    2017-09-01

    Sedation with fentanyl and midazolam during bronchoscopic examination is commonly employed by pulmonary physicians in the USA and Europe. We assessed the efficacy of such sedation in the bronchoscopic diagnosis of peripheral lung cancer. We retrospectively evaluated data from 102 patients who underwent transbronchial biopsies (TBB) for diagnosis of peripheral lung cancer. Bronchoscopies with and without fentanyl were performed in 61 (group A) and 41 (group B) patients, respectively. Midazolam was administered to all patients. Medical records were retrieved, and between-group comparisons were made using unpaired Student's t-tests. The mean fentanyl dose was 49.5 μg (range: 10-100 μg), and midazolam doses in groups A and B were 4.29mg (range: 1-14mg) and 5.54mg (range: 1-12mg), respectively. Diagnostic histological specimens were obtained from 75.4% and 65.8% of group A and B patients, respectively (P = 0.30). The diagnostic sensitivities for lung cancer, via at least one of TBB, cytological brushing, or bronchial washing, in groups A and B were 88.5% and 70.4%, respectively (P = 0.035). Moreover, lesion diagnostic sensitivities, via at least one of TBB, cytological brushing, and bronchial washing, in groups A and B were 98.1% and 68.0%, respectively (P = 0.01). Fentanyl and midazolam sedation during bronchoscopy facilitated the diagnosis of peripheral pulmonary lung cancers. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  3. Acid-base status and cardiovascular function in mink (Mustela vison) anaesthetized with ketamine/midazolam.

    Science.gov (United States)

    Wamberg, S; Svendsen, P; Johansen, B

    1996-01-01

    Heart rate, arterial blood pressure and blood acid-base status were determined in 18 adult female mink (mean (+/- SEM) body weight 1052 +/- 34 g) during long-term anaesthesia with either controlled ventilation (n=12) or spontaneous respiration (n=6). Surgical anaesthesia was induced by intramuscular injection of ketamine hydrochloride (Ketaminol Vet, 40.0 +/- 1.7 mg/kg) and midazolam hydrochloride (Dormicum 2.8 +/- 0.1 mg/kg) and maintained for at least 5 h by continuous intravenous infusion of this drug combination in 0.9% saline. For all animals, the mean rates of infusion of ketamine and midazolam were 48.4 +/- 1.6 and 1.61 +/- 0.12 mg/h, respectively. Following continuous infusion of the anaesthetics in isotonic saline, at a rate of 20 ml/h, a moderate 'dilution acidosis' developed, which could be corrected by replacement of part of the saline with sodium bicarbonate to a final concentration of approximately 25 mmol NaHCO3 per litre. However, when the animals were allowed to breathe spontaneously, an increase in heart rate and a combined respiratory and metabolic acidosis occurred, due to severe respiratory depression. Apart from these effects and a few cases of increased salivation, no adverse effects over time were observed on the arterial blood acid-base status and cardiovascular function of the animals during ketamine/midazolam anaesthesia. It is concluded that the procedure described for long-term anaesthesia in mink is convenient and safe for acute physiological experiments in this species, provided normal body temperature and pulmonary gas exchange is sufficiently maintained. Thus, the need for an adequately controlled artificial ventilation is strongly emphasized. Finally, a proposal for the composition of an intravenous solution, containing ketamine and midazolam hydrochloride, and sodium bicarbonate in saline, suitable for long-term anaesthesia in adult mink is presented.

  4. Evaluation of 6 years use of sedation with midazolam for dental treatment

    DEFF Research Database (Denmark)

    Østergaard, Birthe; Haukali, Gro; Poulsen, Sven

      Abstract: Titel: Evaluering af seks års brug af midazolam til sedering ved tandbehandling. B. Høgsbro Østergaard 1,2 , G. Haukali 1,2, S. Poulsen 2 . 1 Tandplejen Århus, 2 Afd. for Samfundsodontologi og Pædodonti, Århus Tandlægeskole, Århus Universitet. Mål: At evaluere midazolamsedering til...

  5. Allosteric activation of cytochrome P450 3A4 by efavirenz facilitates midazolam binding.

    Science.gov (United States)

    Ichikawa, Tomohiko; Tsujino, Hirofumi; Miki, Takahiro; Kobayashi, Masaya; Matsubara, Chiaki; Miyata, Sara; Yamashita, Taku; Takeshita, Kohei; Yonezawa, Yasushige; Uno, Tadayuki

    2017-12-18

    1. The purpose of this study is to investigate the heteroactivation mechanism of CYP3A4 by efavirenz, which enhances metabolism of midazolam in vivo, in terms of its binding to CYP3A4 with in vitro spectroscopic methods. 2. Efavirenz exhibited a type II spectral change with binding to CYP3A4 indicating a possible inhibitor. Although dissociation constant (K d ) was approximated as 520 μM, efavirenz enhanced binding affinity of midazolam as a co-existing drug with an estimated iK d value of 5.6 µM which is comparable to a clinical concentration. 3. Efavirenz stimulated the formation of 1'-hydroxymidazolam, and the product formation rate (V max ) concentration-dependently increased without changing the K m . Besides, an efavirenz analogue, [6-chloro-1,4-dihydro-4-(1-pentynyl)-4-(trifluoromethyl)-2H-3,1-benzoxazin-2-one] (efavirenz impurity) slightly facilitated the binding affinity of midazolam in a concentration-dependent manner. These results propose that efavirenz affects midazolam-binding via binding to the peripheral site which is apart from the active site of CYP3A4. 4. A molecular dynamics simulation also suggested the bound-efavirenz was repositioned to effector-binding site. As a consequence, our spectroscopic studies clarified the heteroactivation of CYP3A4 caused by efavirenz with a proper affinity to the peripheral site, and we concluded the method can be a useful tool for characterising the potential for drug-drug interactions.

  6. Efficacy and safety of flumazenil injection for the reversal of midazolam sedation after elective outpatient endoscopy.

    Science.gov (United States)

    Lee, Sang Pyo; Sung, In-Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup

    2018-02-01

    Midazolam sedation during elective endoscopy is widely performed and flumazenil is frequently administered after endoscopy to reverse sedation in clinical practice. This study aimed to investigate the safety and efficacy of flumazenil injections after elective endoscopy under midazolam sedation. Participants who underwent an upper endoscopy under midazolam sedation were randomly divided into two groups. In group I, flumazenil was administered i.v. 10 min after the patient's transfer to the recovery room, and no antidote was injected in group II. The time of stay in the recovery room and adverse events were reviewed through the nursing records. We asked the patients about their pain and degree of satisfaction according to a visual analogue scale (VAS), their memory of the procedure, mental status and the presence of uncomfortable symptoms on the day of the procedure and the day afterwards. The length of stay in recovery was significantly shorter in group I than in group II. No significant differences were found in the number of patients with pain (VAS ≥1), adverse events and discomfort between the two groups. Additionally, there were no differences in the patients' memory of the procedure, satisfaction with sedation, willingness to repeat the endoscopy and mental status. The time in the recovery room after flumazenil administration was significantly shortened, and the use of the drug did not increase the risk of adverse events or discomfort. The use of flumazenil for reversing midazolam sedation seems to be safe and effective. © 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  7. Evaluation of Intranasal Midazolam as an Anesthetic Premedication in Preschool Children

    Directory of Open Access Journals (Sweden)

    Sh Behdad

    2005-10-01

    Full Text Available Introduction: Preoperative psycho emotional preparation of patients is one of the principle purposes of anesthesia which can be achieved by administration of premedications. Children should receive premedication before entering the operating room due to their dependence on parents and the fear and anxiety of separation from parents. Different drugs are administered for this purpose, but considering children's sensitivity, it is wise to use the most effective and comfortable medication with least side effects. Midazolam is a rapid onset, short acting and water soluble benzodiazapine which can be administered by oral, intravenous, intramuscular, rectal or intranasal routes. The purpose of this study was to evaluate the result of intranasal midazolam administration (0.2 mg/kg as a premedication in children aged 2-6 years.( Min dose and enough time Methods: In this randomized prospective study, 100 children aged between 2-6 years old in class ASA 1 and candidates of surgery were divided into two groups; case and control. The control group received several nasal drops of normal saline, while the case group received 0.2 mg/kg nasal midazolam 20 minutes before anesthesia induction. Results: Twenty minutes after administration of the nasal drops, 14% in the control group and 68% in the case group were alert and calm. (P value=0.0 . Mask acceptance during induction of anesthesia in control and case group was 14%and 72%, respectively (P value >0.00 The recovery time in the case group was longer (P value >0.5, but no complications (nausea, vomiting, respiratory and cardiovascular problems were seen in either group. Conclusion: Nasal midazolam with its anxiolytic, tranquilizing effects and no respiratory or cardiovascular complications is a safe drug and being better than parenteral drugs is acceptable by children.

  8. IS ATOMIZED INTRANASAL MIDAZOLAM A NOVEL SEDATIVE PREMEDICATION IN PAEDIATRIC PATIENTS?

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    Savitri D. Kabade

    2017-06-01

    Full Text Available BACKGROUND The successful conduct of anaesthesia in children depends on adequate premedication, which not only comforts the anxious child but also comforts the parents or guardians. Atomized Intranasal Midazolam is quickly absorbed through the nasal mucosa, resulting in a rapid and reliable onset of action. Clonidine has several applications in paediatric anaesthesia as a premedication and as an adjuvant in general as well as regional anaesthesia. Thus, in search of a novel premedication technique, we conducted a study to compare the effectiveness of atomized intranasal midazolam with intranasal clonidine for preoperative sedation in paediatric patients undergoing elective surgery. MATERIALS AND METHODS After obtaining Institutional Ethical Committee clearance and parent’s consent, a prospective, randomised, double-blinded clinical study was conducted in 78 children of ASA I and II, belonging to 2 - 10 years age, posted for various elective surgery. Group M (n= 39 received atomized intranasal midazolam (0.3 mg/kg and Group C (n= 39 received clonidine (4 mcg/kg instilled into both the nostrils. Sedation score (Ramsay, separation score, mask acceptance, recovery and vital parameters were recorded. Statistical analysis of data was done using IBM-SPSS version 21.0. RESULTS Mean sedation scores (± SD were higher in Group M than in Group C (at 5th minute 1.58 ± 0.55 in Group M and 1.15 ± 0.36 in Group C with P= 0.002, at 10th minute 2.34 ± 0.97 in Group M and 1.75 ± 0.71 in Group C with P= 0.008. Separation scores and mask acceptance were better with Group M than Group C. Haemodynamic parameters were similar in both the groups and no major adverse effects were noted. CONCLUSION Atomized intranasal midazolam produces superior sedation levels, child-parent separation and mask acceptance compared to intranasal clonidine in children.

  9. Anticonvulsant treatment of sarin-induced seizures with nasal midazolam: An electrographic, behavioral, and histological study in freely moving rats

    International Nuclear Information System (INIS)

    Gilat, E.; Kadar, T.; Levy, A.; Rabinovitz, I.; Cohen, G.; Kapon, Y.; Sahar, R.; Brandeis, R.

    2005-01-01

    Centrally mediated seizures and convulsions are common consequences of exposure to organophosphates (OPs). These seizures rapidly progress to status epilepticus (SE) and contribute to profound brain injury. Effective management of these seizures is critical for minimization of brain damage. Nasal application of midazolam (1.5 mg/kg) after 5 min of sarin-induced electrographic seizure activity (EGSA) ameliorated EGSA and convulsive behavior (238 ± 90 s). Identical treatment after 30 min was not sufficient to ameliorate ECoG paradoxical activity and convulsive behavior. Nasal midazolam (1.5 mg/kg), together with scopolamine (1 mg/kg, im) after 5 min of EGSA, exerted a powerful and rapid anticonvulsant effect (53 ± 10 s). Delaying the same treatment to 30 min of EGSA leads to attenuation of paroxysmal ECoG activity in all cases but total cessation of paroxysmal activity was not observed in most animals tested. Cognitive tests utilizing the Morris Water Maze demonstrated that nasal midazolam alone or together with scopolamine (im), administered after 5 min of convulsions, abolished the effect of sarin on learning. Both these treatments, when given after 30 min of convulsions, only decreased the sarin-induced learning impairments. Whereas rats which were not subject to the anticonvulsant agents did not show any memory for the platform location, both treatments (at 5 min as well as at 30 min) completely abolished the memory deficits. Both treatments equally blocked the impairment of reversal learning when given at 5 min. However, when administered after 30 min, midazolam alone reversed the impairments in reversal learning, while midazolam with scopolamine did not. Rats exposed to sarin and treated with the therapeutic regimen with the exclusion of midazolam exhibited severe brain lesions that encountered the hippocampus, pyriform cortex, and thalamus. Nasal midazolam at 5 min prevented brain damage, while delaying the midazolam treatment to 30 min of EGSA resulted in

  10. Anticonvulsant treatment of sarin-induced seizures with nasal midazolam: An electrographic, behavioral, and histological study in freely moving rats

    Energy Technology Data Exchange (ETDEWEB)

    Gilat, E [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Kadar, T [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Levy, A [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Rabinovitz, I [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Cohen, G [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Kapon, Y [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Sahar, R [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel); Brandeis, R [Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100 (Israel)

    2005-11-15

    Centrally mediated seizures and convulsions are common consequences of exposure to organophosphates (OPs). These seizures rapidly progress to status epilepticus (SE) and contribute to profound brain injury. Effective management of these seizures is critical for minimization of brain damage. Nasal application of midazolam (1.5 mg/kg) after 5 min of sarin-induced electrographic seizure activity (EGSA) ameliorated EGSA and convulsive behavior (238 {+-} 90 s). Identical treatment after 30 min was not sufficient to ameliorate ECoG paradoxical activity and convulsive behavior. Nasal midazolam (1.5 mg/kg), together with scopolamine (1 mg/kg, im) after 5 min of EGSA, exerted a powerful and rapid anticonvulsant effect (53 {+-} 10 s). Delaying the same treatment to 30 min of EGSA leads to attenuation of paroxysmal ECoG activity in all cases but total cessation of paroxysmal activity was not observed in most animals tested. Cognitive tests utilizing the Morris Water Maze demonstrated that nasal midazolam alone or together with scopolamine (im), administered after 5 min of convulsions, abolished the effect of sarin on learning. Both these treatments, when given after 30 min of convulsions, only decreased the sarin-induced learning impairments. Whereas rats which were not subject to the anticonvulsant agents did not show any memory for the platform location, both treatments (at 5 min as well as at 30 min) completely abolished the memory deficits. Both treatments equally blocked the impairment of reversal learning when given at 5 min. However, when administered after 30 min, midazolam alone reversed the impairments in reversal learning, while midazolam with scopolamine did not. Rats exposed to sarin and treated with the therapeutic regimen with the exclusion of midazolam exhibited severe brain lesions that encountered the hippocampus, pyriform cortex, and thalamus. Nasal midazolam at 5 min prevented brain damage, while delaying the midazolam treatment to 30 min of EGSA resulted

  11. The effect of auricular acupuncture on pain during colonoscopy with midazolam and pethidine

    Science.gov (United States)

    Kusumastuti, R.; Srilestari, A.; Abdurrohim, K.; Abdullah, M.

    2017-08-01

    Colonoscopy is the standard procedure for colorectal cancer screening. One of its common complications is abdominal pain. Analgesia has not provided favorable outcomes so various complementary practices have been developed, including auricular acupuncture. In this study, a randomized controlled trial of 56 patients who underwent colonoscopy was conducted to determine the effect of acupuncture on the pain experienced during colonoscopy. Subjects were divided into two groups: The first received acupuncture combined with midazolam and pethidine, while the second were administered placebo puncture in addition to midazolam and pethidine. The median Critical Care Pain Observation Tool (CPOT) score was lower in the auricular acupuncture group than in the placebo puncture group(0.7 [0-4.83] vs. 1.9 [0-6.20] p = 0.010), while there were no significant differences to median Visual Analog Scale (VAS) scores (29 [0-100] vs. 44.5 [0-100] p = 0.147), heart rate changes (-2.58 [14.31] vs.-2.43 [12.28]; p = 0.970), or the mean time to the cecum (16 [8-51] vs. 22 [5-63] p = 0.206). Auricular acupuncture combined with midazolam and pethidine was found to be effective at reducing pain during colonoscopy.

  12. Effects of Propofol and Midazolam on Newborns’ Apgar Scores and Mothers’ Hemodynamic under Spinal Anesthesia

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    Navid Kalani

    2016-05-01

    Full Text Available At present, cesarean section is the most prevalent surgical procedure in women and the anesthesia performed for it has turned into a selective technique. This study compared the effects of midazolam and propofol on newborns’ Apgar scores and on the hemodynamic status of the mothers undergoing cesarean sections. This research, in the form of a double-blind clinical trial, was carried out on forty-two15 - 35 year-old of class ASAI and II pregnant women who underwent cesarean section. Using the simple random method, they were divided into two groups of equal members: 21 in the Propofol and 21 in the midazolam groups. The newborns’ Apgar scores were recorded 1 and 5 minutes after birth and the mothers’ hemodynamic status 3, 5, 10, 15, 30, 60 minutes into the surgical procedure. The data was analyzed using SPSS, the repeated measurement test, and the independent t-test. One and five minutes after birth, there were no significant differences between the newborns’ Apgar scores in the two groups (p=0.08, or between the two groups (p=0.33. Results showed there were no statistically significant differences between the Apgar scores of the newborns at low doses of midazolam and propofol.

  13. Midazolam conscious sedation in a large Danish municipal dental service for children and adolescents.

    Science.gov (United States)

    Uldum, Birgitte; Hallonsten, Anna-Lena; Poulsen, Sven

    2008-07-01

    The aim of this study was to describe the introduction and the first six years use of midazolam for conscious sedation in a municipal dental service in Denmark. In 1998, all dentists were introduced to midazolam conscious sedation. A sedation chart was filled in for each session, and parents' assessment was obtained. In 2004, all clinical materials were collected. Six hundred and eighty sessions were performed; 63.7% of the children were between 2 and 6 years of age; 88.5% belonged to American Society of Anesthesiologists grade 1; 74.8% of the sedations performed used the oral route of administration. Restorations were performed during 60.3% of the sessions, and extractions during 38.4%. Complications during the sessions were rare, the most frequent being double vision (6.1%), hiccups (2.7%), and paradoxical reaction (2.0%). Using Wilton's sedation scale, 42.9% were calm and 27.7% were agitated during treatment, whereas after treatment 61.7% were calm; 80.4% of the parents were very positive towards this sedation method. Sedation with midazolam for dental treatment of children with dental fear and anxiety is a feasible and an efficient method with a low rate of complications. It can probably reduce the need for dental treatment under general anaesthesia.

  14. Midazolam with Bupivacaine for Improving Analgesia Quality in Brachial Plexus Block for Upper Limb Surgeries

    International Nuclear Information System (INIS)

    Laiq, N.; Khan, M.N.; Khan, S.

    2008-01-01

    To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine with midazolam 50 micro g kg/sup -1/. Hemodynamic variables (heart rate, noninvasive blood pressure, oxygen saturation), pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A (p < 0.001). Pain scores were significantly lower in group B for 24 hours postoperatively (p < 0.001). Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine (0.5%) in combination with Midazolam (50 micro g kg/sup -1/) quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine (0.5%) in equal volume. (author)

  15. Hyperalgesic effect induced by barbiturates, midazolam and ethanol: pharmacological evidence for GABA-A receptor involvement

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    M.A.K.F. Tatsuo

    1997-02-01

    Full Text Available The involvement of GABA-A receptors in the control of nociception was studied using the tail-flick test in rats. Non-hypnotic doses of the barbiturates phenobarbital (5-50 mg/kg, pentobarbital (17-33 mg/kg, and thiopental (7.5-30 mg/kg, of the benzodiazepine midazolam (10 mg/kg or of ethanol (0.4-1.6 g/kg administered by the systemic route reduced the latency for the tail-flick response, thus inducing a 'hyperalgesic' state in the animals. In contrast, non-convulsant doses of the GABA-A antagonist picrotoxin (0.12-1.0 mg/kg administered systemically induced an increase in the latency for the tail-flick response, therefore characterizing an 'antinociceptive' state. Previous picrotoxin (0.12 mg/kg treatment abolished the hyperalgesic state induced by effective doses of the barbiturates, midazolam or ethanol. Since phenobarbital, midazolam and ethanol reproduced the described hyperalgesic effect of GABA-A-specific agonists (muscimol, THIP, which is specifically antagonized by the GABA-A antagonist picrotoxin, our results suggest that GABA-A receptors are tonically involved in the modulation of nociception in the rat central nervous system

  16. Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy.

    Science.gov (United States)

    Lee, Hyuk; Kim, Jeong Hwan

    2009-08-14

    To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

  17. [Conscious sedation and amnesic effect of intravenous low-dose midazolam prior to spinal anesthesia].

    Science.gov (United States)

    Koyama, Shinichi; Ohashi, Naotsugu; Kurita, Satoshi; Nakatani, Keiji; Nagata, Noboru; Toyoda, Yoshiroh

    2008-06-01

    The pain associated with spinal puncture is severe, and the memory of this uncomfortable procedure often deters patients from undergoing the procedure again. Therefore, it is important to make the patient as comfortable as possible when this procedure is performed. We administrated a low-dose (1-2.5 mg) of midazolam intravenously several minutes before conducting a spinal-tap in 200 patients undergoing elective surgery of the lower limb. The dose of midazolam used was based on the patient's age and weight, and we investigated remaining of a memory concerning the spinal-tap procedure and side effects of midazolam at the end of surgery. Memory of the spinal-tap procedure remained in 14.0%, 1.9%, and 32.7% of the patients who had received benzodiazepine preoperatively and in 25.0%, 40.0%, and 60.9% of the patients who hadn't received benzodiazepine preoperatively in the age group or =70 years, respectively. No patient experienced severe respiratory depression, but an excessive sedation or restlessness was experienced in 1.6%, 4.8%, and 5.2% of the patients. In the patients aged memory concerning the spinal-tap procedure; however, it is important to note that the number of side effects associated with this procedure increases in patients aged > or =60 years.

  18. Effect of Oral Midazolam Premedication on Children's Co-operation Before General Anesthesia in Pediatric Dentistry.

    Science.gov (United States)

    Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

    2014-09-01

    Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events.

  19. Midazolam: uma nova alternativa para sedação em odontopediatria = Midazolam: a new alternative to sedation in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Duque, Cristiane

    2005-01-01

    Full Text Available Na prática clínica, existem muitas crianças imaturas e ansiosas ou pacientes com comprometimento físico e/ou mental que não cooperam durante o tratamento odontológico. A sedação pré-operatória é uma das alternativas que facilitam o manejo desses pacientes. O midazolam é um benzodiazepínico que pode ser indicado para crianças, como pré-medicação em procedimentos de curta duração. Isso porque apresenta propriedades hipnóticas e sedativas, além de ser absorvido e eliminado rapidamente pelo organismo. Dessa forma, o objetivo deste estudo é avaliar, por meio de uma revisão de literatura, a efetividade do midazolam, administrado por via oral e intranasal, como agente sedativo para crianças não cooperadoras submetidas a tratamento odontológico

  20. Cognitive properties of sedation agents: comparison of the effects of nitrous oxide and midazolam on memory and mood.

    Science.gov (United States)

    Thompson, J M; Neave, N; Moss, M C; Scholey, A B; Wesnes, K; Girdler, N M

    1999-11-27

    To compare the effects of nitrous oxide and midazolam on cognition and mood. A three-way, counterbalanced, cross-over study, using patients receiving conscious sedation for routine dental treatment. On each of three separate visits, patients performed a computerised test battery to determine baseline cognitive performance. Then, following administration of either midazolam, nitrous oxide, or no drug, patients re-performed the test battery. Finally, patients completed visual analogue scales assessing their subjective mood state. Relative to baseline performance, midazolam administration produced significantly slower reaction times compared with nitrous oxide and no-drug conditions. Furthermore, patients receiving midazolam were impaired in accuracy relative to the other conditions on many of the cognitive tasks, particularly those assessing the recall of information. Patient performance in nitrous oxide and control conditions did not significantly differ. These results could not be explained by differences in mood between the conditions, as subjective mood ratings during midazolam or nitrous oxide administration were very similar. It is important for clinicians to be aware that peri-operative recall of information is reduced in patients who have undergone midazolam sedation. This is an advantage for patients who are anxious, and do not wish to be aware of the operative treatment being performed. However, as the cognitive impairment is enduring, an adult escort and written post-operative instructions should be mandatory for midazolam sedation patients. In contrast, the use of nitrous oxide sedation does not significantly impair higher cognitive tasks and thus patients receiving nitrous oxide sedation can resume normal activities in the post-operative period.

  1. Propofol or midazolam infusion associated with subarachnoid anaesthesia in sheep submitted to bilateral tibial osteotomy

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    Marcos Paulo Antunes de Lima

    2016-09-01

    Full Text Available ABSTRACT. de Lima M.P.A., Comassetto F., Regalin D., Dallabrida A.L., Ronchi S.J. & Oleskovicz N. [Propofol or midazolam infusion associated with subarachnoid anaesthesia in sheep submitted to bilateral tibial osteotomy.] Infusão contínua de propofol ou midazolam associado à anestesia subaracnóidea em ovinos submetidos a osteotomia bilateral de tíbia. Revista Brasileira de Medicina Veterinária, 38(3:250-256, 2016. Departamento de Medicina Veteriná- ria, Centro de Ciências Agroveterinárias, Universidade do Estado de Santa Catarina, Av. Luís de Camões, 2090, Conta Dinheiro, Lages, SC 88520-000, Brasil. E-mail: noleskovicz@yahoo.com.br The sheep stands out for being a great experimental model in the orthopedic area. Thus, the aim of this study was to evaluate the safety and efficacy of the anesthetic maintenance by continuous infusion of propofol or midazolam associated with spinal anesthesia with morphine and ropivacaine in sheep underwent bilateral tibial osteotomy. Twelve healthy sheep, with an average weight of 30.5±2.7 kg were used. The animals were sedated with 0.3 mg.Kg-1 of morphine IM associated with 20 mcg.Kg-1 of detomidine IV. Then they were allocated into two groups: Midazolam group (GMID, which were induced with ketamine 5 mg.Kg-1 and midazolam 0.5 mg.Kg-1 IV, and anesthetic maintenance being performed by continuous infusion of 0 7 mg.Kg-1.h-1 of midazolam; Propofol group (GPRO, which were induced to anesthesia with 4 mg.Kg-1 propofol and maintained with its own infusion at a rate of 0.25 mg.Kg-1.min-1. The animals were intubated and maintained on spontaneous ventilation with 100% oxygen. Spinal anesthesia was performed with 0.5 mg.Kg-1 of 0.75% ropivacaine combined with 0.1 mg.Kg-1 of morphine, diluted with NaCl 0.9% solution to total volume of 1mL/7.5Kg. Significant respiratory depression after anesthesia induction was characterized by significantly increased levels of CO2 and reduced pH in both groups. A significant

  2. Efficacy and safety of non-intravenous midazolam for the treatment of status epilepticus in children: a Meta-analysis

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    Yan LIN

    2016-02-01

    Full Text Available Objective To evaluate the clinical efficacy and safety of non-intravenous midazolam for treating status epilepticus (SE in children.  Methods Taking midazolam, status epilepticus and children both in Chinese and English as search terms, retrieve in databases such as PubMed, ScienceDirect, China National Knowledge Infrastructure (CNKI, VIP and Wanfang Data, assisted by manual searching and Google Scholar, in order to collect randomized controlled trials (RCTs about non-intravenous midazolam for treating SE in children from January 2000 to January 2015. Jadad Scale was used to evaluate the quality of literatures. Meta-analysis was performed by using RevMan 5.3 software. Results There were a total of 258 records after preliminary searching, and 6 RCTs involving 766 episodes were finally included after excluding duplicate ones and those which did not meet the inclusion criteria. The results were as follows: 1 midazolam via intranasal administration was as effective as intravenous diazepam in achieving seizure control in children (RD = -0.070, 95%CI: -0.200—0.060, P = 0.290. However, non-intravenous (intranasal or buccal midazolam showed better effects on seizure control than rectal diazepam (RD = 0.170, 95% CI: 0.030—0.320; P = 0.020. 2 The mean time from arrival at hospital to cessation was not significantly different between intranasal midazolam and intravenous diazepam (SMD = -1.570, 95%CI: -3.280—0.140; P = 0.070. 3 There was no statistical difference between intranasal midazolam and intravenous diazepam for the time from giving drug to cessation (SMD = 0.240, 95%CI: -0.110—0.590; P = 0.170. 4 There was no statistical difference on the occurrence rate of adverse drug reactions between non-intravenous midazolam and intravenous or non-intravenous diazepam (RD = -0.010, 95% CI: -0.030—0.200; P = 0.500.  Conclusions Non-intravenous midazolam is safe and effective in the treatment for status epilepticus in children. However, the

  3. The effect of midazolam on implicit and explicit memory in category exemplar production and category cued recall.

    Science.gov (United States)

    Arndt, Jason; Passannante, Anthony; Hirshman, Elliot

    2004-03-01

    Transfer-appropriate processing theory (Roediger, Weldon, & Challis, 1989) proposes that dissociations between performance on explicit and implicit memory tests arise because these tests often rely on different types of information processing (e.g., perceptual processing vs conceptual processing). This perspective predicts that implicit and explicit memory tasks that rely primarily on conceptual processing should show comparable results, not dissociations. Numerous studies have demonstrated such similarities. It is, however, possible that these results arise from explicit memory contamination of performance on implicit memory tasks. To address this issue, an experiment was conducted in which participants were administered the sedative midazolam prior to study. Midazolam is known to create a temporary, but dense, period of anterograde amnesia. The effects of blocking stimulus materials by semantic category at study and generation at study were investigated on category exemplar production and category-cued recall. The results of this study demonstrated a dissociation of the effects of midazolam on category exemplar production and category-cued recall. Specifically, midazolam reduced the effect of blocking stimulus materials in category-cued recall, but not in category exemplar production. The differential effect of midazolam on explicit and implicit memory is at odds with transfer-appropriate processing theory and suggests that theories of memory must distinguish the roles of different types of conceptual processing on implicit and explicit memory tests.

  4. Midazolam inhibits hippocampal long-term potentiation and learning through dual central and peripheral benzodiazepine receptor activation and neurosteroidogenesis.

    Science.gov (United States)

    Tokuda, Kazuhiro; O'Dell, Kazuko A; Izumi, Yukitoshi; Zorumski, Charles F

    2010-12-15

    Benzodiazepines (BDZs) enhance GABA(A) receptor inhibition by direct actions on central BDZ receptors (CBRs). Although some BDZs also bind mitochondrial receptors [translocator protein (18 kDa) (TSPO)] and promote the synthesis of GABA-enhancing neurosteroids, the role of neurosteroids in the clinical effects of BDZs is unknown. In rat hippocampal slices, we compared midazolam, an anesthetic BDZ, with clonazepam, an anticonvulsant/anxiolytic BDZ that activates CBRs selectively. Midazolam, but not clonazepam, increased neurosteroid levels in CA1 pyramidal neurons without changing TSPO immunostaining. Midazolam, but not clonazepam, also augmented a form of spike inhibition after stimulation adjacent to the pyramidal cell layer and inhibited induction of long-term potentiation. These effects were prevented by finasteride, an inhibitor of neurosteroid synthesis, or 17PA [17-phenyl-(3α,5α)-androst-16-en-3-ol], a blocker of neurosteroid effects on GABA(A) receptors. Moreover, the synaptic effects were mimicked by a combination of clonazepam with FGIN (2-[2-(4-fluorophenyl)-1H-indol-3-yl]-N,N-dihexylacetamide), a selective TSPO agonist, or a combination of clonazepam with exogenous allopregnanolone. Consistent with these in vitro results, finasteride abolished the effects of midazolam on contextual fear learning when administrated 1 d before midazolam injection. Thus, dual activation of CBRs and TSPO appears to result in unique actions of clinically important BDZs. Furthermore, endogenous neurosteroids are shown to be important regulators of pyramidal neuron function and synaptic plasticity.

  5. Comparing the Effect of Intravenous Midazolam with Rectal Sodium Valproate in Controlling of Children with Refractory Status Epilepticus

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    T Mahmoudian

    2006-01-01

    Full Text Available Background: Refractory status epilepticus usually defined as a seizure lasting at least 60 minutes which is uncontrollable by Diazepam, Phenytoin, or Phenobarbital. The aim of this study was to compare the effect of interavenous Midazolam and rectal Sodium valproate in controlling refractory status epilepticus. Methods: In this case-control study; 76 children with (mean age of 37± 20 months with refractory status epilepticus were randomly divided into two groups to receive IV Midazolam and rectal Sodium Valproate. The effect of the two drugs were compared in control of seizure during first 20 minutes of treatment. Results: In 84.2 percent of children treated with IV Midazolam, the seizure was under control within 4.5 ± 0.5 minutes, while in 63 percent of those receiving Sodium Valproate, the seizure was completely controlled within 16.5 ± 0.8 minutes (P < 0.00001. Conclusion: The IV Midazolam was more effective than Sodium valproate, but the latter can be used in hospitals or pediatric emergency wards without ICU for controlling of refractory status epilepticus. Key words: refractory status epilepticus, midazolam, sodium valproate

  6. Can intravenous conscious sedation with midazolam be effective at facilitating surgical dentistry in adolescent orthodontic patients? A service evaluation.

    Science.gov (United States)

    Stamp, A J; Dorman, M L; Vernazza, C R; Deeming, G; Reid, C; Wilson, K E; Girdler, N M

    2017-01-27

    Background Surgical dentistry during orthodontic care often occurs in adolescence and may involve surgical removal or exposure of teeth. The invasive nature of treatment, combined with dental anxiety, means care can often be provided under general anaesthesia (GA). Best-practice guidelines however endorse conscious sedation as an alternative, where appropriate. Although a limited number of studies have shown safe and effective use of intravenous conscious sedation (IVCS) with midazolam in this cohort, robust evidence to support routine use is lacking. Aim To assess whether IVCS with midazolam can effectively facilitate surgical dentistry in adolescent orthodontic patients in primary care.Method A retrospective service evaluation was undertaken reviewing clinical records of adolescents (aged 12-15 years) undergoing surgical exposure and/or surgical removal of teeth under IVCS with midazolam.Results A total of 174 adolescents (mean age 14.2 years) attended for treatment between 2009 and 2015. Of these adolescents, 98.9% (N = 172) allowed cannulation, with all surgical dentistry completed during a single visit. Midazolam dose ranged from 2-7 mg with 79.1% of patients having good or excellent cooperation and three minor adverse events occurring.Conclusion This service evaluation shows IVCS with midazolam can effectively facilitate surgical orthodontics in carefully selected adolescents. There is however a distinct need to further explore potential for this technique to provide a viable alternative to GA.

  7. Sedation with midazolam in flexible bronchoscopy – A prospective study

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    R. Rolo

    2012-09-01

    Full Text Available Introduction: Sedatives have been increasingly used to improve patient comfort during flexible bronchoscopy (FOB. Due to its rapid-onset, anxiolytic and amnestic properties, midazolam is one of the most commonly used sedatives. Objectives: To evaluate the effect of sedation with midazolam, including patient tolerance, complications and its potential use on a daily routine basis. Methods: A multi-centre, prospective, randomized, placebo-controlled study was made on 100 patients submitted to FOB in two Pulmonology Departments. Midazolam (0.05 mg/kg was administered to patients in Group 1 and saline solution (0.9% NaCl to patients in Group 2, 5 min before the procedure. The Hospital Anxiety and Depression Scale (HADS-A was used to determine patient anxiety level. Subjective questionnaires concerning main fears and complaints were answered before and after FOB. Results: Mean age was 56.0 ± 14.1 years; 66% were male. Most (65% patients had low score ( 0.05 and pain (4% vs 12%; p > 0.05 were not statistically different.Willingness to repeat the exam was reported in all patients in Group 1 and in 82% in Group 2 (p = 0.003. Conclusion: Sedation with midazolam in FOB improved patient's comfort and decreased complaints, without significant haemodynamic changes. It should be offered to the patient on a routine basis. Resumo: Introdução: Os agentes sedativos têm vindo a ser cada vez mais utilizados na broncofibroscopia (BF para melhorar o conforto do doente. Devido à sua rápida ação, propriedades ansiolíticas e amnésicas, o midazolam é um dos sedativos mais frequentemente usados. Objetivos: Avaliar o efeito da sedação com midazolam na BF, incluindo a tolerância do doente, complicações e a sua potencial aplicação na prática clínica diária. Material e Métodos: Estudo multicêntrico, prospetivo, randomizado, controlado com placebo, com inclusão de 100 indiv

  8. Systemic or Intra-Amygdala Injection of a Benzodiazepine (Midazolam) Impairs Extinction but Spares Re-Extinction of Conditioned Fear Responses

    Science.gov (United States)

    Hart, Genevra; Harris, Justin A.; Westbrook, R. Frederick

    2009-01-01

    Rats were subjected to one or two cycles of fear conditioning and extinction, injected with a benzodiazepine, midazolam, before the first or second extinction, and tested for long-term inhibition of fear responses (freezing). In Experiment 1, inhibition of context-conditioned fear was spared when midazolam was injected before the second…

  9. Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    Afzalimoghaddam, Mohammad; Edalatifard, Maryam; Nejati, Amir; Momeni, Mehdi; Isavi, Nader; Karimialavijeh, Ehsan

    2016-01-01

    Tolerance to opioids among opium-dependent patients creates obstacles for proper pain management of these patients in the emergency department (ED). The aim of the present study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine analgesia among opium-dependent patients. Opium-dependent adults who were admitted to the ED for new-onset severe pain in the limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating scale [NRS]) were recruited. Participants were randomly assigned into two groups. Group A received morphine 0.05 mg/kg intravenously (IV) and a mixture of midazolam 2.5 mg and haloperidol 2.5 mg (diluted in 5 cc of distilled water, IM); group B received morphine 0.05 mg/kg IV and distilled water 5 cc, IM. Measured outcomes were related to: 1) pain intensity; 2) total doses of morphine; 3) changes in hemodynamic status and level of consciousness of patients. NRS scores (zero to 10) before and one, three and six hours following intervention, as well as total doses of morphine, were recorded. We recruited 68 males (78.16%) and 19 females (21.83%). The mean age was 38.28±6.59 years. The pain score in group A declined more rapidly over six hours than that in group B. Moreover, as compared to group B, the amount of morphine use decreased significantly in group A. Based on the present data, adding haloperidol plus midazolam to morphine for pain management improved pain scores and lowered morphine consumption among opium-dependent patients. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  10. Oral Midazolam Premedication for Children Undergoing General Anaesthesia for Dental Care

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    Saad A. Sheta

    2009-01-01

    Full Text Available Objectives. To assess the efficacy and safety of injectable midazolam administered orally in 3 different doses in children undergoing complete dental rehabilitation under GA. Subjects and Methods. 60 children aged 2–6 years were enrolled in the study. The children were randomly assigned to one of 3 groups and received orally 0.5, 0.75, or 1.0 mg/kg of injectable midazolam mixed with apple juice 30 minutes before separation from parents. The following measurements were assessed: patient's acceptance of the medication, reaction to separation from parents, sedation scores, and recovery conditions. Results. More children were comfortable with parent separation in the group that received the 1.0 mg/kg dose (90% compared to the group that received the 0.75 mg/kg dose (75% and the group that received the 0.5 mg/kg dose (55%. The number of children who had desirable sedation was similar in the 0.75 mg/kg and 1.0 mg/kg dose groups. Twenty five percent of the children in the group that received the 0.5 mg/kg dose did not allow venepuncture before induction of GA, and induction of GA was poor for 20% of the children in this group. An increasing number of children scored excellent in terms of ease of venepuncture in 0.75 mg/kg dose group (10% and in the 1.0 mg/kg dose group (20% and in terms of induction of GA, 25% and 35%, respectively. Recovery of spontaneous ventilation and extubation was delayed by over 15 minutes in 2 children in the 1.0 mg/kg dose group. Conclusion. The dose of 0.75 mg/kg of injectable midazolam given orally as premedication is acceptable, effective, and safe.

  11. COMPARATIVE STUDY TO EVALUATE ANALGESIC EFFICACY OF CAUDAL MIDAZOLAM AND CLONIDINE POSTOPERATIVE ANALGESIA IN CHILDREN

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    Ramalinga Raju A.V.S

    2017-03-01

    Full Text Available BACKGROUND Caudal epidural analgesia is one of the most popular regional techniques used in paediatric patients undergoing lower limb, anoperineal and abdominal surgical procedures for postoperative pain relief. The aim of postoperative pain relief is to provide subjective comfort and inhibit trauma-induced nociceptive impulses to blunt autonomic and reflex responses to pain and subsequently to enhance the restoration of function. Caudal epidural analgesia though practiced widely is of short duration even when used with long-acting local anaesthetics. MATERIALS AND METHODS Children of either sex undergoing elective hernia or hydrocele surgery within in the age group of 2-8 years belonging to ASA I and II were included in the study. Informed consent was obtained from the parents before procedure. RESULTS The duration of analgesia in the study group was 10.14 ± 4.69 hrs. and 6.83 ± 0.79 hrs. in the clonidine group and midazolam group. Duration of analgesia in clonidine group was significantly longer when compared to with midazolam group with a p value of <0.05. Sedation Score- There was decrease in heart rate and mean arterial pressure from baseline, but these were under allowable limits of 20%. The patient had pain scores of less than 8 for first 6-8 hrs. The patients were well sedated and were easily arousable. CONCLUSION We conclude that in our study we found that clonidine 8 μg/kg provided good analgesia for a longer duration when compared with midazolam. Clonidine also provided good sedation with minimal haemodynamic variations. This is in agreement with studies conducted to know haemodynamic stability with higher doses of clonidine.

  12. Mechanism-based pharmacodynamic modeling of the interaction of midazolam, bretazenil, and zolpidem with ethanol.

    Science.gov (United States)

    Tuk, Bert; van Gool, Toon; Danhof, Meindert

    2002-06-01

    The pharmacokinetic and pharmacodynamic interactions of ethanol with the full benzodiazepine agonist midazolam, the partial agonist bretazenil and the benzodiazepine BZ1 receptor subtype selective agonist zolpidem have been determined in the rat in vivo, using an integrated pharmacokinetic-pharmacodynamic approach. Ethanol was administered as a constant rate infusion resulting in constant plasma concentrations of 0.5 g/l. The pharmacokinetics and pharmacodynamics of midazolam, bretazenil, and zolpidem were determined following an intravenous infusion of 5.0, 2.5, and 18 mg/kg respectively. The amplitude in the 11.5-30 Hz frequency band of the EEG was used as measure of the pharmacological effect. For each of the benzodiazepines the concentration-EEG effect relationship could be described by the sigmoid Emax pharmacodynamic model. Significant differences in both EC50 and Emax were observed. The values of the EC50 were 76 +/- 11, 12 +/- 3, and 512 +/- 116 ng/ml for midazolam, bretazenil, and zolpidem respectively. The values of the Emax were 113 +/- 9, 44 +/- 3, and 175 +/- 10 microV/s. In the presence of ethanol the values of the EC50 of midazolam and zolpidem were reduced to approximately 50% of the original value. The values for Emax and Hill-factor were unchanged Due to a large interindividual variability no significant change in EC50 was observed for bretazenil. Analysis of the data on basis of a mechanism-based model showed only a decrease in the apparent affinity constant KPD for all three drugs, indicating that changes in EC50 can be explained entirely by a change in the apparent affinity constant KPD without concomitant changes in the efficacy parameter ePD and the stimulus-effect relationship. The findings of this study show that the pharmacodynamic interactions with a low dose of ethanol in vivo are qualitatively and quantitatively similar for benzodiazepine receptor full agonists, partial agonists, and benzodiazepine BZ1 receptor subtype selective

  13. Allosteric activation of midazolam CYP3A5 hydroxylase activity by icotinib - Enhancement by ketoconazole.

    Science.gov (United States)

    Zhuang, XiaoMei; Zhang, TianHong; Yue, SiJia; Wang, Juan; Luo, Huan; Zhang, YunXia; Li, Zheng; Che, JinJing; Yang, HaiYing; Li, Hua; Zhu, MingShe; Lu, Chuang

    2016-12-01

    Icotinib (ICO), a novel small molecule and a tyrosine kinase inhibitor, was developed and approved recently in China for non-small cell lung cancer. During screening for CYP inhibition potential in human liver microsomes (HLM), heterotropic activation toward CYP3A5 was revealed. Activation by icotinib was observed with CYP3A-mediated midazolam hydroxylase activity in HLM (∼40% over the baseline) or recombinant human CYP3A5 (rhCYP3A5) (∼70% over the baseline), but not in the other major CYPs including rhCYP3A4. When co-incubated with selective CYP3A4 inhibitor CYP3cide or monoclonal human CYP3A4 inhibitory antibody in HLM, the activation was extended to ∼60%, suggesting CYP3A5 might be the isozyme involved. Further, the relative activation was enhanced to ∼270% in rhCYP3A5 in the presence of ketoconazole. The activation was substrate and pathway dependent and observed only in the formation of 1'-OH-midazolam, and not 4-OH-midazolam, 6β-OH-testosterone, or oxidized nifedipine. The activation requires the presence of cytochrome b5 and it is only observed in the liver microsomes of dogs, monkeys, and humans, but not in rats and mice. Kinetic analyses of 1'-OH-midazolam formation showed that ICO increased the V max values in HLM and rhCYP3A5 with no significant changes in K m values. By adding CYP3cide with ICO to the incubation, the V max values increased 2-fold over the CYP3cide control. Addition of ketoconazole with ICO alone or ICO plus CYP3cide resulted in an increase in V max values and decrease in K m values compared to their controls. This phenomenon may be attributed to a new mechanism of CYP3A5 heterotropic activation, which warrants further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Characterization of mucoadhesive nasal gels containing midazolam hydrochloride prepared from Linum usitatissimum L. mucilage

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    Shyamoshree Basu

    2011-12-01

    Full Text Available Nasal drug delivery systems prepared from natural materials are gaining importance in the field of pharmaceutical technology. Mucilage isolated from Linum usitatissimum L. (LUM seeds was reported to be an effective natural mucoadhesive agent. The present study deals with a comparison of various characteristics of nasal gels containing midazolam hydrochloride (HCl prepared from mucoadhesive agent extracted from Linum usitatissimum L. seeds and synthetic polymers like HPMC and Carbopol 934P in terms of texture profile analysis, mucoadhesive strength, and in vivo drug absorption profiles. It was observed that gels formulated with the natural mucilage showed better results than the synthetic gels in all aspects like hardness, adhesiveness, cohesiveness and mucoadhesive strength. The absolute bioavailability of midazolam hydrochloride from the natural gel was 97.55% whereas that of synthetic gels was 57.33% and 76.81% respectively.Sistemas de liberação nasal preparados com produtos naturais estão ganhando importância no campo da tecnologia farmacêutica. A mucilagem isolada de sementes de Linum usitatissimum L. (LUM mostrou-se agente mucoadesivo eficaz. O presente estudo trata da comparação de várias características de géis nasais contendo cloridrato de midazolam preparados com agente mucoadesivo extraído das sementes de Linum usitatissimum L. e com polímeros sintéticos, como HPMC e Carbopol 943P, com relação ao perfil de textura, força mucoadesiva e perfis de absorção do fármaco in vivo. Observou-se que os géis formulados com mucilagem natural apresentam melhores resultados do que os sintéticos em todos os aspectos, como dureza, adesão, coesão e força mucoadesiva. A biodisponibilidade absoluta do cloridrato de midazolam a partir do gel natural foi de 97,55%, enquanto que nos géis sintéticos foi de 57,33% e 76,81%, respectivamente.

  15. Midazolam microdose to determine systemic and pre-systemic metabolic CYP3A activity in humans.

    Science.gov (United States)

    Hohmann, Nicolas; Kocheise, Franziska; Carls, Alexandra; Burhenne, Jürgen; Haefeli, Walter E; Mikus, Gerd

    2015-02-01

    We aimed to establish a method to assess systemic and pre-systemic cytochrome P450 (CYP) 3A activity using ineffective microgram doses of midazolam. In an open, one sequence, crossover study, 16 healthy participants received intravenous and oral midazolam at microgram (0.001 mg intravenous and 0.003 mg oral) and regular milligram (1 mg intravenous and 3 mg oral) doses to assess the linearity of plasma and urine pharmacokinetics. Dose-normalized AUC and Cmax were 37.1 ng ml(-1 ) h [95% CI 35.5, 40.6] and 39.1 ng ml(-1) [95% CI 30.4, 50.2] for the microdose and 39.0 ng ml(-1 ) h [95% CI 36.1, 42.1] and 37.1 ng ml(-1) [95% CI 26.9, 51.3] for the milligram dose. CLmet was 253 ml min(-1) [95% CI 201, 318] vs. 278 ml min(-1) [95% CI 248, 311] for intravenous doses and 1880 ml min(-1) [95% CI 1590, 2230] vs. 2050 ml min(-1) [95% CI 1720, 2450] for oral doses. Oral bioavailability of a midazolam microdose was 23.4% [95% CI 20.0, 27.3] vs. 20.9% [95% CI 17.1, 25.5] after the regular dose. Hepatic and gut extraction ratios for microgram doses were 0.44 [95% CI 0.39, 0.49] and 0.53 [95% CI 0.45, 0.63] and compared well with those for milligram doses (0.43 [95% CI 0.37, 0.49] and 0.61 [95% CI 0.53, 0.70]). The pharmacokinetics of an intravenous midazolam microdose is linear to the applied regular doses and can be used to assess safely systemic CYP3A activity and, in combination with oral microdoses, pre-systemic CYP3A activity. © 2014 The British Pharmacological Society.

  16. The effect of midazolam on neutrophil mitogen-activated protein kinase.

    LENUS (Irish Health Repository)

    Ghori, Kamran

    2010-06-01

    Neutrophil p38 mitogen-activated protein kinase (MAPK) is a key enzyme in the intracellular signalling pathway that is responsible for many neutrophil functions, which are important in neutrophil-endothelial interaction. The imidazole compounds are inhibitors of this enzyme system. The objectives of this in-vitro investigation were to examine the effect of midazolam on neutrophil p38 MAPK activation (phosphorylation) following in-vitro ischaemia-reperfusion injury, and the expression of adhesion molecule CD11b\\/CD18.

  17. Changes to the bispectral index and regional cerebral blood flow in a sedative state, caused by midazolam administration

    International Nuclear Information System (INIS)

    Ikeda, Junko

    2006-01-01

    Psychosedation, as used in the field of dentistry, is intended to provide trouble-free dental care while maintaining a proper level of sedation. One drug used in psychosedation is midazolam, which is known to have a strong amnestic effect. In the current research, I sought to clarify whether the bispectral index (BIS) using electroencephalogram (EEG) analysis can be used for assessment of optimal sedation in psychosedation, and what effects midazolam has on the cerebrum's mechanism of memory. The subjects were 17 healthy adult volunteers. Intravenous sedation involved a single administration of 0.06 mg/kg midazolam, or 6 mg/kg/h propofol, administered for 5 minutes and then continuously administered for 25 minutes at 3 mg/kg/h. For nitrous oxide inhalation sedation, 10-30% nitrous oxide was used. Clinical sedation and the BIS were measured in a variety of circumstances. To examine the effects of midazolam on the central nervous system, changes in brain oxygen consumption in visual memory tasks were assessed through observing changes in areas of brain activation using 3T fMRI. With intravenous sedation using midazolam or propofol, the BIS decreased immediately after drug administration, and the BIS at which optimal sedation was clinically determined was about 65. In contrast, no decrease in the BIS was noted with nitrous oxide inhalation sedation. In observing areas of brain activation by fMRI, the oxygen consumption mainly of visual cortices in the occipital lobe increased as a result of stimulation by visual memory tasks. Regardless of the amnestic effect midazolam produced in subjects, it did not suppress activation of the visual cortices in the occipital lobe. In intravenous sedation using midazolam or propofol, the BIS is effective in determining optimal sedation, and appropriate perioperative management can be performed using the BIS. However, in nitrous oxide inhalation sedation it appears that the BIS cannot be used to monitor levels of sedation. Amnestic

  18. Computerized electrocardiogram in agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam

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    Anaemilia N. Diniz

    Full Text Available ABSTRACT: An electrocardiogram is a test that assesses heart electrical activity and is applied more frequently in the veterinary care of wild animals. The present study aimed to define the electrocardiogram pattern of agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam. Eighteen clinically healthy agoutis (D. prymnolopha were used from the Nucleus for Wild Animal Studies and Conservation (NEPAS of the Federal University of Piauí, Brazil. The animals were chemically restrained with 5% ketamine hydrochloride at a dose of 15mg/kg and midazolam at a dose of 1mg/kg by intramuscular injection. Electrocardiogram tests were carried out by a computerized method with the veterinary electrocardiogram [Acquisition Model for Computer (ECG - PC version Windows 95 Brazilian Electronic Technology (TEB consisting of an electronic circuit externally connected to a notebook computer with ECGPC-VET (TEB software installed on the hard disc. In analysing the EKG results, significant differences were observed for QRS complex duration, PR and QT intervals and for R wave millivoltage between the genders; but we observed a significant influence of weight despite the gender. In the present experiment, the anaesthetic protocol was shown to be well tolerated by the agoutis, and no arrhythmias occurred during the time the animals were monitored. The reference values obtained should be used to better understand the cardiac electrophysiology of the species and for its clinical and surgical management.

  19. Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol.

