Tesis Especializaciones (Ciencias Médicas)

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Browsing Tesis Especializaciones (Ciencias Médicas) by Subject "Analgesia"

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    Analgesia postcesarea y estudio del apgar en recién nacidos con fentanyl y morfina por vía peridural en los años 1992-1993 lugar de estudio HVCM
    (1994) López Bustamante, Lauro Raúl; Marín Torres, Tarquino Gerardo; Barzallo Sacoto, Jorge Eduardo; Morales Sanmartín, Jaime Rodrigo
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    Analgesia postoperatoria con bloqueo de plexo braquial con: L-bupivacaina al 0,25% VS bupivacaina al 0,25% en pacientes mayores de 18 años, Hospital Vicente Corral Moscoso, 2009-2010
    (2010) Molina Neira, Sofía Marcela; Barzallo Sacoto, Jorge Eduardo; Orellana Cabrera, Iván Eladio
    Objective. Compare produced by L-bupivacaine sensitive block time and frequency motor lock compared with bupivacaine, to the same concentration and dose administered to patients in whom was blocking brachial plexus for upper limb surgery. Materials and methods. With an experimental design included 90 patients of both sexes, age 18, divided into two equal groups to receive either 30-40 ml of L-bupivacaine 0.25% (n = 45) or 30-40 ml of 0.25% bupivacaine (n = 45). Measured time sensitive lock postoperative, frequency motor lock, hemodynamic behavior and secondary reactions to drugs. Results. Groups were comparable in demographic characteristics and the control variables. There was also significant differences in hemodynamic behavior of groups but was detected transient tachycardia in 8.9% (n = 4) of the group that received bupivacaine (P = 0,041). The average time sensitive lock was 637,3 ± 72.6 min (range 540-840) for the group to receive L-bupivacaine and 314.8 ± 51,1 min (range 180-420) for the group that received bupivacaine (P < 0.01). There was no engine block in the group receiving L-bupivacaine but yes in 80% (n = 36) of the group that received bupivacaine (P < 0.01). Conclusions. L-bupivacaína is as effective as bupivacaine for brachial plexus block when required surgery of the upper limb in patients 18 years of age or older. L-bupivacaine relevant feature is its long time sensitive lock and the lower frequency motor lock as bupivacaine. Key words: L-bupivacaine, bupivacaine, brachial plexus, sensitive block, motor block.
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    Comparación entre analgesia epidural y analgesia parenteral post colecistectomia abierta. Hospital Vicente Corral. Cuenca, 2013
    (2014) Alava Zambrano, Vivian Carolina; Barzallo Sacoto, Jorge Eduardo; Morocho Malla, Manuel Ismael
    Objetive. To compare the quality of analgesia and recovery from bupivacaine + fentanyl by epidural catheter + parenteral ketorolac vs buprenorphine in acute pain after open cholecystectomy. Methods. In a randomized single-blind design, two groups of 44 participants each were compared. One group received postoperative analgesia with epidural catheter and the other group received parenteral analgesia. It was found that method provided better analgesia and quality of recovery in patients undergoing open cholecystectomy in order to determine which method is best. Results. The groups were comparable in demographic variables. In the postoperative period, pain was significantly lower in the epidural catheter group ( P < 0