    Science.gov (United States)

    Franken, L G; de Winter, B C M; van Esch, H J; van Zuylen, L; Baar, F P M; Tibboel, D; Mathôt, R A A; van Gelder, T; Koch, B C P

    2016-06-01

    A variety of medications are used for symptom control in palliative care, such as morphine, midazolam and haloperidol. The pharmacokinetics of these drugs may be altered in these patients as a result of physiological changes that occur at the end stage of life. This review gives an overview of how the pharmacokinetics in terminally ill patients may differ from the average population and discusses the effect of terminal illness on each of the four pharmacokinetic processes absorption, distribution, metabolism, and elimination. Specific considerations are also given for three commonly prescribed drugs in palliative care: morphine, midazolam and haloperidol). The pharmacokinetics of drugs in terminally ill patients can be complex and limited evidence exists on guided drug use in this population. To improve the quality of life of these patients, more knowledge and more pharmacokinetic/pharmacodynamics studies in terminally ill patients are needed to develop individualised dosing guidelines. Until then knowledge of pharmacokinetics and the physiological changes that occur in the final days of life can provide a base for dosing adjustments that will improve the quality of life of terminally ill patients. As the interaction of drugs with the physiology of dying is complex, pharmacological treatment is probably best assessed in a multi-disciplinary setting and the advice of a pharmacist, or clinical pharmacologist, is highly recommended.

  20. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.

    Science.gov (United States)

    Mainwaring, C J; Wong, C; Lush, R J; Smith, J G; Singer, C R

    1996-12-01

    This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.

  1. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases.

    Science.gov (United States)

    Runes, J; Ström, C

    1996-01-01

    In 1987 the Swedish Dental Act was amended to allow Swedish dentists who have undergone a specific accreditation course to administer intra-venous sedation. Midazolam is a benzodiazepin derivate with express sedative and hypnotic qualities, powerful amnesia, a short half-life time and few secondary effects. From 1989-1994 midazolam intravenous conscious sedation (ICS) was administered in 372 cases in the Department of Oral and Maxillofacial Surgery, County Hospital, Falun. This study presents data on the 298 patients. Although surgical removal of impacted wisdom teeth predominated, implant surgery, reduction of fractures and correction of anomalies were also carried out. Supplementary sedative premedication was rarely used. Most patients were treated under local anaesthesia. The mean dosage was 10.45 mg (range 1.25-40 mg). Mean dosage/kg was 0.15 mg (range 0.03-0.50 mg). The average duration of anaesthesia was 50 minutes. The average recovery time was 94 minutes. Three hundred and sixty-nine of 372 planned treatments were completed. No serious complications occurred. The patients were co-operative during surgery and were satisfied with the treatment. Compared with full anaesthesia this method required less resources and is a valuable complement in management of anxious patients undergoing oral surgery.

  2. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation Sedação com midazolam e hidroxizina por via oral em Odontopediatria: ensaio clínico randomizado, controlado e cruzado

    Directory of Open Access Journals (Sweden)

    Alessandra Rodrigues de Almeida Lima

    2003-09-01

    Full Text Available The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg, or MH - midazolam (0.75 mg/kg plus hydroxyzine (2.0 mg/kg. Vital signs (blood pressure, breathing rate, pulse and oxygen saturation and behavior parameters (consciousness, crying, movement, overall behavior were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg; MH - midazolam (0,75 mg

  3. Aerosolized intranasal midazolam for safe and effective sedation for quality computed tomography imaging in infants and children.

    Science.gov (United States)

    Mekitarian Filho, Eduardo; de Carvalho, Werther Brunow; Gilio, Alfredo Elias; Robinson, Fay; Mason, Keira P

    2013-10-01

    This pilot study introduces the aerosolized route for midazolam as an option for infant and pediatric sedation for computed tomography imaging. This technique produced predictable and effective sedation for quality computed tomography imaging studies with minimal artifact and no significant adverse events. Copyright © 2013 Mosby, Inc. All rights reserved.

  4. Differential effects of midazolam and zolpidem on sleep-wake states and epileptic activity in WAG/Rij rats

    NARCIS (Netherlands)

    Depoortere, H.; Francon, D.; Luijtelaar, E.L.J.M. van; Drinkenburg, W.H.I.M.; Coenen, A.M.L.

    1995-01-01

    Hypnotic drugs are known to possess antiepileptic activity. Therefore, the effects of the benzodiazepine hypnotic midazolam (10 mg/kg) and the novel imidazopyridine hypnotic zolpidem (10 mg/kg) on sleep-wake states and on the number of spike-wave discharges were evaluated in WAG/Rij rats. Rats of

  5. [Evaluation of N2O inhalation and oral midazolam conscious sedation in pediatric dentistry of children with intellectual disability].

    Science.gov (United States)

    Tian, Xiao-hua; Yang, Yan-zhong; Li, Xiao-feng

    2015-06-01

    To evaluate the effect of N2O inhalation and oral midazolam sedation on uncooperative patients with intellectual disability in pediatric dentistry. N2O inhalation (35%-50%) and oral midazolam conscious sedation (dosages range: 0.50-0.75 mg/kg) were applied to 67 uncooperative pediatric patients with intellectual disability in outpatient department. The patients were divided into 2 groups: group A (N2O inhalation conscious sedation) and group B(oral midazolam conscious sedation).Treatment results and safety were statistically analyzed by Chi-square test with SPSSl3.0 software package. The mean success rate was 70%. The success rate in group B (75%) was higher than group A (67%). The overall incidence of adverse reactions was 13%(9/67). The adverse reaction rate in group B (25%) was significantly higher than group A (5%, P<0.05). N2O inhalation and oral midazolam conscious sedation are effective and safe in pediatric dental uncooperative patients with intellectual disability.

  6. Comparison of the Effects of Fentanyl and Midazolam as a Premedication in Children Undergoing Inguinal Hernial Surgery

    Directory of Open Access Journals (Sweden)

    MH Abdollahi

    2011-04-01

    Full Text Available Introduction: Premedication with midazolam can occasionally result in increased pediatric anxiety. In this study, we compared the effects of intravenous midazolam and fentanyl as pediatric premedication in children posted for inguinal hernia surgery. Methods: In this double blind randomized clinical trial study, sixty pediatric patients were randomly allocated to two study groups. Anesthesia was similar in both groups. Sedation score by Richmond agitation sedation scale was repeatedly measured on arrival to the preoperative part of the operating room, during drug administration, separation of the child from parent for transfer to the operating room, induction of anesthesia, time of transfer to the recovery room and discharge from the recovery room. Post-operative nausea and vomiting was also recorded. The collected data was analyzed with SPSS 15 and P value<0.05 was considered meaningful. Results: Baseline characteristics of the two study groups were similar. Mean RASS at separation of patients from parents; the time between the study drug administrations till separation from parents, induction of anesthesia and end of operation and need for additional drug during separation was significantly lower in the midazolam group. Opioid need in the fentanyl group was higher. Other findings were similar in the two groups. Conclusion: Use of fentanyl instead of midazolam as a premedication is not a priority in children posted for surgery.

  7. Evaluation of limited sampling models for prediction of oral midazolam AUC for CYP3A phenotyping and drug interaction studies.

    Science.gov (United States)

    Mueller, Silke C; Drewelow, Bernd

    2013-05-01

    The area under the concentration-time curve (AUC) after oral midazolam administration is commonly used for cytochrome P450 (CYP) 3A phenotyping studies. The aim of this investigation was to evaluate a limited sampling strategy for the prediction of AUC with oral midazolam. A total of 288 concentration-time profiles from 123 healthy volunteers who participated in four previously performed drug interaction studies with intense sampling after a single oral dose of 7.5 mg midazolam were available for evaluation. Of these, 45 profiles served for model building, which was performed by stepwise multiple linear regression, and the remaining 243 datasets served for validation. Mean prediction error (MPE), mean absolute error (MAE) and root mean squared error (RMSE) were calculated to determine bias and precision The one- to four-sampling point models with the best coefficient of correlation were the one-sampling point model (8 h; r (2) = 0.84), the two-sampling point model (0.5 and 8 h; r (2) = 0.93), the three-sampling point model (0.5, 2, and 8 h; r (2) = 0.96), and the four-sampling point model (0.5,1, 2, and 8 h; r (2) = 0.97). However, the one- and two-sampling point models were unable to predict the midazolam AUC due to unacceptable bias and precision. Only the four-sampling point model predicted the very low and very high midazolam AUC of the validation dataset with acceptable precision and bias. The four-sampling point model was also able to predict the geometric mean ratio of the treatment phase over the baseline (with 90 % confidence interval) results of three drug interaction studies in the categories of strong, moderate, and mild induction, as well as no interaction. A four-sampling point limited sampling strategy to predict the oral midazolam AUC for CYP3A phenotyping is proposed. The one-, two- and three-sampling point models were not able to predict midazolam AUC accurately.

  8. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

    Directory of Open Access Journals (Sweden)

    Ayse Ozcan

    2014-12-01

    Full Text Available Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after

  9. Complete recovery from intractable complex regional pain syndrome, CRPS-type I, following anesthetic ketamine and midazolam.

    Science.gov (United States)

    Kiefer, Ralph-Thomas; Rohr, Peter; Ploppa, Annette; Altemeyer, Karl-Heinz; Schwartzman, Robert Jay

    2007-06-01

    To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam. A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3-5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days. On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now. In a patient with severe spreading and refractory CRPS, a complete and long-term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment. This case report illustrates the effectiveness and safety of high-dose ketamine in a patient with generalized, refractory CRPS.

  10. Stability of midazolam hydrochloride injection 1-mg/mL solutions in polyvinyl chloride and polyolefin bags.

    Science.gov (United States)

    Karlage, Kelly; Earhart, Zachary; Green-Boesen, Kelly; Myrdal, Paul B

    2011-08-15

    The stability of midazolam hydrochloride injection 1-mg/mL solutions in polyvinyl chloride (PVC) and polyolefin bags under varying conditions was evaluated. Triplicate solutions of midazolam hydrochloride 1-mg/mL were prepared in polyolefin and PVC i.v. bags by diluting midazolam hydrochloride injection 5 mg/mL with 5% dextrose injection. Bags were then stored under refrigeration (3-4 °C), exposed to light at room temperature (20-25 °C), or protected from light in amber bags at room temperature. Samples were taken immediately after preparation (day 0) and on days 1, 2, 3, 6, 13, 20, and 27 for analysis with a stability-indicating high-performance liquid chromatography assay in order to determine solution concentration. Stability was defined as retention of at least 90% of the initial drug concentration. The pH of each solution was also measured weekly. Sterility of the i.v. bags was determined at the end of the study by microbiological testing with culture in growth media. Differences in concentrations under the various storage conditions and bags used were analyzed using analysis of variance. All solutions retained over 98% of the initial midazolam hydrochloride concentration, with no statistically significant (p ≥ 0.05) change in concentration over the four-week period. Stability was not affected by temperature, exposure to light, or bag type. The pH of all solutions remained between 3.2 and 3.4 throughout the study. Sterility after 28 days was retained. Midazolam hydrochloride 1-mg/mL solutions diluted in 5% dextrose injection remained stable over 27 days in both polyolefin and PVC i.v. bags, regardless of storage condition.

  11. The safety and efficacy of using a concentrated intranasal midazolam formulation for paediatric dental sedation.

    Science.gov (United States)

    Wood, Michael

    2011-01-01

    To add to the evidence base for safe and effective paediatric conscious sedation techniques in primary dental care. To consider the safety and effectiveness of an alternative sedation technique for facilitating dental treatment in anxious children, thereby avoiding dental general anaesthetic. Leagrave Dental Sedation Clinic. A primary care-based general and referral clinic for anxious patients, special care dentistry and oral surgery. This is a prospective service evaluation of 114 selected anxious children requiring invasive dental treatment. Each child was administered 0.25 mg/kg intranasal midazolam using a concentrated 40 mg/ml midazolam (INM) in 2% lignocaine solution. Successful completion of intended dental treatment with a child who is co-operative and who meets the UK accepted definition of conscious sedation. 57% of the children found the administration of the new formulation acceptable. Of the 114 patients who received INM, 104 completed the treatment (91%). The 10 children who could not complete the treatment with INM were converted to intravenous sedation and treatment was completed successfully at the same appointment. During treatment there was no desaturation and only one patient desaturated briefly in the recovery area. Parents rated the technique acceptable in 76% of cases and would have the procedure repeated in 83% of cases. Parents rated this technique as having 8.3 out of 10 with only 5 parents awarding a score of less than 7 out of 10. Side effects included blurred vision, sneezing, headaches, restlessness with one patient having post-operative nausea and vomiting. In selected cases intranasal sedation provides a safe and effective alternative for dental GA in short invasive procedures limited to one or two quadrants in children. Other techniques, e.g., oral and intravenous sedation, appear to have a much higher acceptability of administration. This technique may be useful if inhalation sedation, oral sedation or intravenous sedation is

  12. Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Drainage of Hepatic Hydatid Cysts.

    Science.gov (United States)

    Bavullu, Emine Nilgün; Aksoy, Esra; Abdullayev, Ruslan; Göğüş, Nermin; Dede, Doğan

    2013-12-01

    Hydatid cyst still continues to be a public health problem. The basic treatment for the disease is surgery, but ultrasound-guided percutaneous drainage has become an important treatment alternative. Agents preferred for sedation during drainage performed under local anaesthesia must also preserve respiration and hemodynamic stability while providing adequate sedation. We compared the sedative properties of midazolam, which has a short duration of action, and a selective α2 adrenergic receptor agonist, dexmedetomidine, and the intraoperative complications. After approval by the clinical trials ethics committee, 40 patients with similar demographic data were randomized into two groups. All patients received 10 mg metoclopramide and 45.5 mg pheniramine before the procedure. Then, midazolam (0.07 mg kg(-1) IV bolus followed by 0.01 mg kg(-1) h(-1) infusion) was administered to Group 1, and dexmedetomidine (1 μg kg(-1) loading dose in 10 minutes, followed by 0.2 μg kg(-1) h(-1) continuous infusion) was administered to Group 2 for sedation. Just before the surgical procedure, all patients received IV propofol in a subhypnotic dose of 0.5 mg kg(-1); the dose was repeated if adequate sedation could not be achieved. Observer's assessment of alertness/sedation (OAA/S) scale and Bispectral index (BIS) were used to evaluate the sedation level during the procedure. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide pressure (ETCO2) were monitored before and after induction and every 5 minutes thereafter. Propofol requirement was noted for each group. Sedation in the dexmedetomidine group was as effective and adequate as that observed in the midazolam group. BIS values were significantly lower in the dexmedetomidine group, especially after 10 minutes and thereafter. RR, SpO2, and ETCO2 were similar in both groups, whereas clinically insignificant decreases in HR and MAP were observed in the

  13. Midazolam Injection

    Science.gov (United States)

    ... the effects of exposure to anesthesia on brain development in young children. Parents and caregivers of children younger than 3 years of age and pregnant women should talk to their doctors about the risks of anesthesia on brain development and appropriate timing of procedures that require general ...

  14. Induction of anaesthesia with remifentanil after bolus midazolam administration in Landrace/Large White swine

    DEFF Research Database (Denmark)

    Zacharioudaki, Argyro; Lelovas, Pavlos; Sergentanis, Theodoros N.

    2017-01-01

    relaxation, resistance to the laryngoscope, vocal cord position, vocal cord movement and response to intubation. The time required to intubate and necessity for an additional midazolam dose were recorded. Baseline and post-intubation variables were compared with paired t tests, whereas for differences......Objective To investigate an alternative combination for anaesthesia induction in swine. Study design Randomized, ‘blinded’ experimental study. Animals Forty-five Landrace/Large White swine weighing 20.0 ± 1.5 kg. Methods Pulse oximetry, heart rate (HR) and blood pressure were measured after...... = 0.008 and p = 0.032, respectively) between baseline and post-intubation phase; in groups R3 and R4, there were decreases in systolic blood pressure (p = 0.040 and p = 0.019, respectively). In the multivariate analysis, remifentanil dose was not associated with the observed changes in haemodynamic...

  15. Addition of low-dose ketamine to midazolam and low-dose bupivacaine improves hemodynamics and postoperative analgesia during spinal anesthesia for cesarean section

    Directory of Open Access Journals (Sweden)

    Ahmed Sobhy Basuni

    2016-01-01

    Conclusion: Intrathecal low-dose ketamine combined with midazolam and low-dose bupivacaine stabilizes hemodynamics and prolongs postoperative analgesia without significant side-effects in parturients undergoing CS.

  16. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

    OpenAIRE

    Baldaçara,Leonardo; Sanches,Marsal; Cordeiro,Daniel Cruz; Jackowski,Andrea Parolin

    2011-01-01

    OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or halop...

  17. Intranasal sedation using ketamine and midazolam for pediatric dental treatment (NASO): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Gomes, Heloisa Sousa; Miranda, Analya Rodrigues; Viana, Karolline Alves; Batista, Aline Carvalho; Costa, Paulo Sucasas; Daher, Anelise; Machado, Geovanna de Castro Morais; Sado-Filho, Joji; Vieira, Liliani Aires Candido; Corrêa-Faria, Patrícia; Hosey, Marie Therese; Costa, Luciane Rezende

    2017-04-11

    Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children. We have designed a three-armed, parallel RCT to assess intranasal sedation using ketamine/midazolam in terms of the following measures: efficacy, safety, and cost-effectiveness. Two- to 6-year-old healthy children, referred for dental treatment in a dental sedation center in Brazil due to uncooperative behavior and requiring restorative dental procedures, will be recruited. Each child will be randomly assigned to one of the three groups: A - Intranasal administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.2 mg/kg, maximum 5.0 mg); B - Oral administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.5 mg/kg, maximum 20 mg); and C - Oral administration of midazolam (1.0 mg/kg, maximum 20 mg). The primary outcome is the child's behavior assessed through an observational scale using digital videos of the restorative dental treatment under sedation. The secondary outcomes are as follows: acceptance of sedative administration; memory of intraoperative events; the child's stress; adverse events; the child's pain during the procedure; the parent's, dentists', and child's perceptions of sedation; and economic analysis. Measures will be taken at baseline and drug administration and during and after the dental procedure. The necessary sample size was estimated to be 84 children after a blinded interim analysis of the first 30 cases. This study will provide data that can substantially add to science and pediatric dentistry as it examines the effect of sedative

  18. Farmacovigilancia de la sertralina en pacientes cubanos con episodio de depresión mayor Pharmaceutical surveillance of sertraline in Cuban patients affected by major depression episode

    Directory of Open Access Journals (Sweden)

    Leslie Pérez Ruiz

    2011-03-01

    Full Text Available En la depresión predominan síntomas como: desinterés, fatiga, sentimientos de inutilidad, desconcentración, deseos de muerte e insomnio. Entre los medicamentos para tratarla se encuentra la sertralina. Con el objetivo de evaluar su seguridad, se revisaron 40 historias clínicas y cuadernos de recogida de datos de los pacientes incluidos en ensayo clínico fase III, aletatorizado, controlado y a doble ciegas: "Uso de sertralina en pacientes con episodio de depresión mayor", pertenecientes al Hospital "Dr. Gustavo Aldereguía Lima". Se obtuvieron datos demográficos, clínicos y eventos adversos, con los cuales se realizó un estudio descriptivo, observacional y transversal que clasifica como un estudio de utilización de medicamentos sobre consecuencias prácticas. La información fue analizada mediante SPSS, versión 13.0 para Windows. De los 40 pacientes incluidos, 24 presentaron eventos adversos para un 60 %; de ellos, 16 (67 % en el grupo tratado con sertralina y 8 (33 % en los tratados con placebo. Los eventos adversos más frecuentes fueron: disminución de peso, sequedad bucal, cefalea, diarreas y náuseas. En su mayoría resultaron de intensidad ligera, causalidad probable y sin necesidad de tratamiento. El uso del fármaco se consideró seguro en el tratamiento de estos pacientes.Some predominant symptoms in depression are lack of interest, fatigue, feeling of uselessness, lack of concentration, desire of being dead and insomnia. One of the drugs to treat this illness is Sertraline. For the purpose of evaluating its safety, 40 medical histories and data collection logs with information on patients included in a double-blind, controlled, randomized phase III clinical trial "Use of Sertraline in patients suffering episodes of great depression" were reviewed. These patients were seen at "Gustavo Aldereguía Lima" hospital. Demographic, clinical and adverse event data were obtained to undertake a descriptive, observational and cross

  19. Stability of Fentanyl Citrate, Hydromorphone Hydrochloride, Ketamine Hydrochloride, Midazolam, Morphine Sulfate, and Pentobarbital Sodium in Polypropylene Syringes

    OpenAIRE

    Anderson, Collin; MacKay, Mark

    2015-01-01

    Purpose: Determine the stability of fentanyl 10 mcg/mL in 0.9% sodium chloride, fentanyl 10 mcg/mL in 5% dextrose, fentanyl 50 mcg/mL, hydromorphone 100 mcg/mL in 0.9% sodium chloride, ketamine 10 mg/mL, midazolam 0.4 mg/mL in 5% dextrose, midazolam 5 mg/mL, morphine 1 mg/mL in 0.9% sodium chloride, morphine 1 mg/mL in 5% dextrose, and pentobarbital 50 mg/mL when stored as single drug entities at room temperature in polypropylene syringes. Methods: Four 5 mL samples of each drug and concentra...

  20. Effect of a herbal extract containing curcumin and piperine on midazolam, flurbiprofen and paracetamol (acetaminophen) pharmacokinetics in healthy volunteers

    Science.gov (United States)

    Volak, Laurie P; Hanley, Michael J; Masse, Gina; Hazarika, Suwagmani; Harmatz, Jerold S; Badmaev, Vladimir; Majeed, Muhammed; Greenblatt, David J; Court, Michael H

    2013-01-01

    Aims Turmeric extract derived curcuminoids (curcumin, demethoxycurcumin and bisdemethoxycurcumin) are currently being evaluated for the treatment of cancer and Alzheimer's dementia. Previous in vitro studies indicate that curcuminoids and piperine (a black pepper derivative that enhances curcuminoid bioavailability) could inhibit human CYP3A, CYP2C9, UGT and SULT dependent drug metabolism. The aim of this study was to determine whether a commercially available curcuminoid/piperine extract alters the pharmacokinetic disposition of probe drugs for these enzymes in human volunteers. Methods A randomized placebo-controlled six way crossover study was conducted in eight healthy volunteers. A standardized curcuminoid/piperine preparation (4 g curcuminoids plus 24 mg piperine) or matched placebo was given orally four times over 2 days before oral administration of midazolam (CYP3A probe), flurbiprofen (CYP2C9 probe) or paracetamol (acetaminophen) (dual UGT and SULT probe). Plasma and urine concentrations of drugs, metabolites and herbals were measured by HPLC. Subject sedation and electroencephalograph effects were also measured following midazolam dosing. Results Compared with placebo, the curcuminoid/piperine treatment produced no meaningful changes in plasma Cmax, AUC, clearance, elimination half-life or metabolite levels of midazolam, flurbiprofen or paracetamol (α = 0.05, paired t-tests). There was also no effect of curcuminoid/piperine treatment on the pharmacodynamics of midazolam. Although curcuminoid and piperine concentrations were readily measured in plasma following glucuronidase/sulfatase treatment, unconjugated concentrations were consistently below the assay thresholds (0.05–0.08 μm and 0.6 μm, respectively). Conclusion The results indicate that short term use of this piperine-enhanced curcuminoid preparation is unlikely to result in a clinically significant interaction involving CYP3A, CYP2C9 or the paracetamol conjugation enzymes. PMID:22725836

  1. Midazolam inhibits hippocampal long-term potentiation and learning through dual central and peripheral benzodiazepine receptor activation and neurosteroidogenesis

    OpenAIRE

    Tokuda, Kazuhiro; O’Dell, Kazuko A.; Izumi, Yukitoshi; Zorumski, Charles F.

    2010-01-01

    Benzodiazepines (BDZs) enhance γ-aminobutyric acid-A (GABAA) receptor inhibition by direct actions on central BDZ receptors (CBRs). Although some BDZs also bind mitochondrial receptors (translocator protein 18kDa, TSPO) and promote the synthesis of GABA-enhancing neurosteroids, the role of neurosteroids in the clinical effects of BDZs is unknown. In rat hippocampal slices, we compared midazolam, an anesthetic BDZ with clonazepam, an anticonvulsant/anxiolytic BDZ that activates CBRs selectivel...

  2. The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block.

    Science.gov (United States)

    El-Baradey, Ghada F; Elshmaa, Nagat S

    2014-11-01

    The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block. This is a prospective randomized controlled observer-blinded study. This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request. The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant. Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E. In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.

  3. Predicting the Best Fit: A Comparison of Response Surface Models for Midazolam and Alfentanil Sedation in Procedures With Varying Stimulation.

    Science.gov (United States)

    Liou, Jing-Yang; Ting, Chien-Kun; Mandell, M Susan; Chang, Kuang-Yi; Teng, Wei-Nung; Huang, Yu-Yin; Tsou, Mei-Yung

    2016-08-01

    Selecting an effective dose of sedative drugs in combined upper and lower gastrointestinal endoscopy is complicated by varying degrees of pain stimulation. We tested the ability of 5 response surface models to predict depth of sedation after administration of midazolam and alfentanil in this complex model. The procedure was divided into 3 phases: esophagogastroduodenoscopy (EGD), colonoscopy, and the time interval between the 2 (intersession). The depth of sedation in 33 adult patients was monitored by Observer Assessment of Alertness/Scores. A total of 218 combinations of midazolam and alfentanil effect-site concentrations derived from pharmacokinetic models were used to test 5 response surface models in each of the 3 phases of endoscopy. Model fit was evaluated with objective function value, corrected Akaike Information Criterion (AICc), and Spearman ranked correlation. A model was arbitrarily defined as accurate if the predicted probability is effect-site concentrations tested ranged from 1 to 76 ng/mL and from 5 to 80 ng/mL for midazolam and alfentanil, respectively. Midazolam and alfentanil had synergistic effects in colonoscopy and EGD, but additivity was observed in the intersession group. Adequate prediction rates were 84% to 85% in the intersession group, 84% to 88% during colonoscopy, and 82% to 87% during EGD. The reduced Greco and Fixed alfentanil concentration required for 50% of the patients to achieve targeted response Hierarchy models performed better with comparable predictive strength. The reduced Greco model had the lowest AICc with strong correlation in all 3 phases of endoscopy. Dynamic, rather than fixed, γ and γalf in the Hierarchy model improved model fit. The reduced Greco model had the lowest objective function value and AICc and thus the best fit. This model was reliable with acceptable predictive ability based on adequate clinical correlation. We suggest that this model has practical clinical value for patients undergoing procedures

  4. The influence of midazolam on heart rate arises from cardiac autonomic tones alterations in Burmese pythons, Python molurus.

    Science.gov (United States)

    Lopes, Ivã Guidini; Armelin, Vinicius Araújo; Braga, Victor Hugo da Silva; Florindo, Luiz Henrique

    2017-12-01

    The GABA A receptor agonist midazolam is a compound widely used as a tranquilizer and sedative in mammals and reptiles. It is already known that this benzodiazepine produces small to intermediate heart rate (HR) alterations in mammals, however, its influence on reptiles' HR remains unexplored. Thus, the present study sought to verify the effects of midazolam on HR and cardiac modulation in the snake Python molurus. To do so, the snakes' HR, cardiac autonomic tones, and HR variability were evaluated during four different experimental stages. The first stage consisted on the data acquisition of animals under untreated conditions, in which were then administered atropine (2.5mgkg -1 ; intraperitoneal), followed later by propranolol (3.5mgkg -1 ; intraperitoneal) (cardiac double autonomic blockade). The second stage focused on the data acquisition of animals under midazolam effect (1.0mgkg -1 ; intramuscular), which passed through the same autonomic blockade protocol of the first stage. The third and fourth stages consisted of the same protocol of stages one and two, respectively, with the exception that atropine and propranolol injections were reversed. By comparing the HR of animals that received midazolam (second and fourth stages) with those that did not (first and third stages), it could be observed that this benzodiazepine reduced the snakes' HR by ~60%. The calculated autonomic tones showed that such cardiac depression was elicited by an ~80% decrease in cardiac adrenergic tone and an ~620% increase in cardiac cholinergic tone - a finding that was further supported by the results of HR variability analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

    Directory of Open Access Journals (Sweden)

    Ayse Ozcan

    2014-11-01

    Full Text Available Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after

  6. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

    Science.gov (United States)

    El Batawi, Hisham Yehia

    2015-01-01

    Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. Results: The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Conclusions: Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time. PMID:25992332

  7. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia.

    Science.gov (United States)

    El Batawi, Hisham Yehia

    2015-01-01

    To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time.

  8. Síndrome de abstinência associada à interrupção da infusão de fentanil e midazolam em pediatria Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics

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    J.N. Bicudo

    1999-03-01

    Full Text Available OBJETIVO: Determinar a ocorrência de síndrome de abstinência em crianças internadas em UCI Pediátrica em uso de fentanil e midazolam. MÉTODOS: Avaliadas 36 crianças internadas na UCI Pediátrica do Hospital São Paulo - Universidade Federal de São Paulo, no período de março a setembro de 1997, com idade variando de 5 dias a 22 meses (22 masc : 14 fem que fizeram uso de fentanil e midazolam por mais de 24 horas. Utilizado o Escore Neonatal de Abstinência adaptado por Finnegan que determina a ocorrência de síndrome de abstinência em crianças menores de 2 anos. Escore maior ou igual a 8 é considerado como síndrome de abstinência. Correlacionados a síndrome de abstinência com a dose total acumulada, velocidade de infusão, dose diária e tempo de utilização do fentanil e do midazolam. RESULTADOS: Determinada síndrome de abstinência em 18 (50% das 36 crianças. Aplicado o teste estatístico de Mann Whitney para comparar os grupos com e sem síndrome de abstinência. Dose total acumulada de fentanil (5732.7 ± 5114.91 vs. 624.2 ± 591.2mcg, pPURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU in fentanyl use and midazolam METHODS: Evaluation of 36 children interned in PICU of the Hospital São Paulo - Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam. RESULTS: Certain abstinence syndrome in 18 (50% of the 36 children. Applied Mann Whitney's statistical

  9. Sedative effects of midazolam and xylazine with or without ketamine and detomidine alone following intranasal administration in Ring-necked Parakeets.

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    Vesal, Nasser; Eskandari, Mohammad H

    2006-02-01

    To evaluate the effects of intranasal administration of midazolam and xylazine (with or without ketamine) and detomidine and their specific antagonists in parakeets. Prospective study. 17 healthy adult Ring-necked Parakeets (Psittacula krameri) of both sexes (mean weight, 128.83+/-10.46 g [0.28+/-0.02 lb]). The dose of each drug or ketamine-drug combination administered intranasally that resulted in adequate sedation (ie, unrestrained dorsal recumbency maintained for >or=5 minutes) was determined; the onset of action, duration of dorsal recumbency, and duration of sedation associated with these treatments were evaluated. The efficacy of the reversal agents flumazenil, yohimbine, and atipamezole was also evaluated. In parakeets, intranasal administration of midazolam (7.3 mg/kg [3.32 mg/lb]) or detomidine (12 mg/kg [5.45 mg/lb]) caused adequate sedation within 2.7 and 3.5 minutes, respectively. Combinations of midazolam (3.65 mg/kg [1.66 mg/lb]) and xylazine (10 mg/kg [4.55 mg/lb]) with ketamine (40 to 50 mg/kg [18.2 to 22.7 mg/lb]) also achieved adequate sedation. Compared with detomidine, duration of dorsal recumbency was significantly longer with midazolam. Intranasal administration of flumazenil (0.13 mg/kg [0.06 mg/lb]) significantly decreased midazolam-associated recumbency time. Compared with the xylazineketamine combination, duration of dorsal recumbency was longer after midazolam-ketamine administration. Intranasal administration of flumazenil, yohimbine, or atipamezole significantly decreased the duration of sedation induced by midazolam, xylazine, or detomidine, respectively. Intranasal administration of sedative drugs appears to be an acceptable method of drug delivery in Ring-necked Parakeets. Reversal agents are also effective when administered via this route.

  10. Efficacy of antidotes (midazolam, atropine and HI-6) on nerve agent induced molecular and neuropathological changes.

    Science.gov (United States)

    RamaRao, Golime; Afley, Prachiti; Acharya, Jyothiranjan; Bhattacharya, Bijoy Krishna

    2014-04-04

    Recent alleged attacks with nerve agent sarin on civilians in Syria indicate their potential threat to both civilian and military population. Acute nerve agent exposure can cause rapid death or leads to multiple and long term neurological effects. The biochemical changes that occur following nerve agent exposure needs to be elucidated to understand the mechanisms behind their long term neurological effects and to design better therapeutic drugs to block their multiple neurotoxic effects. In the present study, we intend to study the efficacy of antidotes comprising of HI-6 (1-[[[4-(aminocarbonyl)-pyridinio]-methoxy]-methyl]-2-[(hydroxyimino) methyl] pyridinium dichloride), atropine and midazolam on soman induced neurodegeneration and the expression of c-Fos, Calpain, and Bax levels in discrete rat brain areas. Therapeutic regime consisting of HI-6 (50 mg/kg, i.m), atropine (10 mg/kg, i.m) and midazolam (5 mg/kg, i.m) protected animals against soman (2×LD50, s.c) lethality completely at 2 h and 80% at 24 h. HI-6 treatment reactivated soman inhibited plasma and RBC cholinesterase up to 40%. Fluoro-Jade B (FJ-B) staining of neurodegenerative neurons showed that soman induced significant necrotic neuronal cell death, which was reduced by this antidotal treatment. Soman increased the expression of neuronal proteins including c-Fos, Bax and Calpain levels in the hippocampus, cerebral cortex and cerebellum regions of the brain. This therapeutic regime also reduced the soman induced Bax, Calpain expression levels to near control levels in the different brain regions studied, except a mild induction of c-Fos expression in the hippocampus. Rats that received antidotal treatment after soman exposure were protected from mortality and showed reduction in the soman induced expression of c-Fos, Bax and Calpain and necrosis. Results highlight the need for timely administration of better antidotes than standard therapy in order to prevent the molecular and biochemical changes and

  11. Uso del Registro de Solicitudes de Medicamentos no Incluidos en el Listado de Medicamentos Esenciales como Nueva Fuente de Información en los Sistemas Nacionales de Farmacovigilancia.

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    Buendía, Jefferson Antonio; Zuluaga Salazar, Andrés Felipe; Vacca González, Claudia Patricia

    2013-12-01

    To describe the frequency of adverse drugs events (ADEs) as possible causes of request of drugs not included in national essential Medicines list in Colombia. This was a descriptive study developed in a private medical insurance company in Bogota, Colombia. Data were obtained from drug request form of drugs not included in a national essential Medicines list. We analyzed the content of the notes to identify the records related to the occurrence of ADEs in the period 2008 to 2009. Information concerning the adverse event and the drug involved was recorded in a data collection instrument developed by the researchers. The pharmacological classification of drugs was performed according to the Anatomical Therapeutic Chemical Classification System (ATC). We study 3,336 request forms of drugs not included in a national essential Medicines list. The level 1 groups of the ATC of drugs with greater frequency of ADEs were the cardiovascular agents (47%), nervous system agents (24%) and antineoplastic and immunomodulating agents (15%). The great majority was cases of light severity (62.7%) and classified as possible (48.4%). The results of this study support the innovative approach of using request form of drug not included in national essential Medicines list to obtain information regarding ADEs in developing countries; recognizing the importance of looking for new sources of report of adverse reactions to diminish the under-notification of ADEs. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

  12. Preliminary investigation into the ventilatory effects of midazolam in isoflurane-anaesthetised goats

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    George F. Stegmann

    2012-05-01

    Full Text Available The ventilatory effects of intravenous midazolam (MDZ were evaluated in isoflurane- anaesthetised goats. Eight female goats aged 2–3 years were fasted from food and water for 12 h. Anaesthesia was then induced using a face mask with isoflurane in oxygen, whilst the trachea was intubated with a cuffed tracheal tube and anaesthesia maintained with isoflurane at 1.5% end-tidal concentration. Ventilation was spontaneous. The goats were treated with either a saline placebo (PLC or MDZ intravenously at 0.2 mg/kg. Analysis of variance for repeated measures was used for the analysis of data. Significance was taken at the 0.05 level. Differences between treatments were not statistically significant (p > 0.05 for tidal volume, ventilation rate, tidal volume/kg (VT/kg and end-tidal carbon dioxide partial pressure. Within treatments, VT and VT/kg differed 5 min after MDZ administration; this was statistically significant (p < 0.05. The occurrence of apnoea in the MDZ-treated goats was statistically significant (p = 0.04 compared with the PLC treated goats. Intravenous MDZ at 0.2 mg/kg administered to isoflurane-anaesthetised goats may result in transient apnoea and a mild decrease in VT and VT/kg.

  13. Preliminary investigation into the ventilatory effects of midazolam in isoflurane-anaesthetised goats

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    George F. Stegmann

    2012-04-01

    Full Text Available The ventilatory effects of intravenous midazolam (MDZ were evaluated in isoflurane- anaesthetised goats. Eight female goats aged 2–3 years were fasted from food and water for 12 h. Anaesthesia was then induced using a face mask with isoflurane in oxygen, whilst the trachea was intubated with a cuffed tracheal tube and anaesthesia maintained with isoflurane at 1.5% end-tidal concentration. Ventilation was spontaneous. The goats were treated with either a saline placebo (PLC or MDZ intravenously at 0.2 mg/kg. Analysis of variance for repeated measures was used for the analysis of data. Significance was taken at the 0.05 level. Differences between treatments were not statistically significant (p > 0.05 for tidal volume, ventilation rate, tidal volume/kg (VT/kg and end-tidal carbon dioxide partial pressure. Within treatments, VT and VT/kg differed 5 min after MDZ administration; this was statistically significant (p < 0.05. The occurrence of apnoea in the MDZ-treated goats was statistically significant (p = 0.04 compared with the PLC treated goats. Intravenous MDZ at 0.2 mg/kg administered to isoflurane-anaesthetised goats may result in transient apnoea and a mild decrease in VT and VT/kg.

  14. Reducing risk of overdose with midazolam injection in adults: an evaluation of change in clinical practice to improve patient safety in England.

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    Flood, Chris; Matthew, Linda; Marsh, Rachel; Patel, Bhavesh; Mansaray, Mariama; Lamont, Tara

    2015-02-01

    This study sought to evaluate potential reductions in risk associated with midazolam injection, a sedating medication, following a UK National Patient Safety Alert. This alert, 'Reducing risk of overdose with midazolam injection in adults', was sent to all National Health Service organizations as a Rapid Response Report detailing actions services should take to minimize risks. To evaluate any potential changes arising from this alert, a number of data sources were explored including reported incidents to a national reporting system for health care error, clinician survey and audit data, pharmaceutical purchasing patterns and feedback from National Health Service managers. Prior to the Rapid Response Report, 498 incidents were received by the National Patient Safety Agency including three deaths. Post-implementation of the Rapid Response Report (June 2009), no incidents resulting in death or severe harm had been received. All organizations reported having completed the Rapid Response Report actions. Purchase and use of risk-prone, high-strength sedating midazolam by health care organizations decreased significantly as did the increased use of safer, lower strength doses (as recommended in the Rapid Response Report). Organizations can achieve safer medication practices, better knowledge, awareness and implementation of national safer practice recommendations. Risks from inadvertent overdose of midazolam injection were reduced post-implementation of national recommendations. Ongoing monitoring of this particular adverse event will be required with a sustained patient safety message to health services to maintain awareness of the issue and reduction in the number of midazolam-related errors. © 2014 John Wiley & Sons, Ltd.

  15. Avaliação da associação midazolam/droperidol na tranqüilização de suínos Evaluation of midazolam/droperidol association for tranquilization of swines

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    José Antonio Marques

    1995-01-01

    Full Text Available Na presente pesquisa, avaliou-se a associação midazolam/droperidol na tranqüilização de 11 suínos da raça Landrace. Foram analisadas as frequências cardíaca, respiratória, temperatura retal e hemogasimetria arterial antes e após a administração do midazolam (0,4mg/kg IM associado ao droperidol (0,4mg/kg IM. As anotações paramétricas e análises hemogasimétricas foram realizadas a intervalos de 10 minutos, durante uma hora após a administração das drogas. Concomitantemente efetuaram-se observações clínicas a respeito da eficácia da tranqüilização. Não ocorreram alterações significativas nos parâmetros de frequência cardíaca e equilíbrio ácido-base. A frequência respiratória diminuiu significativamente, quando comparada aos valores basais. O tempo médio de ação das drogas foi de 60 minutos, com período de latência de 3 minutos. Durante a tranqüilização houve relaxamento muscular, perda dos reflexos posturais, indiferença ao meio ambiente e manutenção dos reflexos protetores. A análise dos resultados permite indicar a associação midazolam/droperidol para a tranqüilização/sedação de suínos.The association midazolam/droperidol was evaluated in the chemical restraint of 11 Landrace swines. Cardiac and respiratory rates were studied as well as rectal temperature and blood gas analisis after and before the midazolam (0.4mg/kg/droperidol (0.4mg/kg injection. The parametrical values and the blood gas analisis were performed during an hour period after drug administration, at 10 minutes intervals. At the same time, clinical trials were performed about the effectiveness of the tranquilization. Significant changes did not occur in the heart rate and acid-basic equilibrium. The respiratory rate decreased significantly, when compared to basal measurements. The set time of the drug action was that of 60 minutes, with an onset period of 3 minutes. During the tranquilization it was observed muscle relief

  16. VACUNACIÓN CONTRA EL VIRUS DEL PAPILOMA HUMANO Y AUTOINMUNIDAD

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    Juan-Manuel Anaya

    2014-10-01

    Full Text Available El desarrollo de enfermedades autoinmunes es un tema de suma importancia cuando de vacunas se trata, dado el riesgo que pueden tener éstas de favorecer fenómenos de autoinmunidad en individuos susceptibles. La relación riesgo/beneficio de desarrollar enfermedades autoinmunes luego de la vacunación contra el virus del papiloma humano (VPH aún no se ha resuelto. Los datos disponibles son limitados para ofrecer conclusiones definitivas. Dado el aumento reciente de reporte de efectos adversos, se espera que estudios con suficiente tamaño muestral, en diversas poblaciones, confirmen la seguridad de la vacunación contra el VPH en niñas con enfermedades autoinmunes. Un análisis personalizado de cada paciente, que incluya la evaluación de autoinmunidad personal y familiar, podría ser sugerido, aunque no hay estudios que demuestren que sea costo-efectivo. Por lo tanto, la farmacovigilancia permanente de esta vacuna sigue siendo de suma importancia.

  17. Pharmacokinetic Evaluation of the Interactions of Amenamevir (ASP2151) with Ketoconazole, Rifampicin, Midazolam, and Warfarin in Healthy Adults.

    Science.gov (United States)

    Kusawake, Tomohiro; den Adel, Martin; Groenendaal-van de Meent, Dorien; Garcia-Hernandez, Alberto; Takada, Akitsugu; Kato, Kota; Ohtsu, Yoshiaki; Katashima, Masataka

    2017-11-01

    Amenamevir is a nonnucleoside antiherpes virus compound available for treating herpes zoster infections. Four studies aimed to determine any potential interactions between amenamevir and ketoconazole, rifampicin, midazolam, or warfarin in healthy male participants. Two studies were open-label studies that evaluated the effects of multiple doses of ketoconazole (400 mg) and rifampicin (600 mg) on the pharmacokinetics of a single oral dose of amenamevir. The other two studies were randomized, double-blind, parallel-group studies that evaluated the effects of multiple doses of amenamevir on the pharmacokinetics of a single dose of midazolam (7.5 mg) and warfarin (25 mg). A drug interaction was considered to occur if the 90% confidence interval (CI) of the least squares geometric mean ratio (GMR) of amenamevir to the comparator was outside the prespecified interval of 0.80-1.25. Interactions were observed between amenamevir and ketoconazole, rifampicin, and midazolam, but not between amenamevir and warfarin. After a single 400-mg dose of amenamevir, the GMRs of amenamevir plus ketoconazole or rifampicin versus amenamevir alone for C max and the area under the plasma concentration-time curve from time zero to infinity (AUC inf ) were 1.30 (90% CI 1.17-1.45) and 2.58 (90% CI 2.32-2.87), respectively, for ketoconazole and 0.42 (90% CI 0.37-0.49) and 0.17 (90% CI 0.15-0.19), respectively, for rifampicin. Following multiple doses of amenamevir (400 mg), the GMRs of midazolam plus amenamevir versus midazolam alone for AUC inf and C max were 0.53 (90% CI 0.47-0.61) and 0.63 (90% CI 0.50-0.80), respectively. After a single dose of warfarin, the (S)-warfarin and (R)-warfarin mean C max increased and mean AUC inf decreased in the presence of amenamevir; however, the 90% CIs of the GMRs for these parameters remained within the predefined limits. These findings confirm that amenamevir (as a cytochrome P450 3A4 substrate) can interact with ketoconazole or rifampicin, and (as a

  18. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

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    Valérie Collado

    Full Text Available The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID compared to dentally anxious patients (DA. Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale, and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS. 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test. Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test. Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test. Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions and were less often relaxed after induction (58.9% ID vs. 90.3% DA and during dental treatment (39.5% ID vs. 59.7% DA (p<0.001, Fisher exact test than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂, were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  19. Effect of Intranasal Sedation Using Ketamine and Midazolam on Behavior of 3-6 Year-Old Uncooperative Children in Dental Office: A Clinical Trial

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    Majid Mehran

    2017-02-01

    Full Text Available Objectives: The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments.  Materials and Methods: In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg or midazolam (0.2mg/kg prior to treatment. The other medication was used in the next visit. The children’s behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA.Results: The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002; movement of children decreased with fewer incidence of treatment interruption (P=0.001 while their sleepiness increased (P=0.003. Despite higher success of sedation with ketamine compared to midazolam, no significant differences were found between the two regarding patients’ overall behavior (P>0.05. The patients had higher heart rate and blood pressure with ketamine; however, no significant difference was found regarding respiratory rate and oxygen saturation (P>0.05.  Conclusions: Ketamine (0.5mg/kg led to fewer movements, less crying and more sleepiness compared to midazolam (0.2mg/kg. No significant differences were found between the two drugs regarding children’s overall behavior and sedation efficiency. Both drugs demonstrated positive efficacy for sedation of children during dental treatments.Keywords: Conscious Sedation; Ketamine; Midazolam; Administration, Intranasal

  20. Injection anaesthesia with fentanyl-midazolam-medetomidine in adult female mice: importance of antagonization and perioperative care.

    Science.gov (United States)

    Fleischmann, Thea; Jirkof, Paulin; Henke, Julia; Arras, Margarete; Cesarovic, Nikola

    2016-08-01

    Injection anaesthesia is commonly used in laboratory mice; however, a disadvantage is that post-anaesthesia recovery phases are long. Here, we investigated the potential for shortening the recovery phase after injection anaesthesia with fentanyl-midazolam-medetomidine by antagonization with naloxone-flumazenil-atipamezole. In order to monitor side-effects, the depth of anaesthesia, heart rate (HR), core body temperature (BT) and concentration of blood gases, as well as reflex responses, were assessed during a 50 min anaesthesia. Mice were allowed to recover from the anaesthesia in their home cages either with or without antagonization, while HR, core BT and spontaneous home cage behaviours were recorded for 24 h. Mice lost righting reflex at 330 ± 47 s after intraperitoneal injection of fentanyl-midazolam-medetomidine. During anaesthesia, HR averaged 225 ± 23 beats/min, respiratory rate and core BT reached steady state at 131 ± 15 breaths/min and 34.3 ± 0.25℃, respectively. Positive pedal withdrawal reflex, movement triggered by tail pinch and by toe pinch, still occurred in 25%, 31.2% and 100% of animals, respectively. Arterial blood gas analysis revealed acidosis, hypoxia, hypercapnia and a marked increase in glucose concentration. After anaesthesia reversal by injection with naloxone-flumazenil-atipamezole, animals regained consciousness after 110 ± 18 s and swiftly returned to physiological baseline values, yet they displayed diminished levels of locomotion and disrupted circadian rhythm. Without antagonization, mice showed marked hypothermia (22 ± 1.9℃) and bradycardia (119 ± 69 beats/min) for several hours. Fentanyl-midazolam-medetomidine provided reliable anaesthesia in mice with reasonable intra-anaesthetic side-effects. Post-anaesthetic period and related adverse effects were both reduced substantially by antagonization with naloxone-flumazenil-atipamezole. © The Author(s) 2016.

  1. Intentional intra-arterial injection of midazolam in a patient with status epilepticus in the intensive care unit

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    Muhammad Asghar Ali

    2017-01-01

    Full Text Available Fundamental medical care includes intravenous (IV access which provides prompt resuscitation and reliable delivery of analgesics, antibiotics, and vasoactive medication. Difficult access populations, especially in critical area, continue to challenge providers to consider and utilize alternative means to provide IV access. Potential options under such circumstances include intramuscular, intraosseous, and intratracheal drug administration, but in extreme cases where no other options are available, intra-arterial route might be considered. We present a case where midazolam was intentionally injected intra-arterially to abort seizure activity in a patient with status epilepticus in the Intensive Care Unit.

  2. Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial

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    Mehrdad Esmailian

    2015-01-01

    Full Text Available Background: Restless and violent behaviors are common in Emergency Departments (EDs, which need therapeutic interventions in most of the times. The first-generation anti-psychotic drugs are one of the most applicable therapeutic agents in the management of such patients, but their use has some limitations. Some studies suggest midazolam as an alternative medicine. Therefore, this study was performed with the aim of comparison of the efficacy and safety of haloperidol and midazolam in the restless management of referring patients to EDs. Materials and Methods: The present double-blinded trial was done on patients needed sedation and referred to the ED of Alzahra Hospital, Isfahan, Iran, in 2014. The patients were categorized into two random groups of haloperidol (5 mg and midazolam receivers (2.5 mg for those weighing 50 kg, as intramuscular administration. The time to achieve sedation, need for rescue dose, need to resedation within the first 60 min, and adverse effects of drugs were compared among the groups. Results: Forty-eight patients were entered to the study. The mean age in the haloperidol and midazolam groups was 44.8 ± 4.1 years and 45.5 ± 4.7 years, respectively (P = 0.91. The mean time of sedation in the haloperidol and midazolam groups was 5.6 ± 0.3 min and 5.2 ± 0.1 min, respectively (P = 0.31. The mean time of full consciousness after sedation was 36.2 ± 4.5 min and 38.2 ± 3.4 min in the haloperidol and midazolam groups, respectively (P = 0.72. On average, time to arousal in the midazolam group was 10.33 min more than the haloperidol group, but it was not statistically significant. Conclusion: The results of the present study show that administration of midazolam and haloperidol have similar efficacy in the treatment of restless symptoms with the same recovery time from drug effects for referring patients to the ED. In addition, none of the adverse effects were observed in this study.

  3. Simultaneous determination of midazolam and 1'-hydroxymidazolam in human plasma by liquid chromatography with tandem mass spectrometry.

    Science.gov (United States)

    Li, Wenkui; Luo, Suyi; Smith, Harold T; Tse, Francis L S

    2007-08-01

    A sensitive and simple liquid chromatography-tandem mass spectrometry method for the determination of midazolam and 1'-hydroxymidazolam in human plasma has been developed and validated with a dynamic range of 0.1-250 ng/mL. The analysis was based on semi-automated liquid-liquid extraction followed by evaporation of the extraction solvent, reconstitution and chromatography on a reversed-phase C(18) column. The mobile phase consists of 5 mm ammonium acetate and methanol and runs in gradient at a flow rate of 0.25 mL/min with column temperature of approximately 20 degrees C. The entire column effluent was transferred into the LC-MS/MS interface operated in positive electrospray ionization mode. The chromatographic run time was 4.3 min per injection, with retention times for midazolam, 1'-hydroxymidazolaml and the internal standard, triazolam, of 2.5, 2.3 and 2.1 min, respectively. The intra-day and inter-day precision (RSD %) and accuracy (bias %) of the quality control samples were <15.0% and within +/-13%, respectively. The current method has been applied to a clinical drug-drug interaction study in human. Copyright (c) 2007 John Wiley & Sons, Ltd.

  4. Stability of Fentanyl Citrate, Hydromorphone Hydrochloride, Ketamine Hydrochloride, Midazolam, Morphine Sulfate, and Pentobarbital Sodium in Polypropylene Syringes.

    Science.gov (United States)

    Anderson, Collin; MacKay, Mark

    2015-12-16

    Determine the stability of fentanyl 10 mcg/mL in 0.9% sodium chloride, fentanyl 10 mcg/mL in 5% dextrose, fentanyl 50 mcg/mL, hydromorphone 100 mcg/mL in 0.9% sodium chloride, ketamine 10 mg/mL, midazolam 0.4 mg/mL in 5% dextrose, midazolam 5 mg/mL, morphine 1 mg/mL in 0.9% sodium chloride, morphine 1 mg/mL in 5% dextrose, and pentobarbital 50 mg/mL when stored as single drug entities at room temperature in polypropylene syringes. Four 5 mL samples of each drug and concentration were prepared in 10 mL polypropylene syringes. The samples were stored at ambient room temperature in a locked cabinet. Triplicate determinations of drug concentration for each sample were performed initially, on day 50 or 51, and on day 100 using high-performance liquid chromatography with diode-array detection. With the exception of the hydromorphone 100 mcg/mL dilution, all compounds were found to contain greater than 95% of their initial concentration remaining at 100 days. Each sample remained clear and colorless when visually inspected.

  5. Evaluation of the use of midazolam as a co-induction agent with ketamine for anaesthesia in sedated ponies undergoing field castration.

    Science.gov (United States)

    Allison, A; Robinson, R; Jolliffe, C; Taylor, P M

    2018-05-01

    There are limited investigations comparing ketamine to a ketamine-midazolam co-induction. To compare quality and safety of general anaesthesia induced using ketamine alone with anaesthesia co-induced using ketamine and midazolam. Randomised, double blinded, placebo controlled trial. After i.v. detomidine (20 μg/kg) thirty-eight ponies undergoing field castration received either 0.06 mg/kg (0.6 mL/50 kg) midazolam (group M) or 0.6 mL/50 kg placebo (group P) with 2.2 mg/kg ketamine i.v. for anaesthetic induction. Quality of anaesthetic induction, endotracheal intubation, surgical relaxation and recovery were scored using combinations of simple descriptive and visual analogue scales. Time of sedation, induction, start of endotracheal intubation, first movement, sternal recumbency and standing were recorded, as were time, number and total quantity of additional i.v. detomidine and ketamine injections. Cardiorespiratory variables were assessed every 5 min. Adverse effects were documented. Data were tested for normality and analysed with a mixed model ANOVA, Fisher's exact test, unpaired Students' t test and Wilcoxon Rank-sum as appropriate; Pketamine (P = 0.04). Time (minutes) from induction to first movement (PKetamine-midazolam co-induction compared to ketamine alone improved quality of induction, ease of intubation and muscle relaxation without impacting recovery quality. © 2017 EVJ Ltd.

  6. Systemic or Intra-Amygdala Infusion of the Benzodiazepine, Midazolam, Impairs Learning, but Facilitates Re-Learning to Inhibit Fear Responses in Extinction

    Science.gov (United States)

    Hart, Genevra; Harris, Justin A.; Westbrook, R. Frederick

    2010-01-01

    A series of experiments used rats to study the effect of a systemic or intra-amygdala infusion of the benzodiazepine, midazolam, on learning and re-learning to inhibit context conditioned fear (freezing) responses. Rats were subjected to two context-conditioning episodes followed by extinction under drug or vehicle, or to two cycles of context…

  7. Benzodiazepine receptor equilibrium constants for flumazenil and midazolam determined in humans with the single photon emission computer tomography tracer [123I]iomazenil

    DEFF Research Database (Denmark)

    Videbaek, C; Friberg, L; Holm, S

    1993-01-01

    twice, once without receptor blockade and once with a constant degree of partial blockade of the benzodiazepine receptors by infusion of nonradioactive flumazenil (Lanexat) or midazolam (Dormicum). Single photon emission computer tomography and blood sampling were performed intermittently for 6 h after...

  8. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment. A double-blinded randomized placebo-controlled trial

    NARCIS (Netherlands)

    Shoroghi, Mehrdad; Arbabi, Shahriyar; Farahbakhsh, Farshid; Sheikhvatan, Mehrdad; Abbasi, Ali

    2011-01-01

    Purpose: To investigate and compare the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in children who underwent skin laser treatment in an academic educational Hospital. Methods: Ninety children, candidates for skin laser

  9. The CLOSED trial; CLOnidine compared with midazolam for SEDation of paediatric patients in the intensive care unit : Study protocol for a multicentre randomised controlled trial

    NARCIS (Netherlands)

    A. Neubert (Antje); M.A. Baarslag (Manuel A.); M. van Dijk (Monique); J.M. van Rosmalen (Joost); J.F. Standing (Joseph); Y. Sheng (Yucheng); W. Rascher; D. Roberts (Deborah); J. Winslade (Jackie); L. Rawcliffe (Louise); S.M. Hanning (Sara M.); T. Metsvaht (Tuuli); V. Giannuzzi (Viviana); P. Larsson (Peter); P. Pokorna (Pavla); A. Simonetti (Alessandra); D. Tibboel (Dick)

    2017-01-01

    markdownabstract__Introduction__ Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label

  10. Conscious Sedation Efficacy of 0.3 and 0.5 mg/kg Oral Midazolam for Three to Six Year-Old Uncooperative Children Undergoing Dental Treatment: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Masoud Fallahinejad Ghajari

    2016-10-01

    Full Text Available Objectives: Midazolam with variable dosages has been used to induce sedation in pediatric dentistry. The aim of this study was to compare the efficacy of two dosages of oral midazolam for conscious sedation of children undergoing dental treatment.Materials and Methods: In this randomized crossover double blind clinical trial, 20 healthy children (ASA I aged three to six years with negative or definitely negative Frankl behavioral rating scale were evaluated. Half of the children received 0.5mg/kg oral midazolam plus 1mg/kg hydroxyzine (A orally in the first session and 0.3mg/kg oral midazolam plus 1mg/kg hydroxyzine (B in the next session. The other half received the drugs on a reverse order. Sedation degree by Houpt sedation rating scale, heart rate and level of SpO2 were assessed at the beginning and after 15 and 30 minutes. The data were analyzed using SPSS 19 and Wilcoxon Signed Rank and McNemar’s tests.Results: The results showed that although administration of 0.5mg/kg oral midazolam was slightly superior to 0.3mg/kg oral midazolam in terms of sedation efficacy, the differences were not significant (P>0.05. The difference in treatment success was not significant either (P>0.05. Heart rate, oxygen saturation (SpO2 and respiratory rate were within the normal range and did not show a significant change (P>0.05.Conclusions: The overall success rate of the two drug combinations namely 0.5mg/kg oral midazolam plus hydroxyzine and 0.3mg/kg oral midazolam plus hydroxyzine was not significantly different for management of pediatric patients.Keywords: Conscious Sedation; Pediatric Dentistry; Midazolam; Hydroxyzine

  11. Anestesia com cetamina, midazolam e óxido nitroso em cães submetidos à esofagoplastia cervical Ketamine, midazolam and nitrous oxide anesthesia in dogs submitted to cervical esophagoplasty

    Directory of Open Access Journals (Sweden)

    Juliana Tabarelli Brondani

    2003-12-01

    Full Text Available Este estudo foi realizado para avaliar a anestesia intravenosa com cetamina e midazolam (K-M em cães ventilados mecanicamente com 66% de óxido nitroso e 33% de oxigênio ou 100% de oxigênio. Foram utilizados 16 cães sem raça definida, hígidos, com peso médio de 14,2 ± 3,78kg, submetidos a jejum sólido de 12 horas prévio ao procedimento. A anestesia foi induzida com a associação de cetamina (10mg.kg-1 e midazolam (0,5mg.kg-1 administrados na mesma seringa por via intravenosa (IV. Para manutenção anestésica, foi utilizada cetamina (5mg.kg-1 e midazolam (0,25mg.kg-1 administrados por via IV em intervalos de 10 minutos. Os animais foram distribuídos em dois grupos: N2O e O2. No grupo N2O, os cães foram ventilados mecanicamente com 66% de óxido nitroso e 33% de oxigênio. No grupo O2, somente o oxigênio foi utilizado para ventilação artificial. Em ambos os grupos, os animais foram submetidos à esofagoplastia cervical. As variáveis fisiológicas utilizadas para comparação entre os grupos foram: freqüência cardíaca, pressões arteriais sistólica, média e diastólica, saturação de oxigênio da hemoglobina e temperatura corporal. A necessidade ou não de doses adicionais da associação cetamina e midazolam também foi registrada para comparação. A análise estatística dos resultados não demonstrou diferenças significativas nas variáveis fisiológicas entre os grupos. No grupo O2, foram necessárias doses maiores da associação K-M para manutenção anestésica nos 30 minutos iniciais (pThis study was conducted to evaluate the effects of ketamine, midazolam, and nitrous oxide anesthesia (K-M in dogs artificially ventilated with 66% nitrous oxide and 33% oxygen or 100% oxygen. These dogs were submitted to experimental cervical esophagoplasty. Sixteen clinically healtly mixed breed dogs with mean body weight of 14.2 ± 3.78kg were studied. A 12-hour fasting period was established for each dog. Anesthesia was produced

  12. The role of a low-dose ketamine-midazolam regimen in the management of severe painful crisis in patients with sickle cell disease.

    Science.gov (United States)

    Tawfic, Qutaiba A; Faris, Ali S; Kausalya, Rajini

    2014-02-01

    Acute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration. We studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis. A retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics. A ketamine-midazolam regimen was added to the ongoing opioids as an initial bolus of ketamine 0.25mg/kg, followed by infusion of 0.2-0.25mg/kg/h. A midazolam bolus of 1mg followed by infusion of 0.5-1mg/h was added to reduce ketamine emergence reactions. Reduction in morphine daily requirements and improvement in pain scores were the determinants of ketamine-midazolam effect. The t-tests were used for statistical analysis. Nine patients were assessed, with mean age of 27±11 years. Morphine requirement was significantly lower after adding the IV ketamine-midazolam regimen. The mean±SD IV morphine requirement (milligram/day) in the pre-ketamine day (D0) was 145.6±16.5, and it was 112±12.2 on Day 1 (D1) of ketamine treatment (P=0.007). The Numeric Rating Scale scores on D0 ranged from eight to ten (mean 9.1), but improved to range from five to seven (mean 5.7) on D1. There was a significant improvement in pain scores after adding ketamine-midazolam regimen (P=0.01). Low-dose ketamine-midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sickle cell disease with severe painful crisis. Further controlled studies are required to prove this effect. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  13. Factors predisposing to coma and delirium: fentanyl and midazolam exposure; CYP3A5, ABCB1, and ABCG2 genetic polymorphisms; and inflammatory factors.

    Science.gov (United States)

    Skrobik, Yoanna; Leger, Caroline; Cossette, Mariève; Michaud, Veronique; Turgeon, Jacques

    2013-04-01

    Delirium and sedative-induced coma are described as incremental manifestations of cerebral dysfunction. Both may be associated with sedative or opiate doses and pharmacokinetic or pharmacogenetic variables, such as drug plasma levels (exposure), drug metabolism, and/or their transport across the blood-brain barrier. To compare biological and drug treatment characteristics in patients with coma and/or delirium while in the ICU. In 99 patients receiving IV fentanyl, midazolam, or both, we evaluated drug doses, covariates likely to influence drug effects (age, body mass index, and renal and hepatic dysfunction); delirium risk factors; concomitant administration of CYP3A and P-glycoprotein substrates/inhibitors; ABCB1, ABCG2, and CYP3A5 genetic polymorphisms; and fentanyl and midazolam plasma levels. Delirium and coma were evaluated daily. In patients with only coma (n=15), only delirium (n=7), and neither ever (n=14), we measured plasma levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1RA, IL-6, IL-8, IL-10, IL-17,macrophage inflammatory protein-1β, and monocyte chemotactic protein-1. Time to first coma was associated with fentanyl and midazolam doses (p=0.03 and p=0.01, respectively). The number of days in coma was associated with the number of days of coadministration of CYP3A inhibitors (r=0.30; p=0.006). Plasma levels of fentanyl were higher in patients with clinical coma (3.7±4.7 vs. 2.0±1.8 ng/mL, p=0.0001) as were midazolam plasma levels (1050±2232 vs. 168±249 ng/mL, p=0.0001). Delirium occurrence was unrelated to midazolam administration, cumulative doses, or serum levels. Days with delirium were associated with days of coadministration of P-glycoprotein inhibitor (r=0.35; p=0.0004). Delirious patients had higher levels of the inflammatory mediator IL-6 than comatose patients (129.3 vs. 35.0 pg/mL, p=0.05). Coma is associated with fentanyl and midazolam exposure; delirium is unrelated to midazolam and may be linked to inflammatory status

  14. Comparison of the changes in blood glucose level during sedation with midazolam and propofol in implant surgery: a prospective randomized clinical trial.

    Science.gov (United States)

    Kaviani, Nasser; Koosha, Farzad; Shahtusi, Mina

    2014-09-01

    Reducing the patients' stress can prevent, or at least, limit the increase in blood glucose level. The study compares the effect of propofol and midazolam on blood glucose level in the patients undergoing dental implant surgery. The effect of pre-operational stress on blood glucose level during the surgery is also evaluated. This prospective randomized clinical trial recruited 33 patients undergoing dental implant surgery and divided into two groups. Conscious sedation was performed by midazolam in one group and with propofol in another group. The pre-operational stress was scored and the blood glucose level was measured in 4 different stages; before the operation, two minutes after the local anesthetic injection; thirty minutes after the onset of operation and at the end of the operation. The results were analyzed by employing ANOVA and Pearson test. The p Value was adopted 0.05 and the confidence coefficient was assumed 95%. The average levels of the blood glucose in midazolam and propofol group were 93.82 mg/dl and 94 mg/dl before the operation which displayed a meaningful increase of blood glucose level in both groups as the operation went on. The values were 103.76 mg/dl for midazolam and 108.56 mg/dl for the propofol group (pblood glucose level between two groups in the different stages of the operation (p= 0.466). The Pearson correlation coefficient test revealed a higher increase in the blood glucose level in the patients with a higher pre-operational stress score (r= 0.756, pblood glucose level while undergoing an operation. No statistically significant difference was detected between midazolam and propofol.

  15. A comparison of the effects of propofol and midazolam on memory during two levels of sedation by using target-controlled infusion.

    Science.gov (United States)

    de Roode, A; van Gerven, J M; Schoemaker, R C; Engbers, F H; Olieman, W; Kroon, J R; Cohen, A F; Bovill, J G

    2000-11-01

    We examined memory during sedation with target-controlled infusions of propofol and midazolam in a double-blinded five-way, cross-over study in 10 volunteers. Each active drug infusion was targeted to sedation level 1 (asleep) and level 4 (lethargic) as determined with the Observer Assessment of Alertness/Sedation scale. At the target level of sedation, drug concentration was clamped for 30 min, during which time neutral words were presented. After 2 h, explicit memory was assessed by recall, and implicit memory by using a wordstem completion test. Venous drug concentrations (mean +/- SD) were 1350 ng/mL (+/-332 ng/mL) for propofol and 208 ng/mL (+/-112 ng/mL) for midazolam during Observer Assessment of Alertness/Sedation scale level 4; and 1620 ng/mL (+/-357 ng/mL) and 249 ng/mL (+/-82 ng/mL) respectively during level 1. The wordstem completion test frequencies at low level sedation were significantly higher than spontaneous frequencies (8.7% + 2.4%; P: sedation were accompanied by small differences in venous propofol or midazolam concentrations. This indicates steep concentration-effect relationships. Neutral information is still memorized during low-level sedation with both drugs. The memory effect of propofol and midazolam did not differ significantly. Implicit memory can occur during different states of consciousness and might lead to psychological damage. In 10 volunteers, implicit memory was investigated during sedation with propofol and midazolam in a double-blinded, placebo-controlled study. To compare the effects of both drugs, they were titrated using a computer-controlled infusion system to produce similar high and low levels of sedation.

  16. Impact of Solutol HS 15 on the pharmacokinetic behavior of midazolam upon intravenous administration to male Wistar rats.

    Science.gov (United States)

    Bittner, Beate; González, Roberto Carlos Bravo; Isel, Hughes; Flament, Christophe

    2003-07-01

    The pharmacokinetic profile of midazolam (MDZ) and its major metabolites 1'-OH-midazolam (1'OH-MDZ) and 4-OH-midazolam (4OH-MDZ) was investigated in rats. MDZ was administered intravenously at 5 mg/kg either in the absence (NaCl 0.9%, control group) or in the presence of the surfactant Solutol HS 15, a weak inhibitor of cytochrome P450 3A (CYP3A) activity in vitro (Solutol HS 15-treated group). It was found that the pharmacokinetic profiles of MDZ, 1'OH-MDZ and 4OH MDZ did not differ significantly in the two dosing vehicles (P values above 0.2). MDZ exhibited a high plasma clearance (Cl) of 79 and 92 ml/min/kg (corresponding to a blood Cl of 64 and 75 ml/min/kg), a high volume of distribution (V(d)) of 4.0 and 3.6 l/kg, and an area under the plasma concentration-time curve (AUC(t0-tinf)) of 1062 and 932 h.ng/ml in the control group and in the Solutol HS 15-treated group, respectively. The amount of MDZ excreted unchanged into urine was below 0.01% with both dosing vehicles. AUC(t0-tinf) in the control group was 12.3 h.ng/ml for 1'OH-MDZ and 38.8 h.ng/ml 4OH-MDZ. In the Solutol HS 15-treated group, AUC(t0-tinf) was 14 h.ng/ml for 1'OH-MDZ and 35.4 h.ng/ml for 4OH-MDZ. The metabolite concentrations excreted into urine were below the limit of quantification. In the rat, MDZ has a high blood clearance that is limited by liver blood flow. Therefore, weak CYP3A inhibitors like Solutol HS 15 are not likely to affect the hepatic blood clearance of MDZ in vivo.

  17. Efeitos hemodinâmicos da combinação de dexmedetomidina-fentanil versus midazolam-fentanil em crianças submetidas à cirurgia cardíaca com circulação extracorpórea Efectos hemodinámicos de la combinación de dexmedetomidina-fentanil versus midazolam-fentanil en ninõs sometidos a la cirugía cardíaca con circulación extracorpórea Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2010-08-01

    íaca con circulación extracorpórea (CEC en niños. MÉTODO: Treinta y dos niños, con edad entre 1 mes y 10 años, citados para cirugía cardíaca con circulación extracorpórea, que fueron distribuidos aleatoriamente en dos grupos: el Grupo MDZ recibió midazolam 0,2 mg.kg-1.h-1, mientras que el Grupo DEX recibió dexmedetomidina 1 µg.kg-1.h-1 durante una hora y enseguida el ritmo de infusión se redujo a la mitad en los dos grupos. Los dos grupos recibieron fentanil 10 µg. kg-1, midazolam 0,2 mg.h-1 y vecuronio 0,2 mg.kg-1 para la inducción de la anestesia. Las mismas dosis de fentanil con vecuronio de la inducción fueron infundidas durante la primera hora después de la inducción y enseguida reducidas a la mitad. Las infusiones fueron iniciadas inmediatamente después de la inducción y mantenidas hasta el final de la cirugía. El isoflurano se administró por un corto tiempo para el control de la respuesta hiperdinámica a la incisión y esternotomía. RESULTADOS: En los dos grupos, la presión arterial sistólica y la frecuencia cardíaca se redujeron ostensiblemente después de una hora de infusión anestésica, pero el aumento de la presión arterial sistólica y diastólica y el de la frecuencia cardíaca al momento de la incisión de la piel, fueron significantemente menores en el Grupo DEX. Un número significativamente menor de pacientes exigió un suplemento con isoflurano en el Grupo DEX. Después de la CEC, los pacientes de los dos grupos tuvieron respuestas hedominámicas similares. CONCLUSIONES: La infusión sin bolo de dexmedetomidina parece ser un adyuvante efectivo del fentanil en la promoción de la sedación y el control de las respuestas hemodinámicas durante la cirugía para las cardiopatías congénitas en niños.BACKGROUND AND OBJECTIVES: To evaluate the efficacy of the combined infusion of dexmedetomidine and fentanyl on the hemodynamic response during cardiac surgery with cardiopulmonary bypass (CPB in children. METHODS: Thirty

  18. INTUBATIONS CONDITIONS AND HOMODYNAMIC RESPONSES UNDER ANESTHESIA INDUCTION WITH THREE COMBINATION DRUGS: ALFENTANIL- MIDAZOLAM, ALFENTANIL- THIOPENTAL AND ALFENTANIL- KETAMINE

    Directory of Open Access Journals (Sweden)

    H SOLTANI NEZHAD

    2000-03-01

    Full Text Available Background. Administration of alfentanil followed by propofol intravenously (IV without neuromuscular blockage for induction of anesthesia provides adaquate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. The aim of the present study was comparison of intubation conditions and hemodynamic responses of anesthesia induction with alfentanil/midazolam, alfentanil/Na thiopental and alfentanil/ ketamine. Methods. In a clinical trial study one hundred and twenty children were randomly allocated to four groups. Medication in these groups were alfentanil 40 µg/kg+ midazolam 200 µg/kg,alfentanil 40 µg/kg+Na thiopental 6 µg/kg, alfentanil 40 µg/kg+ketamin 2 mg/kg & Na thipental 6 mg/kg+suxamethonium 2 mg/kg (as control group. In all patients the ease of ventilation via face mask, jaw mobility, degree of exposure and position of vocal cords, patient's response to tracheal intubation, duration of time was needed for intubation and hemodynamic changes after intubation were assessed and recorded. Findings. There are significant differences between first three groups (interventional groups for jaw mebility, ventilation, vocal cord visuality, vocal cord position, patient movement during laryngoscopy and mean laryngoscopy time, (P < 0.05. There is significant difference between all groups of nesdonal+alfentanil except for patient movement. There is significant difference between mean SBP and PR before and after intubation in first and third group. Conclusion. Results represent that the group of Alfentanil plus Nesdonal had a better quality of ventilation rather than two other groups. It is recommended that administration of alfentanil plus thiopental combination is preferred in cases that using muscle relaxant is contraindicated.

  19. Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

    Directory of Open Access Journals (Sweden)

    Rahşan Karayazılı

    2010-12-01

    Full Text Available Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain. Methods: Sixty pediatric patients (aged 2-12 years with American Society of Anesthesiology (ASA classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP, heart rates (HR, Ramsey sedation scores (Rss and sedation agitation scores (Sas were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2. Recovery times, Alderete scores and facial pain scores (FPS were recorded. Results: There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05. There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium. Conclusion: Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents. (The Medical Bulletin of Haseki 2010; 48: 146-52

  20. The cost effectiveness of licensed oromucosal midazolam (Buccolam(®)) for the treatment of children experiencing acute epileptic seizures: an approach when trial evidence is limited.

    Science.gov (United States)

    Lee, Dawn; Gladwell, Daniel; Batty, Anthony J; Brereton, Nic; Tate, Elaine

    2013-04-01

    In the UK, two treatment options are used for acute epileptic seizures in the community-rectal diazepam and unlicensed buccal midazolam. In practice, the former is rarely used, with unlicensed buccal midazolam being widely recommended and prescribed by physicians. In September 2011, Buccolam(®) (licensed midazolam oromucosal solution) became the first medicine to receive a Paediatric-Use Marketing Authorization (PUMA) and it is indicated for the treatment of prolonged, acute, convulsive seizures by caregivers in the community for children (aged 6 months to marketing authorization processes and may be based upon small population subsets and may not, in some cases, require new safety or efficacy data to be generated; a similar situation to that seen for orphan drugs. This can lead to challenges when conducting economic evaluations. The aim of this study was to assess the cost effectiveness of Buccolam(®) for children with a diagnosis of epilepsy suffering prolonged, acute, convulsive seizures occurring in the UK community setting. DESIGN AND PERSPECTIVE: A hybrid model was developed according to a UK payer perspective. The model included a time-to-event simulation for the frequency and location of occurrence of seizures, along with a decision-tree model that assessed the treatment pathway when a seizure occured. The model compared treatment with Buccolam(®) with standard care in the community (95 % unlicensed buccal midazolam and 5 % rectal diazepam) or either treatment alone. The model was informed by data from a variety of sources, including clinical effectiveness estimates, and costs based on published UK data, using 2012-13 prices, where possible. To determine current practice and real-world effectiveness, a Delphi panel and a survey of parents of children with epilepsy were conducted. Buccolam(®) showed a reduction in costs of £2,939 compared with standard care, £14,269 compared with rectal diazepam alone and £886 compared with unlicensed buccal midazolam

  1. Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

    LENUS (Irish Health Repository)

    Ghori, Kamran A

    2012-02-03

    BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8\\/15 patients (53%) in the midazolam group and 7\\/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg\\/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg\\/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg\\/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg\\/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

  2. Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study.

    Science.gov (United States)

    Zhou, Yongfang; Jin, Xiaodong; Kang, Yan; Liang, Guopeng; Liu, Tingting; Deng, Ni

    2014-06-16

    Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients. A total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events. The incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P memory of the uncomfortable events was lower than in group M (11.7% versus 25.0%, P memory was similar (P >0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01). Sequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical

  3. Hemodynamics and bispectral index (BIS of dogs anesthetized with midazolam and ketamine associated with medetomidine or dexmedetomidine and submitted to ovariohysterectomy Avaliação hemodinâmica e do índice bispectral (BIS de cadelas anestesiadas com midazolam e cetamina associados à medetomidina ou dexmedetomidina e submetidas a ovário-salpingo-histerectomia

    Directory of Open Access Journals (Sweden)

    Fernando do Carmo Silva

    2010-04-01

    Full Text Available PURPOSE: To evaluate hemodynamics and bispectral index (BIS in bitches anesthetized with ketamine and midazolam in combination with dexmedetomidine or medetomidine and submitted to ovariohysterectomy. METHODS: Twenty bitches pretreated with levomedetomidine and buprenorphine were anesthetized with 5 mg.kg-1 ketamine and 0.2 mg.kg-1 midazolam i.v. Continuous infusion of 0.4 mg.kg-1.h-1 midazolam and 20 mg.kg-1.h-1 ketamine was initiated in combination with DEX (n=10: 20 µg.kg-1.h-1 dexmedetomidine or MED (n=10: 30 µg.kg-1.h-1 medetomidine over 30 minutes. A pharmacokinetic study provided dexmedetomidine plasma concentration, set to be 3.0 ng.mL-1. RESULTS: BIS decreased in both groups (P0.05, but heart rate decreased in both groups, as compared to control values (POBJETIVO: Verificar o comportamento hemodinâmico e o índice bispectral de cadelas anestesiadas com cetamina e midazolam associados à dexmedetomidina ou medetomidina. MÉTODOS: Vinte cadelas receberam pré-tratamento com levomepromazina e buprenorfina e foram anestesiadas com cetamina, 5 mg.kg-1 i.v., e midazolam, 0,2 mg.kg-1 i.v., seguidos da administração contínua de midazolam, 0,4 mg.kg-1.h-1, e cetamina, 20 mg.kg-1.h-1, associados, conforme o grupo, à: DEX (n=10: dexmedetomidina 20 µg.kg-1.h-1 ou MED (n=10: medetomidina 30 µg.kg-1.h-1, mantidos por 30 minutos. A dose de dexmedetomidina foi obtida por meio de estudo farmacocinético planejando-se concentração plasmática de 3,0 ng.mL-1. RESULTADOS: Os valores do BIS diminuíram em ambos os grupos (P0,05, sem a presença de efeitos adversos. CONCLUSÃO: A administração contínua de dexmedetomidina em concentração plasmática calculada de 3 ng.mL-1, em combinação com midazolam e cetamina, resulta em plano anestésico adequado para castração de cadelas, estabilidade hemodinâmica e despertar tranquilo, sem efeitos adversos.

  4. Síndrome de abstinência associada à interrupção da infusão de fentanil e midazolam em pediatria

    OpenAIRE

    Bicudo,J.N.; Souza,N. de; Mângia,C.M.F.; Carvalho,W.B. de

    1999-01-01

    OBJETIVO: Determinar a ocorrência de síndrome de abstinência em crianças internadas em UCI Pediátrica em uso de fentanil e midazolam. MÉTODOS: Avaliadas 36 crianças internadas na UCI Pediátrica do Hospital São Paulo - Universidade Federal de São Paulo, no período de março a setembro de 1997, com idade variando de 5 dias a 22 meses (22 masc : 14 fem) que fizeram uso de fentanil e midazolam por mais de 24 horas. Utilizado o Escore Neonatal de Abstinência adaptado por Finnegan que determina a oc...

  5. Associação entre midazolam e detomidina na medicação pré-anestésica para indução da anestesia geral com cetamina em potros A combination study of midazolam and detomidine in the premedication anesthesia for the induction of general anesthesia with ketamine in foals

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    J.A. Marques

    2009-12-01

    Full Text Available Empregou-se a associação midazolam e detomidina para indução de anestesia com cetamina em 16 potros, machos e fêmeas, entre três e seis meses de idade, distribuídos aleatória e equitativamente em dois grupos (GI e GII. A todos os animais foram administrados midazolam, via intramuscular, na dose de 0,2mg/kg, e após 15 minutos, detomidina, via intravenosa, na dose de 0,02mg/kg. Os animais do GII receberam cetamina pela via intravenosa, dose 2,0mg/kg, três minutos após a administração de detomidina. Quinze minutos após o midazolam, ocorreram sedação e ligeira ataxia, e dois minutos após a administração da detomidina, decúbito lateral em todos os potros, com miorrelaxamento e presença dos reflexos de deglutição e miorrelaxamento, anal e oculo-palpebral. A associação midazolam/detomidina e cetamina provocou ausência dos reflexos de deglutição. Para todos os animais, o tempo de recuperação foi de 45-60 minutos, e temperatura retal e frequência respiratória permaneceram estáveis. Ocorreram bradicardia, bloqueio atrioventricular de segundo grau e aumento das pressões arteriais sistólica, diastólica e média após dois minutos da administração da detomidina. A associação midazolam/detomidina e cetamina demonstrou ser um método eficiente e seguro para a anestesia de potros hígidos.A combination of midazolam, 0.2mg/kg body weight given via intramuscular, and detomidine, 0.02mg/kg body weight given via intravenous (IV, was evaluated as a method for induction of anesthesia with ketamine, 2.0mg/kg body weight given via IV in foals. Sixteen male and female foals aging from three to six-month old were distributed into two groups. Both groups were first injected with midazolam and with detomidine 15 minutes later. Three minutes later, ketamine was injected in the foals. Sedation and light ataxia were observed 15 minutes after midazolam administration. Bradycardia, atrioventricular block, increased blood pressure, lateral

  6. Turning up the Noise or Turning Down the Volume? On the Nature of the Impairment of Episodic Recognition Memory by Midazolam

    Science.gov (United States)

    Malmberg, Kenneth J.; Zeelenberg, Rene; Shiffrin, Richard M.

    2004-01-01

    E. Hirshman, J. Fisher, T. Henthom, J. Amdt, and A. Passanname (2002) found that Midazolam disrupts the mirror-patterned word-frequency effect for recognition memory by reversing the typical hit-rate advantage for low-frequency words. They noted that this result is consistent with dual-process accounts (e.g., R. C. Atkinson & J. F. Juola, 1974; G.…

  7. Short- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam--a pilot study.

    Science.gov (United States)

    Sackey, Peter V; Martling, Claes-Roland; Carlswärd, Christine; Sundin, Orjan; Radell, Peter J

    2008-03-01

    To compare memories from the intensive care unit (ICU) and short- and long-term psychological morbidity in patients after sedation with intravenous midazolam or inhaled isoflurane. Prospective long-term follow-up after randomized controlled trial. General ICU at Karolinska University Hospital, Solna, Stockholm. Forty patients in need of sedation during ventilator treatment. Patients were randomized to receive isoflurane or midazolam for goal-directed sedation until extubation or for a maximum of 96 hrs. For short-term follow-up, doctors', nurses', and physiotherapists' notes from the 4 days following exposure to the study drugs were reviewed for words indicating adequate or pathologic cognitive and psychological recovery. For long-term follow-up, all 6-month survivors received questionnaires including the ICU Memory Tool (ICU-MT), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), and Well-Being Index. Additionally, several screening questions for previous posttraumatic stress symptoms were included. In the short term follow-up, no significant differences were found between groups. In the long-term follow-up, a trend toward fewer hallucinations/delusions after isoflurane sedation than after midazolam (two of ten isoflurane patients vs. five of seven midazolam patients) was found (p = .06). None of the five solely isoflurane-sedated patients reported hallucinations/delusions from the ICU. There was no difference in groups in long-term psychological morbidity as measured with HADS and IES. Memories of negative feelings in the ICU (ICU-MT) were associated with high HADS and IES scores (Fisher's exact test, p = .02 and p = .01, respectively). Sedation of ICU patients with isoflurane may result in fewer delusional memories or hallucinations from the ICU compared with more commonly used intravenous sedation. Memories of negative feelings from the ICU were associated with symptoms of depression or anxiety or symptoms indicating posttraumatic stress

  8. Optimal and safe standard doses of midazolam and propofol to achieve patient and doctor satisfaction with dental treatment: A prospective cohort study

    Science.gov (United States)

    Nonaka, Mutsumi; Nishimura, Akiko; Gotoh, Kinuko; Oka, Shuichirou; Iijima, Takehiko

    2017-01-01

    Background The incidences of morbidity and mortality caused by pharmacosedation for dental treatment have not yet reached zero. Adverse events are related to inappropriate respiratory management, mostly originating from an overdose of sedatives. Since sedation is utilized for the satisfaction of both the dentist and the patient, the optimal dose should be minimized to prevent adverse events. We attempted to define the optimal doses of midazolam and propofol required to achieve high levels of patient and dentist satisfaction. Methods One thousand dental patients, including those undergoing third molar extractions, were enrolled in this study. A dose of 1 mg of midazolam was administered at 1-minute intervals until adequate sedation was achieved. Propofol was then infused continuously to maintain the sedation level. Both the patients and the dentists were subsequently interviewed and asked to complete a questionnaire. A multivariate logistic regression analysis was used to examine the factors that contributed to patient and dentist satisfaction. Results The peak midazolam dose resulting in the highest percentage of patient satisfaction was 3 mg. Both a lower dose and a higher dose reduced patient satisfaction. Patient satisfaction increased with an increasing dosage of propofol up until 4 mg/kg/hr, reaching a peak of 78.6%. The peak midazolam dose resulting in the highest percentage of dentist satisfaction (78.8%) was 2 mg. Incremental propofol doses reduced dentist satisfaction, in contrast to their effect on patient satisfaction. The strongest independent predictors of patient satisfaction and dentist satisfaction were no intraoperative memory (OR, 5.073; 95% CI, 3.532–7.287; Psedation is relatively light, memory loss and an absence of unintentional patient movements can be expected without adverse events. PMID:28182732

  9. A pré-medicação com midazolam antes de secção cesariana não tem efeitos adversos no neonato

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    Ahmet Can Senel

    2014-01-01

    Full Text Available Como todos os pacientes cirúrgicos, pacientes obstétricas também sentem estresse e ansieda de operatórios. Isso pode ser prevenido se forem passadas à paciente informações detalhadas sobre sua operação e se forem administrados medicamentos farmacológicos pré-operatórios. Devido aos efeitos depressivos dos sedativos nos neonatos, os medicamentos farmacológicos são omitidos, especialmente em pacientes obstétricas. A literatura contém poucos estudos concernentes ao uso de midazolam no pré-operatório em pacientes de secção cesariana (C/S. Nosso objetivo nesse estudo foi ajudar nossas pacientes passando por cirurgia C/S. Um grupo agendado para C/S eletiva recebeu midazolam 0,025 mg kg−1 por via intraveno sa; o outro grupo recebeu salina. A ansiedade materna foi avaliada com o uso dos escores da Amsterdam Preoperative Anxiety and Information Scale (APAIS (Escala de Ansiedade e Informação Pré-operatória de Amsterdam, e os neonatos foram avaliados por Apgar e pelo instrumento Neonatal Neurologic and Adaptive Capacity Score (NACS (Escore Neurológico e de Capacidade Adaptativa do Neonato. Em conclusão, os pacientes pré-medicados com midazolam 0,025 mg kg−1 medicação tiveram escores de ansiedade significativamente baixos, sem qualquer efeito adverso nos neonatos. Portanto, midazolam pode, com segurança, ser utilizado como agente de pré-medicação na cirurgia C/S.

  10. The Effects of Single-Dose Rectal Midazolam Application on Postoperative Recovery, Sedation, and Analgesia in Children Given Caudal Anesthesia Plus Bupivacaine

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    Sedat Saylan

    2014-01-01

    Full Text Available Background. This study aimed to compare the effects of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, and sedation and to find out its adverse effects in children having lower abdominal surgery. Methods. 40 children between 2 and 10 years of ASA I-II were randomized, and they received caudal anesthesia under general anesthesia. Patients underwent the application of caudal block in addition to saline and 1 mL/kg bupivacaine 0.25%. In the postoperative period, Group C (n = 20 was given 5 mL saline, and Group M (n = 20 was given 0.30 mg/kg rectal midazolam diluted with 5 mL saline. Sedation scale and postoperative pain scale (CHIPPS of the patients were evaluated. The patients were observed for their analgesic need, first analgesic time, and adverse effects for 24 hours. Results. Demographic and hemodynamic data of the two groups did not differ. Postoperative sedation scores in both groups were significantly lower compared with the preoperative period. There was no significant difference between the groups in terms of sedation and sufficient analgesia. Conclusions. We conclude that caudal anesthesia provided sufficient analgesia in peroperative and postoperative periods, and rectal midazolam addition did not create any differences. This trial is registered with ClinicalTrials.gov NCT02127489.

  11. Success rate of IR midazolam sedation in combination with C-CLAD in pediatric dental patients—a prospective observational study

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    Malka Ashkenazi

    2014-03-01

    Full Text Available Objective. To evaluate the success rate of intra-rectal (IR midazolam in combination with nitrous oxide/oxygen (N2O sedation in young uncooperative dental patients when the local anesthesia is delivered by a computerized controlled local anesthetic delivery (C-CLAD.Study Design. This observational study consisted of 219 uncooperative children (age: 4.3 ± 1.69 y who received IR midazolam (0.4 mg/kg and N2O to complete their dental treatment. Measured variables included: child’s pain disruptive behavior during delivery of anesthesia by C-CLAD (CHEOP Scale, child behavior during treatment (Houpt scale, dental procedure performed, and side effects that appeared during treatment.Results. There was a high level of cooperation (mean score: 6.69 ± 2.1 during administration of local anesthesia. Good-to-excellent behavior was shown by 87% of the children during treatment. Planned treatment was completed by 184 (92% patients. No statistically significant changes were noticed in the oxygen saturation levels before and after treatment. Children with side effects included 3 (1.3% with nistagmus, 5 (2.3% with diplopia, and 18 (8.2% with hiccups. Three consecutive sedations decreased the overall behavior score by 5.7% compared to the first appointment (p < .05.Conclusions. IR midazolam-N2O sedation in combination with C-CLAD is very effective for delivery of dental treatment to young uncooperative children.

  12. Peces del Noroeste del Ecuador

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    Barriga, Ramiro

    1994-01-01

    La ictiofauna del occidente del Ecuador es poco conocida. Los peces del noroccidente son diferentes a los del suroccidente del Ecuador. 34 familias y 82 especies fueron colectadas que equivale al 11 % de las especies de peces continentales registradas en el Ecuador. Icteogeográficamente se sabe que la costa ecuatoriana posee dos provincias: la del Pacifico Norte y la del Guayas, se determinó que el límite de las dos provincias es el río Santiago ya que las especies del mencionado río so...

  13. Estudio preliminar de la profilaxis de la epilepsia en acúmulos, con midazolam.

    OpenAIRE

    Paredes L., Gustavo A.; Andrade, M.; Vielma, Marly; Rondón, Juana

    2006-01-01

    Editorial. ¡Ya tenemos símbolo, ícono o logotipo!. Now we have symbol, icono or logo!. Salinas, Pedro José Accidentes domésticos en ancianos. Municipio Libertador. Mérida. 1993-1996. Domestics accidents in elderly people. Libertador County of Mérida State. 1993-1996. Salinas, Pedro José Rojas Márquez, Reina Estrés y síntomas en personal de salud del Hospital Universitario de Los Andes. Stress and symptoms in health staff of the Hospital Universitario de Los Andes. Méri...

  14. Evaluation of butorphanol, medetomidine and midazolam as a reversible narcotic combination in free-ranging African lions (Panthera leo).

    Science.gov (United States)

    Wenger, Sandra; Buss, Peter; Joubert, Jenny; Steenkamp, Johan; Shikwambana, Purvance; Hatt, Jean-Michel

    2010-11-01

    To evaluate the effects of the combination butorphanol, medetomidine and midazolam (BMM) and its reversibility in lions. Prospective clinical trial. Thirty free-ranging lions, 10 male and 20 female, weighing 81-210 kg. Lions were immobilised with butorphanol mean 0.31 ± SD 0.034 mg kg(-1), medetomidine 0.052 ± 0.006 mg kg(-1), midazolam 0.21 ± 0.024 mg kg(-1) and hyaluronidase 1250 IU administered intramuscularly with a dart gun. Upon recumbency, physiological parameters and anaesthetic depth were monitored 10-15 minutes after darting (T1) and repeated every 10 minutes for a further 30 minutes (T2, T3, T4). Arterial blood gas analyses were performed at T1 and T4. At the end of the procedure, 45-60 minutes after initial darting, immobilisation was reversed with naltrexone 0.68 ± 0.082 mg kg(-1), atipamezole 0.26 ± 0.031 mg kg(-1), and flumazenil 0.0032 ± 0.0007 mg kg(-1) administered intravenously and subcutaneously. The BMM combination rapidly induced immobilisation and lateral recumbency was reached within 7.25 ± 2.3 minutes. Median induction score [scored 1 (excellent) to 4 (poor)] was 1.4 (range 1-2). Cardio-respiratory parameters were stable. Heart rate varied from 32 to 72 beats per minute, respiratory rate from 14 to 32 breaths minute(-1) and rectal temperature from 36.6 to 40.3 °C. No sudden arousals were observed. Arterial blood gas analyses revealed a mean pH of 7.33, PaCO(2) of 33 mmHg and PaO(2) of 87 mmHg. Mild to moderate hypoxemia was seen in four lions. Recovery was smooth and lions were walking within 4.4 ± 4.25 minutes. Median recovery score [scored 1 (excellent) to 4 (poor)] was 1.3 (range 1-2). The drug combination proved to be effective in immobilising free-ranging healthy lions of both sexes with minimal cardio-respiratory changes. © 2010 The Authors. Veterinary Anaesthesia and Analgesia © 2010 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

  15. Cardiovascular effects of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane.

    Science.gov (United States)

    Araújo, Marcelo A; Dias, Bianca P; Bovino, Fernanda; Deschk, Maurício; Abimussi, Caio Jx; Oliva, Valéria Nls; Rodrigues, Celso A; Santos, Paulo Sp

    2014-03-01

    To assess the cardiovascular changes of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane during mechanical ventilation. Prospective, randomized, cross-over, experimental trial. A total of eight, healthy, male Holstein calves, aged 10 ± 1 months and weighing 114 ± 11 kg were included in the study. Calves were administered xylazine followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane (1.3%) using mechanical ventilation. Forty minutes after induction, lidocaine (2 mg kg⁻¹ bolus) or an equivalent volume of saline (0.9%) was administered IV followed by a continuous rate infusion (100 μg kg⁻¹ minute⁻¹) of lidocaine (treatment L) or saline (treatment C). Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP and MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), pulmonary arterial occlusion pressure (PAOP), cardiac output, end-tidal carbon dioxide (Pe'CO2 ) and core temperature (CT) were recorded before lidocaine or saline administration (Baseline) and at 20-minute intervals (T20-T80). Plasma concentrations of lidocaine were measured in treatment L. The HR was significantly lower in treatment L compared with treatment C. There was no difference between the treatments with regards to SAP, DAP, MAP and SVRI. CI was significantly lower at T60 in treatment L when compared with treatment C. PAOP and CVP increased significantly at all times compared with Baseline in treatment L. There was no significant difference between times within each treatment and between treatments with regards to other measured variables. Plasma concentrations of lidocaine ranged from 1.85 to 2.06 μg mL⁻¹ during the CRI. At the studied rate, lidocaine causes a decrease in heart rate which is unlikely to be of clinical significance in healthy animals, but could be a concern in compromised animals. © 2013 Association of Veterinary Anaesthetists

  16. Evaluation of a butorphanol, detomidine, and midazolam combination for immobilization of captive Nile lechwe antelopes (Kobus magaceros).

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    Laricchiuta, Pietro; De Monte, Valentina; Campolo, Marco; Grano, Fabio; Iarussi, Fabrizio; Crovace, Antonio; Staffieri, Francesco

    2012-07-01

    Field immobilization of captive antelope may be required for medical examination, blood sample collection, and animal identification. The aim of this study was to evaluate the effects of a combination of butorphanol, detomidine, and midazolam (BDM) and its partial reversibility in Nile lechwe antelope (Kobus megaceros). Nine captive lechwes, weighing 28-64 kg, were immobilized, in February 2011, with butorphanol 0.20 ± 0.05 (mean ± SD) mg/kg, detomidine 0.20 ± 0.05 mg/kg, and midazolam 0.31 ± 0.08 mg/kg administered intramuscularly (IM) with a blowpipe. Physiologic parameters and depth of anesthesia were recorded when the animals became recumbent at 19.55 ± 8.36 min after darting (T0) and after 10 (T10), 20 (T20), and 30 (T30) min. An arterial blood sample was collected at T20. At the end of the procedures, immobilization was partially reversed with atipamezole 0.25 mg/kg IM. Quality of induction, immobilization, and recovery was scored. The BDM combination induced immobilization and lateral recumbency in 13.44 ± 5.61 min. Median induction score (scored 1 [excellent] to 4 [poor]) was 1 (range 1-2). Heart rate varied 40-104 beats/min, respiratory rate 16-108 breaths/min, and rectal temperature 36.5-40.3 C. Hyperthermia was observed and rapidly treated in three animals that demonstrated insufficient immobilization after darting. Arterial blood gas analyses revealed a mean pH of 7.43 ± 0.07, partial arterial pressure of CO(2) of 44.1 ± 6.0 mmHg, partial arterial pressure of O(2) of 74.0 ± 13.5 mmHg, and an arterial O(2) saturation of 94.77 ± 3.96%. Recovery was smooth and animals were walking in 13.44 ± 7.85 min. Median recovery score (1 = excellent to 4 = poor) was 1 (range 1-2). The BDM was effective in immobilizing captive healthy lechwes with minimal cardiorespiratory changes.

  17. Comparison of alfaxalone, ketamine and thiopental for anaesthetic induction and recovery in Thoroughbred horses premedicated with medetomidine and midazolam.

    Science.gov (United States)

    Wakuno, A; Aoki, M; Kushiro, A; Mae, N; Kodaira, K; Maeda, T; Yamazaki, Y; Ohta, M

    2017-01-01

    There is limited information on clinical use of the new injectable anaesthetic agent alfaxalone in Thoroughbred horses. To compare anaesthetic induction and recovery characteristics and cardiopulmonary responses between alfaxalone, ketamine and thiopental in Thoroughbred horses premedicated with medetomidine and midazolam. Randomised blinded experimental cross-over study. Six Thoroughbred horses were anaesthetised 3 times with alfaxalone 1 mg/kg bwt, ketamine 2.5 mg/kg bwt or thiopental 4 mg/kg bwt after premedication with medetomidine 6 μg/kg bwt and midazolam 20 μg/kg bwt. Qualities of anaesthetic induction and recovery were scored on a scale of 1 (poor) to 5 (excellent). Induction time and recovery time were recorded. Cardiopulmonary values (heart rate, respiratory rate, arterial blood pressures, and arterial blood gases) were recorded throughout anaesthesia. Data were analysed with nonparametric methods. The anaesthetic induction (P = 0.2) and recovery (P = 0.1) quality scores (median, range) were not different amongst protocols and were 4.0, 3-5; 5.0, 4-5; 4.5, 3-5; and 4.5, 3-5; 3.5, 2-5; 4.0, 2-5 for alfaxalone, ketamine and thiopental, respectively. Induction time for ketamine (67, 53-89 s) was significantly longer than that for alfaxalone (49, 40-51 s, P = 0.01) and thiopental (48, 43-50 s, P = 0.01). Time to standing for alfaxalone (44, 40-63 min, P = 0.01) and thiopental (39, 30-58 min, P = 0.01) was significantly longer than that for ketamine (25, 18-26 min). Cardiovascular values were maintained within the clinically acceptable level throughout anaesthesia. Respiratory rate significantly decreased during anaesthesia for all 3 drugs; however, spontaneous breathing did not disappear, and PaCO 2 values were maintained at approximately 50 mmHg. All 3 drugs showed similar effects in relation to anaesthetic induction and recovery qualities and cardiopulmonary responses. However, alfaxalone and thiopental prolonged recovery time

  18. Evaluation of a combination of low-dose ketamine and low-dose midazolam in terminal dyspnea-attenuation of "double-effect"

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    Abhijit Kanti Dam

    2008-01-01

    Full Text Available Aim: Of all symptoms in palliative medicine those concerning respiration are most excruciating and difficult to treat. Reticence about the use of morphine for palliation of dyspnea is common, especially in nonmalignant diseases, as there is a fear of causing respiratory depression, particularly where Chronic Obstructive Pulmonary Disease (COPD exists. This factor is also compounded by the lack of availability of morphine in parts of developing countries. Ketamine has excellent anesthetic and analgesic effects in addition to being easily available. It produces bronchodilatation and does not produce respiratory or cardiovascular depression. The author seeks to evaluate the role of low-dose (0.2 mg/kg ketamine and midazolam (0.02 mg/kg in the attenuation of terminal dyspnea. Methods: Sixteen patients with terminal dyspnea, admitted to the Critical Care Unit (CCU with cancer and other noncancer diagnoses were recruited. The subjective component of dyspnea was assessed using the Graphic Rating Scale (GRS, which has values from 0 - 10, 10 being maximum dyspnea. Each patient received a low-dose of ketamine and midazolam for relief of dyspnea. All the patients received low-flow (2 L/min. oxygen therapy via nasal cannula. Immediately after admission, all the patients were reassured and nursed in a decubitus position of their choice. The GRS was recorded at the point of admission, 10 minutes after starting oxygen therapy, and ten minutes after administration of low-dose ketamine and midazolam. Hemodynamic parameters were also recorded at these three points. Result: All the patients who enrolled in our study had significant dyspnea at admission, as was evident from the GRS scores of 8.250 (SD 0.91, respiratory rate of 28.56 (SD 5.0, mean arterial blood pressure (MABP of 102.7 (SD 14.63, pulse rate of 115.62 (SD 23.3, and SpO2 of 92.43 (SD 2.38. All the patients benefited from the combination of ketamine and midazolam, as evidenced by the statistically

  19. Pre-anesthetic Anxiety Level in Children with Congenital Heart Disease: Comparison between Maternal Presence during Anesthetic Induction and Midazolam Premedication

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    Ratna F Soenarto

    2016-09-01

    Full Text Available General anesthesia was needed by children with congenital heart disease (CHD who underwent cardiaccatheterization procedure and surgery. Pre-anesthetic anxiety in children with CHD can cause significantproblems during induction of anesthesia which leads to negative postoperative outcomes. This studycompared the role of maternal presence during anesthesia induction with midazolam premedication onpre-anesthetic anxiety level in children with CHD. Dr. Cipto Mangunkusumo National Hospital on April toSeptember 2014. Forty-five CHD patients aged 2-5 years old who underwent cardiac invasive procedurewere divided into P group (received midazolam premedication and M group (had maternal presence duringanesthesia induction. Modified Yale Pre-anxiety Scale (MYPAS was used for measuring anxiety level ineach patient during preoperative visit, on the time patient entered the procedure room and during induction ofanesthesia. There was no significant difference of MYPAS scores between the two groups in all measurementtimes. The MYPAS score results were non-anxious (median score 23.4 and the highest was at induction ofanesthesia. Inter-rater agreement test between 2 observers was good (k>0.5. In conclusion, there was nosignificant difference between the effect of maternal presence during induction of anesthesia and midazolampremedication on pre-anesthetic anxiety level in children with CHD. Keywords: pre-anesthetic anxiety, congenital heart disease, maternal presence, midazolam.   Peran Kehadiran Ibu selama Induksi Anestesia dengan PremedikasiMidazolam terhadap Tingkat Kecemasan Pra-anestesia Anak denganPenyakit Jantung Bawan Abstrak Pembiusan umum diperlukan oleh pasien dengan penyakit jantung bawaan (PJB pada saat kateterisasiatau pembedahan jantung. Kecemasan pra-anestesia dapat menimbulkan masalah saat induksi anestesiayang berdampak negatif pascapembedahan. Penelitian ini bertujuan untuk membandingkan efek premedikasimidazolam dan kehadiran ibu selama

  20. Facilitating influence of stress on the consolidation of fear memory induced by a weak training: reversal by midazolam pretreatment.

    Science.gov (United States)

    Maldonado, Noelia Martina; Martijena, Irene Delia; Molina, Víctor Alejandro

    2011-11-20

    It is well known that an emotionally arousing experience usually results in a robust and persistent memory trace. The present study explored the potential mechanisms involved in the influence of stress on the consolidation of a contextual fear memory in animals subjected to a weak fear training protocol, and whether pretreatment with intra-basolateral amygdala or systemic administration of midazolam (MDZ) prevents the potential stress-induced influence on fear memory formation. A previous restraint session facilitated fear retention, this effect was not due to a sensitized effect of restraint on the footshock experience. MDZ, both systemically or intra-basolateral amygdala infusion prior to the restraint, attenuated the stress-induced promoting influence on fear memory formation. In addition, stress exposure activated the ERK1/2 pathway in basolateral amygdala (BLA) after the weak training procedure but not after the immediate footshock protocol. Similar to our behavioral findings, MDZ attenuated stress-induced elevation of phospho-ERK2 (p-ERK2) in BLA following the acquisition session. Given that the activation of ERK1/2 pathway is essential for associative learning, we propose that stress-induced facilitation of p-ERK2 in BLA is an important mechanism for the promoting influence of stress on the consolidation of contextual fear memory. Copyright © 2011 Elsevier B.V. All rights reserved.

  1. Cartas al editor

    Directory of Open Access Journals (Sweden)

    Facultad de Medicina Revista

    1995-10-01

    Full Text Available Con respecto al ensayo "Evaluación del aprendizaje en la educación superior" de la Dra. Análida Pinilla / Ciencia y conciencia en la medicina colombiana / Farmacovigilancia: Una necesidad urgente

  2. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment: a double-blinded randomized placebo-controlled trial Efeitos peroperatórios da premedicação oral de midazolam em crianças submetidas a tratamento de pele por laser: estudo duplo-cego randomizado e controlado

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    Mehrdad Shoroghi

    2011-08-01

    Full Text Available PURPOSE: To investigate and compare the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in children who underwent skin laser treatment in an academic educational Hospital. METHODS: Ninety children, candidates for skin laser treatment were randomly assigned to 1 of 3 groups of 30 each: the placebo group received 0.1 ml/kg orange flavored juice, group 2 and 3 receiving 0.5 and 1 mg/kg of injectable midazolam mixed with an equal volume of orange juice, respectively. The main outcome measures included the mask acceptance, patients' behavioral scales and postoperative events. RESULTS: There were no significant differences in heart rate, respiratory rate, and systolic blood pressure among the three groups. However, arterial oxygen saturation was significantly reduced in those given 1 mg.kg-1 midazolam. The median scores of anxiety, separation from parent, preparing an intravenous line, acceptance of the oxygen mask, good sedation, crying reduction and consciousness level were better in midazolam group. Postoperative agitation and re-crying were also more frequent in placebo receivers. Those given 1 mg.kg-1 midazolam were significantly more optimal for sedation, crying, consciousness, preparing an intravenous line, and postoperative re-crying compared with 0.5 mg.kg-1 midazolam receivers. CONCLUSION: As a preanaesthetic medication, the 1 mg.kg-1 dose of orally given midazolam especially in a volume of orange juice and can optimize the children's behavior during skin laser treatment with no serious adverse effects, enhancing their parents' satisfactions about the sedative protocol.OBJETIVO:Investigar e comparar a eficácia do uso oral de midazolam com duas diferentes doses de suco de laranja na hemodinâmica peropeatória e mudanças de desempenho em crianças submetidas tratamento de pele por laser em Hospital educacional e acadêmico. MÉTODOS:Noventa crianças candidatas a

  3. Changes in blood glucose level during and after light sedations using propofol-fentanyl and midazolam-fentanyl in diabetic patients who underwent cataract surgery.

    Science.gov (United States)

    Khalighinejad, Pooyan; Rahimi, Mojtaba; Naghibi, Khosro; Niknam, Negar

    2015-01-01

    Surgeries may trigger the stress response which leads to changes in blood glucose level, and studies suggest that different sedation and anesthesia methods have different effects on blood glucose level. The aim of this study was to investigate changes of blood glucose levels in diabetic patients and compare them in two sedation methods of propofol + fentanyl and midazolam + fentanyl. Totally, 80 diabetic candidates for cataract surgery who had all the inclusion criteria, underwent cataract surgery using two methods of propofol (1 mg/kg/h) + fentanyl (2 μg/kg) (Group P) and midazolam (0.03 mg/kg) + fentanyl (2 μg/kg) (Group M) for light sedation. In the end, 70 patients (Group P n = 35 and Group M n = 35) remained in the study. Patients' blood glucose levels, vital signs, and hemodynamic data were assessed 30 min prior to the surgery, each 15 min during surgery and at the end of surgery. Hemodynamic parameters did not have a statistically significant difference between the two groups mean blood glucose level in Group M was 149.15 mg/dl and in Group P was 149.2 mg/dl, and based on repeated measures analysis of variance test, significant differences were not observed between the two groups (P = 0.99). T-test showed no significant differences in the blood glucose level at any time of the study between the two groups. Light sedation methods of propofol + fentanyl and midazolam + fentanyl did not have any differences in alteration of blood glucose level.

  4. Sedative Effects of Intranasal Midazolam Administration in Wild Caught Blue-fronted Amazon (Amazona aestiva) and Orange-winged Amazon (Amazona amazonica) Parrots.

    Science.gov (United States)

    Schaffer, Débora P H; de Araújo, Nayone L L C; Raposo, Ana Cláudia S; Filho, Emanoel F Martins; Vieira, João Victor R; Oriá, Arianne P

    2017-09-01

    Safe and effective sedation protocols are important for chemical restraint of birds in clinical and diagnostic procedures, such as clinical evaluations, radiographic positioning, and blood collection. These protocols may reduce stress and ease the management of wild-caught birds, which are susceptible to injury or death when exposed to stressful situations. We compare the sedative effect of intranasal midazolam in wild-caught blue-fronted (Amazona aestiva) and orange-winged (Amazona amazonica) Amazon parrots. Ten adult parrots of each species (n = 20), of unknown sex, weighing 0.337 ± 0.04 (blue-fronted) and 0.390 ± 0.03 kg (orange-winged), kg were used. Midazolam (2 mg/kg) was administered intranasally and the total volume of the drug was divided equally between the 2 nostrils. Onset time and total sedation time were assessed. Satisfactory sedation for clinical evaluation was induced in all birds. Onset time and total sedation times were similar in both species: 5.36 ± 1.16 and 25.40 ± 5.72 minutes, respectively, for blue-fronted Amazons and 5.09 ± 0.89 and 27.10 ± 3.73 minutes, respectively, for orange-winged Amazons. A total of 15 animals showed absence of vocalization, with moderate muscle relaxation and wing movement upon handling, and 2 animals presented with lateral recumbence, with intense muscle relaxation and no wing movement, requiring no restraint. Three blue-fronted Amazons had no effective sedation. Intranasally administered midazolam at a dose of 2 mg/kg effectively promoted sedative effects with a short latency time and fast recovery in wild-caught parrots.

  5. Liquid chromatography-tandem mass spectrometry method for simultaneous quantification of bisoprolol, ramiprilat, propranolol and midazolam in rat dried blood spots.

    Science.gov (United States)

    Cvan Trobec, Katja; Trontelj, Jurij; Springer, Jochen; Lainscak, Mitja; Kerec Kos, Mojca

    2014-05-01

    Dried blood spot (DBS) sampling represents a suitable method for pharmacokinetic studies in rats, particularly if serial sampling is needed. To study the pharmacokinetics of drugs in a rat heart failure (HF) model, we developed and validated a method for the simultaneous determination of bisoprolol, ramiprilat, propranolol and midazolam in DBS samples. Bisoprolol and ramipril are widely used in the treatment of HF, and midazolam and propranolol are markers of hepatic metabolism, which can be altered in HF. A 20μL sample of rat blood was pipetted onto Whatman 903 Protein Saver Card and allowed to dry. The whole spot was excised and 300μL of solvent (methanol with 10% ultrapure water and 0.1% formic acid) was added. After mixing and incubating the sample in an ultrasonic bath, a mixture of isotopically labeled internal standards was added. After centrifugation, the extracts were cleaned on an Ostro™ plate and analyzed using liquid chromatography-tandem mass spectroscopy. The method was successfully validated. No significant interference was observed in the retention times of analytes or internal standards. The intraday and interday accuracy and precision were within a ±15% interval. The method was linear in the range 5-250μg/L and the lower limit of quantification was 5μg/L for all four analytes. The absolute matrix effect ranged from 98.7% for midazolam to 121% for ramiprilat. The recovery was lowest for ramiprilat and highest for propranolol. Samples were stable at all tested temperatures. The method has been used successfully in a real-time pharmacokinetic study in rats. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Evaluation of injectable anaesthesia with five medetomidine-midazolam based combinations in Egyptian fruit bats ( Rousettus aegyptiacus).

    Science.gov (United States)

    Tuval, Avishag; Las, Liora; Shilo-Benjamini, Yael

    2018-01-01

    Egyptian fruit bats are increasingly used as model animals in neuroscience research. Our aim was to characterize suitable injectable anaesthesia for this species, possibly replacing inhalant anaesthesia, thus minimizing occupational health hazards. Eight bats were randomly assigned by a crossover design for subcutaneously administered combinations of medetomidine-midazolam with: saline (MM-Sal), ketamine (MM-Ket), fentanyl (MM-Fen), morphine (MM-Mor), or butorphanol (MM-But). The anaesthetic depth and vital signs were monitored at baseline and every 10 min until bats recovered. If after 180 min the bats did not recover, atipamezole was administered. Mean induction times were 7-11.5 min with all combinations. Twitching during induction was common. All combinations produced anaesthesia, with significantly decreased heart rate (from 400 to 200 bpm) and respiratory rate (from 120-140 to 36-65 rpm). Arrhythmia and irregular breathing patterns occurred. MM-Fen, MM-Mor, and MM-But depressed respiration significantly more than MM-Sal. Time to first movement with MM-Ket and MM-But lasted significantly longer than with MM-Sal. Recovery time was significantly shorter in the MM-Sal (88 min) in comparison to all other treatments, and it was significantly longer in the MM-But (159 min), with atipamezole administered to four of the eight bats. In conclusion, all five anaesthetic protocols are suitable for Egyptian fruit bats; MM-Ket produces long anaesthesia and minimal respiratory depression, but cannot be antagonized completely. MM-Fen, MM-Mor, and MM-But depress respiration, but are known to produce good analgesia, and can be fully antagonized. Administration of atipamezole following the use of MM-But in Egyptian fruit bats is recommended.

  7. Repeated anaesthesia with isoflurane and medetomidine-midazolam-fentanyl in guinea pigs and its influence on physiological parameters.

    Directory of Open Access Journals (Sweden)

    Sabrina Schmitz

    Full Text Available Repeated anaesthesia may be required in experimental protocols and in daily veterinary practice, but anaesthesia is known to alter physiological parameters in GPs (Cavia porcellus, GPs. This study investigated the effects of repeated anaesthesia with either medetomidine-midazolam-fentanyl (MMF or isoflurane (Iso on physiological parameters in the GP. Twelve GPs were repeatedly administered with MMF or Iso in two anaesthesia sets. One set consisted of six 40-min anaesthesias, performed over 3 weeks (2 per week; the anaesthetic used first was randomized. Prior to Iso anaesthesia, atropine was injected. MMF anaesthesia was antagonized with AFN (atipamezole-flumazenil-naloxone. Abdominally implanted radio-telemetry devices recorded the mean arterial blood pressure (MAP, heart rate (HR and core body temperature continuously. Additionally, respiratory rate, blood glucose and body weight were assessed. An operable state could be achieved and maintained for 40 min in all GPs. During the surgical tolerance with MMF, the GPs showed a large MAP range between the individuals. In the MMF wake- up phase, the time was shortened until the righting reflex (RR returned and that occurred at lower MAP and HR values. Repeated Iso anaesthesia led to an increasing HR during induction (anaesthesias 2-6, non-surgical tolerance (anaesthesias 3-6 and surgical tolerance (anaesthesias 4, 6. Both anaesthetics may be used repeatedly, as repeating the anaesthesias resulted in only slightly different physiological parameters, compared to those seen with single anaesthesias. The regular atropine premedication induced HR increases and repeated MMF anaesthesia resulted in a metabolism increase which led to the faster return of RR. Nevertheless, Iso's anaesthesia effects of strong respiratory depression and severe hypotension remained. Based on this increased anaesthesia risk with Iso, MMF anaesthesia is preferable for repeated use in GPs.

  8. Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial.

    Science.gov (United States)

    Charalambous, M; Bhatti, S F M; Van Ham, L; Platt, S; Jeffery, N D; Tipold, A; Siedenburg, J; Volk, H A; Hasegawa, D; Gallucci, A; Gandini, G; Musteata, M; Ives, E; Vanhaesebrouck, A E

    2017-07-01

    Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs. To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available. Client-owned dogs with idiopathic or structural epilepsy manifesting status epilepticus within a hospital environment were used. Dogs were randomly allocated to treatment with IN-MDZ (n = 20) or R-DZP (n = 15). Randomized parallel-group clinical trial. Seizure cessation time and adverse effects were recorded. For each dog, treatment was considered successful if the seizure ceased within 5 minutes and did not recur within 10 minutes after administration. The 95% confidence interval was used to detect the true population of dogs that were successfully treated. The Fisher's 2-tailed exact test was used to compare the 2 groups, and the results were considered statistically significant if P status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively (P = .0059). All dogs showed sedation and ataxia. IN-MDZ is a quick, safe and effective first-line medication for controlling status epilepticus in dogs and appears superior to R-DZP. IN-MDZ might be a valuable treatment option when intravenous access is not available and for treatment of status epilepticus in dogs at home. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  9. [Effect of dexmedetomidine and midazolam on respiration and circulation functions in patients undergoing open heart surgery under acupuncture-assisted general anesthesia].

    Science.gov (United States)

    Tang, Wei; Wang, Jian; Fu, Guo-Qiang; Yuan, Lan

    2014-06-01

    To evaluate the effect of Dexmedetomidine and Midazolam on respiratory and circulation in patients experiencing open heart surgery under acupuncture-assisted general anesthesia. Sixty patients undergoing open heart surgery (cardiac valve replacement surgery and aortic valve replacement surgery) were randomly and equally divided into Dexmedetomidine (D) and Midazolam (M) groups. Electroacupuncture (EA) was applied to bilateral Yunmen (LU 2), Zhongfu (LU1), Lieque (LU7) and Neiguan (PC6). For patients of group D, Dexmedetomidine (i.v., loading dose: 1 microg/kg, and succedent dose: 0.2-1 microg x kg(-1) x h(-1)) was given. For patients of group M, Midazolam (i.v., loading dose: 0.05 mg/kg, succedent dose: 0.01-0.03 mg x kg(-1) x h(-1)) was given. Arterial oxygen pressure (PaO2), arterial carbondioxide tension (PaCO2), O2 saturation (SPO2), mean arterial pressure (MAP), heart rate (HR), anesthetic effect, time of spontaneous breathing recovery, and time of resuscitation were recorded before operation (T0), immediately after skin incision (T1), immediately after sternotomy (T2), before suspension of cardiopulmonary bypass (CPB, T3), immediately after cardiac re-beating (T4), immediately after CPB cessation (T5), and at the end of surgery (T6). Before operation, no significant differences were found between the group D and M in the levels of PaO2, PaCO2 and SPO2 (P > 0.05). The PaO2 and SPO2 levels after skin incision, sternotomy, before suspension of CPB and at the end of surgery were significantly lower in group M than in group D (P heart re-beating,after CPB cessation and at the end of surgery in group M were considerably higher than those in group D (P 0.05). It suggested that the respiration and circulation states in group D were more smoothly than those in group M. There was no significant difference between the two groups in the time of resuscitation (P > 0.05). Dexmedetomidine is superior to Midazolam in analgesia, and improving respiration and circulation

  10. A pré-medicação com midazolam antes de secção cesariana não tem efeitos adversos no neonato

    OpenAIRE

    Senel, Ahmet Can; Mergan, Fatih

    2014-01-01

    Como todos os pacientes cirúrgicos, pacientes obstétricas também sentem estresse e ansieda de operatórios. Isso pode ser prevenido se forem passadas à paciente informações detalhadas sobre sua operação e se forem administrados medicamentos farmacológicos pré-operatórios. Devido aos efeitos depressivos dos sedativos nos neonatos, os medicamentos farmacológicos são omitidos, especialmente em pacientes obstétricas. A literatura contém poucos estudos concernentes ao uso de midazolam no pré-operat...

  11. Efeitos anestésicos da administração intranasal ou intramuscular de cetamina S+ e midazolam em pomba-rola (Streptotelia sp. Anesthetic effects of intranasal or intramuscular administration of S+ Ketamine and Midazolam in ring necked dove (Streptotelia sp.

    Directory of Open Access Journals (Sweden)

    Suzane L. Beier

    2013-04-01

    Full Text Available A via intranasal é uma boa alternativa por ser indolor e de fácil aplicação em aves. O objetivo deste estudo foi avaliar os efeitos anestésicos da associação de cetamina S+ e midazolam pela via intranasal (IN em comparação com a via intramuscular (IM em pombos. Foram utilizados 12 pombos alocados em dois grupos com 15 dias de intervalo, os quais receberam: grupo IM: 20 mg/kg de cetamina S+ associada a 3,5 mg/kg de midazolam pela via intramuscular (musculatura do peito; e grupo IN, mesmo protocolo, porém, pela via intranasal. Os parâmetros avaliados foram: período de latência, tempo de duração em decúbito dorsal, tempo total de anestesia, tempo de recuperação e efeitos adversos. Para a análise estatística, empregou-se o teste de Wilcoxon, com as diferenças consideradas significativas quando PThe intranasal route is a good alternative because is painless and easy to perform in birds. The objective of this study was to evaluate the anesthetic effects of S+ ketamine and midazolam administered by intranasal or intramuscular route in pigeons. Twelve animals were used in a randomized and crossover design. Animals received two treatments with 2-weeks interval. IM group: animals received 20mg/kg of S+ ketamine and 3.5mg/kg of midazolam by intramuscular route (pectoral muscles; IN group: animals received the same protocol by intranasal route. Parameters evaluated were: onset of action, time of duration in dorsal recumbency; total time of anesthesia and side effects. Statistical analysis was performed using Wilcoxon test and the differences were considered significant when P<0.05. Onset of action was 30 [30-47.5] and 40 [30-50] seconds for IM and IN respectively. Time of duration in dorsal recumbency was 59 [53.25-65] and 63 [37-71.25] minutes for IM and IN respectively, without significant differences between treatments. Total time of anesthesia was 88 [86.25-94.5] and 68 [53.5-93] minutes for IM and IN, respectively, with significant

  12. Decreased absorption of midazolam in the stomach due to low pH induced by co-administration of Banha-sasim-tang

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    Jun Hyeon Jo

    2016-08-01

    Full Text Available Objectives Banha-sasim-tang (BST, which consists of seven different herbs, is one of the most popular herbal formulae for treating gastrointestinal disorders in Eastern Asia. The commonly used herbal medicine is often co-administered with other therapeutic drugs, which raises the possibility of herb–drug interactions and may modify the clinical safety profile of therapeutic drugs. Methods We investigated the potential herb–drug interactions between BST extract and midazolam (MDZ in mice. The area under the plasma concentration-time curve (AUC of MDZ and 1ʹ-hydroxymidazolam (1ʹ-OH-MDZ was evaluated for both oral and intraperitoneal administration of MDZ, following oral administration of BST (0.5 and 1 g/kg. Results It was found that the AUC of MDZ and 1ʹ-OH-MDZ was lower in case of oral administration of MDZ. Administration of BST extract was not associated with hepatic cytochrome P450 activity. BST extract induced a strong reduction in pH and it has been reported that oral mucosal absorption of MDZ is lower at low pH. The decreased absorption rate of MDZ might be caused by the ingredients of BST and may not be related to other factors such as increased excretion of MDZ by P-glycoprotein. Conclusions The altered pharmacokinetics of midazolam caused by co-administration with BST in vivo could be attributed to a decrease in pH and subsequent reduction of MDZ absorption rate.

  13. Analgesia after feline ovariohysterectomy under midazolam-medetomidine-ketamine anaesthesia with buprenorphine or butorphanol, and carprofen or meloxicam: a prospective, randomised clinical trial.

    Science.gov (United States)

    Polson, Sally; Taylor, Polly M; Yates, David

    2012-08-01

    One hundred female cats undergoing routine ovariohysterectomy under midazolam-medetomidine-ketamine anaesthesia were included in a blinded, randomised, prospective clinical study to compare postoperative analgesia produced by four analgesic drug combinations given preoperatively (n = 25 per group). A secondary aim was to assess the effects in kittens and pregnant animals. Buprenorphine 180 µg/m(2) or butorphanol 6 mg/m(2) were given with either carprofen 4 mg/kg (groups BUPC and BUTC, respectively) or meloxicam 0.3 mg/kg (groups BUPM or BUTM, respectively). Medetomidine was not antagonised. A simple, descriptive scale (SDS; 0-4), a dynamic and interactive visual analogue scale (DIVAS; 0-100 mm) and mechanical nociceptive thresholds (MT; 2.5-mm diameter probe) were used to evaluate postoperative pain. All pain scores were low (DIVAS 10 N) and there were no significant differences between the groups. It was concluded that all protocols provided adequate analgesia and when used with midazolam-medetomidine-ketamine are effective for routine feline ovariohysterectomy.

  14. Comparison of Haloperidol Alone and in Combination with Midazolam for the Treatment of Acute Agitation in an Inpatient Palliative Care Service.

    Science.gov (United States)

    Ferraz Gonçalves, José António; Almeida, Ana; Costa, Isabel; Silva, Paula; Carneiro, Rui

    2016-12-01

    Agitation is a very distressing problem that must be controlled as quickly as possible, but using a safe method. The authors conducted a comparison of two protocols: a combination of haloperidol and midazolam and haloperidol alone. The combination drug protocol controlled 101 out of 121 (84%) episodes of agitation with only the first dose, whereas the haloperidol alone protocol controlled 47 out of 74 (64%) episodes. This difference is statistically significant (P =.002), with a post hoc analyzed power of 0.88. The median time from the first dose to the control of agitation was 15 minutes (range: 5-210) with the combination and 60 minutes (range: 10-430) with the other protocol, P haloperidol and midazolam is effective and safe for the control of agitation in palliative care and it is more effective than haloperidol alone. Therefore, the combination should be adopted as the preferred protocol. It would be helpful if the usefulness of this protocol is confirmed by others.

  15. Propofol and midazolam inhibit conscious memory processes very soon after encoding: an event-related potential study of familiarity and recollection in volunteers.

    Science.gov (United States)

    Veselis, Robert A; Pryor, Kane O; Reinsel, Ruth A; Li, Yuelin; Mehta, Meghana; Johnson, Ray

    2009-02-01

    Intravenous drugs active via gamma-aminobutyric acid receptors to produce memory impairment during conscious sedation. Memory function was assessed using event-related potentials (ERPs) while drug was present. The continuous recognition task measured recognition of photographs from working (6 s) and long-term (27 s) memory while ERPs were recorded from Cz (familiarity recognition) and Pz electrodes (recollection recognition). Volunteer participants received sequential doses of one of placebo (n = 11), 0.45 and 0.9 microg/ml propofol (n = 10), 20 and 40 ng/ml midazolam (n = 12), 1.5 and 3 microg/ml thiopental (n = 11), or 0.25 and 0.4 ng/ml dexmedetomidine (n = 11). End-of-day yes/no recognition 225 min after the end of drug infusion tested memory retention of pictures encoded on the continuous recognition tasks. Active drugs increased reaction times and impaired memory on the continuous recognition task equally, except for a greater effect of midazolam (P memory for familiarity (P = 0.03) and possibly for recollection processes (P = 0.12). Propofol shifted ERP amplitudes to smaller voltages (P memory but not working memory. ERP measures of memory revealed different pathways to end-of-day memory loss as early as 27 s after encoding.

  16. Prehospital Agitation and Sedation Trial (PhAST): A Randomized Control Trial of Intramuscular Haloperidol versus Intramuscular Midazolam for the Sedation of the Agitated or Violent Patient in the Prehospital Environment.

    Science.gov (United States)

    Isenberg, Derek L; Jacobs, Dorian

    2015-10-01

    Violent patients in the prehospital environment pose a threat to health care workers tasked with managing their medical conditions. While research has focused on methods to control the agitated patient in the emergency department (ED), there is a paucity of data looking at the optimal approach to subdue these patients safely in the prehospital setting. Hypothesis This study evaluated the efficacy of two different intramuscular medications, midazolam and haloperidol, to determine their efficacy in sedating agitated patients in the prehospital setting. This was a prospective, randomized, observational trial wherein agitated patients were administered intramuscular haloperidol or intramuscular midazolam to control agitation. Agitation was quantified by the Richmond Agitation and Sedation Scale (RASS). Paramedics recorded the RASS and vital signs every five minutes during transport and again upon arrival to the ED. The primary outcome was mean time to achieve a RASS less than +1. Secondary outcomes included mean time for patients to return to baseline mental status and adverse events. Five patients were enrolled in each study group. In the haloperidol group, the mean time to achieve a RASS score of less than +1 was 24.8 minutes (95% CI, 8-49 minutes), and the mean time for the return of a normal mental status was 84 minutes (95% CI, 0-202 minutes). Two patients required additional prehospital doses for adequate sedation. There were no adverse events recorded in the patients administered haloperidol. In the midazolam group, the mean time to achieve a RASS score of less than +1 was 13.5 minutes (95% CI, 8-19 minutes) and the mean time for the return of normal mental status was 105 minutes (95% CI, 0-178 minutes). One patient required additional sedation in the ED. There were no adverse events recorded among the patients administered midazolam. Midazolam and haloperidol administered intramuscularly appear equally effective for sedating an agitated patient in the

  17. The safety and efficacy of intranasal midazolam sedation combined with inhalation sedation with nitrous oxide and oxygen in paediatric dental patients as an alternative to general anaesthesia.

    Science.gov (United States)

    Wood, Michael

    2010-01-01

    Conscious Decision' was published in 2000 by the Department of Health, effectively ending the provision of dental general anaesthesia (DGA) outside the hospital environment. Other aspects of dental anxiety and behavioural management and sedation techniques were encouraged before the decision to refer for a DGA was reached. Although some anxious children may be managed with relative analgesia (RA), some may require different sedation techniques for dentists to accomplish dental treatment. Little evidence has been published in the UK to support the use of alternative sedation techniques in children. This paper presents another option using an alternative conscious sedation technique. to determine whether a combination of intranasal midazolam (IN) and inhalation sedation with nitrous oxide and oxygen is a safe and practical alternative to DGA. A prospective clinical audit of 100 cases was carried out on children referred to a centre for DGA. 100 children between 3 and 13 years of age who were referred for DGA were treated using this technique. Sedation was performed by intranasal midazolam followed by titrating a mixture of nitrous oxide and oxygen. A range of dental procedures was carried out while the children were sedated. Parents were present during the dental treatment. Data related to the patient, dentistry and treatment as well as sedation variables were collected at the treatment visit and a telephonic post-operative assessment from the parents was completed a week later. It was found that 96% of the required dental treatment was completed successfully using this technique, with parents finding this technique acceptable in 93% of cases. 50% of children found the intranasal administration of the midazolam acceptable. There was no clinically relevant oxygen desaturation during the procedure. Patients were haemodynamically stable and verbal contact was maintained throughout the procedure. In selected cases this technique provides a safe and effective alternative

  18. Potencial del Agua del suelo

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    Bustamante Heliodoro

    1986-12-01

    Full Text Available La energía potencial del agua presenta diferencias de un punto del suelo a otro; esas diferencias son las que originan el movimiento del agua de acuerdo a la tendencia universal de la materia en el sentido de moverse de donde la energía potencial es mayor a donde dicha energía es menor. En el suelo el agua en consecuencia se mueve hacia donde su energía decrece hasta lograr su estado de equilibrio. Se desprende entonces que la cantidad de energía potencial absoluta contenida en el agua, no es importante por sí misma, sino por su relación con la energía en diferentes lugares dentro del suelo. El concepto Potencial de agua del suelo es un criterio para esta energía.

  19. MIDAZOLAM IN PEDIATRIC PRACTICES

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    A.E. Aleksandrov

    2007-01-01

    Full Text Available The present overview is dedicated to the issue of the unpleasant emotions among the patients of the pediatric in patient departments. Among the children, the admission to the in patient department is accompanied with the relative effects predominance of the adrenal link of the sympathoadrenal system, which may lead to their depletion against the background of the rapid decrease of their reserves if accompanied with the excessive emotional and psychic or attached painful loads. The authors give recommendations as to the use of the benzodiazepines among children, who are frightened about the treatment and diagnostic manipulations to come.Key words: children, stress, sedation, benzodiazepines.

  20. COMBINE MIDAZOLAM-FENTANYL-KETAMIN FOR EVISERATION SURGERY IN PATIENT WITH MULTIDRUG ALERGY IN ACUTE ON CHRONIC EXCACERBATION OF HIPERSENSITIVITY REACTION

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    Putu Agus Surya Panji

    2018-06-01

    Full Text Available ABSTRACT Multidrug Alergy is a relatively rare imunology abnormality. Generally, it caused by congenital genotype and influence with environment. After treated the acute on chronic exacerbation of hypersensivity tipe 1, and the inflamation can alleviate, the patient schedule of eviseration oculi dextra with general anesthesia. And the opthamologist curious about the proceddure because eviseration need antibiotic to wash the oculi, but there are no antibiotic saved for the patient. For general anesthesia, the patient has no history so we can’t predicted about the anesthetic drug’s allergy. We choose combine ketamine-midazolamadn fentanyl to facilitate the anesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is the opioid which is the most rarely caused allergy and have strong potential. Midazolam can help the sedation

  1. Effectiveness of preoperative intranasal dexmedetomidine, compared with oral midazolam, for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia: a systematic review.

    Science.gov (United States)

    FitzSimons, James; Bonanno, Laura S; Pierce, Stephanie; Badeaux, Jennifer

    2017-07-01

    Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury. A newer drug, dexmedetomidine, is a selective alpha-2 agonist, which works in the brain and spinal cord that has sedative, analgesic and anxiolytic properties. Dexmedetomidine also has the ability to lower the overall anesthetic requirements by reducing sympathetic outflow in response to painful surgical stimulation. In current literature, there is not a systematic review that compares the effectiveness of preoperative intranasal dexmedetomidine administration against oral midazolam for the prevention of emergence delirium. The objective of this review was to identify the effectiveness of preoperative intranasal dexmedetomidine compared to oral midazolam for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia. This review considered studies that included pediatric patients aged three to seven years, with an American Society of Anesthesiologists (ASA) classification of I or II, and undergoing general anesthesia for elective/ambulatory surgery. This review excluded studies that included patients who had special needs including: developmental delay, chronic pain issues, and/or any preexisting mental or physical health disorders which categorized them above an ASA II. This review considered studies that compared preoperative intranasal administration of dexmedetomidine with preoperative oral administration of midazolam for the prevention of emergence delirium. This review considered both experimental and non-experimental study

  2. Sedation using 5% lidocaine patches, midazolam and propofol in a combative, obese adolescent with severe autistic disorder undergoing brain magnetic resonance imaging: a case report.

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    Seo, Kwon Hui; Jung, Hong Soo; Kang, Eu Gene; Kim, Change Jae; Rhee, Ho Young; Jeon, Yeon Soo

    2014-12-01

    We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.

  3. Assessment of Pharmacokinetic Interactions Between Obeticholic Acid and Caffeine, Midazolam, Warfarin, Dextromethorphan, Omeprazole, Rosuvastatin, and Digoxin in Phase 1 Studies in Healthy Subjects.

    Science.gov (United States)

    Edwards, Jeffrey E; Eliot, Lise; Parkinson, Andrew; Karan, Sharon; MacConell, Leigh

    2017-09-01

    Obeticholic acid (OCA), a potent and selective farnesoid X receptor agonist, is indicated for the treatment of primary biliary cholangitis (PBC). We investigated the potential drug-drug interaction effect of OCA on metabolic CYP450 enzymes and drug transporters. Five phase 1 single-center, open-label, fixed-sequence, inpatient studies were conducted in healthy adult subjects to evaluate the effect of oral daily doses of 10 or 25 mg OCA on single-dose plasma pharmacokinetics of specific probe substrates for enzymes CYP1A2 (caffeine, R-warfarin), CYP3A (midazolam, R-warfarin), CYP2C9 (S-warfarin), CYP2D6 (dextromethorphan), CYP2C19 (omeprazole), and drug transporters, BCRP/OATP1B1/OATP1B3 (rosuvastatin), and P-gp (digoxin). OCA showed no substantial suppression/inhibition of S-warfarin, digoxin, and dextromethorphan and weak interactions with caffeine, omeprazole, rosuvastatin, and midazolam. The maximal pharmacodynamic responses (E max ) to warfarin-based INR, PT, and aPTT were reduced by 11%, 11%, and 1%, respectively, for the 10-mg dose group and by 7%, 7% and 0%, respectively, for the 25-mg dose group. Overall, drugs dosed in combination with OCA were well tolerated, and most adverse events were mild in severity. No clinically important trends were noted in laboratory evaluations, vital signs, or 12-lead ECGs. In these studies, OCA showed weak to no suppression/inhibition of metabolic enzymes and drug transporters at the highest recommended therapeutic dose in patients with PBC. On the basis on these analyses, monitoring and maintenance of target INR range are required during coadministration of OCA with drugs that are metabolized by CYP1A2 (R-warfarin). Intercept Pharmaceuticals, Inc.

  4. The CLOSED trial; CLOnidine compared with midazolam for SEDation of paediatric patients in the intensive care unit: study protocol for a multicentre randomised controlled trial.

    Science.gov (United States)

    Neubert, Antje; Baarslag, Manuel Alberto; Dijk, Monique van; Rosmalen, Joost van; Standing, Joseph F; Sheng, Yucheng; Rascher, Wolfgang; Roberts, Deborah; Winslade, Jackie; Rawcliffe, Louise; Hanning, Sara M; Metsvaht, Tuuli; Giannuzzi, Viviana; Larsson, Peter; Pokorná, Pavla; Simonetti, Alessandra; Tibboel, Dick

    2017-06-21

    Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, the CLOSED trial aims to provide data on the pharmacokinetics, safety and efficacy of clonidine for the sedation of mechanically ventilated patients in order to obtain a paediatric-use marketing authorisation. The CLOSED study is a multicentre, double-blind, randomised, active-controlled non-inferiority trial with a 1:1 randomisation between clonidine and midazolam. Both treatment groups are stratified according to age in three groups with the same size: <28 days (n=100), 28 days to <2 years (n=100) and 2-18 years (n=100). The primary end point is defined as the occurrence of sedation failure within the study period. Secondary end points include a pharmacokinetic/pharmacodynamic relationship, pharmacogenetics, occurrence of delirium and withdrawal syndrome, opioid consumption and neurodevelopment in the neonatal age group. Logistic regression will be used for the primary end point, appropriate statistics will be used for the secondary end points. Written informed consent will be obtained from the parents/caregivers. Verbal or deferred consent will be used in the sites where national legislation allows. The study has institutional review board approval at recruiting sites. The results will be published in a peer-reviewed journal and shared with the worldwide medical community. EudraCT: 2014-003582-24; Clinicaltrials.gov: NCT02509273; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Tranquilização rápida para pacientes agitados nos serviços de emergência psiquiátrica: um ensaio clínico randomisado de olanzapina, ziprasidona, haloperidol mais prometazina, haloperidol mais midazolam e haloperidol em monoterapia

    OpenAIRE

    Baldaçara, Leonardo; Sanches, Marsal; Cordeiro, Daniel Cruz; Jackowski, Andrea Parolin

    2011-01-01

    OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or halop...

  6. Informes periódicos de seguridad en farmacovigilancia veterinaria

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    Francisco Jaramillo

    2016-11-01

    The Periodic Safety Update Reports are documents of post authorization monitoring that must be submitted by the Marketing Authorisation Holder to the National Competent Authority, in a specific temporality, to report adverse reactions. Its preparation must have the information regarding amount of selling product and target species.

  7. del alcoholismo

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    Rodrigo Arias Duque

    2005-01-01

    Full Text Available Desde el punto de vista farmacológico, es importante comprender qué es el alcohol y cómo actúa en el organismo. No existe una causa simple, sino una interacción complicada de factores neuroquímicos, fisiológicos, psicológicos y sociales que originan y desarrollan esta grave enfermedad fármaco-dependiente. La acción psicofisiológica y farmacodinámica del alcohol es fundamentalmente depresiva, por la reducción de la transmisión sináptica en el sistema nervioso humano. Es un hecho conocido que el consumo excesivo de alcohol causa una disfunción aguda y crónica del cerebro, produciendo trastornos en el sistema nervioso central, presentando alteraciones en la memoria y en las funciones intelectuales como cálculo, comprensión y aprendizaje. A nivel hepático tiene lugar, en su mayoría, el metabolismo del alcohol, produciéndose un hígado graso alcohólico, aumentando el tamaño, terminando en necrosis e inflamación grave del hígado; esto se llama hepatitis alcohólica, y si se sigue consumiendo alcohol se desarrollará la cirrosis. El alcohol también ha estado relacionado con alteraciones del miocardio; se ha constatado en animales de experimentación sanos que tanto la velocidad de contracción del músculo cardiaco y su máxima tensión disminuyen en presencia del alcohol, como consecuencia, la fuerza de cada contracción y el aumento de presión en el ventrículo izquierdo son menores, perdiendo eficacia el corazón como bomba.

  8. Culturas del Mundo

    DEFF Research Database (Denmark)

    Benwell, Ann Fenger; Costa, Alberto; Waehle, Espen

    2006-01-01

    ’Culturas del mundo. Colecciones del Museo Nacional de Dinamarca’ with Ann Fenger Benwell in Culturas del Mundo. Colecciones del Museo Nacional de Dinamarca, ed. Silvia Sauquet, Fundación "la Caixa", Barcelona 2006, pp. 31-39......’Culturas del mundo. Colecciones del Museo Nacional de Dinamarca’ with Ann Fenger Benwell in Culturas del Mundo. Colecciones del Museo Nacional de Dinamarca, ed. Silvia Sauquet, Fundación "la Caixa", Barcelona 2006, pp. 31-39...

  9. Continuous infusion in adult females dogs submitted to ovariohysterectomy with midazolam-xylazine and/or medetomidine pre-treated with methotrimeprazine and buprenorphine Infusão continua em cães fêmeas submetidas à ovariohisterectomia com midazolam/cetamina/xilazina e/ou medetomidina pré-tratadas com levomepromazina e buprenorfina

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    Fernando do Carmo Silva

    2007-08-01

    Full Text Available PURPOSE: To compare, by continuous infusion of ketamine or medetomidine combined to methotrimeprazine and buprenorphine, ketamine and midazolam, the degree of hypnosis, myorelaxation, anesthetic quality and surgical feasibility through evaluation of possible parametric alterations and recovery quality. METHODS: 20 healthy adult females dogs, aged 3 to 5 years, body weight between 7 and 15 kg, were assigned randomly and homogenously to 2 groups of 10 animals each (n=10, group 1 (G1 and group 2 (G2, respectively. Animals of G1 were subjected to a pre-treatment with intravenous 1.0 mg/kg methotrimeprazine and or 3ì/kg. After 15 minutes, a 5.0 mg/kg ketamine and 0.2 mg/kg midazolam were intravenously injected. Immediately after induction, an anesthetic combination of 0.4 mg/kg/h midazolam, 20 mg/kg/h ketamine and 1.0 mg/kg/h xylazine, was continuously and intravenously administered for 30 minutes. The same techniques were used in G2 except for the substitution of xylazine for 30ìg/kg/h medetomidine. RESULTS: In G1 there was a 1st and 2nd degree atrioventricular heart block, a longer recovery period and lower quality. In G2 a 1st degree atrioventricular heart block occurred but isolated and ephemeral. CONCLUSIONS: The continuous infusion method, besides reducing drugs utilization, prevented collateral effects allowing a more tranquil recovery with no excitations, both protocols permitted the surgical procedure (ovary-hysterectomy bringing about a reduction in hypnosis and an accentuated myorelaxation. Xylazine and medetomidine showed a similar pharmacodynamic behavior but with different clinical aspects. The electrocardiographic alterations observed in G2 and in a lower degree in G1 must be well studied. Describers: dogs, ketamine, methotrimeprazine, medetomidine, midazolam and xylazine.OBJETIVO: Comparar através de infusão contínua de xilazina ou medetomidina associada à metotrimeprazina e buprenorfina, cetamina e midazolam, o grau de hipnose

  10. A prospective, randomized, double blind and placebo-control study comparing the additive effect of oral midazolam and clonidine for postoperative nausea and vomiting prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystecomy

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    Ghanshyam Yadav

    2013-01-01

    Full Text Available Background: Reduction of postoperative nausea and vomiting (PONV continues to be a major challenge in perioperative care in spite of introduction of newer antiemetics with better efficacy and safety profiles. Therefore, we evaluated the additive effect of oral midazolam and clonidine for PONV prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystectomy. Materials and Methods: In a prospective, randomized fashion, 120 selected cases were randomized into three groups: I, II or III to receive a tablet of midazolam (15 mg, n = 36, clonidine (150 mcg, n = 40, or glucose as placebo (5 g, n = 44 orally, 1 h before anesthesia. Occurrence of PONV along with need for rescue antiemetic during the first postoperative day was compared between groups as a primary outcome. Results: Episodes of PONV reduced significantly in Group II (15% as compared to group I and III (22.2%, 59% at various time points during the period of observation (P = 0.002. Need for rescue antiemetic was significantly lower in group I (13.88% and II (5% as compared to group III (52.27%, P < 0.001. Conclusion: Oral clonidine is better adjuvant for PONV prophylaxis, as compared to midazolam, in granisetron premedicated patients undergoing laparoscopic cholecystectomy.

  11. Effects of Rolapitant Administered Intravenously on the Pharmacokinetics of a Modified Cooperstown Cocktail (Midazolam, Omeprazole, Warfarin, Caffeine, and Dextromethorphan) in Healthy Subjects.

    Science.gov (United States)

    Wang, Xiaodong; Zhang, Zhi-Yi; Arora, Sujata; Wang, Jing; Lu, Sharon; Powers, Dan; Kansra, Vikram

    2018-04-25

    Rolapitant is a selective, long-acting neurokinin-1 receptor antagonist, approved in the United States and Europe for prevention of delayed chemotherapy-induced nausea and vomiting in adults. This open-label study evaluated the effects of a new intravenous formulation of rolapitant on cytochrome P450 (CYP) enzyme (CYP3A, CYP1A2, CYP2C9, CYP2C19, and CYP2D6) activity. On days 1 and 14, 36 healthy volunteers received a modified Cooperstown cocktail (midazolam 3 mg [CYP3A substrate], caffeine 200 mg [CYP1A2 substrate], S-warfarin 10 mg [CYP2C9 substrate] + vitamin K 10 mg, omeprazole 40 mg [CYP2C19 substrate], and dextromethorphan 30 mg [CYP2D6 substrate]). On day 7, subjects received the modified Cooperstown cocktail after 166.5-mg rolapitant infusion. On days 21, 28, and 35, subjects received oral dextromethorphan. Maximum plasma concentration (C max ) and area under the plasma concentration-time curve (AUC 0-last ) of probe drugs post- vs pre-rolapitant administration were assessed using geometric least-squares mean ratios (GMRs) with 90%CIs. The 90%CIs of the GMRs were within the 0.80-1.25 no-effect limits for caffeine and S-warfarin C max and AUC 0-last . For midazolam C max and AUC 0-last and omeprazole C max , the 90%CIs of the GMRs were marginally outside these limits. Intravenous rolapitant coadministration increased dextromethorphan exposure, peaking 14 days post-rolapitant administration (GMRs: C max , 2.74, 90%CI 2.21-3.40; AUC 0-last , 3.36, 90%CI 2.74-4.13). Intravenous rolapitant 166.5 mg and probe drugs were well tolerated when coadministered. These data suggest that intravenous rolapitant is not an inhibitor of CYP3A, CYP2C9, CYP2C19, or CYP1A2 but is a moderate inhibitor of CYP2D6. © 2018, The American College of Clinical Pharmacology.

  12. Comparison of oral dexmedetomidine and midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study

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    Keles S

    2018-03-01

    Full Text Available Sultan Keles,1 Ozlem Kocaturk2 1Department of Pediatric Dentistry, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey; 2Department of Oral and Maxillofacial Surgery, Division of Anesthesiology, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey Background: Premedication is the most common way to minimize distress in children entering the operating room and to facilitate the smooth induction of anesthesia and is accomplished using various sedative drugs before the children are being transferred to the operating room. The aim of this study was to compare the effect of oral dexmedetomidine (DEX and oral midazolam (MID on preoperative cooperation and emergence delirium (ED among children who underwent dental procedures at our hospital between 2016 and 2017.Patients and methods: The medical records of 52 children, who were American Society of Anesthesiologists I, aged between 3 and 7 years, and who underwent full-mouth dental rehabilitation under general anesthesia (GA, were evaluated. Twenty-six patients were given 2 µg/kg of DEX, while another 26 patients were given 0.5 mg/kg of MID in apple juice as premedication agents. The patients’ scores on the Ramsay Sedation Scale (RSS, Parental Separation Anxiety Scale (PSAS, Mask Acceptance Scale, Pediatric Anesthesia Emergence Delirium Scale (PAEDS, and hemodynamic parameters were recorded from patients’ files. The level of sedation of children had been observed just before premedication and at 15, 30, and 45 min after premedication. The data were analyzed using a chi-square test, Fisher’s exact test, Student’s t-test, and analysis of variance in SPSS.Results: The Mask Acceptance Scale and PSAS scores and RSS scores at 15, 30, and 45 min after premedication were not statistically different (p>0.05 in both groups, whereas the PAEDS scores were significantly lower in the DEX group (p<0.05.Conclusion: Oral DEX provided satisfactory sedation levels, ease of parental

  13. Functional and morphological effects of diazepam and midazolam on tumor vasculature in the 9L gliosarcoma brain tumor model using dynamic susceptibility contrast MRI: a comparative study

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    Yan N

    2017-10-01

    Full Text Available Nuo Yan,1 Yuzhen Zheng,2 Cheng Yang1 1Second Department of Anesthesiology, The Affiliated Hospital to Logistics University of PAP, Tianjin, 2Department of Anesthesiology, Tianjin Huanhu Hospital, Tianjin, China Abstract: Antiangiogenic therapy attenuates tumor growth by reducing vascularization. Diazepam (DZP and midazolam (MZL have antiangiogenic properties in human umbilical vein endothelial cells. Thus, we investigated the antiangiogenic activity of DZP and MZL in the rat 9L gliosarcoma brain tumor model. The effect on tumor vasculature was evaluated using dynamic susceptibility contrast magnetic resonance imaging with gradient-echo (GE and spin-echo (SE to assess perfusion parameters, including cerebral blood volume (CBV, cerebral blood flow (CBF, mean transit time (MTT, and mean vessel diameter. The GE-normalized CBF (nCBF in the tumors of untreated controls was significantly lower than that in normal brain tissue, whereas the CBV and MTT were higher. DZP- and MZL-treated rats had higher CBF and lower CBV and MTT values than did untreated controls. The tumor size decreased significantly to 33.5% in DZP-treated rats (P<0.001 and 22.5% in MZL-treated rats (P<0.01 relative to controls. The SE-normalized CBV was lower in DZP-treated (32.9% and MZL-treated (10.6% rats compared with controls. The mean vessel diameter decreased significantly by 32.5% in DPZ-treated and by 24.9% in MZL-treated rats compared with controls (P<0.01. The GE and SE nCBF values were higher in DZP-treated (49.9% and 40.1%, respectively and MZL-treated (41.2% and 32.1%, respectively rats than in controls. The GE- and SE-normalized MTTs were lower in DZP-treated (48.2% and 59.8%, respectively and MZL-treated (40.5% and 51.2%, respectively rats than in controls. Both DZP and MZL had antiangiogenic effects on tumor perfusion and vasculature; however, the antiangiogenic activity of DZP is more promising than that of MZL. Keywords: diazepam, midazolam, 9L gliosarcoma

  14. Total intravenous anesthesia with midazolam, ketamine, and xylazine or detomidine following induction with tiletamine, zolazepam, and xylazine in red deer (Cervus elaphus hippelaphus) undergoing surgery.

    Science.gov (United States)

    Auer, Ulrike; Wenger, Sandra; Beigelböck, Christoph; Zenker, Wolfgang; Mosing, Martina

    2010-10-01

    Sixteen captive female red deer were successfully anesthetized to surgically implant a telemetry system. The deer were immobilized with (mean±SD) 1.79±0.29 mg/kg xylazine and 1.79±0.29 mg/kg tiletamine/zolazepam given intramuscularly with a dart gun. Anesthesia was maintained for 69±2 min using a total intravenous protocol with a catheter placed in the jugular vein. Group X received xylazine (0.5±0.055 mg/kg/hr) and group D, detomidine (2±0.22 μg/kg/hr), both in combination with ketamine (2±0.02 mg/kg/hr) and midazolam (0.03±0.0033 mg/kg/hr), as a constant rate infusion. Anesthesia was reversed with 0.09±0.01 mg/kg atipamezole and 8.7±1.21 μg/kg sarmazenil given intravenously in both groups. These drug combinations provided smooth induction, stable anesthesia for surgery, and rapid recovery. Respiratory depression and mild hypoxemia were seen, and we, therefore, recommend using supplemental intranasal oxygen.

  15. Cardiopulmonary effects of medetomidine or midazolam in combination with ketamine or tiletamine / zolazepam for the immobilisation of captive cheetahs (Acinonyx jubatus

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    G.F. Stegmann

    2006-06-01

    Full Text Available Captive cheetah (Acinonyx jubatus scheduled for either general health examination or dental surgery were immobilised with combinations of medetomidine-ketamine (K/DET, n = 19, midazolam-ketamine (K/MID, n = 4 or medetomidine-tiletamine-zolazepam (Z/DET, n=5. Induction time and arterial blood pressure was not statistically significantly (P > 0.05 different between treatment groups. Transient seizures were observed in the K/DET treated animals during induction. Hypertension was present in all groups during anaesthesia with mean(+SD systolic pressure of 30.7+5.0 kPa for the K/DET group, 27.7+ 2.7 kPa for the K/MID group, and 33.1+4.6 kPa for the Z/DET group. Heart rate was statistically significantly (P < 0.05 lower in the K/DET group (69 + 13.2 beats/min compared to the K/MID group (97 + 22.6 beats/min, and ventilation rate was statistically significantly (P < 0.05 lower in the K/MID group (15 + 0.0 breaths/min compared with the K/DET group (21+4.6. A metabolic acidosis and hypoxia were observed during anaesthesia when breathing air. Oxygen (O2 administration resulted in a statistically significant (P < 0.05 increase in the arterial partial pressure of carbon dioxide (hypercapnoea, arterial partial pressure of O2, and % oxyhaemoglobin saturation.

  16. KETAMINE-MEDETOMIDINE AND KETAMINE-MEDETOMIDINE-MIDAZOLAM ANESTHESIA IN CAPTIVE CHEETAHS (ACINONYX JUBATUS)-COMPARISON OF BLOOD PRESSURE AND KIDNEY BLOOD FLOW.

    Science.gov (United States)

    Stagegaard, Julia; Hørlyck, Arne; Hydeskov, Helle B; Bertelsen, Mads F

    2017-06-01

    Six clinically healthy captive cheetahs ( Acinonyx jubatus ) were anesthetized twice using two different drug combinations to investigate if blood pressure and kidney blood flow are affected by medetomidine dosage. Protocol KM (2.0 mg/kg ketamine and 0.05 mg/kg medetomidine) was compared with protocol KMM (2.0 mg/kg ketamine, 0.02 mg/kg medetomidine, and 0.1 mg/kg midazolam). Heart rate (HR), respiratory rate (RR), body temperature, end-tidal carbon dioxide pressure (ETCO 2 ), and anesthetic depth were monitored every 10 min. Noninvasive mean (MAP), systolic (SAP), and diastolic (DAP) arterial blood pressure were measured, and Duplex Doppler ultrasonography was performed on the kidneys. The mean arterial resistive index (RI) was determined and the pulse pressure index (PPI) was calculated, as indicators for kidney blood flow. There were no significant differences in induction and recovery times. MAP was significantly higher with KM than KMM at 35 min, and in both protocols decreased significantly after atipamezole administration. DAP was significantly higher at 25 and 35 min in animals anesthetized with KM; it also decreased significantly with both protocols after atipamezole administration. The PPI was significantly lower throughout the procedure with KM, and with both protocols increased significantly after atipamezole administration. Both the higher blood pressure and the reduced PPI with KM were likely a direct effect of the higher medetomidine dosage, and these findings indicate that lower medetomidine dosages might reduce hypertension and lead to a better PPI in cheetah immobilization.

  17. Il dono del racconto

    DEFF Research Database (Denmark)

    Polito, Paola

    1998-01-01

    L'articolo indaga a vari livelli strutturali del romanzo "Il coraggio del pettirosso" (rete metaforica, dialogismo diegetico, dialogismo come fenomeno di voce, strategie discorsive messe in atto dalla voce narrante, stile colloquiale) la complessa realizzazione testuale del genere narrativo...

  18. A comparison of the effect of two doses of oral melatonin with oral midazolam and placebo on pre-operative anxiety, cognition and psychomotor function in children: A randomised double-blind study

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2016-01-01

    Full Text Available Background and Aims: Melatonin (MT, a naturally occurring pituitary hormone has a sleep promoting effect. There are very few studies on pre-operative oral MT (0.2-0.5 mg/kg in children. We planned a study to assess the efficacy of oral MT in two doses and compare it with oral midazolam and placebo for pre-operative anxiolysis, sedation, maintenance of cognition and psychomotor skills, parental separation behaviour and venepuncture compliance. Methods: This prospective double-blind randomised study was conducted after ethical committee approval on 100 children aged 5-15 years, American Society of Anaesthesiologists physical status I and II undergoing elective surgery at our hospital from January 1, 2014, to December 31, 2014. Mentally disordered children were excluded from the study. They were randomised into four groups of 25 each (A, B, C, D to receive either oral MT 0.5 mg/kg or 0.75 mg/kg or oral midazolam 0.5 mg/kg or placebo 45-60 min, respectively, before induction. The child′s anxiety, cognition and psychomotor function before and after pre-medication, behaviour during the parental separation and venepuncture were appropriately scored. Kruskal-Wallis analysis of variance for intergroup and Wilcoxon matched pairs tests for intragroup comparisons of data were applied. Results: The four groups were comparable regarding mean age, weight and sex. The anxiety score reductions in the three groups when compared to placebo were statistically significant. Children receiving MT 0.75 mg/kg had maximum anxiolysis and venepuncture compliance (P < 0.05. Cognition was decreased with maximum sedation, successful parental separation and psychomotor impairment in the midazolam group (P < 0.05. Conclusion: Oral MT (0.5 mg/kg and 0.75 mg/kg in children decreases pre-operative anxiety without impairing cognitive and psychomotor functions, the 0.75 mg/kg dose being most effective.

  19. Efeitos sedativos da associação de Cetamina e Midazolam administrados pela via intranasal ou intramuscular em papagaio (Amazona aestiva e Amazona vinacea

    Directory of Open Access Journals (Sweden)

    Eduarda H. Bitencourt

    2013-09-01

    Full Text Available A falta de protocolos de sedação seguros para uso em papagaios na literatura demonstra a necessidade de conhecer os anestésicos que são eficazes nestes animais. Devido a pouca massa muscular desta espécie, notou-se a necessidade de estudar outra via de administração, menos invasiva e dolorosa ao animal, como a via intranasal. O objetivo deste estudo foi avaliar os efeitos sedativos e a viabilidade da administração intranasal, em comparação à via intramuscular, de 15mg/kg de Cetamina e 1mg/kg de Midazolam. Foram utilizados 14 papagaios das espécies Amazona aestiva e Amazona vinacea, de ambos os sexos, adultos, peso médio de 388,5±29,1g. Os animais foram distribuídos aleatoriamente em dois grupos: intramuscular (IM, n=7 e intranasal (IN, n=7. No grupo intramuscular, a administração dos anestésicos foi realizada nos músculos peitorais, utilizando seringas de insulina e no grupo intranasal, com auxílio de uma micropipeta. Avaliou-se o período de latência, tempo de duração, qualidade de sedação, e o tempo de recuperação total. A média para o período de latência no grupo IM foi de 6,13±2,02 minutos e no grupo IN de 4,84±2,37 minutos. Já para o tempo de duração da sedação no grupo IM a média foi de 35,81±29,56 e no grupo IN de 24,52±14,83 minutos. Ambas as vias promoveram sedação adequada, pois a média do escore da qualidade de sedação obtida pelo grupo IM foi 2±1,5 e pelo grupo IN 1,28±1,1. O tempo de recuperação total no grupo IM foi de 27,04±11,69 e no grupo IN de 17,67±11,64 minutos. Apesar do grupo IN ter apresentado os menores tempos de período de latência, duração e de recuperação total e ter obtido melhor escore na qualidade de sedação, não houve diferença estatística significativa entre os grupos. Os resultados obtidos neste estudo indicam que a administração de 15 mg/kg de cetamina e 1mg/kg de midazolam pela via intranasal ou intramuscular em papagaios (Amazona aestiva e

  20. Anestesia epidural com associação medetomidina e lidocaína, em gatos pré-medicados com acepromazina e midazolam

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    D.A.S.D. Lima

    2011-04-01

    Full Text Available Avaliaram-se os efeitos anestésicos promovidos pela associação medetomidina e lidocaína por via epidural, em gatos pré-tratados com acepromazina e midazolam. Foram utilizados 10 gatos adultos, machos e fêmeas, hígidos e com média de peso de 2,5±0,6kg, distribuídos em dois grupos (GM e GL de igual número (n=5. Administraram-se, como medicação pré-anestésica, acepromazina, 0,2mg/kg, e midazolam, 0,5mg/kg, via intramuscular, e 20 minutos depois, nos animais do GM, por via epidural, lidocaína, 4,4mg/kg, associada à medetomidina, 0,02mg/kg. Os gatos do GL receberam lidocaína, 4,4mg/kg, associada à solução de NaCl a 0,9%. As avaliações ocorreram antes da pré-anestesia (MPA, 20 minutos após a MPA e antes da anestesia epidural, e aos 10, 20, 30 e 40 minutos após a anestesia epidural, respectivamente, T-20, T0, T10, T20, T30 e T40. Foram avaliados: frequência cardíaca (FC e respiratória (FR, temperatura do corpo, saturação de oxiemoglobina, analgesia, miorrelaxamento e período de recuperação. No GM, a FC diminuiu em T20, T30 e T40 em relação ao T-20 e T10 e foi mais baixa que a FC do GL em T20, T30 e T40, respectivamente, 86, 91 e 88 bat/min e 194, 205 e 177 bat/min. A FR variou entre o T-20 e os outros momentos de avaliação nos animais do GL. Nas variáveis eletrocardiográficas, houve diferenças entre T20, T30 e T40 e T-20 e T0, valores de 235, 238 e 240ms e 156 e 161ms, respectivamente, somente no GM. Este grupo diferiu do GL nas avaliações em T20, T30 e T40, valores de 147, 132 e 150ms para os gatos do GL. Oitenta por cento dos gatos tiveram analgesia intensa, e em todos os animais ocorreu relaxamento da mandíbula e da língua. O tempo de recuperação foi de 40 e 15min no GM e no GL, respectivamente. Concluiu-se que a associação lidocaína com medetomidina promoveu plano anestésico estável com grau de anestesia e recuperação anestésica de boa qualidade.

  1. Activation of ERK2 in basolateral amygdala underlies the promoting influence of stress on fear memory and anxiety: influence of midazolam pretreatment.

    Science.gov (United States)

    Maldonado, N M; Espejo, P J; Martijena, I D; Molina, V A

    2014-02-01

    Exposure to emotionally arousing experiences elicits a robust and persistent memory and enhances anxiety. The amygdala complex plays a key role in stress-induced emotional processing and in the fear memory formation. It is well known that ERK activation in the amygdala is a prerequisite for fear memory consolidation. Moreover, stress elevates p-ERK2 levels in several areas of the brain stress circuitry. Therefore, given that the ERK1/2 cascade is activated following stress and that the role of this cascade is critical in the formation of fear memory, the present study investigated the potential involvement of p-ERK2 in amygdala subnuclei in the promoting influence of stress on fear memory formation and on anxiety-like behavior. A robust and persistent ERK2 activation was noted in the Basolateral amygdala (BLA), which was evident at 5min after restraint and lasted at least one day after the stressful experience. Midazolam, a short-acting benzodiazepine ligand, administered prior to stress prevented the increase in the p-ERK2 level in the BLA. Pretreatment with intra-BLA infusion of U0126 (MEK inhibitor), but not into the adjacent central nucleus of the amygdala, attenuated the stress-induced promoting influence on fear memory formation. Finally, U0126 intra-BLA infusion prevented the enhancement of anxiety-like behavior in stressed animals. These findings suggest that the selective ERK2 activation in BLA following stress exposure is an important mechanism for the occurrence of the promoting influence of stress on fear memory and on anxiety-like behavior. © 2013 Published by Elsevier B.V. and ECNP.

  2. Relationships between Endogenous Plasma Biomarkers of Constitutive Cytochrome P450 3A Activity and Single-Time-Point Oral Midazolam Microdose Phenotype in Healthy Subjects.

    Science.gov (United States)

    Woolsey, Sarah J; Beaton, Melanie D; Choi, Yun-Hee; Dresser, George K; Gryn, Steven E; Kim, Richard B; Tirona, Rommel G

    2016-04-01

    Due to high basal interindividual variation in cytochrome P450 3A (CYP3A) activity and susceptibility to drug interactions, there has been interest in the application of efficient probe drug phenotyping strategies, as well as endogenous biomarkers for assessment of in vivo CYP3A activity. The biomarkers 4β-hydroxycholesterol (4βHC) and 6β-hydroxycortisol (6βHCL) are sensitive to CYP3A induction and inhibition. However, their utility for the assessment of constitutive CYP3A activity remains uncertain. We investigated whether endogenous plasma biomarkers (4βHC and 6βHCL) are associated with basal CYP3A metabolic activity in healthy subjects assessed by a convenient single-time-point oral midazolam (MDZ) phenotyping strategy. Plasma 4βHC and 6βHCL metabolic ratios (MRs) were analysed in 51 healthy adult participants. CYP3A activity was determined after administration of an oral MDZ microdose (100 μg). Simple linear and multiple linear regression analyses were performed to assess relationships between MDZ oral clearance, biomarkers and subject covariates. Among study subjects, basal MDZ oral clearance, 4βHC and 6βHCL MRs ranged 6.5-, 10- and 13-fold, respectively. Participant age and alcohol consumption were negatively associated with MDZ oral clearance (p = 0.03 and p = 0.045, respectively), while weight and female sex were associated with lower plasma 4βHC MR (p = 0.0003 and p = 0.032, respectively). Neither 4βHC nor 6βHCL MRs were associated with MDZ oral clearance. Plasma 4βHC and 6βHCL MRs do not relate to MDZ single-time-point metabolic phenotype in the assessment of constitutive CYP3A activity among healthy individuals. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  3. In vitro investigation on the impact of the surface-active excipients Cremophor EL, Tween 80 and Solutol HS 15 on the metabolism of midazolam.

    Science.gov (United States)

    Bravo González, Roberto C; Huwyler, Jörg; Boess, Franziska; Walter, Isabelle; Bittner, Beate

    2004-01-01

    The impact of the surface-active formulation ingredients Cremophor EL, Tween 80 and Solutol HS 15 on the intrinsic clearance (Clint) of midazolam (MDZ) was investigated in rat hepatocytes and microsomes. In rat hepatocytes with 0.003%, 0.03% and 0.3% (w/v) Solutol HS 15 already present in the incubation medium, the Clint was significantly reduced in a dose-dependent manner by about 25%, 30% and 50%, respectively. In the presence of Cremophor EL and Tween 80 a significant reduction in Clint by about 30% and 25%, respectively, was observed at 0.03% surfactant concentration. At 0.3% of Cremophor EL and Tween 80, Clint was reduced by about 50% and 20%, respectively. A reduction in Clint was also observed in experiments with rat liver microsomes. At surfactant concentrations up to 0.03%, cytotoxicity assays (lactate dehydrogenase release, adenosine triphosphate content) as well as light microscope investigations did not reveal any cytotoxic impact of the surfactants on the hepatocyte monolayer. A potential interaction of the surfactants with biological membranes was determined using phosphatidylcholine-cholesterol liposomes loaded with self-quenching concentrations of carboxyfluorescein. No marked release of carboxyfluorescein from the liposomes (that would be an indication for a surfactant-dependent disruption of membrane integrity) was observed up to concentrations of 0.03% of the different surfactants. It is concluded that cytochrome P450 3A mediated metabolism of MDZ seems to be prevented by all surfactants at concentrations above 0.03%. In our experiments the surfactants did not show toxic effects at concentrations that resulted in a decreased Clint of MDZ. Thus, a direct inhibition of the metabolizing enzymes, a molecular interaction with the microsomes as well as an alteration of membrane properties that did not yet result in a release of LDH have to be taken into consideration as reasons for the observed changes in the metabolism of MDZ. Copyright 2004 John

  4. Spatio-temporal dynamics of multimodal EEG-fNIRS signals in the loss and recovery of consciousness under sedation using midazolam and propofol.

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    Seul-Ki Yeom

    Full Text Available On sedation motivated by the clinical needs for safety and reliability, recent studies have attempted to identify brain-specific signatures for tracking patient transition into and out of consciousness, but the differences in neurophysiological effects between 1 the sedative types and 2 the presence/absence of surgical stimulations still remain unclear. Here we used multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS measurements to observe electrical and hemodynamic responses during sedation simultaneously. Forty healthy volunteers were instructed to push the button to administer sedatives in response to auditory stimuli every 9-11 s. To generally illustrate brain activity at repetitive transition points at the loss of consciousness (LOC and the recovery of consciousness (ROC, patient-controlled sedation was performed using two different sedatives (midazolam (MDZ and propofol (PPF under two surgical conditions. Once consciousness was lost via sedatives, we observed gradually increasing EEG power at lower frequencies (15 Hz, as well as spatially increased EEG powers in the delta and lower alpha bands, and particularly also in the upper alpha rhythm, at the frontal and parieto-occipital areas over time. During ROC from unconsciousness, these spatio-temporal changes were reversed. Interestingly, the level of consciousness was switched on/off at significantly higher effect-site concentrations of sedatives in the brain according to the use of surgical stimuli, but the spatio-temporal EEG patterns were similar, regardless of the sedative used. We also observed sudden phase shifts in fronto-parietal connectivity at the LOC and the ROC as critical points. fNIRS measurement also revealed mild hemodynamic fluctuations. Compared with general anesthesia, our results provide insights into critical hallmarks of sedative-induced (unconsciousness, which have similar spatio-temporal EEG-fNIRS patterns regardless of the stage and

  5. del cambio

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    Alejandro Canales

    2006-01-01

    Full Text Available El artículo analiza las propuestas y los compromisos en materia de cobertura y de financiamiento en el periodo 2000-2006. En particular, revisa las modificaciones y los ajustes de los tres principales documentos en los que se expresaron las iniciativas: el de la Asociación Nacional de Universidades e Instituciones de Educación Superior, el del equipo de la transición y el programa sectorial. Los resultados muestran que las cifras de atención a la demanda educativa e inversión quedaron lejos de las metas autoimpuestas por el gobierno federal y que será necesario realizar mayores esfuerzos para atender tales desafíos.

  6. Genotype-phenotype associations for common CYP3A4 and CYP3A5 variants in the basal and induced metabolism of midazolam in European- and African-American men and women.

    Science.gov (United States)

    Floyd, Michael D; Gervasini, Guillermo; Masica, Andrew L; Mayo, Gail; George, Alfred L; Bhat, Kolari; Kim, Richard B; Wilkinson, Grant R

    2003-10-01

    CYP3A activity in adults varies between individuals and it has been suggested that this has a genetic basis, possibly related to variant alleles in CYP3A4 and CYP3A5 genes. Accordingly, genotype-phenotype associations were investigated under constitutive and induced conditions. Midazolam's systemic and oral clearances, and the erythromycin breath test (ERBT) were determined in 57 healthy subjects: 23 (11 men, 12 women) European- and 34 (14 men, 20 women) African-Americans. Studies were undertaken in the basal state and after 14-15 days pretreatment with rifampin. DNA was characterized for the common polymorphisms CYP3A4*1B, CYP3A5*3, CYP3A5*6 and CYP3A5*7 by direct sequencing, and for exon 21 and exon 26 variants of MDR1 by allele-specific, real-time polymerase chain reaction. In 95% of subjects, the basal systemic clearance of midazolam was unimodally distributed and variability was less than four-fold whereas, in 98% of the study population, oral clearance varied five-fold. No population or sex-related differences were apparent. Similar findings were observed with the ERBT. Rifampin pretreatment markedly increased the systemic (two-fold) and oral clearance (16-fold) of midazolam, and the ERBT (two-fold) but the variabilities were unchanged. No associations were noted between these phenotypic measures and any of the studied genotypes, except for oral clearance and its fold-increase after rifampin. These were related to the presence of CYP3A4*1B and the inversely linked CYP3A5*3 polymorphism, with the extent of induction being approximately 50% greater in CYP3A5*3 homozygotes compared to wild-type subjects. In most healthy subjects, variability in intestinal and hepatic CYP3A activity, using midazolam as an in-vivo probe, is modest and common polymorphisms in CYP3A4 and CYP3A5 do not appear to have important functional significance.

  7. La superaci??n del modelo del ??ngel del hogar:

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    Hurtado Mu??oz, M??nica

    2012-01-01

    La Tesis Doctoral titulada "La superaci??n del modelo del "??ngel del hogar". Recuperaci??n de la escritora Leonor Canalejas y Fustegueras (1869-1945)" aborda, en primer lugar, un an??lisis sociol??gico de las circunstancias que rodearon a la mujer espa??ola en el cambio de siglo en el ??mbito social y educativo, en un intento de esclarecer las caracter??sticas propias del contexto en el que la mujer accede a la intelectualidad en general y a la literatura en particular. Esta parte concluye q...

  8. Análise comparativa dos efeitos do diazepam, midazolam, propofol e etomidato na contratilidade miocárdica e no fluxo coronariano: estudo em corações isolados de ratos Effects of diazepam, midazolam, propofol and etomidate in myocardial contractility and coronary blood flow: comparative analysis in isolated rat's hearts

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    Carlos Geraldo Sobral de Medeiros

    2004-06-01

    Full Text Available OBJETIVO: Avaliar o efeito, na contratilidade miocárdica e no fluxo coronariano, de drogas comumente utilizadas na prática clínica (diazepam, midazolam, propofol e etomidato. MÉTODO: Foram estudados 50 corações isolados de ratos Wistar divididos em cinco grupos de dez, em preparação de Langendorff com líquido de perfusão de Krebs-Henseleit (K-H, mantendo-se constantes a pressão de perfusão (90 centímetros de água e a temperatura (37° + 0,5 graus Celsius. Com exceção do Grupo I (Controle, foram feitas infusões únicas, em um minuto, de diazepam (50 microgramas - Grupo II; midazolam (25 microgramas - Grupo III; propofol (25 e 50 microgramas - Grupo IV e etomidato (25 microgramas - Grupo V. Cada dose foi diluída e administrada em 0,1 mililitro de K-H, mantendo-se o fluxo e a pressão de perfusão coronarianos do sistema, durante sua infusão. Aferiu-se a freqüência cardíaca em batimentos por minuto (BPM, a tensão miocárdica em gramas (g, e o fluxo coronariano em mililitros por minuto (ml/min em 1, 3, 5, 10, 15, 20, 25 e 30 minutos; a contratilidade miocárdica foi avaliada pelo cálculo da primeira derivada tensão/tempo (dT/dtmax, naquelas marcas. RESULTADOS: A freqüência cardíaca apresentou variações nos Grupos I, III e IV. Em relação à tensão miocárdica, apenas o Grupo I não sofreu declínio; o fluxo coronariano, exceto no Grupo IV, apresentou variações para menos, ao longo do estudo; a contratilidade miocárdica decresceu em todos os grupos estudados, exceto no Grupo I. CONCLUSÃO: As drogas ensaiadas diminuíram a contratilidade miocárdica (p0,05.OBJECTIVE: The effects on myocardial contractility (dT/dtmax and coronary blood flow (CBF of common drugs used in clinical practice (diazepam, midazolam, propofol and etomidate were studied. METHOD: Fifty Wistar rat's hearts were divided into five groups of ten, and perfused by Langendorff method with Krebs-Henseleit solution (K-H, with the perfusion pressure

  9. Chemical restraint of captive Kinkajous Potos flavus (Schreber, 1774 (Carnivora: Procyonidae using a ketamine, xylazine and midazolam combination and reversal with yohimbine

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    Jesús Lescano

    2016-12-01

    Full Text Available Detailed information on the anaesthetic and cardiorespiratory effects of drug combinations used for the chemical immobilization of Kinkajous (Potos flavus is scarce.  This study assessed the effects of ketamine (2.5mg/kg, xylazine (1mg/kg and midazolam (0.5mg/kg combination in P. flavus.  Five clinically healthy adult Kinkajous of both sexes were included.  Heart rate, respiratory rate, oxygen saturation, blood pressure and body temperature were recorded at five-minute intervals for 25 minutes.  Then, animals received 0.125mg/kg of yohimbine by intramuscular injection.  Anaesthetic depth was assessed based on stimulus response and muscle tone.  Induction, immobilization, and recovery periods were recorded and qualitatively assessed based on the absence of adverse effects.  The durations of the induction, immobilization, and recovery periods were 9.42±1.73, 33.33±2.16, and 31.37±5.82 minutes.  All periods showed good quality and adequate anaesthetic depth was achieved.  Mean heart and respiratory rates were 99±20 beats/minute and 44±9 breaths/minute.  Both parameters decreased over the duration of the anaesthesia but they did not reach levels suggesting either bradycardia or bradypnea.  Mean body temperature was 37.1±1.5 0C and it also showed a decreasing trend over the duration of the anaesthesia.  Mean oxygen saturation was 92±6% and it showed a mildly increasing trend over the duration of the anesthesia.  Mean blood pressure was 129±23 mmHg and mild to moderate hypertension was observed.  No mortality occurred and no adverse effects were observed in any of the individuals during the three months following immobilization.  The assessed anaesthetic combination effectively immobilized the P. flavus individuals, provided good quality and acceptable duration of both induction and recovery periods.  It should, however, not be used in Kinkajous with either known hypertension record or pre-existing target organ disease (e

  10. Acerca del moho

    Science.gov (United States)

    El moho forma parte del medio ambiente natural. Afuera del hogar, el moho juega un papel en la naturaleza al desintegrar materias organicas tales como las hojas que se han caido o los arboles muertos. El moho puede crecer adentro del hogar cuando las espor

  11. Del bit al qubit

    OpenAIRE

    Torras Font, Josep

    2011-01-01

    Aquest document pretén donar una visió del desenvolupament dels computadors electrònics i dels components que els han fet possibles. Dintre de les opcions de futur en computació, també intenta donar una visió de les bases en que es fonamenta la computació quàntica.

  12. Efeitos da associação de tiletamina/zolazepam ou cetamina S(+/midazolam/tramadol para contenção química em bugios-ruivos (Allouatta guariba clamitans Effects of tiletamine/zolazepam or S(+ ketamine/midazolam/tramadol for chemical contention in red howler monkeys (Allouatta guariba clamitans

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    Pâmela Spolti

    2013-02-01

    Full Text Available Avaliaram-se dois protocolos para contenção química em bugios-ruivos. Para tal, foram utilizados 12 macacos bugios, hígidos, com peso médio de 6,4±0,4 kg, os quais foram submetidos a jejum alimentar e hídrico de seis e duas horas, respectivamente. Os animais foram alocados em dois grupos que receberam injeção via intramuscular: TZ (n=6, os quais receberam uma associação de tiletamina e zolazepam (Zoletil® na dose de 3,6mg/kg e CEMTRA (n=6, que receberam cetamina S(+, midazolam e tramadol (Cemtra ®, lote piloto 001/10, Ouro Fino Saúde Animal Ltda., Cravinhos, SP-Brasil, constituído por 100mg/ml de cetamina S+, 20mg/ml de tramadol e 10mg/ml de midazolam na dose de 1ml da associação para cada 10kg de peso corporal, correspondendo às doses de 10mg/kg, 1mg/kg e 2mg/kg, respectivamente. Anteriormente a administração dos fármacos (M0 foram avaliadas: frequência cardíaca (FC e respiratória (f, temperatura retal (TR, tempo de preenchimento capilar (TPC, pressão arterial sistólica (PAS, saturação de oxigênio na hemoglobina (SpO2, presença de salivação, grau de miorrelaxamento e sedação, índice Bispectral (BIS e Sinal de Qualidade do BIS (SQI, resposta ao pinçamento interdigital e tempos de latência, deambulação e de recuperação total (TRT. Os parâmetros foram reavaliados em M5, M10, M20, M30, M40 e M50 (5, 10, 20, 30, 40 e 50 minutos após a administração dos fármacos. No TZ os animais foram mais responsivos ao pinçamento interdigital ao longo dos tempos. Os animais do CEMTRA apresentaram maior grau de miorrelaxamento e de sedação. A f do CEMTRA foi menor após a administração do tratamento em todos os momentos em relação ao M0. Entre grupos a f do CEMTRA foi menor em relação ao TZ em M2 e M4. Os tempos totais de sedação e de recuperação foram de 48±4 e 150,1±42,1 min para o CEMTRA e de 38±7 e 73,1±20,6 para o TZ. Conclui-se que ambas as formulações são seguras para contenção química de

  13. Efeitos da associação de tiletamina/zolazepam ou cetamina S(+)/midazolam/tramadol para contenção química em bugios-ruivos (Allouatta guariba clamitans)

    OpenAIRE

    Spolti,Pâmela; Moraes,Aury N. de; Tamanho,Renato B.; Gehrcke,Martielo I.; Souza Júnior,Júlio C.; Oleskovicz,Nilson

    2013-01-01

    Avaliaram-se dois protocolos para contenção química em bugios-ruivos. Para tal, foram utilizados 12 macacos bugios, hígidos, com peso médio de 6,4±0,4 kg, os quais foram submetidos a jejum alimentar e hídrico de seis e duas horas, respectivamente. Os animais foram alocados em dois grupos que receberam injeção via intramuscular: TZ (n=6), os quais receberam uma associação de tiletamina e zolazepam (Zoletil®) na dose de 3,6mg/kg e CEMTRA (n=6), que receberam cetamina S(+), midazolam e tramadol ...

  14. Algunas aclaraciones acerca del conocimiento del singular.

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    Carlos Llano Cifuentes

    2013-11-01

    Full Text Available Llano tries to explain the main purpose of El Conocimiento del Singular, showing how the individuals about which the book is concerned are basically human individuals: people as decision makers.

  15. Psicodrama del duelo.

    OpenAIRE

    José Antonio Espina Barrio; Marisol Filgueira Bouza

    1997-01-01

    La pérdida de rituales agrava y alarga la reacción del duelo. Se define el Psicodrama Antropológico y su intervención en el proceso del duelo. El Psicodrama Focal del Duelo es una psicoterapia breve centrada en el proceso de Duelo. Se comentan varios casos y resultados. Se concluye con un programa sencillo para el duelo en Atención Primaria.

  16. Fractura triple del complejo suspensorio del hombro

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    Eraclio Delgado Rifá

    2015-06-01

    Full Text Available El complejo suspensorio del hombro es una estructura sumamente importante, compuesta por un anillo de huesos y tejidos blandos. Las lesiones aisladas de este complejo anatómico son frecuentes y no afectan su estabilidad. La interrupción doble conduce a la inestabilidad de esta estructura y usualmente requiere tratamiento quirúrgico. La triple interrupción, por su parte, es sumamente rara y es encontrada en casos de trauma de alta energía a menudo en asociación con otras lesiones. Se presenta una triple lesión del complejo suspensorio del hombro en un paciente de 46 años de edad, con una fractura de la glenoides, del acromion tipo III de Kuhn y de la coracoides tipo II de Ogawa. En este caso, la fractura del acromion fue tratada con fijación percutánea con alambres de Kirschner, por tener asociado lesiones de partes blandas que contraindicaron la reducción abierta. La fractura de la glenoides y de la apófisis coracoides fueron tratadas conservadoramente. Después de 6 meses de evolución, el paciente tuvo un resultado funcional aceptable, con una abducción de 90 grados, los 30 grados de rotación externa y 70 de rotación interna, además asintomático y consolidación de todas las fracturas. A pesar de ser catalogada de una lesión grave del cinturón escapular y estar asociada a otras lesiones se obtuvo un resultado satisfactorio al final del tratamiento.

  17. Vigencia del Darwinismo

    OpenAIRE

    Lessa, Enrique P

    2009-01-01

    En este ensayo se presenta una revisión histórica del signifcado y legado del darwinismo, con énfasis en el último siglo. La principal conclusión es que la visión darwiniana de la evolución, con las modifcaciones requeridas para dar cuenta de los grandes desarrollos de la disciplina, se ha impuesto y mantiene vigencia en nuestros días. En particular, el papel del azar, la evolución como proceso de “descendencia con modifcación” a lo largo de diversas ramas del árbol de la vida, el pensamiento...

  18. La luz del origen del universo

    Directory of Open Access Journals (Sweden)

    Casas, Alberto

    2015-10-01

    Full Text Available Penzias and Wilson discovered the cosmic microwave background, a luminous echo of the Big Bang, in 1965. The amount of information encoded in this relic of the early universe is truly extraordinary. At present, the most precise data about the origin and structure of the universe comes from the study of this primordial light, the full potential of which has yet to be explored.En 1965 se descubrió el fondo de radiación de microondas, un eco luminoso de la Gran Explosión (Big Bang. La cantidad de información contenida en esta reliquia del universo primitivo es verdaderamente extraordinaria. En la actualidad los datos más precisos sobre el origen y estructura del universo provienen del estudio de esta luz primigenia, que aún no ha sido explorada en todo su potencial.

  19. Effects of laparoscopy on the cardiorespiratory system of brown brocket deer (Mazama gouazoubira anesthetized with ketamine/ xylazine/ midazolam combination and isoflurane Efeitos da laparoscopia sobre o sistema cardiorrespiratório de veados-catingueiro (Mazama gouazoubira anestesiados com a associação cetamina/xilazina/midazolam e isofluorano

    Directory of Open Access Journals (Sweden)

    Marina Salles Munerato

    2008-11-01

    Full Text Available Laparoscopy is not widely used as a tool to perform assisted reproduction techniques in South American cervids; thus, scarce information in literature is available regarding its effects and appropriate anesthetic protocols to perform it. This study evaluated the effect of laparoscopy on heart rate (HR, respiration rate (RR, saturation of oxyhemoglobin (SpO2 and rectal temperature (RT of six female brown brocket deer (Mazama gouazoubira anesthetized with ketamine (5mg/kg, xylazine (0.3mg/kg, midazolam (0.5mg/kg combination i.v. and isoflurane. Twelve laparoscopies were performed and each animal was used twice with a 40-day interval. After anesthetized, the animals were placed in dorsal recumbency to perform laparoscopy procedure using abdominal CO2 insufflations (14.2 ± 2.39mmHg; M ± SE. The main events of the laparoscopy procedure were divided into three periods: animal without (P1 and with abdominal insufflation (P2 and abdominal insufflation with the hips raised at 45º (P3. As a control, the animals were anesthetized again 40 days after the last laparoscopy, and were maintained in a dorsal recumbency for the same average duration of the previous anesthesia and no laparoscopy procedure was conducted. The period of anesthesia for the controls was also divided into P1, P2, and P3 considering the average duration of these periods in previous laparoscopies performed. Data were analyzed through the (ANOVA variance analysis followed by Tukey test and values at PA laparoscopia ainda é pouco utilizada como ferramenta para técnicas de reprodução assistida em cervídeos sul-americanos, não havendo informações sobre seus efeitos e protocolos anestésicos seguros para sua realização. Objetivaramse avaliar as possíveis alterações na freqüência cardíaca (FC, respiratória (FR, saturação de oxihemoglobina (SpO2 e temperatura retal (TR durante a laparoscopia para visualização dos órgãos reprodutivos de seis fêmeas de veado

  20. Archivo del Duelo

    OpenAIRE

    Ferrera, Tamara

    2010-01-01

    Photos taken from the Archive of Mourning following the March 11 terrorist attacks El Archivo del Duelo. Creación de un archivo etnográfico de los Atentados del 11 de marzo en Madrid. Ministerio de Educación y Ciencia HUM2005-03490.

  1. Displasias del seno

    Directory of Open Access Journals (Sweden)

    Ernesto Andrade Valderrama

    1971-04-01

    Full Text Available En general, las Displasias no se presentan antes de la iniciación del estímulo Gonadal y tienden a desaparecer con el climaterio. Se definen entonces como las afecciones benignas del Seno, de origen endocrino.

  2. La crisi del diritto del lavoro

    Directory of Open Access Journals (Sweden)

    Alessandro Garilli

    2012-01-01

    Full Text Available Riassunto - L’Autore ripercorre in chiave critica l’evoluzione delle politiche legislative in materia di lavoro, alla luce dell’attuale fase di crisi economico finanziaria. Nell’esaminare i principali interventi normativi attuati da inizio secolo, l’Autore mette in evidenza le scelte di metodo e gli elementi di continuità che accomunano i vari provvedimenti, individuandoli nell’affannosa ricerca del punto di equilibrio tra flessibilità e garantismo. La riflessione si chiude con alcuni interrogativi sulle ultime linee di riforma del mercato del lavoro e con l’auspicio che, anche al cospetto delle imprescindibili ragioni dell’economia, il diritto del lavoro possa continuare a svolgere il proprio tradizionale ruolo di disciplina di tutela della persona.   Abstract - The author analyzes, with a critically oriented approach, the development of the employment law, in the light of the current economic and financial crisis. In examining the main regulatory measures implemented since the beginning of the century, the author highlights the methodological choices and the elements of continuity that unite the various measures, focusing them in a hard research of a point of balance between flexibility and security. The discussion concludes with some questions about the last lines of the reform of the labor market and with the hope that, even in the face of compelling reasons of economy, labor law can continue to play its traditional role of governing the protection of person.

  3. OBJETIVO DEL DESARROLLO DEL MILENIO 7

    Directory of Open Access Journals (Sweden)

    Margarita M. Pérez O.

    2013-10-01

    Full Text Available Los Objetivos de Desarrollo del Milenio, también conocidos como los Objetivos del Milenio, constituyeron las metas finales que aprobaron los dirigentes mundiales, 189 jefes de estado y de gobierno en la Cumbre del Milenio de las Naciones Unidas celebrada en Nueva York en el año 2000, en la cual los Estados miembros de la organización reafirmaron su compromiso de luchar por un mundo en el que el desarrollo sostenible y la eliminación de la pobreza tuvieran máxima prioridad1 . En la cumbre se definió la Declaración del Milenio, la cual detalla los objetivos, principios, valores, metas y acciones para erradicar la pobreza Mundial hacia el año 2015, todos ellos ratificados con alto interés y acción estratégica de carácter global, como marco para la medición de los progresos en materia de desarrollo.

  4. Elementos del sistema electoral del Congreso Mexicano

    Directory of Open Access Journals (Sweden)

    Aldo Medina García

    2013-08-01

    Full Text Available El presente artículo es un estudio de los componentes del sistema electoral, diseñado por el legislador mexicano para integrar al parlamento federal. Estudio desarrollado a sabiendas de la importancia que reviste el sistema electoral como un medio que permite a los ciudadanos convertir su voto expresado en las urnas en escaños a favor de determinado candidato o partido. En dicho análisis tomamos en cuenta la evolución constitucional del sistema electoral mexicano, la participación de las fuerzas minoritarias en la integración del Senado y de la Cámara de Diputados, la división que se hace del territorio en circunscripciones electorales, la barrera electoral que se fija a los partidos políticos para acceder a la representación en el Parlamento, la fórmula de asignación que se aplica a la votación obtenida, para finalmente concluir que el sistema electoral mexicano es esencialmente mayoritario aun cuando se vista de proporcional.

  5. Castillo del Real. Olocau

    OpenAIRE

    AUÑÓN VALLEJO, JONATAN

    2012-01-01

    El objetivo que se quiere alcanzar con este proyecto es el de realizar un estudio lo más cercano posible del Catillo del Real, de manera que se pueda conocer su origen, su evolución a lo largo de la historia, así como las diferentes técnicas y sistemas constructivos utilizados en su construcción. Auñón Vallejo, J. (2011). Castillo del Real. Olocau. http://hdl.handle.net/10251/14244. Archivo delegado

  6. La Representabilidad del Genocidio

    OpenAIRE

    Cardona González, Lorena

    2012-01-01

    El presente artículo intenta hacer una aproximación histórica y analítica al fenómeno del Genocidio, sus implicaciones sociales y culturales que dieron como resultado la reformulación analítica y conceptual de hechos que hasta entonces superaban el conocimiento y la moral humana. De este modo, se hace un trayecto histórico de la paulatina aparición del asesinato masivo como practica de Estado, enmarcado en las experiencias del genocidio armenio y el alemán. A su vez, se hace una mirada sobre ...

  7. Significado presente del CSIC

    OpenAIRE

    Garrido Gallardo, Miguel Angel

    2000-01-01

    Not available

    Este artículo, elaborado en 1999, ofrece una panorámica de la realidad del Consejo Superior de Investigaciones Científicas en la actualidad. Repasa su organización, su volumen de publicaciones, sus indicadores de productividad, su capacidad de obtener recursos y, en suma, su lugar en el conjunto del sistema español de Ciencia y Tecnología, considerado en sí mismo y en relación con la Universidad. Como conclusión del repaso de datos, se afirma que, aunque la fó...

  8. Tratamiento del pie equino

    OpenAIRE

    Robles, Fernanda

    2012-01-01

    El pie equino varo es una patología frecuente en los pacientes con Encefalopatía crónica no evolutiva (ECNE).Se observó que existe una mayor frecuencia en el sexo masculino. Se realizó un estudio descriptivo, comparativo y secundario, durante el periodo de septiembre del 2006 a septiembre del 2011, con un total de 125 pacientes con Ecne, de los cuales se encontraron 101 con pie equino varo congénito. Objetivo: observar los resultados obtenidos en la rehabilitación del pie equino, en niños de ...

  9. Del Pasadismo al Futurismo

    OpenAIRE

    Agudo-Martínez, M. J.

    2003-01-01

    Uno de los habituales prejuicios a la hora de abordar el análisis del movimiento futurista, al igual que sucede con el constructivismo, es la consideración del contexto político en el que se desarrollaron ambas vanguardias. Sin embargo, y dejando a un lado un enfoque del arte con finalidad política de signo diverso, habría que insistir en el hecho de que posiblemente sean tanto el futurismo italiano como el constructivismo ruso, los movimientos que con mayor entusiasmo se manifestaron, en un ...

  10. Preferencias del Turista

    Directory of Open Access Journals (Sweden)

    Jose Luis Leiva Olivencia

    2015-01-01

    Full Text Available Actualmente existen aplicaciones orientadas al turismo basadas en realidad aumentada, pero no integran técnicas de recomendación. Este articulo describe RAMCAT (Realidad Aumentada Móvil Contextual Aplicada al Turismo un modelo de guía turística, que recomienda puntos de interés, teniendo en cuenta factores como preferencias personales y atributos contextuales. Se presentan los componentes teóricos de la arquitectura propuesta, así como sus características, destacando la integración de diferentes sistemas de recomendación, que permiten añadir nuevos motores en el futuro. El articulo se centra en describir sus funcionalidades y el modulo correspondiente al sistema de recomendación basado en el perfil del turista. Otra característica importante del sistema propuesto es la retroalimentación del mismo mediante calificaciones del turista y su trazabilidad.

  11. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available La millonaria contratación del futbolista David Beckham, un fenómeno del mercado, ha provocado cuestionamientos a los que se busca respuesta. Es tema de análisis el por qué el betseller "Harry Potter" ha causado tanta conmoción en la opinión pública. Respecto al periodista cibernético, se señalan los contornos del presente y atisban las posibilidades del futuro de esta nueva profesión. El tratamiento de los mitos de la prensa, los temores de la Ley mordaza venezolana y la brutalidad de los video juegos e Internet son temas de enorme interés. Se comenta las pocas veces que la prensa reflexiona sobre la comunicación corporal y la anorexia.

  12. Los muertos del Floreanismo

    Directory of Open Access Journals (Sweden)

    Enrique Ayala Mora

    2008-06-01

    Full Text Available El artículo analiza el crimen político durante las primeras décadas de vida de la República del Ecuador. Específicamente centra su estudio en el período dominado por la figura de Juan José Flores, primer presidente del Ecuador. La inestabilidad política, la precariedad de las alianzas entre las élites regionales, la crisis económica generada por las guerras de Independencia, las conspiraciones y la violencia que caracterizaron al período de surgimiento de las repúblicas andinas hicieron del crimen político un “vicio de nacimiento”. El asesinato del general Antonio José de Sucre, la muerte de los miembros de la sociedad El Quiteño Libre, el homicidio de Juan Otamendi, entre otros, hicieron patente esta característica.

  13. Niveles del aprendizaje organizacional

    OpenAIRE

    Garzón Castrillón, Manuel Alfonso

    2005-01-01

    En la propuesta de modelo de aprendizaje organizacional (AO), la segunda variable se denomina niveles del aprendizaje organizacional ; los niveles de aprendizaje que contemplamos para nuestra investigación son: individual, de equipo, organizacional e interorganizacional.

  14. La escritura del Yo

    Directory of Open Access Journals (Sweden)

    Patricio Landaeta Mardones

    2013-11-01

    Full Text Available Si la creación de una imagen fidedigna del mundo fue la condición de la conquista cognitiva y económica de la tierra, las imágenes mediáticas circulan hoy en día a la manera de un montaje que organiza los sujetos como elementos de un territorio. En esta presentación abordaremos el cruce entre estos dos hechos, entre la escritura del mundo y la de los sujetos, a partir de la idea de Fabulación para mostrar otra escritura del mundo y del yo, leyendo textos e imágenes de la Primera buena Corónica y Buen Gobierno de Felipe Guaman Poma de Ayala.

  15. Consideraciones alrededor del Libro del Almismo, el Libro del Pensar.

    Directory of Open Access Journals (Sweden)

    MartaLucía Tamayo Fernandez

    1999-12-01

    Full Text Available

    La doctora MarthaLucía Tamayo comparte muchas inquietudes alrededor del Libro del Almismo, el Libro del Pensar; de dónde salió ese nombre; de juntar en medicina y en genética a tres escritores como lo son Jorge Luis Borges, Macedonio Fernández y Julio Cortázar. Su conferencia dice así:

    El término almismo fue ideado por Macedonio Fernández porque defendía mucho el ensimismamiento y el pensamiento hacia el interior, mirar hacia adentro; cada uno somos un “sí mismo” que nos hace diferentes aunque al mismo tiempo podemos ser iguales. Todos tenemos esa parte interior que la medicina debe trabajar y que no puede olvidar.

    “El Libro del Almismo, el libro del pensar” nos lleva a replantear y a repensar un poco la medicina que queremos, una medicina vuelta a pensar.

    Quiero contarles la historia de cómo se llegó a este libro y por qué y para qué se sigue trabajando en estos temas: Después de mi internado y de un trabajo un poco triste de rural, volví al Instituto de Genética y a la Universidad Javeriana en donde encontré al doctor Bernal y un espacio que estaba buscando para esa medicina diferente que quería, con un grupo de personas que me permitía no sólo ver la medicina sino ver muchas otras cosas más; había espacio para la literatura, para Mafalda, para hablar de niños, de locos, había incluso tiempo para hablar de medicina dentro del golf, de carros antiguos y de todo eso fui aprendiendo.

    Eso era lo que estaba buscando. Una medicina que diera espacios diferentes, que fuera más humanizada. Rápidamente me ubiqué y me quedé! No me arrepiento en lo absoluto de haberme quedado porque fue, ha sido y sigue siendo, una experiencia enriquecedora, de muchas vivencias importantes. Sabía exactamente dónde estaba y sabía que había que seguir rápido y había que trabajar muchos aspectos de esa medicina que estábamos buscando y de esa genética especial.

    Rápidamente empezamos a trabajar

  16. Actualidad del relativismo cultural

    OpenAIRE

    Sánchez Durá, Nicolás

    2013-01-01

    Este ensayo tiene tres propósitos. En primer lugar, propone examinar las relaciones entre etnocentrismo y relativismo. El etnocentrismo puede tomar tres formas distintas: a saber, la de una universalidad impostada, la del exotismo y la de un particularismo narcisista exacerbado. El relativismo cultural es una postura que asume la inconmensurabilidad de los conceptos y valores que deben ser considerados como válidos dentro de las imágenes del mundo definidas. En segundo lugar, se argumenta que...

  17. el Valle del Cauca

    Directory of Open Access Journals (Sweden)

    Carlos Humberto Ortiz

    2007-01-01

    Full Text Available Este artículo se enfoca en la identi- ficación de aquellos factores estructurales que explican la pérdida de dinamismo económico de largo plazo en Colombia y, en particular, en el Valle del Cauca. Se examina la competitividad del Valle en relación con Colombia y con el resto del mundo. Se cuestiona la insistencia en una estrategia exportadora como dinamizadora del desarrollo económico. Se identifica que una gran parte de la población está excluida de los beneficios del desarrollo económico. Para construir un modelo de desarrollo que incluya a esta población se recomienda recuperar la senda de la industrialización, invertir en el capital humano (educación de alta calidad, salud, salubridad y nutrición, e invertir en infraestructura. La participación del Estado en estas inversiones sociales es necesaria para disminuir la desigualdad y aumentar el crecimiento económico.

  18. Espectroscopia del Cometa Halley

    Science.gov (United States)

    Naranjo, O.; Fuenmayor, F.; Ferrin, L.; Bulka, P.; Mendoza, C.

    1987-05-01

    Se reportan observaciones espectroscópicas del cometa Halley. Los espectros fueron tomados usando el espectrógrafo del telescopio reflector de 1 metro del Observatorio Nacional de Venezuela. Se utilizó óptica azul, con una red de difracción de 600 lineas/min, obteniéndose una dispersión de 74.2 A/mm y una resolución de 2.5 A, en el rango espectral de 3500 a 6500 A. Seis placas fueron tomadas con emulsión IIa-O y dos con IIa-D. Los tiempos de exposición fueron entre 10 y 150 minutos. El cometa se encontraba entre 0.70 y 1.04 UA del Sol, y entre 1.28 y 0.73 UA de la Tierra. Las emisiones más prominentes en el espectro, son las del CN, C2, y C3. Otras emisiones detectadas corresponden a CH, NH2 y Na. Los espectros muestran un fuerte continuo, indicando un contenido significativo de polvo. Se detectó mayor intensidad del contínuo, en la dirección anti solar, lo cual es evidencia de la cola de polvo.

  19. Inventario nacional del uso actual del agua

    OpenAIRE

    Oficina Nacional de Evaluación de Recursos Naturales

    1984-01-01

    Establece como se emplea el agua en el Perú, teniendo en cuenta el tipo de uso, consuntivo y no consuntivo, discriminando según sea el destino: agrícola, pecuario, poblacional,industrial, minero, energético y pesquero, así como su localización geográfica; ello con la finalidad de que sirva de información básica para la planificación del desarrollo.

  20. Gerencia del cuidado-gerencia del servicio

    Directory of Open Access Journals (Sweden)

    Marta Palmet Jiménez

    2016-01-01

    Full Text Available La gerencia de este siglo debe estar plenamente identificada con la administración para planear, organizar, decidir y obtener resultados definidos, evaluados y alcanzados a través de las personas. Para poder gerenciar el cuidado se debe saber administrar. El objetivo de enfermería es cuidar; el objetivo de la gerencia es la conducción de la producción de bienes o servicios en las organizaciones. La gerencia del cuidado implica: motivación, creatividad, responsabilidad y ética por parte del cuidador y de quien cuida, claridad de actitud frente al ser y al qué hacer por parte del cuidador. Se puede concluir que la gerencia (administración, el cuidado (producto de calidad, el servicio (valor intangible, querer servir son un trinomio que deben ir de la mano de manera integrada para el logro de los objetivos propuestos por la organización de salud y de enfermería.

  1. Determinantes del ingreso y del gasto corriente de los hogares

    OpenAIRE

    Muñoz C., Manuel

    2004-01-01

    Este ensayo de investigación empírica analiza los determinantes del ingreso y del gasto en los hogares colombianos. Utilizando un modelo del ciclo de vida con datos de la encuesta de hogares de 1994 y 1995, muestra que el comportamiento del ingreso está afectado principalmente por las características demográficas del hogar y los rasgos socio ocupacionales de sus miembros. El comportamiento del gasto está determinado ante todo por el ingreso y, en menor medida, por las características sociales...

  2. Las fluctuaciones del nivel del mar durante el Cuaternario

    OpenAIRE

    Pousa, Jorge Lorenzo; Isla, Federico Ignacio; Schnack, Enrique Jorge

    2002-01-01

    Los cambios del nivel del mar han ejercido una fuerte influencia en la evolución del planeta y en la historia de la humanidad. En una escala de tiempo geológico, las variaciones de los niveles oceánicos han dejado un registro ampliamente distribuido en la forma de depósitos sedimentarios. El descenso del nivel del mar durante la Ultima Glaciación, que alcanzó unos 120 metros hace 18.000 años, permitió la emergencia del estrecho de Bering y la migración humana desde Eurasia hacia América. Se e...

  3. La imagen del pase.

    Directory of Open Access Journals (Sweden)

    Hernando Bernal.

    1999-11-01

    Full Text Available A partir de un texto del poeta Octavio Paz llamado «La imagen», se busca proseguir la equivalencia entre las imágenes de la poesía y la función que ellas tienen para el poeta, y el fantasma fundamental y su función para el analizante que está en el momento del pase. Se parte de la idea de que la poesía busca entrar en el ser así como el psicoanálisis tiene como finalidad apuntar al corazón del ser del sujeto. Se hace entonces una distinción del concepto de «ser» para el psicoanálisis, haciendo alusión también al discurso de la filosofía. Esclarecido el sentido de lo que es el «ser» para el psicoanálisis, se aborda de lleno – entre otras cosas, relacionadas con la experiencia del pase específicamente- la equivalencia entre la definición que hace Octavio Paz de «La Imagen» y el momento del pase en el análisis de un sujeto, imagen que, al igual que el mito para la filosofía, las leyes para la ciencia y el matema para el psicoanálisis, se constituyen en los instrumentos con los que cada una de estas disciplinas horadan en lo real.

  4. del Estado Aragua

    Directory of Open Access Journals (Sweden)

    Joselys Cintia Zerpa

    2008-01-01

    Full Text Available Diagnostica la situación actual de los bienes que conforman al patrimonio histórico-cultural del Municipio Zamora, Estado Aragua, Venezuela. La Investigación es descriptiva y de campo, comprendió la elaboración de un inventario de los bienes inmuebles, festividades religiosas y manifestaciones artesanales del municipio. Se estudiaron la condición física y uso actual de estos bienes y los planes y proyectos existentes. Analizó el marco normativo que los rige. Se obtuvo la opinión de los representantes de organismos públicos relacionados con la actividad turística del Municipio, de los visitantes, cronistas e historiadores. Aportes: La mayoría de los bienes se encuentran en buen estado de conservación, Las manifestaciones culturales, festividades y la artesanía se desarrollan periódicamente pero no son aprovechadas turísticamente, Se determinó que existe un marco normativo para tales bienes y No existen propuestas actuales referentes a estos bienes. Se reflejó el interés de los sectores institucional y privado para la incorporación de estos bienes a la oferta turística del Municipio y del Estado

  5. APOSTILLAS ACERCA DEL POSTRABAJO

    Directory of Open Access Journals (Sweden)

    Arturo Torrecilla

    2000-01-01

    Full Text Available El más reciente debate en torno al postrabajo transforma la herencia de los dos ciclos que le precedieron desde los años setenta. El primero se correspondía con la crítica de la división social y técnica de labores informada por una filosofía de la alienación o bien por una rectificación de la arquitectónica marxista pero salvaguardando la promesa laborista del buen trabajo. El segundo ciclo hacía eco del rechazo a las cadenas de montaje fordistas y se abría al horizonte de la abolición del trabajo salarial, manteniendo sin embargo el abolengo del sujeto unitario de la historia. La presente escena asume una densidad mayor, producto del encuentro entre las nuevas tecnologías informacionales, las discusiones en el ámbito de la sociología y la antropología, de la tecnología y la ciencia, junto al dueto que inaugura el posmodernismo.

  6. Apostillas acerca del postrabajo

    Directory of Open Access Journals (Sweden)

    Arturo Torrecilla

    2000-04-01

    Full Text Available El más reciente debate en torno al postrabajo transforma la herencia de los dos ciclos que le precedieron desde los años setenta. El primero se correspondía con la crítica de la división social y técnica de labores informada por una filosofía de la alienación o bien por una rectificación de la arquitectónica marxista pero salvaguardando la promesa laborista del buen trabajo. El segundo ciclo hacía eco del rechazo a las cadenas de montaje fordistas y se abría al horizonte de la abolición del trabajo salarial, manteniendo sin embargo el abolengo del sujeto unitario de la historia. La presente escena asume una densidad mayor, producto del encuentro entre las nuevas tecnologías informacionales, las discusiones en el ámbito de la sociología y la antropología, de la tecnología y la ciencia, junto al dueto que inaugura el posmodernismo.

  7. La universidad del futuro

    Directory of Open Access Journals (Sweden)

    FERNANDO SANCÉN CONTRERAS

    2013-01-01

    Full Text Available El trabajo señala la necesidad de reconstruir la Universidad, dado el dinamismo que muestra la ciencia y la sociedad, pues trae consigo cambios sustanciales en la visión del mundo y en el aumento del poder del hombre sobre la naturaleza. Se analizan los supuestos epistemológicos de la universidad tradicional y se propone una nueva explicación del conocimiento humano, enfatizando el conocimiento científico. Postula una docencia fundada en las propiedades de la ciencia, cuyo método inductivo basado en los paradigmas vigentes: analítico, crítico, pragmático, ofrece una herramienta para la docencia, la investigación y la difusión de la cultura. Se propone una educación centrada en el sujeto que se hace a sí mismo (etopoiética y que insiste en el proceso de auto-creación del individuo y de la sociedad.

  8. Significado presente del CSIC

    Directory of Open Access Journals (Sweden)

    Garrido Gallardo, Miguel Angel

    2000-05-01

    Full Text Available Not available

    Este artículo, elaborado en 1999, ofrece una panorámica de la realidad del Consejo Superior de Investigaciones Científicas en la actualidad. Repasa su organización, su volumen de publicaciones, sus indicadores de productividad, su capacidad de obtener recursos y, en suma, su lugar en el conjunto del sistema español de Ciencia y Tecnología, considerado en sí mismo y en relación con la Universidad. Como conclusión del repaso de datos, se afirma que, aunque la fórmula del CSIC, como organismo nacional e interdisciplinario, no es la única posible, la organización del Estado de las Autonomías, así como la evaluación de los datos con que se cuenta, la hacen vivamente recomendable. No hay, pues, sino que seguir con su desarrollo.

  9. Dalt del tren

    Directory of Open Access Journals (Sweden)

    Jaume Subirana

    2001-11-01

    Full Text Available Ens consta que la saviesa popular hi toca més del que a aquest temps d’enquestes, telèfons mòbils i targetes de crèdit li ve de gust admetre, per això em fa gràcia, en veure la pausada però continuada intrusió de la cultura catalana a Internet, recordar les cançons de quan era petit: “Dalt del tren, tots anem-hi dalt del tren, hi ha lloc per tota la gent”, dèiem, i “El tren pinxo de Banyoles és el més bonic que hi ha, ple de llaunes i cassoles i barrets de capellà”. I resulta que per una vegada a la vida hem pujat, efectivament, dalt del tren que passava per l’estació de Catalunya i en cinc anys hem passat de gairebé res a prou pàgines amb un contingut, a més, apreciable i, sobretot, a un petit teixit de persones i institucions que han entès la importància de la revolució comunicativa que Internet representa i que hi teixeixen i projecten webs amb el convenciment dels conversos.

  10. Las carreras del futuro

    Directory of Open Access Journals (Sweden)

    Luis Piscoya Hermoza

    2011-07-01

    Full Text Available La primera década del siglo XXI ha estado signada por un énfasis en los estudiosde prospectiva, los mismos que, a partir de procesos de complejizacióny articulación de la sociedad planetaria como son la digitalización, el progresivodeterioro del medio ambiente, la necesidad del cambio de la matriz energéticay la globalización del mercado, han ensayado hipótesis para identificar lastendencias que se fortalecerán y profundizarán durante las próximas décadas.Desde el punto de vista metodológico, existen muchas maneras de clasificarlaspara conceptualizarlas y entenderlas mejor. Sin embargo, considerando lanaturaleza de esta edición nos proponemos enfocar directamente aquellas queestán estrechamente ligadas a la formación universitaria.Naturalmente, no pensamos que estamos ante tendencias inevitables en lamedida que epistemológicamente la creencia en leyes históricas deterministases insostenible y la práctica social nos muestra que la construcción del futuroes nuestra responsabilidad y siempre rebasa las mejores previsiones.

  11. Componente Cultura del Agua del PMGRH: plan de trabajo

    OpenAIRE

    Autoridad Nacional del Agua; Proyecto de Modernización de la Gestión de Recursos Hídricos

    2012-01-01

    Describe el plan de trabajo del Componente Cultura del Agua del Proyecto de Modernización de la Gestión de Recursos Hídricos (PMGRH) en relacion a dos aspectos estructurales del proyecto: 1. Mejora de la capacidad de la Gestión Integrada de Recursos Hídricos (GIRH) a nivel nacional y 2. Fortalecimiento de las capacidades de GIRH en las cuencas.

  12. En busca del concepto de gerencia del cuidado

    Directory of Open Access Journals (Sweden)

    Ligia Teresa Mora-Delgado

    2005-12-01

    Full Text Available Este articulo, presenta los conceptos de gerencia del cuidado de enfermería, desarrollado por las enfermeras profesionales que laboran en le Empresa social del estado Hospital Universitario Erasmo Meoz de las Ciudad de Cúcuta, desde su desempeño en la asistencia, administración y docencia. Se pretende además precisar los elementos gerenciales, sociales, humanísticos y éticos que deben hacer parte del concepto de gerencia del cuidado.

  13. LA PERSISTENCIA DEL SUBALTERNO

    Directory of Open Access Journals (Sweden)

    John Beverley

    2002-01-01

    Full Text Available Este trabajo es el texto literal de una ponencia presentada en un panel sobre los estudios culturales latinoamericanos en el congreso de LASA en 2001 en Washington DC. Representa la posición desarrollada en el trabajo colectivo del llamado Grupo de Estudios Subalternos Latinoamericano, desde nuestra fundación en 1992 hasta la disolución del grupo en 2001, que sirve como pretexto introductorio para la ponencia. Los otros participantes en el panel eran Walter Mignolo, representando los estudios poscoloniales, Néstor García Canclini y John Kraniauskas, representando los estudios culturales, y Nelly Richard representando la llamada crítica cultural. El trabajo dialoga y debate con cada una de estas posiciones respectivamente desde el punto de vista específico de los estudios subalternos. Concluye con un llamado a una crítica del saber académico en sí.

  14. Acalasia. Controversias del tratamiento

    OpenAIRE

    Restrepo P, Antonio J; Rey T, Mario H; Garzón O, Martín A; Farfán Q, Yesid A; Molano V, Juan C; Marulanda, Juan C; Lizarazo, Jorge I

    2007-01-01

    La acalasia es un desorden motor del esófago caracterizado por pérdida de la peristalsis esofágica con falta en la relajación o relajación incompleta del esfínter esofágico inferior (EEI) (1). La causa exacta de este trastorno es desconocida. Los síntomas más comunes son disfagia, regurgitación, pérdida de peso y dolor torácico (2). La manometría esofágica es el principal método diagnóstico, mostrando aperistalsis del cuerpo esofágico con aumento de la presión, falta de relajación o relajació...

  15. Procedimiento Del Triple Fin

    Directory of Open Access Journals (Sweden)

    Oscar L. Bellido Aguilera

    2008-01-01

    Full Text Available Presenta un procedimiento novedoso basado en un método dialéctico - sistémico - integrador, que facilita la precisión de los fines u objetivos más generales de un proceso de desarrollo comunitario o de otros procesos de cambio deseados (un proyecto sociocultural, una investigación social, un proceso de mejoramiento organizacional, etc.. Su importancia radica en que los fines, según Marx, son una guía que rige como una ley la actuación del hombre y determinarlos es parte esencial del planeamiento del cambio. Se trata de un asunto aparentemente simple, sin embargo, en la práctica es mucho más problemático de lo que comúnmente se cree.

  16. Efecto del silicio y plaguicidas en la fertilidad del suelo y rendimiento del arroz

    OpenAIRE

    Furcal-Beriguete, Parménides; Herrera-Barrantes, Alejandra

    2013-01-01

    Efecto del silicio y plaguicidas en la fertilidad del suelo y rendimiento del arroz. El objetivo de este trabajo fue evaluar el efecto del silicio en la fertilidad del suelo, la incidencia de enfermedades y plagas insectiles, el rendimiento y la calidad de granos del cultivo de arroz. El estudio se realizó en La Vega, Florencia, San Carlos, Costa Rica entre mayo y octubre en los años 2010 y 2011, en el mismo lote con la variedad CR 4477. Se establecieron cinco tratamientos: silicio al suelo, ...

  17. Storia del pensiero matematico

    CERN Document Server

    Kline, Morris

    1999-01-01

    Costruita con l'intento di presentare le idee oltre ai protagonisti della matematica, questa storia ha il duplice pregio dell'esaustività e della chiarezza. Essa prevede infatti vari livelli di lettura: lo specialista vi trova una messe di dati, fonti e spunti di ricerca, mentre lo studente ha a disposizione un formidabile strumento di consultazione e sintesi. L'arco temporale coperto è vasto: dalla Mesopotamia a Euclide, da Fibonacci all'invenzione del calcolo infinitesimale, da Gauss a Poincare, con un'appendice dedicata agli sviluppi piu recenti scritta appositamente per la prima edizione italiana del 1991, nei «Manuali» Einaudi.

  18. La escritura del quechua

    OpenAIRE

    Authier, Martine du

    2015-01-01

    La mayor fantasía ha acompañado siempre la transcripción del quechua. El primer intento de sistematización fue el sistema de la Paz, en 1953. Sin embargo, no existe en el comercio un diccionario satisfactorio en lo que se refiere al quechua del Cusco y, prácticamente, nada se edita en quechua, fuera de algunos trabajos antropológicos bilingües. Bajo la égida de la UNESCO, la Academia Peruana de la Lengua Quechua, que tiene su sede en el Cusco, ha colaborado en un diccionario de doce de los tr...

  19. El lenguaje del cerebro

    Directory of Open Access Journals (Sweden)

    Antonio Ibáñez Molina

    2011-04-01

    Full Text Available La introducción de nuevas técnicas de análisis de ritmos EEG en estudio de la comprensión del lenguaje permite explorar esta habilidad humana desde una perspectiva de integración de grupos de redes neuronales. Los ritmos de disparo neuronal que generan estos grupos pueden conectarse por sincronía formando unidades funcionales transitorias distribuidas en diversas áreas del cerebro. En esta revisión comentamos algunos de estos ritmos y su relación con el lenguaje.

  20. Plasticidad del sistema nervioso

    Directory of Open Access Journals (Sweden)

    L. M. Garcia-Segura

    1976-06-01

    Full Text Available En este trabajo se revisan los conocimientos más recientes sobre el fenómeno de la plasticidad del sistéma nervioso, tanto a nivel morfológico como a nivel fisiológico y molecular. Se estudian los cambios morfólogicos y fisiológicos de las neuronas frente a la experiencia. Tambien se considera la adaptación molecular del sistéma nervioso a la información que recibe como la base de todo tipo de plasticidad.

  1. Las causas del desempleo

    OpenAIRE

    García Balbás, Salomé

    2014-01-01

    En este documento vamos a tratar de dar respuesta a la siguiente pregunta: ¿cuáles son las causas del desempleo? Para ello realizaremos un repaso de las principales teorías económicas del desempleo llegando a la conclusión de que existe una causa fundamental que lo genera: la rigidez de los salarios a la baja. Consideramos el desempleo como la existencia de un exceso de oferta en el mercado de trabajo y haremos alusión, únicamente, a la existencia de desempleo involuntario. La exposición de l...

  2. Inventario del Archivo del conde de Bornos

    Directory of Open Access Journals (Sweden)

    Pedro Antonio Porras Arboledas

    1995-01-01

    Full Text Available Mi primer contacto con esta Casa se remonta a algunos años atrás, cuando me Mamó la atención un documento muy interesante, publicado a comienzos del presente siglo por el ilustre erudito ubetense don Alfredo Cazaban, por el que los Reyes Católicos hacían merced a su secretario y jefe de la artillería real durante la Guerra contra Granada, Francisco Ramírez de Madrid, personaje madrileño de origen cántabro, de una heredad en término de Jaén —el cortijo de Bornos— por sus grandes esfuerzos en la conquista de las plazas, hasta el momento inexpugnables, de Cambil y Alhabar. Posteriormente, al realizar un estudio sobre el régimen señorial en el Reino de Jaén, intenté localizar los archivos de las diferentes casas nobiliarias asentadas en esta provincia, gracias a lo cual pude saber que la documentación del Condado de Bornos se hallaba en Madrid, bien en la Biblioteca Nacional o en el Archivo Histórico, ya que el actual Conde, el Excmo. Sr. Don Ignacio Ramírez de Haro, así me lo comunicó en marzo de 1983.

  3. Competencia Desarrollo del Pensamiento Creativo

    OpenAIRE

    Rodríguez, Eric; Miceli, Francisco; Tiburcio, Georgina; Gómez, Orlando

    2012-01-01

    1. ¿Qué significa la competencia Desarrollo del Pensamiento Creativo? 2. ¿Por qué es relevante que adquiera la competencia Desarrollo del Pensamiento Creativo en mi formación? 3. ¿Cómo aprendo la competencia Desarrollo del Pensamiento Creativo? 4. ¿Cómo aplico la competencia Desarrollo del Pensamiento Creativo? 5. ¿Cómo puedo autoevaluar mi competencia (con miras a un constante crecimiento)?

  4. Efeitos da associação de tiletamina/zolazepam ou cetamina S(+/midazolam/tramadol para contenção química em bugios-ruivos (Allouatta guariba clamitans

    Directory of Open Access Journals (Sweden)

    Pâmela Spolti

    2013-02-01

    Full Text Available Avaliaram-se dois protocolos para contenção química em bugios-ruivos. Para tal, foram utilizados 12 macacos bugios, hígidos, com peso médio de 6,4±0,4 kg, os quais foram submetidos a jejum alimentar e hídrico de seis e duas horas, respectivamente. Os animais foram alocados em dois grupos que receberam injeção via intramuscular: TZ (n=6, os quais receberam uma associação de tiletamina e zolazepam (Zoletil® na dose de 3,6mg/kg e CEMTRA (n=6, que receberam cetamina S(+, midazolam e tramadol (Cemtra ®, lote piloto 001/10, Ouro Fino Saúde Animal Ltda., Cravinhos, SP-Brasil, constituído por 100mg/ml de cetamina S+, 20mg/ml de tramadol e 10mg/ml de midazolam na dose de 1ml da associação para cada 10kg de peso corporal, correspondendo às doses de 10mg/kg, 1mg/kg e 2mg/kg, respectivamente. Anteriormente a administração dos fármacos (M0 foram avaliadas: frequência cardíaca (FC e respiratória (f, temperatura retal (TR, tempo de preenchimento capilar (TPC, pressão arterial sistólica (PAS, saturação de oxigênio na hemoglobina (SpO2, presença de salivação, grau de miorrelaxamento e sedação, índice Bispectral (BIS e Sinal de Qualidade do BIS (SQI, resposta ao pinçamento interdigital e tempos de latência, deambulação e de recuperação total (TRT. Os parâmetros foram reavaliados em M5, M10, M20, M30, M40 e M50 (5, 10, 20, 30, 40 e 50 minutos após a administração dos fármacos. No TZ os animais foram mais responsivos ao pinçamento interdigital ao longo dos tempos. Os animais do CEMTRA apresentaram maior grau de miorrelaxamento e de sedação. A f do CEMTRA foi menor após a administração do tratamento em todos os momentos em relação ao M0. Entre grupos a f do CEMTRA foi menor em relação ao TZ em M2 e M4. Os tempos totais de sedação e de recuperação foram de 48±4 e 150,1±42,1 min para o CEMTRA e de 38±7 e 73,1±20,6 para o TZ. Conclui-se que ambas as formulações são seguras para contenção química de

  5. Ruptura del projecte parental i disposició dels preembrions

    OpenAIRE

    Farnós Amorós, Esther

    2010-01-01

    La tesi doctoral "Ruptura del projecte parental i disposició dels preembrions" analitza els efectes del consentiment a les tècniques de reproducció assistida prestat en el marc d'un projecte parental. La tesi ofereix una resposta als conflictes que enfronten exesposos o exconvivents en relació al destí dels preembrions sobrants d'un cicle de fecundació "in vitro" iniciat durant la relació. Aquests conflictes constitueixen un grup de casos al voltant del qual no hi ha solucions legislatives qu...

  6. La equinoterapia en las distintas alteraciones del desarrollo del menor.

    OpenAIRE

    Chamorro González, Mireya

    2015-01-01

    La equinoterapia consiste en la utilización del caballo como un método terapéutico para rehabilitar a personas con discapacidad. Esta terapia es considerada una gran alternativa para aumentar el autoestima de los que sufren algún tipo de discapacidad, también a través de esta terapia se mejora y fortalece el estado emocional, así del mismo modo ayuda a mejorar la manera de desenvolverse en su entorno social. Esta terapia se realiza a través de la trasmisión del calor corporal del caballo, del...

  7. Gestión del riesgo del cambio (segunda parte)

    OpenAIRE

    Zorrilla Salgador, Juan Pablo

    2004-01-01

    Segunda parte del artículo acerca del uso de futuros sobre el tipo de cambio. Esta continuación abarca estrategias, definiciones, metodología y explicaciones sobre todo lo relacionado con el Ratio de cobertura de los futuros y la aparición del riesgo base.Segunda parte del artículo acerca del uso de futuros sobre el tipo de cambio. Esta continuación abarca estrategias, definiciones, metodología y explicaciones sobre todo lo relacionado con el Ratio de cobertura de los futuros y la aparición d...

  8. Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Somri, Mostafa; Matter, Ibrahim; Hadjittofi, Christopher; Hoash, Naser; Moaddi, Bian; Kharouba, Johnny; Parisinos, Constantinos A; Peretz, Benjamin

    Sedation is becoming more commonplace for pediatric patients undergoing minor procedures. Fortunately, electronic monitors have contributed to a reduction in the associated respiratory adverse events (RAEs). To test the hypothesis that adding the pretracheal stethoscope (PTS) to standard monitoring methods (SMMs) may improve RAE detection in sedated pediatric dental patients, the frequency of RAEs detected by SMMs (i.e. visual observation, capnography, and pulse oximetry) was compared to that detected by SMMs alongside continuous PTS auscultation. A prospective, randomised, controlled trial was performed with 100 pediatric patient participants of ASA≤2, who were scheduled to receive dental treatment under 0.75 mg/kg and oxygen. Patients were randomised into Groups A (n=50; SMMs) and B (n=50; SMMs+PTS). Inclusion criteria were behavioral management problems and intolerance to dental treatment despite behavioral management techniques or nitrous oxide administration. Exclusion criteria were high-risk conditions for RAEs, altered mental status, gastrointestinal disorders, parental refusal of conscious sedation and failure of previous conscious sedation. An anesthesist was present throughout the dental treatments. RAEs were detected in 10 (20%) and 22(44%) Group A and B patients respectively (p=0.01). The majority of RAEs within Group B were detected by PTS auscultation (n=19). Capnography produced 13 and 15 false-positive results in Groups A and B respectively, whereas the PTS produced 4(8%) false-positive results in Group B (p=0.009). PTS was found to be useful for detecting RAEs during pediatric dental sedation with 0.75mg/kg midazolam and oxygen, in the presence of an anesthesist.

  9. del's Proof

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 12; Issue 5. Gödel's Proof - Incompleteness Theorems. S M Srivastava. General Article Volume 12 Issue 5 May 2007 pp 71-84. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/012/05/0071-0084. Keywords.

  10. Marketing Mix del Software.

    Directory of Open Access Journals (Sweden)

    Yudith del Carmen Rodríguez Pérez

    2006-03-01

    Por ello, en este trabajo se define el concepto de producto software, se caracteriza al mismo y se exponen sus atributos de calidad. Además, se aborda la mezcla de marketing del software necesaria y diferente a la de otros productos para que este triunfe en el mercado.

  11. Gerencia del servicio

    OpenAIRE

    Nancy Peña Acosta

    1992-01-01

    Estamos en la era de la pirámide invertida donde el cliente es primero por lo que es fundamental incentivar la calidad desde abajo; hacer que el trabajador defina su misión, sienta que es parte de la compañía para que la satisfacción del negocio realizado sea de todos.

  12. El Juego del Juego

    OpenAIRE

    Carvalho, Nazaré Cristina

    2012-01-01

    DUVIGNAUD, Jean. El Juego del Juego. Santafé de Bogotá, Colômbia: Fondo de Cultura Econômica, 1997.The game gameDUVIGNAUD, Jean. The Game Game. Santafé de Bogotá, Colombia: Fondo de Cultura Econômica, 1997

  13. El helor del cuerpo

    OpenAIRE

    Sánchez-Biosca, Vicente

    1992-01-01

    Ensayo sobre las formas clásicas y modernas de la metamorfosis. En esta figura mitológica se advierte de manera privilegiada la entrada del imaginario científico, biológico y genético en el dominio de las construcciones literarias y cinematográficas.

  14. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2014-12-01

    Full Text Available La publicación se centra en temas como: Procesos electorales en México e Italia, se analizan los procesos comunicacionales y sus efectos; las infiltraciones de las agencias de seguridad en la actividad periodística en Europa; la radio y la televisión pública en los EE.UU. Para conocer cómo la prensa enfrenta los problemas críticos entre países, esta el caso de Uruguay y Argentina (discrepancia por la planta de procesamiento de papel y la contaminación del Río de La Plata. Otro artículo refiere la difícil relación entre los medios de comunicación y el gobierno de Chávez en Venezuela. Se aborda el caso brasileño para entender el crecimiento de los Observatorios de Medios; otro sobre el crecimiento del "periodismo confidencial" en la web y la prensa gratuita. Se estudia el impacto de la telenovela "pasión de gavilanes". Para quienes interese la penetración del Internet está: "Usos y competencias del weblog en las corporaciones" más otro sobre la lucha sorda que mantienen los gigantes de la autopista de la información Google y Yahoo.

  15. Punctualizaciones del CERN

    CERN Multimedia

    2002-01-01

    "Viene de la pagina anterior. Puntualizaciones del CERN. La valoracion que me merece la aprobacion en el Consejo de Ministros el 24 de mayo de un acuerdo de colaboracion entre el MCYT y el CERN para el proyecto de neutrinos al Gran Sasso es positiva" (1 page).

  16. Software del sistema osteomioarticular

    Directory of Open Access Journals (Sweden)

    Dianelys León Medina

    2015-06-01

    Full Text Available Introducción: la aplicación en la enseñanza de las Tecnologías de la Informática y las Comunicaciones, es una de las líneas que ha trazado el sistema de salud cubano en estudiantes de las ciencias médicas. La anatomía es una de las ciencias que integra la disciplina de Morfofisiología y para facilitar su comprensión resulta necesario el empleo de recursos y estrategias, entre los que puede figurar un software educativo. Objetivo: diseñar un software sobre la anatomía del sistema osteomioarticular de cabeza y cuello para los estudiantes de primer año de la carrera de Estomatología de Pinar del Río. Material y método: se realizó un estudio cualitativo. Para obtener los resultados se utilizó el método materialista dialéctico. Para la dialéctica del desarrollo del proceso estudiado se utilizaron los métodos teóricos, empíricos, el estudio profundo del tema, tipo de plataforma a utilizar y criterios de los especialistas. Para su procesamiento se utilizaron técnicas estadísticas descriptivas e inferenciales no paramétricas. Resultados: debido a la necesidad de fortalecer en los estudiantes las habilidades en la utilización de las tecnologías de la informática y las comunicaciones, se elaboró el software de la anatomía del sistema osteomioarticular de cabeza y cuello "Aprendiendo anatomía" mediante imágenes, videos y textos. Conclusiones: el software constituye un aporte al proceso enseñanza aprendizaje, el cual facilita el trabajo independiente y autopreparación mediante la interactividad con el contenido, retroalimentación y evaluación utilizando medios de enseñanza modernos, lo cual tributa al modo de actuación del futuro egresado.

  17. Historia deldel = History of Padel

    Directory of Open Access Journals (Sweden)

    Bernardino Javier Sánchez-Alcaraz Martínez

    2013-10-01

    Full Text Available El presente trabajo resume la historia del deporte deldel. Existen dos versiones sobre el origen deldel. La primera versión relaciona los antecedentes deldel con los de otros deportes de raqueta como el tenis o el bádminton, siendo su origen común el jeu de la paume francés. Posteriormente, surgen variantes en Estados Unidos como el Paddle Tennis y el Platform Tennis, siendo versiones reducidas del tenis, pero con elementos muy comunes al pádel actual. La segunda versión, aprobada por la Federación Internacional de Pádel, afirma que este deporte nació en México, en 1969, a través del empresario Enrique Corcuera.--------------------------------------------------------------------This research summarizes the history of paddle sport. There are two versions about the origin of paddle. The first version relates the history of paddle with other racket sports like tennis or badminton, and its common origin of the Jeu de Paume French. Later, in in the United States, appear two sports called Paddle Tennis and Platform Tennis, which are reduced versions of tennis sport, but these have lot of common characteristics with paddle. The second version, approved by the International Padel Federation, said the sport was born in Mexico in 1969, through the businessman Enrique Corcuera.

  18. Determinantes del ingreso y del gasto corriente de los hogares

    Directory of Open Access Journals (Sweden)

    Muñoz C., Manuel

    2004-06-01

    Full Text Available Este ensayo de investigación empírica analiza los determinantes del ingreso y del gasto en los hogares colombianos. Utilizando un modelo del ciclo de vida con datos de la encuesta de hogares de 1994 y 1995, muestra que el comportamiento del ingreso está afectado principalmente por las características demográficas del hogar y los rasgos socio ocupacionales de sus miembros. El comportamiento del gasto está determinado ante todo por el ingreso y, en menor medida, por las características sociales del hogar y el gasto de otros hogares con características similares. También examina la influencia de la incertidumbre acerca de los ingresos en el gasto de los hogares para comprobar si estos actúan con motivos de precaución.

  19. Estudio del CH interestelar

    Science.gov (United States)

    Olano, C.; Lemarchand, G.; Sanz, A. J.; Bava, J. A.

    El objetivo principal de este proyecto consiste en el estudio de la distribución y abundancia del CH en nubes interestelares a través de la observación de las líneas hiperfinas del CH en 3,3 GHz. El CH es una molécula de amplia distribución en el espacio interestelar y una de las pocas especies que han sido observadas tanto con técnicas de radio como ópticas. Desde el punto de vista tecnológico se ha desarrollado un cabezal de receptor que permitirá la realización de observaciones polarimétricas en la frecuencia de 3,3 GHz, con una temperatura del sistema de 60 K y un ancho de banda de 140 MHz, y que será instalado en el foco primario de la antena parabólica del IAR. El cabezal del receptor es capaz de detectar señales polarizadas, separando las componentes de polarización circular derecha e izquierda. Para tal fin el cabezal consta de dos ramas receptoras que amplificarán la señal y la trasladarán a una frecuencia más baja (frecuencia intermedia), permitiendo de esa forma un mejor transporte de la señal a la sala de control para su posterior procesamiento. El receptor además de tener características polarimétricas, podrá ser usado en el continuo y en la línea, utilizando las ventajas observacionales y de procesamiento de señal que actualmente posee el IAR.

  20. La pluridimensionalidad del rol del docente hospitalario

    Directory of Open Access Journals (Sweden)

    Marian Serradas Fonseca

    2015-07-01

    Full Text Available Este trabajo es el fruto de la observación y la investigación en la trayectoria personal y profesional de la autora dedicada a la educación de niños y niñas en situación de enfermedad u hospitalización. El objetivo de este ensayo es intentar definir de manera específica, el papel, tareas y competencias que el profesional del ámbito educativo tiene en la atención educativa hospitalaria; haciendo especial énfasis en la importancia de la formación de este profesional abogándose por una preparación que permita brindar una atención educativa de calidad a los niños y niñas en situación de enfermedad u hospitalizados.

  1. EFECTOS ADVERSOS DERMATOLÓGICOS POR ANTIBACTERIANOS.SISTEMA CUBANO DE FARMACOVIGILANCIA. 2007-2009

    Directory of Open Access Journals (Sweden)

    Alfonso Orta Ismary

    2012-01-01

    Full Text Available Introduction: Adverse reactions to antimicrobials in Cuba have taken place since 2003 to date, the first in the report of adverse reactions in general, as well as serious and fatal reactions, on the skin and schedules are the systems more affected. This research aimed to characterize the antibacterial dermatologic toxicities reported by the national coordinating pharmacovigilance unit from 2007 to 2009. Method: An observational study of Pharmacovigilance, descriptive and transversal using Spontaneous Reporting of Suspected Adverse Reaction database and the Cuban system of pharmacovigilance. Reports were analyzed for antibacterial dermatologic toxicities reported from 2007 through 2009, the primary endpoint was the dermatologic adverse effect reported. Results: A total of 3006 suspected adverse reactions to skin. Predominated in females (60.2% and in adults, 53.7%. The antibacterial associated with increased number of notifications were 18.5% RL penicillin, amoxicillin, cephalexin, 17.3% and 9.7%. Dermatological adverse events predominated were rash and urticaria. Moderate adverse effects predominated (64.4%, 87.5% were probable and 81.8% common. Conclusions: Adverse dermatologic antibacterial dominated by females and in adults. RL Penicillin was the drug most associated with adverse reactions. Moderate adverse reactions, probable and common were the more frequent in the study.

  2. CONOCIMIENTOS Y PRÁCTICAS SOBRE FARMACOVIGILANCIA EN PERSONAL DE ESTOMATOLOGÍA

    Directory of Open Access Journals (Sweden)

    Ruiz Hernández A

    2014-03-01

    Full Text Available Cuban system of pharmacovigilance had insufficient reports of adverse drug reactions from personal of dentistry, which constitutes a problem. Our aim was identify knowledge and practical of pharmacovigilance from dentists at Guanabacoa municipality. Method. Observational, descriptive and traverse study. We inquired 104 people (45 dentists and 59 technicians about knowledge and practical in pharmacovigilance. We also asked about years of professional experience, specialty or scientific category. The study was conducted from December 2011 to January 2012. Results. We observed dentists didn't know adverse drug reaction concept (99% although they recognized drug can cause adverse reaction (76%; they didn't know the Cuban official model to report adverse drug reactions (94,2% but the majority recognized pharmacovigilance usefulness (92,3%; they said inform an adverse drug reaction if it appear (85,6%; dentists didn't consult correct sources of information about pharmacovigilance (63,5%; not all of them asked to patient about medications (75%; greater part of them never reported an adverse drug reaction (90,4%. Much of these persons had more than 5 years of professional experience (65,4%; more than middle of dentists was specialist (55,6% but a few of them showed educational or scientific category (9,8%. Conclusions. The knowledge and practical in pharmacovigilance from dentists were deficient; educational and administration strategies about pharmacovigilance can revert these results and improve sanitary attention.

  3. Associação de cetamina S(+ e midazolam pelo método convencional de cálculo e pela extrapolação alométrica em bugios-ruivo (Alouatta guariba clamitans: resposta clínica e cardiorrespiratória S(+ ketamine and midazolam association by the conventional method of calculation and allometric extrapolation in red howler monkeys (Alouatta guariba clamitans: clinical and cardiopulmonary response

    Directory of Open Access Journals (Sweden)

    Joana Aurora Braun Chagas

    2010-02-01

    Full Text Available O objetivo deste estudo foi avaliar o protocolo de contenção química com cetamina S(+ e midazolam em bugios-ruivos, comparando o cálculo de doses pelo método convencional e o método de extrapolação alométrica. Foram utilizados 12 macacos bugios (Alouatta guariba clamitans hígidos, com peso médio de 4,84±0,97kg, de ambos os sexos. Após jejum alimentar de 12 horas e hídrico de seis horas, realizou-se contenção física manual e aferiram-se os seguintes parâmetros: frequência cardíaca (FC, frequência respiratória (f, tempo de preenchimento capilar (TPC, temperatura retal (TR, pressão arterial sistólica não invasiva (PANI e valores de hemogasometria arterial. Posteriormente, os animais foram alocados em dois grupos: GC (Grupo Convencional, n=06, os quais receberam cetamina S(+ (5mg kg-1 e midazolam (0,5mg kg-1, pela via intramuscular, com doses calculadas pelo método convencional; e GA (Grupo Alometria, n=06, os quais receberam o mesmo protocolo, pela mesma via, utilizando-se as doses calculadas pelo método de extrapolação alométrica. Os parâmetros descritos foram mensurados novamente nos seguintes momentos: M5, M10, M20 e M30 (cinco, 10, 20 e 30 minutos após a administração dos fármacos, respectivamente. Também foram avaliados: qualidade de miorrelaxamento, reflexo podal e caudal, pinçamento interdigital, tempo para indução de decúbito, tempo hábil de sedação, qualidade de sedação, e tempo e qualidade de recuperação. O GA apresentou menor tempo para indução ao decúbito, maior grau e tempo de sedação, bem como redução significativa da FC e PANI de M5 até M30, quando comparado ao GC. Conclui-se que o grupo no qual o cálculo de dose foi realizado por meio da alometria (GA apresentou melhor grau de relaxamento muscular e sedação, sem produzir depressão cardiorrespiratória significativa.The aim of this study was to evaluate a protocol of chemical restraint comparing the conventional method of

  4. ABC del Ajedrez. I

    Directory of Open Access Journals (Sweden)

    Marisel Piñeiro Gomez

    2009-03-01

    Full Text Available La promoción del Ajedrez, su conocimiento y práctica por la población constituye uno de los programas de la Revolución, por tal motivo el presente trabajo está encaminado a proponer un material bibliográfico con variadas posiciones sobre el movimiento-captura de las piezas y los sistemas de notación para los masificadores de Ajedrez del municipio Pinar del Río. En esta investigación se utilizaron variados métodos: teóricos, empíricos y estadísticos, además, como método rector el dialéctico materialista. Constituye una novedad científica porque aporta un material bibliográfico que contiene: la composición,  disposición  e  identificación  del  tablero de  ajedrez;  identificación, colocación, movimiento y captura de las piezas de ajedrez; la promoción del Peón; el valor absoluto de las piezas; los sistemas de notación: descriptivo y algebraico. Se le incluyen más de trescientos gráficos, conceptos que son trabajados de lo simple a lo complejo de manera tal que el masificador de Ajedrez lo utilice en sus clases donde se viabilice el conocimiento gracias a las facilidades que le aporta el material; ofrece algoritmos que le guiarán a elaborar nuevas posiciones, los cuales son inexistentes para este propósito en otras bibliografías; su significación práctica radica en que proporciona, tanto al estudiantado como profesorado, ejercicios de ajedrez sencillos que les permitirá a los primeros para que les sirva en su comportamiento, y a los segundos utilizarlos en su auto preparación; el interés social se halla en que pueden ser utilizados por profesores, personal de apoyo a la docencia,  técnicos  del  INDER,  familiares  de  los  estudiantes  para  ayudarlos;  el interés educativo reside en que a través de esos ejercicios contribuimos al fortalecimiento de valores.

  5. FARMACOLOGÍA DEL PACIENTE PEDIÁTRICO

    Directory of Open Access Journals (Sweden)

    Q.F. Claudio González

    2016-09-01

    Full Text Available La ciencia llamada farmacología pediátrica estudia los fármacos usados en estas poblaciones etarias, donde se observan diferencias importantes con los adultos en la farmacocinética (FC y la farmacodinamia (FD. Otros problemas habituales de la pediatría son el uso de formulaciones no aptas para niños, la falta de evidencia científica en cuanto a eficacia/seguridad para muchos medicamentos, el uso de medicamentos no aprobados por autoridades regulatorias y la influencia de otras patologías sobre el comportamiento FC. Estas condicionantes hacen que encontrar la dosis óptima de un medicamento en un niño, sea un reto en muchas terapias. Es fundamental conocer el comportamiento de los medicamentos en un organismo en constante desarrollo y maduración para lograr una terapéutica efectiva, segura y racional. Algunas herramientas como la farmacovigilancia y el monitoreo terapéutico de fármacos podrían ayudar a optimizar terapias en este escenario de incertidumbre.

  6. Arco del milenio

    Directory of Open Access Journals (Sweden)

    Adell, Josep Mª

    2005-02-01

    the most significant stages in the erection of the Millennium Arch outside the Palacio de Congresos, venue for the 12th IBMAC.
    These pictures are divided into six chapters: Background, Components, Springline, Piers, Arch, Centring Erection and Removal, and Trimming.

    A lo largo de la historia, el Arco de fábrica ha sido el componente constructivo más característico de la Arquitectura y la Ingeniería desde que después de sus inicios etruscos en la época romana fuera desarrollado adelantándose con ello a la cultura helénica.
    El Arco, desde entonces, viene empleándose como una solución constructiva eficiente para cubrir espacios con materiales que no soportan tracciones. La originalidad técnica del Arco lo ha llevado a imponerse como símbolo de las hazañas bélicas como era el Arco de Triunfo.
    En el cambio de siglo y milenio en el que nos encontramos, un salto técnico fundamental se desvela en este Congreso, el Sistema de Albañilería Integral, que abre la posibilidad de ampliar el campo de aplicación de la albañilería con la incorporación del acero, a través de las perforaciones de las piezas, lográndose por fin armar en las tres direcciones del espacio cualquier muro de fábrica que se desee.
    El Arco del Milenio conmemoró el 12th IBMAC de Madrid, mostrando en él los avances técnicos que el Sistema de Albañilería Integral permite, al tratarse de un arco inclinado en el espacio y, por tanto, el primer arco de fábrica construido fuera de la vertical, mediante fábrica de Ladriflor aparejada a tizón, reforzada con barras y cercos.
    El Arco del Milenio, diseñado por J.M. Adell (Presidente del 12th IBMAC, parte de un cilindro de 14 m de diámetro, inclinado 30º sobre el terreno, y construido con fábrica de ladrillo de un pie de grueso, alternando una hilada de color amarillo de cada seis en rojo. El hueco deja un paso libre de 10 m de lado y 5,5 m de altura. La fábrica está armada regularmente por tendeles con cerchas cada

  7. Determinantes del trabajo infantil y la escolaridad: el caso del Valle del Cauca en Colombia

    Directory of Open Access Journals (Sweden)

    Sebastián Urueña Abadía

    2009-10-01

    Full Text Available Colombia, al igual que la mayoría de países latinoamericanos, consciente de las repercusiones sociales y económicas negativas del trabajo infantil, se ha comprometido en la lucha por la erradicación de este fenómeno. Prueba de ello es la ratificación por parte del gobierno colombiano en el año 2007, del Convenio 182 de la OIT sobre la Prohibición de las Peores Formas de Trabajo Infantil y la Acción Inmediata para su Eliminación. En el plano regional, como parte del Plan de Desarrollo del Departamento del Valle del Cauca 2008-2011, se está implementando actualmente una estrategia territorial de erradicación del trabajo infantil en sus 42 municipios. Considerando este panorama, este trabajo indaga cuáles son los determinantes del trabajo infantil y la escolaridad en el departamento del Valle a partir de los datos de la Encuesta Nacional de Calidad de Vida del año 2003. Para el análisis se emplea un modelo econométrico Probit Bivariado, que permite el estudio conjunto e interrelacionado de decisiones diferentes, en este caso la asistencia escolar y el trabajo.

  8. En defensa del indigenismo

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Huamán

    2011-05-01

    Full Text Available El indigenismo como movimiento literario, cultural, ideológico y políticoconstituye un hito, una referencia obligada de nuestra tradición culturaly literaria nacional. Su debate no se reduce ni limita a las primerasdécadas del siglo XX, etapa privilegiada en forma recurrente en los estudiosiniciales sobre esta corriente. Podemos afirmar, sin temor a equivocarnos,que no hay momento ni periodo, más o menos visible, en elque no se haya evaluado en forma crítica este acontecimiento, el mismoque ha resurgido con otras denominaciones o referencias (regionalismo,andinismo, mariateguismo, humalismo, etc., a lo largo de nuestro procesohistórico, pero imbuidas de la perspectiva inicial. El propósito deeste artículo es hacer una defensa del indigenismo contestando algunasposiciones contrarias como la de Mirko Lauer.

  9. RESPONSABILIDAD DEL ODONTOPEDIATRA

    OpenAIRE

    Guillen B., Celso

    2014-01-01

    La Responsabilidad de la atención del niño, requiere de una formación y preparación universitaria de la Segunda Especialidad en Odontopediatría para manejar organismos en proceso de crecimiento somático y psicológico. Es por eso que con el proceso de la ciencia se ha comprendido la importancia de la atención del niño desde que nace. Es así que se ha creado sistemas integrales de atención odontopediátrica durante los primeros años de vida, debido a la alta vulnerabilidad de contraer las enferm...

  10. Responsabilidad Constitucional del Gobierno

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    Francisco Zúñiga Urbina

    2006-01-01

    Full Text Available El artículo analiza la responsabilidad constitucional del Gobierno y sostiene que es jurídico-política, de lejano cuño penal y administrativo, y el procedimiento empleado para hacerla efectiva es la acusación en juicio político, que es un típico caso de "justicia política". A la responsabilidad constitucional se suman las responsabilidades civil y penal de Derecho Público del Presidente de la República y sus ministrosThis paper analyses constitutional responsibility of the government and sustains that it is political and juridical, of distant penal and administrative inspiration, and that the procedure used for persecution is impeachment in political trials, demonstrating a typical case of "political justice." Added to the constitutional responsibility of the government are the civil and penal responsibilities of the President and minister's public law

  11. Infecciones del tracto urinario

    Directory of Open Access Journals (Sweden)

    K. Andrés Wurgaft, Dr.

    2010-07-01

    Full Text Available La infección del tracto urinario (ITU, con sus múltiples presentaciones clínicas, está entre las enfermedades infecciosas más frecuentes, tanto en pacientes ambulatorios como hospitalizados. El uso del examen de orina completa y de urocultivo debe ser racional. La bacteriuria asintomática no debe ser buscada ni tratada, en parte porque esto favorece el desarrollo de bacterias resistentes a antibióticos. Distintos cuadros clínicos requieren de distintas duraciones de terapia antibiótica, y tanto el exceso de días de tratamiento como su falta deben evitarse. Se requiere investigación en la búsqueda de estrategias más efectivas para prevenir las ITU recurrentes y en el desarrollo de nuevos antibióticos orales para las ITU resistentes.

  12. Las cruces del olvido

    Directory of Open Access Journals (Sweden)

    Carla Fernandes

    2012-08-01

    Full Text Available Les tragiques événements du « mars paraguayen » ont signifié la disparition de l’espoir en la transition démocratique dans laquelle le pays s’était engagé depuis presque une dizaine d’années. Renée Ferrer, poète, dramaturge, auteur de plusieurs recueils de contes et de deux romans, consigne alors le témoignage poétique de ce drame national dans le recueil Las cruces del olvido (2001. Elle a auparavant publié d’autres textes qui peuvent rentrer dans la catégorie de la poésie sociale : c’est le cas en particulier de Viaje a destiempo (1989 dédié aux victimes de la dictature. Las cruces del olvido, dès son paratexte, insiste sur la fonction de témoignage que l’auteur souhaite assigner à ses vers et sur le rôle que ceux-ci peuvent jouer dans la transmission d’une mémoire collective. La voix d’un jeune disparu de ce « mars paraguayen », le dédoublement qu’il subit et travers lequel il évoque son entrée dans la mort et son absence du monde des vivants, rendent possible l’écriture de cette expérience de l’indicible qu’est la disparition.Los trágicos acontecimientos del «marzo paraguayo» significaron la desaparición de la esperanza en la transición democrática que el país está viviendo desde unos diez años. Renée Ferrer, poeta, dramaturga, autora de varios libros de cuentos y de dos novelas, escribe entonces el testimonio poético de ese drama nacional en su poemario Las cruces del olvido (2001. Ya había publicado antes textos que se pueden considerar como poesía social: es el caso de Viaje a destiempo (1989 dedicado a las víctimas de la dictadura. Desde el texto apertural, Las cruces del olvido potencia la función de testimonio que la autora desea conceder a sus versos y el papel que éstos pueden desempeñar en la transmisión de una memoria colectiva. La voz de un joven desaparecido del «marzo paraguayo», el desdoblamiento que sufre y a través del cual evoca su entrada en la

  13. Carta del editor

    Directory of Open Access Journals (Sweden)

    José Sánchez Gutiérrez

    2018-01-01

    Full Text Available La comunicación científica en México vive enormes retos ante la carrera de adaptar sus formas de comunicación a las nuevas tecnologías. No es tarea fácil convencerse de abandonar el papel y la imprenta para apostar por el código abierto. Sin embargo, esto es apremiante debido al retraso que se lleva en comparación con otras regiones.  Un reto muy evidente ha sido comprender el acceso abierto, reconociendo que este permite mayor visibilidad a la ciencia y que ayuda a evitar el plagio.  Razón por la que nos alegra que a partir del número 37, Mercados y Negocios cuenta con el ISSN electrónico, además del impreso

  14. Carta del Editor

    OpenAIRE

    Luis Eladio Proaño

    2015-01-01

    Henos aquí con un nuevo número de RIESED. Después de casi un año de ver la luz, y como lo anticipábamos en la carta del editor que acompañaba al número fundacional, hacer una revista electrónica no ha sido una tarea sencilla. Un año más tarde no podemos sino confirmar esa opinión.Gracias al decidido trabajo de los autores, revisores y miembros del equipo editorial hemos podido hacerlo. El proceso de revisión de los artículos ha merecido un cuidado, dedicación y tiempo especiales, que hicieron...

  15. Sonidos del Silencio

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    Luz Rodríguez Carranza

    2009-12-01

    Full Text Available La novela ha muerto, afirmaba Alberto Moravia, popularizada, anexada y banalizada por el cine, la televisión, la prensa, la sicología y la sociología. Para Carlos Fuentes en cambio - quien cita a Moravia en 1969 – « lo que ha muerto es sólo la forma burguesa de la novela, el realismo » (17. Basta un viaje rápido por la red para verificar, sin embargo, que la víctima goza de buena salud y que no está confinada en la cultura de masas o en las ciencias sociales : el modelo realista del siglo XIX – y particularmente la creación de tipos representativos de una época, sean éstos promediales o excepcionales - constituye aún la principal preocupación de los escritores y críticos literarios del siglo XXI.

  16. del consumidor mexicano

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    Nadia Huitzilin Jiménez Torres

    2013-01-01

    Full Text Available Pese a que el 80% de la población del mundo vive en mercados emergentes y países en desarrollo, como México, la investigación sobre el consumidor de estos países ha sido insuficiente. El objetivo de este estudio es determinar el perfil del consumidor mexicano en función de variables psicosociológicas como el etnocentrismo, la apertura cultural, el patriotismo, el colectivismo y las características demográficas. Con este propósito se recogió la información de una muestra de 274 consumidores, se realizaron un análisis factorial de sus principales componentes y un análisis cluster con el cual se aglomeró a los individuos en tres grupos con diferentes perfiles psicosociológicos y demográficos.

  17. del noroeste murciano

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    Ma. Luz Tudela Serrano

    2006-01-01

    Full Text Available En la Región de Murcia se está realizando un esfuerzo por aumentar la producción de energías renovables en cumplimiento de los objetivos de Kyoto establecidos para España. Paralelamente, la percepción social acerca de las mismas preocupa cada vez más. En este trabajo, los ciudadanos opinan ante la necesidad de promover el uso e implantación de energías renovables en varias poblaciones afectadas del noroeste. Emplazamientos idóneos, la conservación de los valores naturales y paisajísticos del entorno y las necesidades socioeconómicas de la zona se suman a un uso racional de estas energías y un desarrollo tecnológico paralelo para alcanzar un desarrollo sostenible.

  18. Lo siniestro del enigma.

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    Victoria Eugenia Diaz.

    1999-11-01

    Full Text Available En "El nacimiento de la filosofía griega", Giorgio Colli nos muestra una faceta tenebrosa del enigma. El dios Apolo, de naturaleza ilimitada, insondable, caprichosa, plantea al hombre enigmas que lo enfrentan con el sufrimiento y con la muerte. Allí, Edipo se confronta con enigmas enviados por el dios en los que se pone en juego su propia existencia. Tiempo después, en el transcurrir del siglo XX, reaparece una nueva forma de este dios arbitrario y arrogante: el desaparecedor de personas, ese inmoderado que impone moderación, borra con su acto un cuerpo, una imagen, un nombre, y formula un nuevo enigma siniestro que enfrenta otra vez al hombre con el dolor y con la muerte.

  19. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available El aparecimiento del periodista digital y la educación superior en su formación, el cine indígena y la resistencia cultural, más los Grammy latinos, son temas protagónicos de este número. Se suman la prensa en el combate de piráticas corruptas, los errores de la comunicación del presidente URIBE en el referendo, el fútbol y las Relaciones Públicas en España, la libertad de prensa encarcelada, el Internet y la sociedad de la Información y México: profesiones emergentes para los comunicadores, completan la edición.

  20. Percepcion multisensorial del sabor

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    Charles Spence

    2010-12-01

    Full Text Available La investigación sobre la integración multisensorial de los estímulos auditivos, visuales y táctiles nos está ayudando a entender el funcionamiento de la percepción del sabor. Este conocimiento está teniendo ya un impacto sobre el diseño de alimentos y bebidas, desde los productos que compramos en un supermercado hasta aquellos que encontramos en los restaurantes con estrellas Michelin.

  1. Estado Nutricional del Yodo.

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    Hernando Vargas Uricoechea

    2015-06-01

    Full Text Available INTRODUCCIÓN: Los Desórdenes por Deficiencia de Yodo son un problema serio de salud pública, con cerca de 2 mil millones de personas a riesgo de padecerlos, pudiendo causar bocio neonatal, cretinismo, retardo mental, hipotiroidismo, entre otros. Estos desórdenes son aún prevalentes, y en algunos casos los esfuerzos para su erradicación se han traducido en aumento del riesgo de exceso poblacional de yodo y autoinmunidad tiroidea. En Colombia, se desconoce el estado real de yodo en la población. OBJETIVOS: Determinar la mediana de la yoduría en población escolar, y de los hábitos del consumo de sal, función y parámetros de autoinmunidad tiroidea, y cociente intelectual. MATERIALES Y MÉTODOS: Estudio basado en la comunidad, de corte transversal. Se evaluaron las variables sociodemográficas, la frecuencia de bocio y los niveles de TSH, anti-TPO, anti-Tg, anti-TSHR, yoduria, test de factor G de Cattell, y hábitos del consumo de sal. RESULTADOS: El consumo de sal promedio persona/día fue de 18,13 g. El 37,9% presentó bocio. 36,1% tenían un valor límite en el cociente intelectual. La mediana de yoduria fue de 510,3 μg/L. El 42,75% tuvo anti-TPO positivos, y el 2,87% anti-Tg positivos. El 10% presentó niveles de TSH elevados. CONCLUSIÓN: En escolares de zona urbana, hay un exceso en la mediana de yoduria, pudiendo explicarse por el alto consumo de sal. La alta prevalencia de autoinmunidad tiroidea y bocio, junto al alto nivel de la TSH, puede ser consecuencia del exceso en la ingesta de sal y de otros factores medioambientales/ hereditarios.

  2. El lenguaje del pensamiento

    Directory of Open Access Journals (Sweden)

    Alberto Andreu Marín

    2017-09-01

    Full Text Available ¿Somos capaces de interpretar las señales eléctricas que genera nuestro cerebro cuando estamos pensando? Lo que a priori parece ciencia ficción comienza a ser factible gracias a los avances recientes en técnicas de registro cerebral y en aprendizaje automático. Nos encontramos en el inicio de una nueva era en lo que al conocimiento del cerebro se refiere.

  3. Fundamentos del saber administrativo

    OpenAIRE

    Paola Podestá Correa; Juan Carlos Jurado Jurado

    2005-01-01

    El presente texto tiene por objetivo delimitar, de manera general, algunos de los conceptos más importantes del saber administrativo; en primera instancia, práctica administrativa y saber administrativo. Estos conceptos están ligados con los que en el texto se denominan fundamentos de la administración, estableciendo consensos sobre algunas expresiones comunes en el lenguaje administrativo, y contribuyendo a la comprensión de estos temas para los estudiantes de los primeros niv...

  4. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Jorge Aguirre

    2015-01-01

    Full Text Available La crisis de la prensa Argentina a efecto del mal manejo de la economía y las finanzas, ocupa el tema central. Pasa revista a tres temas de actualidad: El aumento de cobertura y difusión de la prensa gratuita; los esfuerzos de los "viejos" diarios por cambiar de apariencia y el caso del diario estadounidense TODAY que hace veinte años dio un cambio revolucionario en la forma de hacer periodismo diario. Se analizan también temas como: el "carisma" de los líderes actuales, los acuerdos entre los medios de comunicación y el gobierno de México para la difusión de planes y programas oficiales y el rol de los medios en el proceso de establecimiento del ALCA. Agrega el tema controversial sobre la Ley de radiodifusión privada, vigente desde la época de la dictadura pinochetista. En este mismo campo de la Radio otro artículo señala las normas para "contar las noticias" con impacto e interés.

  5. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Jorge Mantilla Jarrín

    2015-01-01

    Full Text Available En este número, el módulo Dibujos Animados, recoge las experiencias del primer curso realizado por el CIESPAL con apoyo de la UNICEF sobre la producción de programas educativos y culturales que utilizan este recurso como una opción comunicacional. Se trata de nuevas tecnologías aprovechadas en Cuba y que pueden ser aplicadas en nuestros países. El módulo relativo al medio ambiente habla del periodismo ecológico con importante desarrollo en América Latina, tema de actualidad que requiere preocupación por parte de los medios de comunicación. Incluye entrevistas a Gunter Grass y Jesús Polanco. Gabriel Alba adentra a los lectores en una novedosa forma de usar las computadoras. En el módulo Debate se trata la Economía, cultura y comunicación; La publicidad vía televisión, La evolución del merchandising en las novelas brasileñas ¿Exigir Ética solo al periodista?

  6. Los felinos del canciller

    Directory of Open Access Journals (Sweden)

    Marco Palacios

    1988-01-01

    Full Text Available En la introducción a una de las obras más influyentes de la historiografía colombiana de nuestros tiempos, el autor, Luis Ospina Vásquez, advierte ciertas dificultades inherentes al oficio de historiar la economía: "Otros aspectos del tema son difíciles de tratar por otros motivos: no se puede citar, entre las causas del difícil adelanto económico de cierta región nuestra, llamada por la generosidad de la naturaleza a una gran riqueza; el hecho de que en ella la política se haya reducido con frecuencia a una pugna entre grupos de hampones[...] Y en el supuesto de que se pudiera dar tratamiento adecuado a lo que, al fin y al cabo, es cosa tangible, no muy difícil de percibir y de describir, faltaría aun dar entrada a un elemento sumamente importante, pero este sí difícil de captar y de transmitir: la 'atmósfera', las 'atmósferas' sucesivas del país y sus regiones, elemento esencial en la historia de la evolución económica.

  7. El Museo del Oro

    Directory of Open Access Journals (Sweden)

    Efraín Sánchez Cabra

    2003-09-01

    Full Text Available El 22 de diciembre de 1939 el Banco de la República compró un objeto de oro de 777,7 gramos de peso y 23,5 centímetros de altura que dio origen al Museo del Oro. Era un poporo quimbaya, pieza maestra de la orfebrería prehispánica. Un objeto bello bello que levanta su bruñido vientre globular y su cuello coronado por cuatro cuerpos esféricos sobre una exquisita base de filigrana fundida, y parece flotar en un espacio propio. Quien lo contempla no puede menos que asombrarse, deleitarse y sentir admiración por sus artífices. Detrás de la compra del poporo había una clara preocupación oficial por proteger una riqueza que comenzaba a entenderse como parte del patrimonio nacional. Esta motivación se pone de manifiesto en una serie de documentos relativos a su adquisición.

  8. Llanto del adulto

    Directory of Open Access Journals (Sweden)

    Alegría Majluf

    2013-09-01

    Full Text Available Se presentan los resultados de un primer estudio transcultural del llanto del adulto que comprende 30 países, entre los que se encuentra el Perú. Vingerhoets et al. (1997 de la Universidad de Tilburg, Holanda, analizan las causas, tendencia y frecuencia del llanto, emociones y sentimientos que inducen al llanto, diferencias y similitudes entre los países y los sexos. Los autores encuentran que las mujeres tienden a llorar con más frecuencia e intensidad que los varones, advirtiendo que en algunos países las mujeres establecen mayor relación entre la tendencia al llanto y el ciclo menstrual que en otros. The results of a first cross-cultural study on adult crying in 30 countries including Peru are presented. Vingerhoets et al. (1997 from the University of Tilburg have analyzed motives, tendencies and frequency of crying, emotions and feelings that provoke crying, as well as differences and similarities among countries and sexes. Results show that women have a tendency to cry more frequently and intensively than men. It has also been noted that, in certain countries, there is a link between crying in women and their monthly period.

  9. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available Artículo de fondo es un ejemplo de una campaña exitosa de Relaciones Públicas realizada para rescatar a Medellín para el turismo, ahora herida de muerte por el narcotráfico. Reinicia el tema sobre el cine, recordando el aniversario del nacimiento de Luis Buñuel. Y sobre el Nuevo Orden Internacional de la Información, Luis Ramiro Beltrán da respuesta a las múltiples interrogantes planteadas en la controversia surgida alrededor del tema. Se da a conocer cómo era el periódico de ayer, de hoy y del futuro frente al desafío de las nuevas tecnologías. Se señala el camino para hacer publicidad en Internet. El Internet y la radio nuevos actores para un mismo mercado. Y para los interesados en la investigación se trata cómo y cuándo hacer sondeos flash y se cierra con el lenguaje periodístico cuándo el dequeísmo es lícito.

  10. comportamiento del consumidor

    Directory of Open Access Journals (Sweden)

    Erico Rentería Pérez

    2006-01-01

    Full Text Available En este artículo se analiza el posicionamiento exitoso de los profesionales, particularmente los jóvenes, a partir de las nuevas realidades del mundo y del mercado laboral, así como la empleabilidad como constructo, estrategias posibles y, finalmente, una discusión sobre falacias y realidades de discursos sobre mercado de trabajo profesional. La reflexión se liga a dos investigaciones, y a redes de discusión en Brasil y Colombia, que reflexionan sobre las implicaciones y requerimientos estratégicos que marcan el ingreso o permanencia en el mercado de trabajo de profesionales jóvenes, y se reconoce que esto afecta a otros tipos de profesionales. La investigación de Rentería (2006ª sobre Empleabilidad arroja información sobre las dos primeras partes. La de Enríquez y Rentería (2006 sobre Estrategias de aprendizaje y empleabilidad informa sobre la tercera. Apoyan la discusión elementos de psicología y comportamiento del consumidor. Se discute la inclusión social y calidad de vida por el trabajo.

  11. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available Abre la revista una retrospectiva de la crisis económica, política y social en la que se precipitó Argentina (2001-2002 y el tratamiento que dieron los medios a esta situación. En opinión se describe el significado de los nuevos paradigmas de Internet como: interactividad, personalidad, multimedialidad, hipertextualidad, actualización, abundancia y mediación. Responde a la cuestión de ¿cómo y cuándo en la prensa latinoamericana sigue imperando la prensa amarilla? Recoge en un artículo los factores que más inciden en el éxito o fracaso de una campaña política. Aborda la implantación de una nueva moneda única en la Unión Europea y sus incidencias. Destaca las consecuencias vividas por México tras el ataque terrorista del 11 de septiembre 2001 y analiza el tratamiento que los medios dan a las informaciones procedentes del Tercer Mundo en Europa. Contesta a la pregunta inquietante sobre las posibilidades del liberalismo económico para garantizar o contrarrestar la libertad de prensa y por último se aclara los mitos y realidades que se han tejido alrededor de Windows XP de Microsoft.

  12. Inestabilidad compleja del codo

    Directory of Open Access Journals (Sweden)

    Héctor Gabriel Díaz Carrillo

    2014-08-01

    Full Text Available La inestabilidad compleja del codo es de reciente descripción y controversial en sus resultados; es el estado que se deriva del daño estructural y funcional, producido por la incongruencia de las superficies articulares y las estructuras ligamentosas que estabilizan el codo. Se realizó un estudio descriptivo prospectivo, en el período comprendido entre enero de 2011 y abril de 2013, en una muestra no probabilística de ocho pacientes (diez codos, seleccionados según criterios de inclusión y exclusión. Los objetivos fundamentales del estudio fueron: la actualización de conocimientos para el manejo de la enfermedad y la caracterización de los resultados obtenidos en los afectados por esta dolencia que fueron operados en el Hospital Dr. Ernesto Guevara de la Serna de la provincia de Las Tunas. Se analizaron los datos mediante técnicas estadísticas descriptivas y se realizó la evaluación clínica y radiográfica de los lesionados. El tratamiento se ejecutó según los hallazgos y consistió en: reparación ligamentosa, actuación sobre las partes óseas dañadas y colocación de osteosíntesis diversas. La edad promedio fue de 39,2 años y predominó el sexo masculino. A todos se les practicó reparación ligamentosa, siete cupulectomías y seis aplicaciones de cerclajes anti-distractores. Existieron dos reluxaciones y una sepsis local. La amplitud de movimientos fue aceptable dentro del rango compatible, con una buena función ergonómica; de acuerdo a las comparaciones bibliográficas actualizadas que se realizaron. La fijación y reparación de los estabilizadores del codo brindan buenos resultados funcionales. La sistematización en el manejo de la enfermedad, la detección de complicaciones y el arsenal terapéutico disponible son factores a tener en cuenta

  13. Nuevos usos del cemento

    Directory of Open Access Journals (Sweden)

    Páez Balaca, A.

    1977-04-01

    Full Text Available In this article, the evolution of the different systems of transporting and storing submarine oil and its by-products (petroleum gas and natural gas, is dealt with stressing the importance of the use of concrete boats. Due to the high cost of oil pipelines, we have passed from tanks built on land to prestressed concrete tanks which can be berthed at great depths or anchored to the bottom to keep them afloat, it being possible to unmoor them for transferring them. Transporting and storing liquated gas leads US to see the advantages of prestressed concrete over steel, as the latter becomes brittle at low temperatures, whereas the former's strength increases. The different forms and possible sections are analyzed, stressing the great importance of the solution of the double concrete hull with pearlite insulation. Finally, a study is made of «light concretes », not the classical types used as thermal and acoustic insulation, but the semi-heavy ones made with expanded clay, high quality sand and P-450 cement, which technique is not yet as developed in Spain at might be wished.En este artículo se trata la evolución de los distintos sistemas de transporte y almacenamiento del petróleo submarino y sus derivados (gas de petróleo y gas natural, resaltando la importancia del uso de barcos de hormigón. Debido al gran coste de los oleoductos, se ha pasado de los tanques construidos en tierra firme a los depósitos de hormigón pretensado que pueden estar fondeados a gran profundidad o anclados al fondo para mantenerlos flotantes, existiendo la posibilidad de poder desamarrarlos para su traslado. El transporte y almacenamiento del gas licuado nos hace ver las ventajas del hormigón pretensado sobre el acero, pues éste se vuelve quebradizo a bajas temperaturas, mientras aquél aumenta su resistencia. Se analizan las diferentes formas y secciones posibles, destacando la gran importancia de la solución del doble casco de hormigón con

  14. Enfermedad Diverticular del Colon

    Directory of Open Access Journals (Sweden)

    Gonzalo López Escobar

    1991-06-01

    Full Text Available

    Los divertículos del colon han sido reconocidos por varios observadores desde hace más de un siglo, pero en su mayor parte se trataba de casos aislados, hoy se la considera como la enfermedad del siglo XX, la de la era moderna y de los países industrializados y de avanzada tecnología (5,18,33.

    Según el diccionario de la Real Academia Española (11, divertículo, del latín, diverticulum, quiere decir desviación de un camino; y desde el punto de vista anatómico, apéndice hueco y terminado en fondo de saco. (Gráfica No. 1.

    Goligher (17 lo define como la “posada al borde del camino, probablemente un lugar, a menudo, de mala reputación”.

    Historia

    Según Hackford (18, el proceso fué descrito brevemente por Littre a comienzos del siglo XVIII; pero se le atribuye a Cruveilhier la primera descripción como proceso patológico en 1849, quien, además, mencionó: “encontramos, no rara vez, en el sigmoide, entre las bandas de fibras musculares longitudinales, una serie de pequeños tumores piriformes oscuros, que están formados por hernias de la mucosa a través de brechas en la capa muscular” (17.

    Fleischman en 1815 hizo la primera observación de la enfermedad y empleó el término divertículo (45.

    Rokitansky en 1.849, habló de una enfermedad adquirida y consideró que su causa consistía en la constipación (45.

    Virchowen 1853 describió la perisigmoiditis (45.

    En 1859 Sidney Jones informó de una fístula colo-vesical debida a diverticulitis (5,45.

    Loomis en 1870 describe una peritonitis como resultante de una diverticulitis (45.

    En 1877 Ball describió la anatomía patológica de la enfermedad y presentó dos casos de fístula colovesical debidas a diverticulitis (9. Cripps en 1.888 popularizó la colostomía de desviación como tratamiento para la fístula colovesical(18...

  15. Max Weber o el enigma emocional del origen del capitalismo

    OpenAIRE

    EDUARDO BERICAT ALASTUEY

    2001-01-01

    Se analiza el trabajo clave de Max Weber, La ética protestante y el espíritu del capitalismo, desde la perspectiva de la Sociología de las Emociones. Aunque la inclusión de las emociones de los fenómenos sociales es clave para entender la idea de Weber sobre el dogma de la predestinación, los sociólogos han trivializado el papel de la emoción. Tras detallar la creencia de Weber en que el espíritu del capitalismo parte del conocimiento de que el destino del hombre está predeterminado (la ética...

  16. Sobre el significado del descubrimiento del gen FOXP2

    OpenAIRE

    Longa Martínez, Víctor Manuel

    2006-01-01

    El reciente descubrimiento del gen FOXP2 ha ofrecido la primera evidencia clara de la base genética del lenguaje, mostrando una correlación inequívoca desde la perspectiva genética entre una versión mutada de F0XP2 y los trastornos lingüísticos de diferente tipo sufridos por una familia inglesa, conocida como KE. El objetivo central del presente trabajo es discutir diferentes aspectos relacionados con tal descubrimiento; especialmente, la discusión del significado de FOXP2 con ...

  17. Competitividad sectorial internacional. Caso: sector del cuero y del calzado

    Directory of Open Access Journals (Sweden)

    Diana Carolina Villegas Álvarez

    2007-01-01

    Full Text Available El presente escrito se origina en un trabajo de investigación cuya pretensión fue indagar sobre el nivel de competitividad internacional (C.I, del sector del cuero y del calzado colombiano, mediante la aplicación de indicadores que, a partir de la información estadística de las variables de comercio exterior permiten establecer ciertas relaciones que dan cuenta de la importancia del producto en los mercados de los países de la Comunidad Andina de Naciones (CAN, seleccionados para la comparación.

  18. La impronta del nuevo mundo

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    Rodrigo Lagos Vergara

    1992-05-01

    Full Text Available Cuando nos aprontamos a conmemorar el quinto centenario del Nuevo Mundo, cabe hacer algunas reflexiones acerca de nuestro continente a la luz del lenguaje propio de las artes y la arquitectura a través del tiempo. Hablamos del Nuevo Mundo en la medida que aceptamos, por una parte, la concepción del nuevo espacio generado a partir del encuentro de dos culturas, la precolombina americana y la propiamente europea llegada principalmente a través de España, y, por otra parte, aceptando también que el nuevo continente resulta ser la pieza clave que ayuda definitivamente a configurar un nuevo cosmos que revela al mundo su otro extremo y aquella parte que manifiesta la totalidad en la certeza de que la tierra es un planeta.

  19. Efectos colaterales del voto preferente

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    Luis Diego Brenes Villalobos

    2012-07-01

    Full Text Available El artículo describe la multiplicidad de potenciales efectos que la implementación del voto preferente podría acarrear en el ordenamiento jurídico y el sistema de partidos. La primera parte del análisis se dirige a caracterizar y definir el voto preferencial. En segunda instancia, el estudio comprenderá la revista de los efectos colaterales del voto preferente como modalidad de votación.

  20. El movimiento del software libre

    OpenAIRE

    Prudencio Óscar Mochi Alemán

    2002-01-01

    El objetivo de este trabajo es describir el surgimiento y desarrollo del movimiento de software libre. Para ello se analizan algunas características importantes que dan cuenta del origen y desarrollo del mismo, así como de sus momentos más críticos y sus tensiones, sus desafíos y sus retos. Otra de las grandes inquietudes de este trabajo, es intentar descifrar cómo el movimiento del software libre y Linux, en su versión más conocida, sobrevivieron y se afirmaron hasta llegar a ...

  1. Analisi del decadimento $W -> \\tau \

    CERN Document Server

    Coscetti, Simone

    Questo lavoro di tesi si e' svolto nell'ambito dell'esperimento CMS a LHC, ed in particolare verte sullo studio delle strategie di identificazione off-line del leptone tau, atteso tra i prodotti di decadimento del bosone di Higgs, cosi' come di altre particelle previste in altri modelli teorici. Il canale utilizzato per testare la procedura di identificazione del tau e' il decadimento semileptonico del bosone vettore W. Infine, sulla base dei risultati ottenuti viene presentata una stima quantitativa della sezione d'urto di produzione pp-> W + X

  2. El pie del adulto mayor

    OpenAIRE

    Parodi García, José Francisco

    2005-01-01

    Acta Médica Peruana es una publicación del Colegio Médico del Perú El estudio del pie y sus patologías es un capítulo muy importante de la Geriatría. Las patologías del pie no escapan las características comunes de muchos síndromes geriátricos como son el ser asumidos como "normales para la edad", ser poco valorados, menospreciados, no tratados, con gran impacto sobre la salud en general y la calidad de vida.

  3. El maestro del Pavo Real

    OpenAIRE

    Montalvo Martín, Francisco J

    2013-01-01

    Este trabajo pretende hacer una primera aproximación al Maestro del Pavo Real, un platero barcelonés del siglo XIX que usó como marca personal la silueta de un pavo real visto de frente con la cola desplegada y todo ello dentro de un círculo. Este trabajo pretende hacer una primera aproximación al Maestro del Pavo Real, un platero barcelonés del siglo XIX que usó como marca personal la silueta de un pavo real visto de frente con la cola desplegada y todo ello dentro de un círculo.

  4. LIDERAZGO VISIONARIO: CENTRO DEL CONOCIMIENTO

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    Rafael Pérez Uribe

    2013-07-01

    Full Text Available El gestor del conocimiento es el ser humano. En el mundo como en las empresas es el centro de la destrucción y la creación del conocimiento. Por esta razón en las empresas se deben generar los escenarios adecuados para revertir el conocimiento de las personas y convertirlo en patrimonio de las organizaciones. El papel del líder es vital para la construcción de escenarios adecuados para que los trabajadores se conviertan en auténticos gestores del «knowledge» y esto permita que las organizaciones sean entes permanentes de aprendizaje continuo.

  5. Efeitos da dexmedetomidina sobre a coagulação sangüínea avaliada através do método da tromboelastografia Efectos de la dexmedetomidina sobre la coagulación sanguínea evaluada a través del método de la tromboelastografía Effects of dexmedetomidine on blood coagulation evaluated by thromboelastography

    Directory of Open Access Journals (Sweden)

    César Romão Martins

    2003-12-01

    adrenérgicos alfa2 puede presentar efectos pro y antiagregantes plaquetarios, por mecanismos directos e indirectos. En este estudio, se evaluaron los efectos de la dexmedetomidina sobre la coagulación a través del método de la tromboelastografia. MÉTODO: Veinticuatro pacientes fueron aleatoriamente divididos en tres grupos. Los pacientes del grupo 1 recibieron infusión de solución fisiológica (control, los del grupo 2 recibieron dexmedetomidina en la dosis de 1 µg.kg-1 en 10 minutos, seguida de infusión de 0,4 µg.kg-1.h-1 por 20 minutos y los del grupo 3 recibieron midazolam en dosis de 0,05 mg.kg-1. Los pacientes sedados mantuvieron índices 3 ó 4 en la escala de la sedación de Ramsay. Fueron colectadas muestras de sangre y se obtuvieron trazados de tromboelastografía previamente y después de 30 minutos del tratamiento. RESULTADOS: La dexmedetomidina, de forma estadísticamente significativa, aumentó el tiempo de reacción (parámetro R y diminuyó el índice de coagulación en los trazados finales en relación a los iniciales. No obstante, los valores permanecieron dentro de los intervalos considerados normales. Este fenómeno no fue observado en los demás grupos. CONCLUSIONES: La interacción de los mecanismos pro y antiagregantes de la dexmedetomidina lleva a una discreta hipocoagulación; sin embargo, mantiene la coagulación dentro de parámetros considerados normales. Los efectos de la dexmedetomidina sobre la coagulación probablemente no ocurren pela ansiólisis, una vez que la sedación fue igual al grupo que recibió midazolam.BACKGROUND AND OBJECTIVES: Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist used in anesthesia for its hypnoanalgesic and cardiovascular effects. Stimulation of alpha2-adrenoceptors may determine pro and anti-platelet aggregation effects through direct and indirect mechanisms. This study aimed at determining the effects of dexmedetomidine on coagulation evaluated by thromboelastography. METHODS: Twenty

  6. Las aristas del racismo

    Directory of Open Access Journals (Sweden)

    Fredy Rivera Vélez

    2000-01-01

    Full Text Available En el presente trabajo se estudia un ámbito que normalmente se esquiva y se enmascara: Las prácticas racistas. Esta evasión del tema se da en diferentes planos discursivos, y es una práctica, cada vez más frecuente en América Latina, pues aquí se hace de la integración étnica uno de los ejes centrales de la construcción de sus relaciones identitarias y políticas. Se propone, entonces, este trabajo develar la naturaleza y el movimiento de prácticas racistas presentes no sólo discursivamente, en la práctica política, en la práctica laboral, sino que también están presente en nuestra vida cotidiana, bajo nuevas formas y contenidos que se distancian del racismo tradicional e incorpora una nueva gramática racista, una suerte de racismo moderno, no basado en el fenotipo o características físicas como elemento central, sino en un racismo basado en la diferencia cultural, lo cual plantea un plano más excluyente, pues en este planteamiento el “objeto de racismo” no es un objeto de racismo limitado, como en el racismo tradicional, en el cual siempre es utilizado por quien practica el racismo; en el racismo contemporáneo se pretende una ruptura completa y una exclusión total del otro.

  7. Etiche del paesaggio

    Directory of Open Access Journals (Sweden)

    Massimo Venturi Ferriolo

    2015-11-01

    Full Text Available L’etica riflette sui rapporti fra uomo e ambiente. Indaga l’azione dell’uomo. Svela la sua visione della vita e il mondo possibile e accoglie in sé un complesso di norme morali e di costume che identificano un preciso comportamento nella vita di relazione. Si riferisce all’agire dell’individuo in una struttura sociale che lo comprende. Siamo alla ricerca di un’essenza del paesaggio indipendente dalla mera pittura, dalla rappresentazione, dall’immagine sentimentale: dalla natura sia ideale che reale. Prendere coscienza della cosa in sé, anche nei suoi aspetti ideali, significa comprenderne la complessità. Possiamo leggere quindi ogni paesaggio come realtà etica, risultato dell'operosità dell'uomo nella natura, ambito complessivo della vita: nel significato peculiare di progetto del mondo umano, che parte da lontano, da quando l'uomo ha incominciato a trasformare il proprio ambiente naturale per creare i luoghi dell'abitare, modellati con la mano e con lo spirito. La conoscenza dei paesaggi in tutta la loro complessità, a partire dal mondo antico, diventa quindi un nostro obiettivo. Questo significa superare, se non addirittura rovesciare, alcuni luoghi comuni consolidati e storicizzati: la teoria secondo la quale il paesaggio, nella sua dimensione estetica, sarebbe un'invenzione della modernità; il collegamento tra la moderna pittura di paesaggio e la nascita dei concetti estetici; la confusione tra natura e paesaggio, frequente nelle concezioni ecologico- ambientaliste; la tesi lessicale della nascita della coscienza del paesaggio, legata all'esistenza di una parola specifica che lo indichi. 

  8. del paradigma comprensivo

    Directory of Open Access Journals (Sweden)

    María Luisa Bacarlett Pérez

    2008-01-01

    Full Text Available A partir de la distinción planteada por von Wright en su texto ya clásico Explicación y comprensión, se analiza la obra de Giambattista Vico (1668-1744 a la luz de su crítica desarrollada hacia Descartes y la distinción que realiza en tre "crítica" y "tópica". No es aventurado decir que en la propuesta viquiana la actividad propia de la tópica, ligada al uso del lenguaje, la retórica y la elocuencia, se acerca más aquello que von Wright ubica dentro del "paradigma comprensivo"; mientras que la crítica, identificada con el método cartesiano, privilegia la abstracción, la deducción lógica y el análisis matemático; es decir, todo aquello ligado al conocimiento de la naturaleza. La gran diferencia en tre tópica y crítica radica, al final, en el criterio de verdad propio de cada perspectiva: mientras la crítica encuentra la verdad en la exterioridad del mundo natural, en algo que los hombres no hacen; en cambio, la única forma de verdad en el terreno de la tópica es como "verdad hecha" o "verum factum"; es decir, la verdad que nosotros mismos hacemos como agentes históricos, lingüísticos, creadores de cultura, de vida política y social.

  9. La era del youtuber

    OpenAIRE

    Sánchez Arufe, Irene

    2017-01-01

    En el trabajo se analizan los cambios que ha provocado y la recuperación que ha tenido la red social YouTube en la sociedad actual, poniendo como antecedentes la aparición de Internet y el auge de las nuevas redes sociales. También se examinan la figura del youtuber como la creación de una nueva profesión y los aspectos económicos y sociales de este nuevo trabajo. Grado en Publicidad y Relaciones Públicas

  10. El desarrollo del emprendedor

    OpenAIRE

    Arco Juan, Francisco Javier del

    2010-01-01

    En este trabajo pretendemos abordar el desarrollo de las competencias y de las cualidades del emprendedor. Para ello analizaremos como mediante el trabajo en equipo, el liderazgo y la toma de decisiones a la hora de elaborar un Plan de Negocio, el alumno desarrollo todas estas competencias básicas. Además, por supuesto, de la capacidad de emprender un negocio a través de las herramientas básicas para la puesta en marcha de un negocio. No data (2010) UEM

  11. Peter Carravetta, Del postmoderno.

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    Alessandro Carrera

    2010-08-01

    Full Text Available Peter Carravetta, professor of “Italian and Italian American Studies” at SUNY Stony Brook, with an Italian and American education, has put together in his massive Del postmoderno possibly the most complete critical review so far of American academic production from the 1970s to the present. “Postmodern” is the key word of the cultural turn that took place between the 1950s and the 1970s only to meet its death, in Carravetta’s opinion, on September 11, 2001, when the shortlived illusion that h...

  12. A favor del Plagio

    OpenAIRE

    Manuel Arranz

    2007-01-01

    Yo no tengo nada contra el plagio. Ustedes, como lectores, seguramente tampoco. Bueno, tal vez prejuicios. Es lógico que los tengan con tanto artículo condenándolo. Hasta ahora, que yo sepa, nadie ha escrito para defenderlo. Los que sí tienen algo, parece ser, son los autores. Una minoría al fin y al cabo. Ya sé que hay que respetar el derecho de las minorías, pero el asunto del plagio, como tantos otros, deberíamos examinarlo con más detalle, y preguntarnos, por ejemplo, ¿por qué se molestan...

  13. El mundo del postfordismo.

    OpenAIRE

    Lipietz, Alain

    2012-01-01

    La crisis de la relación salarial fordista ha conducido a diferentes regímenes salariales aún en bloques continentales integrados. Característica que se suma a la transformación jerárquica de las economías mundiales ocasionadas por el avance competitivo de los nuevos países industrializados y por la concentración de las relaciones económicas internacionales por bloques continentales. Tales son las características básicas del mundo económico internacional posterior a la guerra fría.Este artícu...

  14. emergencia del trabajo liberado

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    Rocío Gómez Z.

    2008-01-01

    Full Text Available Este ensayo sugiere que habría una inestimable conexión entre el compromiso subjetivo y emocional de los jóvenes usuarios de Internet, que invierten tiempo y deseo en realizar un conjunto variado de obras menores (correos electrónicos, imágenes de sí mismos en Facebook, trozos de música, mantenimiento de la bitácora en la Red, y los malestares del bienestar urbano. Estas obras menores encarnan y objetivan las demandas de trabajo liberado -frecuentemente reprimidas, pospuestas, administradas o reguladas-, que algunos de los nuevos repertorios tecnológicos canalizan y movilizan vigorosamente.

  15. Funciones sociales del folclore

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    Alberto Londoño Álvarez

    1969-07-01

    Full Text Available Con el objeto de estudiar los principales aspectos sociológicos del folclore, empecemos con uno de los problemas más significativos, cual es el análisis de sus funciones que cumple en una sociedad. se trata de un asunto perteneciente al sociólogo, quien, con el propósito de mostrar al folclórogo, que su investigación no es única, porque se refiere a un hecho que pertenece al grupo de los fenómenos sociales.

  16. Trastorno del espectro autista

    OpenAIRE

    Mendoza Mendoza, María Yésica

    2012-01-01

    Se explica qué es el autismo, sus causas, tipos, síntomas, tratamiento, detección temprana, técnicas y programas específicos de intervención. A continuación, se analiza el resultado de unos cuestionarios pasados a los padres que tienen hijos con autismo para identificar y conocer el impacto de dicho trastorno en los miembros que conviven con el paciente diagnosticado de autismo y otras comorbilidades asociadas: ansiedad, presión psicológica y trastornos del estado de ánimo

  17. Les Malalties dels cereals

    OpenAIRE

    Puiggrós i Jové, Josep Maria

    1989-01-01

    En aquest treball es fa una descripció de les principals malalties dels cereals que han estat trobades a Catalunya. Agrupant-les segons ataquin la fulla i espiga: oïdi, rovells, septòries, Rhynchosporium, Helminthosporium, i virus; al coll i tija: Cercosporella, Ophiobolus, Rhizoctbnia i Fusarium o bé les que vénen de la llavor: carbons, càries i Helminthospbrium. A part de la descripció, hom fa esment de les observacions efectuades els darrers anys en els diferents indrets de...

  18. La inutilidad del etnocentrismo

    OpenAIRE

    Vanegas Betancourth, Paula C.

    2017-01-01

    El etnocentrismo como filosofía de poder en el mundo occidental. Ha evitado el exaltamiento de las mezclas culturales como opción de vida. Dándole a las minorías un lugar en los suburbios del conocimiento y de la ciencia. La exclusión de las fuentes de conocimiento primitivo por el hombre contemporáneo. Le permite la sensación de dominio sobre el mismo hombre y sobre la naturaleza. La industrialización le permitió al hombre. Como lo menciona David Dickson: « El supuesto dominio sobre la natur...

  19. Catàleg dels Miridae (Heteroptera) del Massís del Garraf

    OpenAIRE

    Goula Goula, Marta

    1989-01-01

    Per a la redacció d'aquest catàleg, s'aporten dades d'observació pròpia al llarg dels anys 1980-1984, així com les troballes publicades per CUNI (1889a,1889b,1889c,1891) i per RIBES (1978a,1978b,1980,1984). Totes aquestes observacions s'han fet en localitats del Massis del Garraf, que será objecte d'una curta descripció.

  20. LAS NEURONAS DEL SEPTUM LATERAL MODIFICAN LA ACTIVIDAD DE LAS NEURONAS DEL NUCLEO TUBEROMAMILAR DEL HIPOTALAMO

    OpenAIRE

    FARIAS RODRIGUEZ, PAULA ANDREA; FARIAS RODRIGUEZ, PAULA ANDREA

    2012-01-01

    El septum lateral (SL), es un núcleo del cerebro anterior, que, procesa la información sensorial afectiva procedente del hipocampo y dirige sus respuestas, importantes para la supervivencia, hacia las zonas del hipotálamo importantes para la motivación, como lo es el núcleo tuberomamilar del hipotálamo (TMN). El TMN contiene las neuronas histaminérgicas en el cerebro, la cual relacionamos con la vigilia y alerta en conductas motivadas y así puede dirigir y reforzar el comportamiento. El TM...

  1. La superación del modelo del ángel del hogar:

    OpenAIRE

    Hurtado Muñoz, Mónica

    2013-01-01

    La Tesis Doctoral titulada "La superación del modelo del "ángel del hogar". Recuperación de la escritora Leonor Canalejas y Fustegueras (1869-1945)" aborda, en primer lugar, un análisis sociológico de las circunstancias que rodearon a la mujer española en el cambio de siglo en el ámbito social y educativo, en un intento de esclarecer las características propias del contexto en el que la mujer accede a la intelectualidad en general y a la literatura en particular. Esta parte concluye que la cr...

  2. RASGOS GEOGRÁFICOS DEL VALLE DEL RIO AGRIO INFERIOR.

    Directory of Open Access Journals (Sweden)

    Celia Torren

    1993-12-01

    Full Text Available El presente artículo es una síntesis del trabajo "Rasgos Geográficos del Valle del Río Agrio Inferior, el cual es un estudio de base para el conocimiento de la geografía de la región: - apoyando el esfuerzo que está realizando la población del área para lograr una identidad propia y una definitiva integración al contexto provincial; - aportando al proyecto "Rescate Arqueológico en Quili Malal, Neuquén" (subsidiado por CONICET y UNESCO, cuya dirección está a cargo de la profesora Susana Rodríguez de la U.N.C., a través de la confección del mapa geomorfológico del área; y - contribuyendo a los estudios que resultan necesarios ante la construcción de una obra hidroeléctrica de la magnitud de "El Chihuido I", emprendimiento que será llevado a cabo por Agua y Energía eléctrica de la Nación. Los límites del área estudiada fueron establecidos teniendo en cuenta el área del valle inferior del Río Agrio que será completamente inundada por el futuro embalse de la represa "El Chihuido I", a emplazarse 5,5 Km aguas abajo de la confluencia de los ríos Agrio y Neuquén. Además de esta área de afectación directa se tomó también una zona de perilago estrechamente vinculada a la anterior. De esta manera los límites este y oeste quedaron establecidos por la confluencia de los ríos antes mencionados y la localidad de Bajada del Agrio, respectivamente.

  3. del cuerpo femenino

    Directory of Open Access Journals (Sweden)

    Betina Hillesheim

    2005-01-01

    Full Text Available Este artículo discute cómo las prácticas de salud dirigidas a las mujeres construyen determinadas significaciones sobre la salud y el cuerpo femenino, comprendiendo que las prácticas en salud producen determinadas formas de ser, vivir y sentir, y constituyen modos de ser mujer y de ser hombre. Se presentan los datos de una investigación desarrollada en un servicio académico de salud, con mujeres que se realizaron exámenes de prevención de cáncer de útero y mama, entre mayo y diciembre del 2002. La recolección de datos se realizó mediante observaciones de las prácticas de la salud y entrevistas con las usuarias del servicio. En términos teóricos, el punto de referencia fueron los estudios feministas, especialmente autores(as cuyas teorizaciones son postestructuralistas. Se espera que este estudio contribuya con la reflexión sobre las prácticas de salud dirigidas a las mujeres, posibilitando una ampliación sobre lo que se entiende por femenino y, dando espacio a otras formas de ser y de estar en el mundo, además de aquellas que el discurso hegemónico sobre mujeres propone como adecuadas.

  4. Fundamentos del metodo cientifico

    Directory of Open Access Journals (Sweden)

    Badii, M. H.

    2004-01-01

    Full Text Available El objetivo de esta obra no radica en realizar una búsqueda exhaustiva de la literatura en el tema, sino, sentar las bases del método científico, notando los aspectos filosóficos e éticos de la ciencia. Se presentan los conceptos y definiciones fundamentales relacionados con la metodología de la investigación científica. Se maneja el concepto de la toma de los datos válidos como un requisito básico en cualquier trabajo científico. Se pone a disposición del lector un modelo denominado el ECOEE que es una herramienta poderosa para establecer puntos de comparación e discusión entre los resultados de diferentes trabajos científicos. Finalmente, ofrece unas sugerencias de que hacer o no hacer en cuanto a realizar un trabajo de investigación.

  5. RECUERDOS DEL SIGLO XX

    Directory of Open Access Journals (Sweden)

    ASUNCIÓN LAVRIN

    2011-10-01

    Full Text Available Este ensayo hace una revisión de conceptos clave en la educación de la mujer en Hispanoamérica, en la primera mitad del siglo XX, y el debate sobre la educación superior de la mujer. También analiza las ideas de Gabriela Mistral para la educación femenina en su Lectura para mujeres, y las compara con las de la escritora mexicana Rosario Castellanos. Finalmente, hace un llamado por nuevos modelos educativos para la mujer de siglo XXI.Este ensayo hace una revisión de conceptos clave en la educación de la mujeren Hispanoamérica, en la primera mitad del siglo XX, y el debate sobre laeducación superior de la mujer. También analiza las ideas de Gabriela Mistralpara la educación femenina en su Lectura para mujeres, y las comparacon las de la escritora mexicana Rosario Castellanos. Finalmente, hace unllamado por nuevos modelos educativos para la mujer de siglo XXI.

  6. Incorrecciones del habla infantil

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    María del Pino LECUONA NARANJO

    2009-11-01

    Full Text Available En el presente trabajo se pretende dar una visión de algunos rasgos característicos del lenguaje infantil, centrándonos especialmente en el estudio de los niños de 4 a 6 años de edad. Es pues, su finalidad fundamental la descripción y análisis de los rasgos que se pueden observar en la expresión verbal de los preescolares. Las diversas peculiaridades que van a ser objeto de examen se refieren a la emisión de incorrecciones de carácter fonético, morfológico y semántico. El análisis unificado de estos tres factores responde a la consideración de que todos surgen como consecuencia de un proceso de simplificación lingüística originado por un estado inconcluso de desarrollo del lenguaje.

  7. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Jorge Jarrín Mantilla

    2015-01-01

    Full Text Available Comunicación y Género, acopia trabajos que vinculan a la mujer y la comunicación y sus esfuerzos por no ser consideradas inferiores. Del libro a la pantalla, acerca a algunas reflexiones sobre el proceso que lleva del libro a la pantalla por la polémica que despierta la adaptación de las novelas, puesto que muchos señalan que la trama se ve desfigurada. Se agregan varios temas sobre el cine. En "Días de Radio", se plantea el que a pesar de la censura y los problemas económicos que deben enfrentar, las radios populares de América Latina, siguen ganando espacios, de su desarrollo depende una mayor profundización de la democracia. Tema de debate es Estrategias comunicativas en Chiapas y Haití. Se añaden dos entrevistas a un caricaturista brasileño y a un corresponsal de guerra muy prestigiado.

  8. Gerencia del Siglo XXI

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    John Orlando Crissien Castillo

    2013-07-01

    Full Text Available El cambio es más rápido que nunca, la tecnología genera nuevos modelos gerenciales, los mercados se abren, el paradigma de la competitividad y la productividad. Los gerentes modernos estamos expuestos a muchas presiones generadoras de estrés; hecho que, según la OMS (Organización Mundial de la  alud, está entre las tres enfermedades que cobran más muertes en el mundo. EL campo de juego gerencial ha cambiado: por ende la gerencia del siglo XXI requiere un perfil de administrador-gerente diferente. Este nuevo gerente se debe tornar líder y administrador. Las cosas se administran, la gente se lidera, se gerencia. Por esto el gerente líder del siglo XXI se debe formar, capacitar, entrenar en aquellas habilidades-competencias requeridas por este nuevo entorno. Por tal razón debe generar dos sets de competencias: las de gerente integral y el desarrollo de la capacidad directiva.

  9. Carta del Editor

    Directory of Open Access Journals (Sweden)

    Luis Eladio Proaño

    2015-01-01

    Full Text Available Refiere el Informe Nacional de Brasil sobre el Diagnóstico de la Comunicación en América Latina en el que se analizan los más importantes medios de comunicación de ese país. En el artículo de opinión se reflexiona sobre los cambios que sufre la comunicación política en la región como resultado de nuevos protagonistas con nuevos mensajes como: Hugo Chávez, Venezuela, Bucarám, Ecuador y Fujimori, Perú. Describe dos noticias que han llamado la atención: la desinformación en la campaña electoral de los Estados Unidos y el peculiar sistema de comunicación del Presidente Chávez para mantener la popularidad. En cultura para la imagen periodística impresa o Infografía muestra los esfuerzos que la prensa diría del mundo entero hace para competir en cuanto a imagen con la televisión. Se trata la elaboración de los guiones cinematográficos y en Comunicación Institucional se responde a cómo a solucionar los problemas de un banco desde Argentina.

  10. El Gobierno del mal menor

    DEFF Research Database (Denmark)

    Agustin, Oscar Garcia

    2012-01-01

    El Gobierno no aspira a ser bueno ni malo. Se conforma con ser el Gobierno del mal menor, cuyas medidas drásticas y poco populares están destinadas a salvar a los ciudadanos del desastre que no ha llegado todavía pero podría llegar....

  11. Tratamiento del paciente con artrosis

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    Francisco Vargas Negrín

    2014-01-01

    Full Text Available El manejo terapéutico del paciente con artrosis tiene como objetivo disminuir la sintomatología dolorosa e inflamatoria, mejorar la capacidad funcional del paciente y la aplicación de intervenciones terapéuticas eficaces y lo más seguras posibles. Un enfoque centrado en el paciente implica su participación activa en el diseño del plan terapéutico y en la toma de decisiones informadas oportunas en todas las etapas de la enfermedad. La educación terapéutica, la actividad física y el ejercicio terapéutico junto con el control de peso, en caso de sobrepeso u obesidad, constituyen el núcleo central del tratamiento. Los autocuidados individuales y por los familiares son fundamentales en el control del día a día del paciente. El uso de terapias físicas, ayudas técnicas (bastón, etc. y de fármacos tipo analgésicos simples, opioides y antiinflamatorios tiene evidencias demostradas en el control del dolor, mejora la funcionalidad y la calidad de vida del paciente y una clara recomendación de uso en el tratamiento de la artrosis. La cirugía conservadora y la de reemplazo articular se indican en los casos en los que no se logran los objetivos terapéuticos en casos concretos.

  12. El Derecho universal del Trabajo

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    Héctor-Hugo Barbagelata

    2014-01-01

    Full Text Available La idea de un derecho universal del trabajo no es nueva, en realidad es más antigua quela legislación del trabajo y por lo tanto, más antigua que la propia rama del derecho que estudia estas cuestiones.Sí, son nuevos los avances que con ese objetivo se han ido registrando desde fines del siglo pasado.I- Introducción.- II Antecedentes.- II Constitucionalización e internacionalización.- IV Principios y criterios de interpretación del bloque de constitucionalidad.- A Criterio fundado en las condiciones del Estado Social de Derecho; B Principio de complementariedad e interdependencia de todas las normas sobre derechos humanos; C Primacía de la disposición más favorable a la persona humana; D Criterio resultante del principio de progresividad.; E Principio de irreversibilidad o de no regresión. F Principio de autoejecución y autoaplicación..- V Conflictos entre los derechos fundamentales .- VI.- Los principios filosóficos: a La Justicia social ; b La especificidad del trabajo humano; c Reafirmación de la dignidad de la persona humana; VII Conclusiones. 

  13. Taquicardias supraventriculares. Estado del arte

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    Jairo Alfonso Gándara Ricardo

    2016-01-01

    El tratamiento de las taquicardias supraventriculares dependerá del estado hemodinámico del paciente, el cual definirá el requerimiento de terapia eléctrica o tratamiento médico. Se debe hacer una selección adecuada de los pacientes que requieren estudio electrofisiológico y ablación.

  14. Avaliação algimétrica por estímulo nociceptivo térmico e pressórico em cães pré-tratados com levomepromazina, midazolam e quetamina associados ou não ao butorfanol ou buprenorfina The algimetry evaluation for thermic and pressoric nociceptive stimulus in pre treated dogs with methotrimeprazine, midazolam and ketamine associated or not with butorphanol or buprenorphine

    Directory of Open Access Journals (Sweden)

    André Leguthe Rosa

    2005-02-01

    Full Text Available OBJETIVO: Quantificar a dor em cães sob anestesia dissociativa através de estímulo térmico e pressórico e o período hábil de dois analgésicos opióides. MÉTODOS: Empregaram-se 30 cães alocados em três grupos (n=10, onde os animais de GI receberam levomepromazina e midazolam associado na mesma seringa à quetamina. Os animais de GII receberam o mesmo tratamento de GI porém associado ao butorfanol e por fim os animais de GIII receberam o mesmo tratamento de GI associando-se a buprenorfina. Procedeu se a avaliação paramétrica rotineira, empregando-se, entretanto, a termoalgimetria mensurada em °C em média de 52°C e a pressoalgimetria em kg. RESULTADOS: Na termoalgimetria houve diferença significativa em GI nos momentos M0 e M1,e em M4 e M5. Em GII houve diferença em M0, M1, M5 e M6. Em GIII houve diferença entre momentos M0 e M1. Na pressoalgimetria houveram diferenças em GI em diferentes momentos: M0, M2 e M3. Em GII observaram-se diferenças em todos os momentos. Em GIII observaram-se diferenças em M0 e M9. Ocorreram diferenças entre os grupos, sendo o M2 de GII menor que GI e GIII. Já em M4 e M5 de GIII demonstrou-se maior que GI e GII. E na avaliação dos períodos observou-se um período de latência significativamente maior em GI, porém com período hábil e de recuperação menor em relação à GII e GIII. Já a recuperação do tônus postural foi maior em GIII seguido de GII e finalmente de GI. CONCLUSÃO: O método empregado para mensuração do estímulo álgico foi eficiente, observando-se um período hábil analgésico de 3 horas para o butorfanol e de 6 horas para a buprenorfina.PURPOSE: This study aimed at quantifies the pain in dogs under dissociative anesthesia, across thermal and pressoric stimulus and quantify the reasonable period between two different opioids analgesics. METHODS: In this study, 30 dogs were used and, divided into three groups of 10 animals each, in which the animals of GI received

  15. Notas del Consejo Editorial

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    Fernando Serpa Florez

    1990-08-01

    Full Text Available

    Merecida Distinción
    Complacidos registrados la señalada distinción de que fue objeto en Hiroshima, Japón, durante la celebración del IX Congreso Mundial de la Organización Internacional a Médicos para la Prevención de la Guerra Nuclear (lPPNW el Académico Honorario Alberto Cárdenas Escovar quien recibió el Premio Albert Schweitzer, en reconocimiento a la meritoria labor que ha cumplido en el campo internacional de la medicina.

    Fernando Serpa Flórez

    Breves de la Academia
    En el número anterior de nuestra revista, por involuntaria omisión no se incluyeron dos señalados acontecimientos, que nos apresuramos a subsanar en la presente edición. Se trata del ingreso a la Corporación de dos distinguidos y muy apreciados Miembros de nuestro Instituto, el Académico correspondiente Joaquín Silva, Profesor de Cirugía y eminente maestro de numerosas generaciones médicas, quien disertó en forma erudita y ponderada sobre el tema “Los albores de la Medicina y Cirugía”. Así mismo tomó posesión como Miembro de Número el actual Presidente del Capítulo de los Santanderes de la Academia Nacional de Medicina, ex-decano de la Escuela de Medicina de la Universidad Industrial de Santander y notable escritor y psiquiátra doctor Roberto Serpa Flórez, quien presentó su libro sobre medicina y enfermedades tropicales en Colombia en la primera mitad de este siglo que, en forma interesante y amena, desarrolló alrededor de la biografía de su padre, el también Académico de Número profesor Roberto Serpa Novoa.

  16. Caracterización del potencial de abuso del flunitracepam

    OpenAIRE

    Martí de la Llave, Cecilia

    1997-01-01

    Con el presente estudio se pretende caracterizar el potencial de abuso del flunitracepam. La pauta de administración del flunitracepam está ajustada para alcanzar concentraciones máximas plasmáticas similares entre los dos regímenes de administración del fármaco activo, aunque a diferente velocidad; con la dosis única se alcanza la concentración máxima plasmática más rápidamente que con la dosis dividida. Cuando el voluntario recibe el fármaco activo a dosis única toma cinco cápsulas que ...

  17. Del Charco del Agua Amarga (Alcañiz

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    Tomás MAIGI

    2009-10-01

    Full Text Available En agosto de 1947, habiendo llegado a la excelentísima Diputación Provincial de Teruel rumores de recientes deterioros en el friso pintado del abrigo rupestre del "Charco del Agua Amarga", nos fué requerida oficialmente, por dicha Corporación, la presentación de un informe sobre la realidad de los hechos expuestos, así como el planeamiento de las medidas adecuadas para salvaguardar en forma eficaz, en el futuro, las referidas pinturas.

  18. Calidad del servicio de taxis del municipio Maracaibo

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    Joheni A. Urdaneta G.

    2011-05-01

    Full Text Available El presente trabajo tiene como objetivo describir la calidad del servicio de los taxis en el municipio Maracaibo, ya que los mismos forman parte del sistema de transporte urbano de la ciudad, y es un servicio público fundamental para la convivencia de la sociedad; para lograr este objetivo se realizó una adaptación del modelo SERVPERF, diseñando un instrumento tipo cuestionario, con 32 ítems en 6 dimensiones, adecuado a las características propias del servicio de taxi, con la finalidad de confirmar que los ítems de los instrumentos se correspondían con las dimensiones adaptadas se aplicó la técnica de análisis factorial resultando un nuevo instrumento con 24 ítems en 3 dimensiones. Se utilizó la escala de Likert con tres (3 alternativas de respuesta. La investigación es de tipo descriptiva y aplicada, bajo diseño no experimental de tipo transeccional descriptiva y de campo. La población quedó conformada por los usuarios de las líneas de taxis del municipio Maracaibo. Se aplicó muestreo aleatorio por conglomerado. La confiabilidad del instrumento se midió a través del coeficiente alfa de Cronbach resultando de 0,82 lo cual se considera aceptable. Los resultados revelan que la calidad del servicio de taxis del municipio Maracaibo es mediana por lo tanto este servicio es susceptible a mejoras, las cuales son necesarias para elevar la calidad de vida de los marabinos. Este resultado se obtuvo con el instrumento originalmente adaptado de 32 ítems y con el cuestionario resultante del análisis factorial, de 24 ítems; esto confirma lo apropiado de esta técnica, ya que se redujo el número de ítems y de las dimensiones originalmente adaptadas y no se encontraron diferencias significativas en los resultados con ambos instrumentos; de esta manera se puede medir la calidad del servicio de taxis en el municipio Maracaibo a través de las dimensiones: confiabilidad del servicio, socialización y responsabilidad.

  19. DE LA SOCIEDAD DEL CONOCIMIENTO A LA SOCIEDAD DEL RIESGO

    OpenAIRE

    Abdala Cardona, Alejandro

    2013-01-01

    El tiempo en el que vivimos: el siglo XXI, presenta a la vez, retos y exigencias al conjunto global de los habitantes del mundo, puesto que, no solo se nos presenta la actualidad como aquella coyuntura histórica en los que el cambio de los acontecimientos gira en torno al rol central del conocimiento, sino también, en torno al potencial que dicho conocimiento trae tras de sí; es decir, el presente siglo impone al conjunto de personas el rótulo de "sociedad del conocimiento" donde se puede enc...

  20. Historia del desarrollo institucional turístico del Meta

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    Ramón Vergel

    2002-11-01

    el primer plan de desarrollo turístico departamental, se comienza a visualizar diferentes tipologías de turismo que se podían desarrollar como el Ecoturismo y a trabajar en pro de ello. Surge luego el segundo Plan Sectorial del Meta visualizando al turismo como producto. Posteriormente se realiza un Estudio Exploratorio sobre el Potencial Turístico del Meta y la promoción turística del departamento comienza a surgir con la participación en ferias y vitrinas turísticas importantes logrando así fijar un mercado turístico: Bogotá.

  1. Perfil del director hospitalario

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    Gabril Pontón Laverde

    1990-04-01

    Full Text Available RESUMEN El hospital, sin importar su tamaño, es una empresa de servicios con una importante función social que trabaja dentro de las características administrativas y económicas generales, toda vez que actúa dentro de un  SISTEMA ABIERTO con los componentes clásicos de una demanda cíclica de servicios de salud, que requiere de una organización con personas, materiales y equipos que trabajan para dar respuesta a esa carencia y que produce resultados que benefician a la comunidad. Tienen un efecto de retroalimentación (Feed – back con base con las experiencias, expectativas y nuevas demandas de servicios y que trabajan dentro de una comunidad precisa, como parte integrante de un sistema mayor, al cual beneficia y fortalece con sus resultados y del que depende para su supervivencia.

  2. Los presupuestos del Concurso

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    Línea de Investigación “De la Crisis Empresarial

    2006-01-01

    Full Text Available Este escrito es el resultado de uno de los proyectos de investigación adelantados por el Departamento de Derecho Comercial de la Universidad Externado de Colombia. En el se hace una aproximación histórica a los presupuestos para acceder a los trámites concursales en Perú, Argentina y España, analizándolos desde los puntos doctrinal, académico y legal.Así mismo, es parte integrante de un trabajo más amplio que pretende elaborar un documento contentivo del tratamiento que se da a los presupuestos concursales a nivel mundial.En este orden de ideas, nos permitimos presentar un análisis minucioso de la legislación de los citados países iberoamericanos.

  3. cuarto del siglo XX

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    José Antonio Nieto Calmaestra

    2005-01-01

    Full Text Available Los últimos 25 años del siglo XX han supuesto un sustancial cambio en el modelo de crecimiento de la población andaluza. Así, mientras la caída de la fecundidad y la estabilización de las tasas de mortalidad han contribuido a un progresivo retroceso de la vitalidad natural, la masiva emigración de antaño ha dado paso al papel de Andalucía como incipiente foco de inmigración y al creciente protagonismo de movimientos internos de relocalización de la población. Desde el punto de vista territorial estas afirmaciones quedan matizadas por los notables contrastes que se producen entre los distintos ámbitos que conforman la región y que contraponen al medio rural con el urbano, al litoral con el interior o a las grandes ciudades con sus periferias.

  4. del caribe colombiano

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    José Amar A.

    2006-01-01

    Full Text Available La investigación indagó acerca de la construcción de conceptos económicos en una muestra de 50 estudiantes universitarios, residentes en una ciudad multifinanciera de la región Caribe colombiana. Para conocer las conceptualizaciones se aplicó una entrevista en profundidad que permitió indagar sobre la función, valor y circulación del dinero y la emisión y acuñación monetaria. Se encontró que sólo el 24% de los jóvenes universitarios alcanza el nivel de pensamiento económico inferencial, y no hay diferencias significativas de acuerdo con el programa académico al que pertenecen. Los resultados indican que los jóvenes presentan un desfase en cuanto a nivel de pensamiento económico, de acuerdo con el contexto internacional.

  5. Avatares del paradigma conexionista

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    Asier Arias

    2012-02-01

    Full Text Available Hace ahora un año que falleciera David Everett Rumelhart, conexionista pionero y editor junto con James Lloyd McClelland de la llamada “biblia del Procesamiento Distribuido en Paralelo” (PDP. Al mismo tiempo, los dos volúmenes de la referida biblia celebraban su vigésimo quinto cumpleaños. También uno de los padres de la inteligencia artificial, John McCarthy, que bautizara de hecho la disciplina, nos abandonó el pasado mes de octubre a los 84 años. Estas tres efemérides nos sirven de pretexto para un breve recorrido por las derivas y obstáculos a los que se ha enfrentado el llamado paradigma conexionista desde su puesta en escena como alternativa al cognitivismo clásico.

  6. El reordenamiento del mundo

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    Antonio Pasquali

    2015-01-01

    Full Text Available Se publica la propuesta de marco histórico y proyección de futuro de Antonio Pasquiali, en nuestra opinión, es útil referente contextualizado para los ensayos y estudios de caso sobre la formación del comunicador profesional. La evolución reciente de la filosofía, la ciencia y la tecnología llevan a Pasquali a afirmar que la humanidad se encamina lentamente hacia la reformulación global de la moral de la intersubjetividad, y a replantear desde sus cimientos el contrato social que concierne a la comunicación social mediática.

  7. Beneficios del descanso peritoneal

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    Jesús Lucas Martín Espejo

    Full Text Available Introducción: Valorar si el descanso peritoneal, de al menos un día semanal, ha supuesto mejoras en la rehabilitación de los pacientes y el impacto clínico que puede suponer. Nos planteamos además cuantificar el beneficio económico. Material y Método: Se realizó un estudio longitudinal, retrospectivo, descriptivo. De los pacientes atendidos en nuestra unidad desde el 1 de enero de 2014 al 31 de diciembre de 2014, se estudiaron los pacientes que cumplieran todo el año de seguimiento y que no procedieran de otras técnicas de depuración como la hemodiálisis o trasplante renal. La muestra de estudio estuvo compuesta por 40 pacientes, de los que 21 tuvieron prescrito al menos 1 día semanal de descanso peritoneal y 19 pacientes sin descanso. Se recogieron las siguientes variables al inicio del periodo de estudio y a los 12 meses: Variables demográficas, variables relacionadas con el estado de volumen, datos clínicos relacionados con la técnica, se pasó una encuesta de satisfacción a todos los pacientes estudiados, y se recogieron los importes del coste mensual de cada tipo de tratamiento. Resultados: Las diferencias iniciales entre los grupos, eran esperables ya que son los valores en los cuales se ha basado la prescripción del día de descanso. La exposición a la glucosa, al comienzo y al final fue menor en el grupo con descanso. Al año, no se encontró diferencias en los parámetros estudiados. Una encuesta de satisfacción nos reveló a que dedican los pacientes el día de descanso y los que no lo tienen a que lo dedicarían. Conclusiones: El descanso peritoneal no ha supuesto una peor evolución de los parámetros clínicos estudiados al año de seguimiento, cumpliendo las recomendaciones de adecuación de diálisis de las guías clínicas. La exposición a la glucosa, aun sin llegar a ser significativa por la duración del estudio, ha sido menor en el grupo con descanso. El día de descanso ha facilitado a los pacientes

  8. Carta del editor

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    Oscar Mauricio Covarrubias-Moreno

    2014-05-01

    Full Text Available Henos aquí con un nuevo número de RIESED. Después de casi un año de ver la luz, y como lo anticipábamos en la carta del editor que acompañaba al número fundacional, hacer una revista electrónica no ha sido una tarea sencilla. Un año más tarde no podemos sino confirmar esa opinión.Gracias al decidido trabajo de los autores, revisores y miembros del equipo editorial hemos podido hacerlo. El proceso de revisión de los artículos ha merecido un cuidado, dedicación y tiempo especiales, que hicieron necesario demorar unos días la fecha de publicación de este tercer número. Asumimos un compromiso con la calidad y estamos convencidos que esa es la única posibilidad de éxito para una revista científica. El contenido y nivel de los artículos disponibles servirá sin duda como incentivo para que los investigadores deseen publicar sus aportes en RIESED.Agradezco especialmente a la Dra. Gloria Rosique Cedillo, Editora Invitada y Coordinadora de este tercer número, así como al investigador César Nicandro Cruz-Rubio, Editor Asociado, apreciados colegas con quienes he tenido el privilegio de trabajar a lo largo de estos meses, y cuya dedicación y esmero han hecho posible RIESED 3.Por otra parte, derivado de nuestro proyecto editorial informo a ustedes de la creación de la Cátedra RIESED. Educación y Sociedad. Esta Cátedra es una iniciativa que la Universidad del Desarrollo Empresarial y Pedagógico ha impulsado en estrecha colaboración con el Grupo de Investigación en Gobierno Administración y Políticas Públicas (GIGAPP del Instituto Universitario de Investigación Ortega y Gasset (IUIOG, Fundación Ortega – Marañón; así como, con la Academia Internacional de Ciencias Político Administrativas y Estudios de Futuro A.C.La Cátedra está concebida como un espacio de diálogo y reflexión interdisciplinario sobre las diferentes temáticas abordadas en RIESED. En el marco de esta iniciativa académica, se invita a los miembros

  9. Memoria del mal

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    Semprún, Jorge

    2011-06-01

    Full Text Available In May 2003 the twelfth edition of the «Aranguren Conferences» was held. Jorge Semprún gave three keynote speeches titled «Kant and the Maquis’ rucksack», «The radical evil and the Buchenwald latrines» and «Literature and memory of the evil: from Sartre to Paul Ricoeur», all of them grouped under the generic denomination Memory of Evil. The thread running through the three speeches was Semprún’s experience as a political deportee at Buchenwald concentration camp, so close to the Weimar camp of Schiller and Goethe. There, he could experience the radical evil, but also the brotherhood through the antifascist resistance groups who coordinated the various clandestine political groups at the camp. This experience helped him review some of the philosophical readings he had done as a philosphy student at the Sorbonne, as well as those readings he took an interest in following the end of the war. In this way, Semprún went over various authors (Immanuel Kant, André Malraux, Edmund Husserl, Jacques Maritain, Martin Heidegger, Karl Marx, Hannah Arendt, Jean Paul Sartre, Paul Ricoeur or Primo Levi arguing their relationship with the issue of Evil.

    En mayo de 2003 se celebró la duodécima edición de las «Conferencias Aranguren». Jorge Semprún dictó tres conferencias magistrales tituladas «Kant y la mochila del maquis», «El mal radical y las letrinas de Buchenwald» y «Literatura y memoria del mal: de Sartre a Paul Ricoeur», agrupadas todas ellas bajo el título genérico de Memoria del mal. El hilo conductor de las tres intervenciones fue la experiencia de Semprún como deportado político en el campo de concentración de Buchenwald, tan cercano al Weimar de Schiller y Goethe. Allí pudo experimentar el mal radical, pero también la fraternidad, a través de los grupos de resistencia antifascista que coordinaban en el campo los distintos grupos políticos clandestinos. Esta experiencia le sirvió para repasar las lecturas

  10. [Feminismos del siglo XXI

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    M. Xosé Agra

    2013-07-01

    Full Text Available ¿Qué soluciones políticas podemos encontrar para las nuevas formas de subjetividad? ¿Cómo debe la teoría feminista interpretar la voluntad de romper los límites y, al mismo tiempo, la necesidad de normalidad? Los pensadores posmodernos son escépticos respecto de las nociones tradicionales de identidad; los límites que definen al sujeto no sólo construyen sino que también excluyen. Debemos oponernos a las interpretaciones dominantes de normalidad y aceptar otras posibles alternativas a los modelos tradicionales. Necesitamos ir más allá del binario sistema sexo/género y de la orientación sexual y mantener una mentalidad abierta, persiguiendo una filosofía de la libertad.

  11. La materialidad del sonido

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    Esteban Manuel Stepanian Taracido

    2012-04-01

    Full Text Available La investigación sobre los procesos de producción sonora en la crea-ción de obras audiovisuales afectan, en términos generales, a cuestio-nes exclusivamente tecnológicas. Para valorar su rendimiento expresi-vo en la construcción del discurso es imprescindible que, de forma paralela, esta investigación se aborde también desde la perspectiva de la realización audiovisual.Para ello es necesario asumir que los conceptos básicos en los que se fundamenta el desarrollo tecnológico no han de ser necesariamente esenciales en los estudios que se plantean desde puntos de vista creati-vos.En particular es oportuno someter a examen el concepto de fidelidad y reivindicar las posibilidades emotivas, e incluso significantes, de formatos de producción sonora hoy en desuso.

  12. La democracia del futuro

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    Rodrigo Borja

    2015-01-01

    Full Text Available El desarrollo logrado por la informática, la microelectrónica y en general las nuevas tecnologías de la información, hace que del zoon politikon aristotélico se pase al homo digitalis posmoderno, de una "democracia restringida" a una telecracia: en el siglo XXI. El autor vaticina que el voto se hará vía computadores desde casa a través de éstos, los gobernantes podrán tener una relación directa con los gobernados, las consultas populares serán más frecuentes, las implicaciones para los regímenes democráticos serán enormes y es en torno a ellas que reflexiona el autor

  13. Valor social del anciano

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    Luna Torres Bertha

    1997-11-01

    Full Text Available

    The old age is been surrounded bymisteries, myths and prejuidices. The concepts and the valoration of the ancient man, have been contradictory. In different places and in many cultural moments, the old man has been taken from the glory to the scorn. The actual world scrolls the ancient in a very fast rhythm; the social changes have generayed conditions of disadvantajes for that group of the population, difficulting even more the process of growing old, that in fact has a lot of limitations. Its important that a lot of professionals from many institutions involved with this important cause, join the work developed by geriatrics and gerontologics;  soin this way we can restore the social values of the ancient, who deserves a peacefull old age in compensation with his participation in the job of building a better society. Only in this way, the fear to grow old will be lost.

    La vejez se ha visto rodeada de tabúes, mitos y prejuicios. Han sido contradictorios los conceptos y la valoración del anciano, quien en lugares y momentos culturales ha estado desde ensalzado hasta despreciado. El mundo actual, desplaza al geronte a ritmo acelerado; los cambios sociales han generado condiciones de marginalidad para ese sector de población, dificultando aun más el proceso de envejecer, que de hecho tiene limitaciones. Es por eso importante que al trabajo que desarrollan geriatras y gerontólogos se sumen otros profesionales y un sinnúmero de entidades; en aras de eliminar prejuicios y rescatar el valor social del anciano, quien por su legado merece un ocaso, que compense su aporte y participación en la construcción de la sociedad, solo así se perderá el miedo a envejecer.

     

  14. Para aprender del pasado

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    Esquivel Valverde, Lidier

    2004-05-01

    Full Text Available Este texto reflexiona sobre la importancia de reconocer el valor que tiene el conocimiento de los eventos del pasado, como fuentes importantes de lecciones aprendidas. Inicia presentando ejemplos de sucesos históricos en Japón y cómo estos han sido utilizados de forma positiva en los procesos de educación en niños y adultos. Posteriormente presenta la realidad de Costa Rica, donde a nivel de la población existe un desconocimiento de hechos históricos sobre el tema, al propiciarse su olvido u ocultamiento. Finalmente, los autores exponen sobre un programa del Área de Prevención de la Comisión Nacional de Prevención de Riesgos y Atención de Emergencias, quienes se han dedicado de distribuir reseñas históricas breves de los principales eventos en el país This text reflects about the importance of recognizing the value of knowing past events as important sources for lessons learned. It starts including examples of historical events in Japan and how they have been used positively in the educational processes for children and adults. Lately, it includes the reality in Costa Rica. The population does not know about historical events on the topic because they have been forgotten or not shared. Finally, the authors refer to a program of the Prevention Area of the National Commission of Risk Prevention and Emergency Response that has dedicated to distribute brief historical reviews about the main events in the country

  15. Discurso del Presidente Entrante

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    Gilberto Rueda Pérez

    1994-09-01

    Full Text Available

    Santafé de Bogotá, D.C., 17 de mayo de 1994

    Señoras y señores:

    Estoy profundamente conmovido y emocionado, al escuchar los elogiosos comentarios de quienes me precedieron en el uso de la palabra, pues, aunque inmerecidos, naturalmente me enorgullecen sobremanera.

    Quiero, antes de iniciar mi discurso, agradecer a la noble Academia de la Lengua, a su presidente doctor Jaime Posada y a los miembros de su Junta Directiva, la generosa hospitalidad en este precioso auditorio que contribuye a dar realce a esta sesión solemne.

    Muchas Gracias.

    Deseo manifestar, que los conceptos que vaya emitir, reflejan mi pensamiento y por tanto, de ellos soy responsable. No pretendo con ellos criticar, ni mucho menos ofender, a personas o instituciones, son más que todo reflexiones, que me llevan a propuestas de trabajo para el futuro y espero que así sean percibidas y analizadas por esta distinguida audiencia.

    El día 3 de enero de 1873, el joven médico Abraham Aparicio, reunió en su residencia, en las primeras horas de la fría noche santafereña, a sus colegas Manuel Plata Azuero, Nicolás Osario, Liborio Zerda, Leoncio Barreta y Evaristo García, con el propósito de crear una sociedad científica, para el estudio y adelanto de las ciencias médicas y naturales, así como para solidarizar al cuerpo médico y darle unidad al ejercicio profesional en el país. Así nació la Sociedad de Medicina y Ciencias Naturales que posteriormente sería elevada a la categoría de Academia Nacional de Medicina, por la Ley 71 de 22 de noviembre de 1890.

    Sin embargo, bien vale la pena rememorar los orígenes aún más remotos, de esta insigne institución.

    El 29 de diciembre de 1816, el Dr. Pablo Fernández de la Reguera, médico cirujano, químico y boticario mayor del ejército expedicionario, inspector de los hospitales, en comunicación dirigida al Sr. Brigadier Don Juan Sámano, Gobernador militar y político de la

  16. Carta del Editor

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    Blasco Fernando Checa Montúfar

    2015-01-01

    Full Text Available En "El laberinto de la ciberred" se habla de los beneficios y problemas que caracteriza el caos existente en la telaraña cibernética. Ahora el cibernauta puede acceder a una inimaginable oferta de información multimedia. Este caos garantiza libertades, pero presenta enormes limitaciones para quienes no tienen acceso a la tecnología, particularmente en países de América Latina, carentes de Políticas de Comunicación que generen condiciones para un uso intensivo, extensivo y democrático de la ciberred. En el tema “La televisión por cable" relacionado con la cultura visual, multimediática, satelital, informática, televisionada, se señala que tiene como soporte a la más antigua nueva tecnología, la televisión por cable. Se trata de uno de los más grandes negocios disputados por los magnates nacionales y transnacionales de la comunicación que atraparon para el año 2000 a más de 20 millones de suscriptores de la televisión pagada. En esta entrega se presentan distintos acercamientos del perfil del ombudsman de prensa, las ventajas y límites de esta institución, su necesaria independencia, trasfondo ético, autonomía y otros aspectos que contribuirán a fortalecer mecanismos adecuados para controlar este "peligroso poder”

  17. Carta del editor

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    Simón Espinosa

    2015-01-01

    Full Text Available La autora relata la historia de las Relaciones Públicas y dice que surgieron y se desarrollaron para legitimar ante el público los intereses económicos y políticos de quienes detentan el poder. Se cuestiona sobre el por qué no aplicar las relaciones públicas, en organizaciones populares, para que mejoren su publicación y orienten sus propósitos de desarrollo. El tema que aborda las Políticas culturales en América Latina acopia un extracto de lo más trascendente de los ensayos del libro editado por Néstor García Canclini. Sobre la telenovela se afirma que esta ha llegado a ser uno de los instrumentos más importantes de la comunicación popular: por ella desfilan las identidades de las más variadas culturas brasileñas. Y en cuanto a la caricatura se relata lo que ocurrió en el Seminario taller " Caricatura y Periodismo", realizado el(9-11 de Nov.- 1987 en el CIESPAL. El estudio sobre el mercado del vídeo se ve dificultado por la imprecisión de los datos obtenidos. Los datos oficiales no siempre se aproximan a la realidad, pues el mercado de vídeo se instauró en América Latina partiendo de una lógica totalmente diversa de los equipos de sonido e imagen.

  18. Los objetivos del desarrollo

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    Currie Lauchlin

    1993-12-01

    Full Text Available To broach the goals of development implies broaching the problem of economic growth in a critical manner. Not only the concept of growth but also the means of achieving it in practice should be questioned. Growth is not an end, it is a means of gaining access to development And development should not be understood as a goal, but as a permanent process of learning tending towards more control over the environment and greater levels of well-being. It is not a matter of increasing GNP linearly; development must occur, sustained growth that, without being a threat to mm or to our natural resources, can lead to the eradication of absolute and relati.ve poverty. The low rates of growth of the developing countries constitute structural problem that can /lot be reso1.ved by resorting to the neo-classical mechanisms of mobility, nor to the Keynesian formulas. These have served as a source of inspiration to the Harrod-lX:m3r·type models of growth which limit themselves to stimulating savings and ending unemployment by concentrating exclusively on the monetary demand. Getting OUt of the vicious circle of low growth implies eradicating poverty with respect into the immediateness of a direct attack on the problem. with respect to the developed counties, growth is starting to became harmful, and, given the prevalence of ostensible consumption and of pecuniary emulation, it is imperative to foment non-economic motivation that will permit the eradication of relative poverty.

    Abordar los objetivos del desarrollo implica abordar de manera crítica el problema del crecimiento econ

  19. Deslumbramientos del mercado

    Directory of Open Access Journals (Sweden)

    Monique Selim

    2006-07-01

    Full Text Available Con eje en los diferentes aspectos que adopta el actual proceso de mundialización de la lógica del mercado y expansión capitalista, aún en países socialistas, el presente artículo plantea la necesidad de una reflexión antropológica susceptible de articular el surgimiento de nuevas formas de dominación y representación simbólicas. Se discute el aparente efecto de unificación intelectual producido por la hegemonía del mercado respecto de hechos sociales heterogéneos dados en la historia reciente de las sociedades contemporáneas. Así, la renovada atracción que ejercen los nuevos escenarios sociales reconfigurados en virtud de las modalidades específicas de encarnación y operación de los procesos globalizantes, llama al estudio antropológico de las coyunturas. La autora despliega una interpretación del socialismo de mercado, conjunción -siempre en tensión- de un monopolio político estatal y una liberalización del mercado económico. En esta perspectiva se reubica el interés de una antropología del presente en relevar localmente, en este caso en Vietnam del Norte, la conformación de un nuevo mercado de demandas simbólicas, donde la reaparición de las prácticas culturales de comunicación con los antepasados expresa la necesidad de reunificación familiar y reconciliación con los muertos en la "larga guerra".Tendo como eixo os aspectos diferentes que adota o processo atual de mundialização da lógica do mercado e de expansão capitalista, até mesmo nos países socialistas, este artigo propoe a necessidade de uma reflexão antropológica capaz de articular o aparecimento de novas formas de dominação e de representação simbólica. Discute-se o efeito de superfície de unificação intelectual causado pela hegemonia do mercado em fatos sociais diversos em sociedades contemporâneas. Assim, a atração renovada de novos fatos sociais pelos modos específicos de incorporação e operação de processos de globaliza

  20. La legitimidad del derecho penal

    Directory of Open Access Journals (Sweden)

    Francisco Bernate-Ochoa

    2010-03-01

    Full Text Available El interrogante sobre la legitimidad del derecho penal se ha convertido en un asunto medular dentro de los estudios contemporáneos sobre la materia, dado que hoy en día se reconoce que a partir de la solución a este interrogante teórico se puede asumir la tarea de construir un sistema. El panorama contemporáneo nos ofrece dos soluciones al respecto: por una parte, se sostiene que la legitimación del derecho penal emana de la Constitución, y se prescinde de una construcción sistémica del delito en aras de la obtención de consecuencias acordes con lo planteado en la Carta Política. Por otra, desde una propuesta -de corte normativista- se entiende que la legitimación del derecho penal debe encontrarse en la sociedad, y a partir del entendimiento de ésta se encuentra la necesidad de aquél, lo cual ejerce una influencia en la construcción del sistema del delito.

  1. Comparison of dexmedetomidine versus midazolam for intranasal ...

    African Journals Online (AJOL)

    route; however, it is not as painful as the intramuscular route, and it is absorbed directly ... respiratory tract infection, any central nervous system disorder, refusal for intranasal administration or history of allergic reaction to dexmedetomidine ... and the calculated dose of drug diluted to a total volume of 1 ml was administered ...

  2. Del internacionalismo al nacionalismo: rumbos del conflicto armado en Colombia

    Directory of Open Access Journals (Sweden)

    Mónica Zuleta P.

    2003-10-01

    Full Text Available Este ensayo tiene por propósito sugerir una interpretación del desarrollo del conflicto armado colombiano durante la última década del siglo XX mediante el uso de la concepción de poder de Michel Foucault. Ello con miras a presentar alternativas analíticas frente a la relación entre lo global y lo local donde se consideren algunas de las hipótesis contemporáneas sobre la cuestión del nacionalismo. El ensayo utiliza el término nacionalismo como sustantivo (lo que es en lugar de como adjetivo (lo que debe ser y ordena los conjuntos de acciones que, en torno al proyecto de lo nacional, han sido puestos en práctica por las guerrillas en Colombia.

  3. Gestión del riesgo del cambio (primera parte

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    Juan Pablo Zorrilla

    2007-07-01

    Full Text Available A partir de la desaparición del sistema Bretton-Woods, y la libre flotación del tipo de cambio, el mundo se volvió más susceptible a todo tipo de riesgos. El presente artículo pretende explicar a los gestores financieros o empresarios interesados en el tema de instrumentos financieros derivados, a conocer lo más relevante y necesario acerca del uso de futuros sobre el tipo de cambio, instrumento útil para cubrir riesgos derivados del tipo de cambio para las empresas que se dedican a importar, exportar o para protegerse de un crédito otorgado en moneda extranjera.

  4. Calidad del software: camino hacia una verdadera industria del software

    Directory of Open Access Journals (Sweden)

    Saulo Ernesto Rojas Salamanca

    1999-07-01

    Full Text Available El software es quizá uno de los productos de la ingeniería que más ha evolucionado en muy poco tiempo, pasando desde el software empírico o artesanal hasta llegar al software desarrollado bajo los principios y herramientas de la ingeniería del software. Sin embargo, dentro de estos cambios, las personas encargadas de la elaboración del software se han enfrentado a problemas muy comunes: unos debido a la exigencia cada vez mayor en la capacidad de resultados del software, debido al permanente cambio de condiciones lo que aumenta su complejidad y obsolescencia; y otros, debido a la carencia de herramientas adecuadas y estándares de tipo organizacional encaminados al mejoramiento de los procesos en el desarrollo del software. Hacia la búsqueda de mecanismos de solución de estos últimos problemas se orienta este artículo...

  5. Perspectivas del derecho procesal constitucional

    OpenAIRE

    Hernández-Villarreal, Gabriel-Angel

    2007-01-01

    Este texto recoge las ponencias que participaron en el Foro Internacional de Derecho Procesal Constitucional, que con gran éxito se realizó en el mes de junio de 2005, en las aulas de la Universidad Colegio Mayor de Nuestra Señora del Rosario de Bogotá; razón por la cual contiene el fruto maduro de las investigaciones realizadas por algunos de los más notables exponentes del derecho procesal constitucional en América del Sur. El lector de esta obra se encontrará con riguroso trabajo sobre alg...

  6. Contabilidad del impuesto sobre beneficios

    OpenAIRE

    Luceño Martínez, Haizea

    2017-01-01

    Este Trabajo Fin de Grado pretende dar una explicación al tratamiento contable del Impuesto de Sociedades. Siendo un impuesto que hay que contabilizar, pero que se calcula siguiendo criterios fiscales, lleva a tener que realizar ajustes que tendrán su repercusión contable. El punto de partida no es otra que la norma de registro y valoración 13ª del PGC, que versa sobre cómo hay que proceder a contabilizar el Gasto por Impuesto de Sociedades, que se compone tanto del Gasto por Impuesto Co...

  7. Entrenamiento funcional del core: eje del entrenamiento inteligente

    Directory of Open Access Journals (Sweden)

    Iván Dario Pinzón Ríos

    2015-06-01

    Full Text Available Antecedentes: La evolución del entrenamiento físico busca la optimización de la salud y el bienestar, como piedra angular de todo programa de ejercicio. El Entrenamiento Funcional (EF es recomendable para optimizar el control postural del core, mejorando el balance y la ejecución de actividades de la vida diaria.  Objetivo: Revisar la definición, elementos constitutivos, características e implicaciones del EF del core en el movimiento corporal humano (MCH y la salud desde la perspectiva del fisioterapeuta. Metodología: Se incluyeron artículos en inglés y español de las bases Pubmed, Scielo y Ebsco; adicionalmente se incluyeron fuentes electrónicas e impresas y libros. Resultados: 56 documentos cumplieron los criterios de inclusión. La definición más adoptada de EF fue entrenar con un propósito buscando obtener un efecto positivo en la aptitud física. Las implicaciones del EF en el MCH, se relacionan con la ganancia y mejoría de la estabilidad. La propuesta de EF enfocada a las actividades de la vida diaria incluye fases que permiten adquirir la estabilidad hasta lograr el desarrollo de movimiento que demanden más agilidad. En la planificación del EF se deben estructurar los procesos a ejecutar considerando el criterio de funcionalidad. Para organizar la sesión del EF, el fisioterapeuta cuenta con tres maneras de planificar la sesión: globales, por hemisferios y por grupos musculares. Conclusión: La fundamentación teórica sobre el EF permite al fisioterapeuta comprender y determinar cómo esta modalidad de intervención repercute de manera positiva sobre el desempeño funcional y calidad de vida de los sujetos.

  8. Aspectos Hardware y Software del microprocesador 68000

    OpenAIRE

    Alcaraz Martínez, Raúl

    2009-01-01

    INTRODUCCIÓN AL 68000.ORGANIZACIÓN INTERNA DEL 68000. PROGRAMACIÓN DEL 68000 EN LENGUAJE ENSAMBLADOR. ORGANIZACIÓN EXTERNA DEL 68000. EXCEPCIONES. PROGRAMACIÓN DE LA VÍA 6522. PROGRAMACIÓN DE LA DUART 68681 PARA COMUNICACIÓN SERIE. EVOLUCIÓN DEL 68000

  9. La finalidad del proceso

    Directory of Open Access Journals (Sweden)

    Iván Alfonso Cordero Gutiérrez

    2011-07-01

    Full Text Available Resumen:El tipo de Estado que Colombia asumió desde 1991 (Estado Social de Derecho, implica que el cumplimiento de los fines estatales se comparten con la población, generando de esta forma grados de responsabilidad respecto a las cargas asumidas por ellos y el Estado para la materialización de los objetivos planteados. La satisfacción de las necesidades básicas de la población como unode los fines esenciales del Estado Social de Derecho, no escapa a este esquema, lo que determina la colaboración armónica no sólo entre las entidades y organismos del Estado sino de este, complementado con la población. Una de las necesidades básicas de la población, se refiere a la posibilidad de resolver sus conflictos haciendo uso de los mecanismos que para tal efecto tiene a su disposición, utilizando las formas de Auto tutela, Autocomposición, híbridas y de Heterocomposiciòn, que el Estado autoriza,de acuerdo a los lineamientos propios de cada mecanismo, respecto a las materias que componen los derechos sustanciales que se debaten en la relación conflictiva. Dentro de estos mecanismos de solución de conflictos, la heterocomposiciòn presenta uno llamado el proceso jurisdiccional, en donde un tercero investido de poderes específicos ejerce la jurisdicción y toma la decisión respecto al conflicto, después del agotamiento de etapas sucesivas y preclusivas que garantizan la efectiva participación, ejercicio y defensa de los derechos fundamentales y sustanciales de las partes, generando una mayor garantía de legalidad respecto a la decisión generada por ese tercero investido de plena Jurisdicción (el Juez. Por ser el proceso jurisdiccional el mecanismo más idóneo por su garantismo reglado y tecnificado, debe ser protegido, fortalecido y preferente respecto a los denominados equivalentesjurisdiccionales pues con estos el Estado pretende desplazar la competencia al momento de la resolución de los conflictos, generando un

  10. Hacia una conceptualización del legado del traductor

    Directory of Open Access Journals (Sweden)

    Guzmán María Constanza

    2009-06-01

    Full Text Available Este artículo se propone investigar el aporte de perspectivas traductológicas para el estudio de la figura del traductor y su legado. Se centra en enfoques teóricos contemporáneos, principalmente aquellos basados en perspectivas postestructuralistas, que consideran el papel del sujeto traductor como un aspecto crucial en la traducción y los estudios literarios, y proponen maneras interesantes de abordarlo. A lo largo del artículo se cuestionan nociones como la idea de un original sacralizado, la relación entre autoría y propiedad, el ideal del significado transparente, y la tensión entre la traducción y la escritura del "original". Se presta especial atención a la importancia de ubicar históricamente la práctica del traductor, reconocer su papel como agente visible, y conceptualizar la traducción como una forma de escritura que se desarrolla en medio de complejas interacciones y negociaciones.

  11. HACIA UNA CONCEPTUALIZACIÓN DEL LEGADO DEL TRADUCTOR

    Directory of Open Access Journals (Sweden)

    María Constanza Guzmán

    2009-01-01

    Full Text Available Este artículo se propone investigar el aporte de perspectivas traductológicas para el estudio de la figura del traductor y su legado. Se centra en enfoques teóricos contemporáneos, principalmente aquellos basados en perspectivas postestructuralistas, que consideran el papel del sujeto traductor como un aspecto crucial en la traducción y los estudios literarios, y proponen maneras interesantes de abordarlo. A lo largo del artículo se cuestionan nociones como la idea de un original sacralizado, la relación entre autoría y propiedad, el ideal del significado transparente, y la tensión entre la traducción y la escritura del "original". Se presta especial atención a la importancia de ubicar históricamente la práctica del traductor, reconocer su papel como agente visible, y conceptualizar la traducción como una forma de escritura que se desarrolla en medio de complejas interacciones y negociaciones.

  12. Ensayo del lisado de amebocitos del Limulus (LAL

    Directory of Open Access Journals (Sweden)

    Rolando Perdomo Morales

    2004-04-01

    Full Text Available En los últimos años, los principales organismos reguladores de productos farmacéuticos (Farmacopeas exigen cada vez más en sus monografías la aplicación del método del lisado de amebocitos de Limulus (LAL para la liberación de pirógenos en productos terminados parenterales. El análisis de pirógenos constituye uno de los principales ensayos en el control de calidad de la fabricación de inyectables por su repercusión en la salud humana, puesto que la presencia y administración de los mismos, es capaz de provocar una serie de respuestas fisiológicas, en su mayoría de carácter perjudicial y en casos extremos, la muerte del paciente. Por las razones anteriores, existe un creciente interés en el conocimiento y dominio de estos métodos. El presente trabajo muestra una revisión bibliográfica del método del LAL, se tratan aspectos como su descubrimiento y estandarización, aparición en la industria farmacéutica y razones para su triunfo, y los basamentos de los principales métodos o variaciones comerciales del LAL (gelificación, turbidimétricos y cromogénicos que se describen en las Farmacopeas.

  13. Ensayo del lisado de amebocitos del Limulus (LAL

    Directory of Open Access Journals (Sweden)

    Rolando Perdomo Morales

    Full Text Available En los últimos años, los principales organismos reguladores de productos farmacéuticos (Farmacopeas exigen cada vez más en sus monografías la aplicación del método del lisado de amebocitos de Limulus (LAL para la liberación de pirógenos en productos terminados parenterales. El análisis de pirógenos constituye uno de los principales ensayos en el control de calidad de la fabricación de inyectables por su repercusión en la salud humana, puesto que la presencia y administración de los mismos, es capaz de provocar una serie de respuestas fisiológicas, en su mayoría de carácter perjudicial y en casos extremos, la muerte del paciente. Por las razones anteriores, existe un creciente interés en el conocimiento y dominio de estos métodos. El presente trabajo muestra una revisión bibliográfica del método del LAL, se tratan aspectos como su descubrimiento y estandarización, aparición en la industria farmacéutica y razones para su triunfo, y los basamentos de los principales métodos o variaciones comerciales del LAL (gelificación, turbidimétricos y cromogénicos que se describen en las Farmacopeas.

  14. HACIA UNA CONCEPTUALIZACIÓN DEL LEGADO DEL TRADUCTOR

    Directory of Open Access Journals (Sweden)

    María Constanza Guzmán

    2009-06-01

    Full Text Available Este artículo se propone investigar el aporte de perspectivas traductológicas para el estudio de la figura del traductor y su legado. Se centra en enfoques teóricos contemporáneos, principalmente aquellos basados en perspectivas postestructuralistas, que consideran el papel del sujeto traductor como un aspecto crucial en la traducción y los estudios literarios, y proponen maneras interesantes de abordarlo. A lo largo del artículo se cuestionan nociones como la idea de un original sacralizado, la relación entre autoría y propiedad, el ideal del significado transparente, y la tensión entre la traducción y la escritura del "original". Se presta especial atención a la importancia de ubicar históricamente la práctica del traductor, reconocer su papel como agente visible, y conceptualizar la traducción como una forma de escritura que se desarrolla en medio de complejas interacciones y negociaciones.

  15. Instalaciones del edificio de Costillares

    Directory of Open Access Journals (Sweden)

    Laorden, José

    1999-08-01

    Full Text Available Not available

    Se describen las instalaciones de calefacción y refrigeración, fontanería, gas, central eléctrica, iluminación, teléfonos y aislamiento térmico del edificio construido en Chamartín de la Rosa para sede del instituto Técnico de la Construcción y del Cemento, dando las consideraciones generales que sirvieron para proyectarlas y analizando después para cada una de ellas las bases del proyecto, su ejecución y, finalmente, los primeros resultados de su funcionamiento. De especial interés creemos los comentarios que hacemos sobre algunos errores de proyecto o de ejecución, con lo cual quizá se puedan evitar en otros trabajos.

  16. Virus del Ébola

    Directory of Open Access Journals (Sweden)

    Miguel Lugones Botell

    Full Text Available En la actualidad, el panorama epidemiológico internacional se presenta con enfermedades infecciosas graves como el Ébola. Recientemente han ocurrido brotes en tres países del África Occidental, por lo que la Organización Mundial de la Salud ha insistido acerca del peligro que existe sobre la expansión y gravedad de esta epidemia. Se realizó una revisión bibliográfica del tema con el objetivo de actualizar al médico sobre aspectos esenciales de la fiebre hemorrágica o enfermedad del Ébola. Los índices de letalidad se encuentran entre el 50 y 90 %, por lo que la Organización Mundial de la Salud hace énfasis en la importancia de la prevención mediante la higiene, lo que constituye un aspecto clave.

  17. TEA, Trastorno del Espectro Autista :

    OpenAIRE

    Vegas Martín, Irene

    2015-01-01

    La autora expone los aspectos fundamentales sobre el concepto del TEA para posteriormente mostrarnos un caso práctico y su tratamiento durante unos meses con la finalidad que sea un trabajo de consulta práctico

  18. Comportamiento del riesgo preconcepcional

    Directory of Open Access Journals (Sweden)

    Jesús L Regueira Naranjo

    1998-04-01

    Full Text Available Se realiza un estudio analítico de casos y controles 1 x 1 sobre el comportamiento del riesgo preconcepcional en 35 consultorios, pertenecientes al Policlínico Comunitario Docente "Tula Aguilera", del Municipio Camagüey. El grupo estudio estuvo constituido por las mujeres con riesgo preconcepcional que concibieron un embarazo y fueron captadas en el período desde el 1ro. de enero al 30 de junio de 1994. El grupo control se constituyó con mujeres sin antecedentes de riesgo preconcepcional y que fueron captadas en igual período y la misma área de salud. Los resultados más notables fueron: como riesgo biológico la desnutrición materna III-IV con el 36,76 %, la anemia con el 48,52 %, la sepsis urinaria con el 25 % y la vaginal con 22,79 %. Se demostró la hipótesis de que los niños nacidos de madres con riesgo preconcepcional y obstétrico están expuestos a tener una mayor morbilidad y mortalidad perinatal que los recién nacidos de madres sin riesgo con un embarazo normalAn analytical 1-1 case-control study on the preconceptional risk behaviour in 35 physicians'offices from «Tula Aguilera» community teaching polyclinic located in Camagüey municipality was performed. The group was made up of women with preconceptional risk who got pregnant and were followed-up from January 1st to June 30th, 1994. The control group was formed by women without preconceptional risk history and who were followed-up in the same period of time and in the same health area. The most out-standing results as to biological risks were: maternal malnutrition III-IV, 36.76 %; anemia, 48.52 %; urinary tract infection; 25 % , and vaginal infection, 22.79 %. The hypotesis that infants born from mothers with preconceptional and obstetric risks are exposed to higher perinatal mortality and morbility risks than those from riskless mothers with a normal pregnancy was proved

  19. Caracterización del mercado laboral del sector hotelero del estado Mérida, Venezuela

    OpenAIRE

    Villasmil R., María A.; Andrade, Henry

    2009-01-01

    Esta investigación trata sobre modelos que permiten caracterizar Mercados Laborales Locales (MLL), ya que en Venezuela el manejo de los mismos es casi inexistente. En este sentido, se plantea como objetivo caracterizar al mercado laboral del sector hotelero del estado Mérida-Venezuela en función del conocimiento de las particularidades económicas, institucionales, políticas, sociales, educativas y culturales de la zona así como las condiciones que se tengan en materia de empleo, oferta de for...

  20. EFECTO DEL SILICIO Y PLAGUICIDAS EN LA FERTILIDAD DEL SUELO Y RENDIMIENTO DEL ARROZ

    OpenAIRE

    Parm\\u00E9nides Furcal-Beriguete; Alejandra Herrera-Barrantes

    2013-01-01

    El objetivo de este trabajo fue evaluar el efecto del silicio en la fertilidad del suelo, la incidencia de enfermedades y plagas insectiles, el rendimiento y la calidad de granos del cultivo de arroz. El estudio se realizó en La Vega, Florencia, San Carlos, Costa Rica entre mayo y octubre en los años 2010 y 2011, en el mismo lote con la variedad CR 4477. Se establecieron cinco tratamientos: silicio al suelo, silicio al suelo más plaguicidas (alternativas químicas), silicio foliar, silicio fol...

  1. Conservacion de truchas del Pacifico

    Science.gov (United States)

    Brooke E. Penaluna

    2016-01-01

    La historia de las truchas del Pacífico, pertenecientes al género Oncorhynchus, es una historia muy interesante que se basa en la persistencia y diversificación de sus especies debido, en gran parte, al dinamismo propio que existe en su medio ambiente. Desde el oeste de Norteamérica, extendiéndose hasta el este de Asia, las truchas del Pacífico han experimentado la...

  2. Carta del editor

    Directory of Open Access Journals (Sweden)

    Juan Braun

    2015-01-01

    Full Text Available Son temas de interés de esta entrega Mujeres, comunicación y desarrollo, en el que se arenga a todas a no solo luchar por el género sino por una sociedad más libre y más justa, de la mano de los hombres. Abre un amplio espectro para exponer la situación de la mujer; Mujer e Iglesia,Prensa, Mujer y revolución, Mujeres comunicadoras, mujer líder comunitaria, etc. Periodismo deportivo, que nunca se incluyó en la revista, hoy gracias a la tecnología, la televisión y la publicidad es el género de mayor crecimiento en el mundo. El tema abarca: Génesis del deporte, Fútbol México - 86. Maradona, Deporte y negocio, Análisis de una Olimpiada, Prensa Olimpiadas y política, Juegos Panamericanos, Escuelas de Periodismo deportivo, Cadenas deportivas en televisión. Se incluye entrevistas a cuatro Mujeres Comunicadoras.

  3. Los Anhelos Del Agro

    Directory of Open Access Journals (Sweden)

    Chaparro G. A.

    1942-08-01

    Full Text Available Hablemos hoy del campesino y de su desventura, y hagámoslo, perfectamente libres de toda insana y falaz intención demagógica. Démosle el frente con resolución a esa obscura costumbre de halagar las pasiones de las gentes y explotar con fines proclives las profundas esperanzas y los honrados anhelos de los campesinos, y digamos que en Colombia, y en muchos países de América, se ha abusado impunemente de esa masa resignada que sustenta las economías de estos países, y se ha desconocido el meollo verdadero de sus problemas fundamentales, sin que las fórmulas prácticas de resolvemos íntegramente hayan aparecido, limitándose la acción a meras iniciativas aisladas e inconexas a veces contradictorias, cuyos resultados quedan perdidos en medio de la magnitud total de las situaciones.

  4. A Favor del Plagio

    Directory of Open Access Journals (Sweden)

    Manuel Arranz

    2007-11-01

    Full Text Available Yo no tengo nada contra el plagio. Ustedes, como lectores, seguramente tampoco. Bueno, tal vez prejuicios. Es lógico que los tengan con tanto artículo condenándolo. Hasta ahora, que yo sepa, nadie ha escrito para defenderlo. Los que sí tienen algo, parece ser, son los autores. Una minoría al fin y al cabo. Ya sé que hay que respetar el derecho de las minorías, pero el asunto del plagio, como tantos otros, deberíamos examinarlo con más detalle, y preguntarnos, por ejemplo, ¿por qué se molestan tanto los autores cuando les plagian? ¿En nombre de qué?, sería también una buena pregunta. No me irán a decir a estas alturas que en nombre de la comunidad científica. A fin de cuentas el plagio beneficia la difusión de la ciencia. Los autores se molestan en nombre propio. Naturalmente tienen su derecho, no se lo vamos a discutir, pero, ¿no demuestra eso cierto narcisismo impropio de un científico? ¿La ciencia no es de todos?, como suelen decir en otras ocasiones.

  5. La liberazione del tempo

    CERN Document Server

    Selleri, Franco

    2003-01-01

    Negli ultimi dieci anni ho lavorato alla descrizione dei fenomeni naturali da parte di osservatori in movimento. E' un problema che molti credono risolto una volta per tutte dalle trasformazioni di Lorentz della teoria della relatività speciale (TRS nel seguito), ma che in realtà era rimasto aperto per una serie di ragioni che esporrò. Sento di dover dire che ho trovato risultati molto importanti, anche se il giudizio finale sul loro valore non può certo essere il mio. Infatti la conclusione di questa ricerca è duplice: una spiegazione dei dati empirici migliore di quella relativistica, e l'eliminazione di quegli aspetti della TRS che fanno a pugni con il buon senso; il tutto grazie alla liberazione del tempo dall'asservimento alle coordinate spaziali cui era stato costretto nello spazio a quattro dimensioni di Minkowski. La faccenda è raccontata con dovizia di particolari in un libro recente [FS]. Nel presente articolo espongo gli aspetti salienti della ricerca lasciando da parte quelli matematici.

  6. del establecimiento permanente

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    V. Ma. Antonieta Martin Granados

    2002-01-01

    Full Text Available A pesar de que en México se han realizado adiciones a la legislación en materia civil y mercantil relacionadas con el uso de medios electrónicos como instrumentos para realizar actos jurídicos, éstas resultan insuficientes, pues nada se ha hecho en materia procesal, penal y laboral, entre otras. En este trabajo se presentan, en materia fiscal, algunas consideraciones acerca del concepto de establecimiento permanente tanto en la legislación mexicana como en el Convenio Modelo (CM de la Organización para la Cooperación y Desarrollo Económico (OCDE y se argumenta que a pesar de que la definición de la legislación mexicana es mucho más amplia que la que se encuentra en el mencionado convenio, el comercio electrónico presenta algunos retos para determinar el lugar en donde residen las partes involucradas, el lugar en donde se celebran las operaciones y se pagan o cobran, sobre todo tratándose de servicios o adquisición de bienes intangibles. Por último, se señala que en materia fiscal es necesario que las autoridades mexicanas permitan el uso de la factura electrónica

  7. del siglo XX

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    Alejandro González Morales

    2006-01-01

    Full Text Available En este trabajo analizamos las diferentes etapas por las que ha pasado el desarrollo turístico de la isla de Lanzarote. Se distinguen tres periodos de características diferenciadas. El primero, antes de los años setenta, supone el desarrollo de una incipiente industria turística, donde predominan el capital belga y francés; el segundo es un periodo que abarca desde 1973 hasta 1983, en estos 10 años la isla experimenta un cambio sustancial, el capital alemán se vuelve hegemónico y se desarrolla con fuerza el denominado turismo de masas, sobre todo en el municipio de Tías (Puerto del Carmen; por último a partir de principios de los ochenta nos encontramos con una etapa de similares características que la anterior hasta 1995, con un gran desarrollo de Yaiza y Teguise, a partir de esta fecha y hasta la actualidad se introducen los valores de sostenibilidad, aunque sin demasiado éxito, pues se sigue construyendo mucho y no de precisamente alta calidad.

  8. Carta del Editor

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    Blasco Fernando Checa Montúfar

    2015-01-01

    Full Text Available En la sección Sociedad, mujer y comunicación, analiza, expone propuestas, experiencias novedosas y aportes teóricos en torno a la problemática de la discriminación de la mujer en el periodismo, pues pese a los avances de la causa femenina todavía perduran estereotipos y discrímenes en la organización y contenidos mediáticos. En Erotismo, Pornografía y Medios se establecen las diferencias entre los dos primeros términos. Señala que los medios son el escenario privilegiado de estas expresiones sexuales. Incluyen dos experiencias, una sobre radio erótica que busca recrear "el prohibido sonido del placer" y la otra una revista brasileña "El tercer sexo", caso inédito, que rompiendo tabúes, aparece para satisfacer los requerimientos informativos de los homosexuales de Brasil. Completan esta entrega con temas como: El mercado audiovisual latinoamericano; La información exterior en América Latina; Tumbas de papel, sobre los desaparecidos en la dictadura argentina; la ciencia como cultura; Variedades de la luz y el abandono.

  9. Calculo del valor en riesgo del futuro de energia e internacionalizacion del sector energetico en Colombia

    OpenAIRE

    Esquivel Fonseca, Leidy Gioanna

    2013-01-01

    El presente trabajo de grado busca definir cuál es el mejor método para determinar el valor en riesgo del contrato de futuro de energía eléctrica que se transa en Colombia, para cumplir con este objetivo se toma como referencia el marco histórico del VaR y de los futuros seguido de las características de la fijación de precios, la estructura del contrato, que políticas y métodos hay para cubrirse del riesgo y como se realiza en otros países, realizando algunos cálculos de los modelos más trad...

  10. Funciones del estilo personal del terapeuta en profesionales del campo de las adicciones

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    Leandro Casari

    2017-01-01

    Full Text Available Objetivo. Comparar el estilo personal del terapeuta entre dos grupos de profesionales, uno dedicado a la atención de pacientes drogodependientes (grupo adicciones y otro a la atención clínica en general (grupo clínico. Método. La muestra estuvo formada por 100 psicoterapeutas que trabajan en instituciones públicas y privadas de tres provincias del interior de Argentina, pareados por las variables socioprofesionales (sexo, edad, años de experiencia profesional, enfoque teórico, grupo etario de trabajo, tipo de abordaje predominante, duración del tratamiento y grado de especialización. El instrumento empleado fue el Cuestionario de Estilo Personal del Terapeuta. Resultados. Para el análisis de datos se emplearon pruebas de comparación de medias y se analizó su tamaño del efecto. Se obtuvieron diferencias signifi cativas en la función expresiva: grupo clínico (M = 40.36 y grupo adicciones (M = 29.86; así como también en la función instruccional: grupo clínico (M = 28.01 y grupo adicciones (M = 32.67. Esto indica una mayor distancia emocional y un incremento en la rigidez del encuadre terapéutico en los terapeutas de pacientes adictos. Conclusión. Se discuten estos resultados en función de postulados previos que señalan la complejidad del vínculo terapéutico y el énfasis en las características del encuadre terapéutico, tal como la puesta de límites.

  11. Estrategias del Teatro del Oprimido para la formación permanente del profesorado

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    Tomás Motos-Teruel

    2012-01-01

    Full Text Available Este artículo relata una experiencia y su valoración de formación permanente del profesorado basada en el aprendizaje vivencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la transferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utilidad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Oprimido es una formulación teórica y un método estético cuya teoría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumento eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.

  12. Franco Modigliani e la teoria del ciclo vitale del consumo

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    Angus Deaton

    2005-06-01

    Full Text Available Nei primi anni ’50, Franco Modigliani e il suo studente Richard Brumberg elaborarono una teoria della spesa fondata sull’idea che gli individui effettuano scelte intelligenti su quanto desiderano spendere a ogni età, con il solo limite delle risorse disponibili nel corso della loro vita. Attraverso l’accumulo e il decumulo delle attività, chi lavora può provvedere alla propriapensione e, più in generale, può adattare i propri modelli di consumo alle esigenze che sipresentano alle diverse età, indipendentemente dal reddito disponibile in ogni momento della suavita. Questa semplice teoria conduce a previsioni rilevanti e non scontate per l’economia nel suo complesso, ad esempio che il risparmio nazionale dipende dal tasso di crescita del reddito nazionale e non dal suo livello, e che esiste una semplice relazione tra il livello della ricchezza nelsistema economico e la lunghezza del periodo trascorso in pensione. Tali previsioni, non verificabili negli anni ’50, hanno trovato considerevole sostegno empirico in successivi lavori di Modigliani e di altri ricercatori. Sebbene nel corso degli anni la teoria del consumo abbia subitonumerosi attacchi, i più recenti dei quali mossi da una coalizione di psicologi ed economisti,l’ipotesi del ciclo vitale rimane una parte essenziale del pensiero degli economisti.

  13. Disgerminoma del ovario (D

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    Jorge Amorocho

    1949-05-01

    Full Text Available Hospital de San Juan de Dios. Pabellón Quirúrgico. Clínica Ginecológica. Servicio del Profesor Aparicio. Historia Clínica número 49-24. G. C. Edad: 36 años. Natural de Susa. Ingresó al Servicio el 28 de febrero de 1949. Antecedentes a Familiares: Sin importancia. b Patológicos: Sarampión, viruela y tos ferina en la infancia. c Quirúrgicos; No. d Traumáticos; Golpe fuerte en la rodilla izquierda hace 4 años, sin fractura. e Tóxicos: Sin importancia. f Obstétricos; Casada desde hace 12 años, vive con el marido y no ha tenido embarazos. Frigidez sexual. g Ginecológicos; Amenorrea primitiva. Su primera regla la tuvo a los 23 años de edad, ' mediante tratamiento especial, a base de estrógenos (distil-estil-gestrol de 0.005 gm. Posteriormente cada 60 días experimentaba malestar general y mediante la ingestión de 2 comprimidos diarios, durante 10 días, de dietil-estil-bestrol de 5 mg. le aparecía su regla que era amenálgica, hipomenorreica y de 4 días de duración. En la fase premenstrual, esto es, mis ntras estaba tornando los comprimidos, le molestaba un flujo blancuzco, claro e inodoro que le almidonaba la ropa; dicho flujo desaparecía tan pronto como venía la menstruación, lo mismo que los síntomas de malestar general.

  14. EFECTO DEL SILICIO Y PLAGUICIDAS EN LA FERTILIDAD DEL SUELO Y RENDIMIENTO DEL ARROZ

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    Parm\\u00E9nides Furcal-Beriguete

    2013-01-01

    Full Text Available El objetivo de este trabajo fue evaluar el efecto del silicio en la fertilidad del suelo, la incidencia de enfermedades y plagas insectiles, el rendimiento y la calidad de granos del cultivo de arroz. El estudio se realizó en La Vega, Florencia, San Carlos, Costa Rica entre mayo y octubre en los años 2010 y 2011, en el mismo lote con la variedad CR 4477. Se establecieron cinco tratamientos: silicio al suelo, silicio al suelo más plaguicidas (alternativas químicas, silicio foliar, silicio foliar más plaguicidas y testigo comercial. Como fuente se utilizaron si- licio en polvo al 70% de SiO2, aplicado quince días antes de siembra en dosis de 100 kg SiO2/ha, y líquido concentrado 40% SiO2 y 36% MgO, aplicado al follaje en dosis de 4 l/ha a los 17 y 30 días después de la siembra. El suelo del orden inceptisol de formación aluvial, al inicio del experimento tenía pH 4,9, valores de P y Si disponibles de 29 ppm y 44,7 ppm, respectivamente, acidez intercambiable 1,2 cmol(+/l y suma de bases 19,11 cmol(+/l. No hubo diferencia estadística significativa del silicio en la fertilidad del suelo, la incidencia de plagas y enfermedades, y en la calidad molinera; sin embargo, la combinación del silicio aplicado al suelo y el uso de plaguicidas incrementaron el contenido de zinc y cobre en el suelo, y del zinc y magnesio en las hojas de arroz, pero este efecto no se tradujo en rendimiento y calidad de granos. La aplicación de plaguicidas influyó positivamente en el peso y rendimiento del arroz en granza (p≤0,05.

  15. Epidemiologia del parasitismo intestinal infantil en el Valle del Guadalquivir

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    Pérez Armengol Cristina

    1997-01-01

    Full Text Available FUNDAMENTO: Las parasitosis intestinales en los niños constituyen un problema de salud pública que debe ser valorado periódicamente en cada región. En este trabajo se aborda, por primera vez en la región natural del Valle del Guadalquivir, un estudio amplio sobre la prevalencia del parasitismo intestinal en la población infantil de la zona. MÉTODOS: Durante el período 1994-1996, mediante análisis coprológico y método de Graham, se ha estudiado a 1.917 niños y niñas asintomáticos, con edades comprendidas entre seis y diez años, residentes en veinte localidades del Valle del Guadalquivir. RESULTADOS: El índice global de parasitación ha sido del 27,12 %. Las especies parásitas detectadas, así como sus prevalencias fueron: Enterobius vermicularis (20,44%, Giardia lamblia (5,05%, Entamoeba coli (2,45%, Endolimax nana (1,61%, Entamoeba histolytica (0,31%, Entamoeba hartmanni (0,05%, Iodamoeba bütschlii (0,05%. CONCLUSIONES: La prevalencia global encontrada es similar a la de otras regiones españolas, aunque quizás pueda considerarse algo más favorable. No se detectan geohelmintos, debido posiblemente a la mejora de la infraestructura higiénico-sanitaria y a los efectos de la prolongada sequía en la zona. La giardiasis, a diferencia de las restantes protozoosis, mantiene una prevalencia relativamente alta.

  16. El valor del consejo en el Libro del caballero Zifar

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    Patricia ROCHWERT-ZUILI

    2011-11-01

    Full Text Available El propósito de este artículo es mostrar el valor que cobra en el Libro del caballero Zifar la definición del consejo como elemento fundamental del molinismo. El análisis permite distinguir no solo la afirmación de una palabra linajística ejemplar sino también la importancia del consejo del verdadero amigo, y en particular, el de la mujer o del caballero. A través de la valoración de la prueba que le tiene que imponer el rey al consejero se vislumbra además la imagen de este consejo privado que se impuso bajo el reinado de Alfonso XI y cuyo papel no fue sino confortar el poder de la realeza.Le propos de cet article est de montrer l’importance que revêt dans le Livre du chevalier Zifar la définition du conseil comme trait essentiel du molinisme. L’analyse permet non seulement de mettre en évidence l’affirmation d’une parole lignagère exemplaire mais aussi de distinguer le conseil de l’ami véritable, en particulier celui de la femme ou du chevalier. À travers la valorisation de l’épreuve que le roi se doit d’imposer au conseiller, on entrevoit en outre l’image du conseil privé qui s’imposa sous le règne d’Alphonse XI et dont le rôle fut de conforter le pouvoir de la royauté.

  17. Gestión del riesgo

    OpenAIRE

    Duque Escobar, Gonzalo

    2014-01-01

    Documento Anexo del Manual de Geología para Ingenieros, con temas asociados a la gestión integral del riesgo de interés para la ecorregión cafetera y Colombia. Parte de los temas ha sido tomada del módulo “Diálogos con el Territorio y Gestión del Riesgo Natural, a mi cargo en la Especialización en Geografía, Ordenamiento Territorial y Manejo del Riesgo Natural en la Universidad de Caldas. Otros, provienen del compendio de temas sobre la materia, elaborado en el marco de mis actividades académ...

  18. Fenomenología del prejuicio

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    Montero Moliner, Fernando

    1992-05-01

    Full Text Available Not available.

    Este trabajo expone la defensa del «prejuicio » llevada a cabo por Gadamer, mostrando su efectividad histórica y confrontándola con la crítica husserliana del «prejuicio» desde el apriorismo. Se pone de relieve, además, la historicidad del «mundo de la vida» y su incidencia en la teoría del a priori, para terminar con un estudio de la racionalidad del a priori y la facticidad del prejuicio.

  19. DESPUÉS DEL COLAPSO

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    Carmen M. Reinhart

    2011-01-01

    Full Text Available El presente artículo examina el comportamiento delPIBreal (montos y tasas decrecimiento, el desempleo, la inflación, el crédito bancario y los precios de los bie-nes raíces a lo largo de un periodo de 21 años en torno de una serie de importantessucesos y choques adversos, tanto globales como específicos por país. Entre estosepisodios se encuentran la caída del mercado accionario de 1929, la crisis petrolerade 1973, el colapso de los créditossubprimede 2007 en los Estados Unidos y 15crisis financieras severas posteriores a la segunda Guerra Mundial. Se hace hincapiéno en los antecedentes inmediatos y las repercusiones de estos sucesos, sino en ho-rizontes más amplios que comparan decenios y no años. Si bien la evidencia de dé-cadas perdidas, como es el caso de la depresión del decenio de los treinta, el deceniode los ochenta en la América Latina y de los noventa en Japón no es omnipresente,el crecimiento delPIBy los precios de la vivienda son significativamente más bajosy el desempleo es mayor en el periodo de 10 años posteriores a la crisis cuando secomparan estos datos con los del decenio precedente...

  20. El sentido cultural del cuidado en casa del enfermo

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    Marina Sánches-Sanabria

    2008-12-01

    Full Text Available Esta investigación tiene un diseño cualitativo descriptivo, transversal para comprender las diferencias existentes en los conocimientos, actitudes y prácticas influidas por la percepción o sentido cultural de cuidar del cuidador primario, como elemento básico para caracterizar elementos culturales presentes en el ambiente de cuidado al enfermo o discapacitado que está en casa a través de la indagación profunda de la percepción y sentimientos que tiene tanto el cuidador primario como el ser cuidado en casa. Se realizó con los usuarios inscritos del Programa de Promoción y Prevención de la indagación profunda de la percepción y sentimientos Universidad Popular del Cesar (IPS-UPC de los enfermos crónicos y discapacitados a nivel comunitario del grupo extramural de la comuna cinco y del Hospital Eduardo Arredondo Daza de la ciudad de Valledupar, Colombia. El valor de realizar este proyecto, está en desocultar los múltiples significados que en la realidad vivida por los seres cuidadores primarios y en los seres cuidados; son esas distintas formas de percibir la existencia, influido por el conocimiento de lo ancestral, los sentimientos y la sabiduría de la cultura que cada uno posee para expresarse en las múltiples formas que el cuidado lo acontece y lo requiere para dar el sentido cultural característico y diferenciado que se percibe en el modo de cuidar y la satisfacción de quien lo recibe y lo ofrece. Este aspecto fue valioso para la comunidad académica del programa de enfermería, porque ubicó epistémicamente la transculturalidad del cuidado como una mirada y forma de enseñar transdisciplinariamente, enseñando y ofreciendo el cuidado desde la cultura, sentimientos y pensamientos del ser cuidado para el mantenimiento de la vida y la salud, en la que estudiantes de enfermeria desde sus primeras experiencias formativas deben incursionar en la intervención holística que se requiere en el cuidado de la salud y de la vida.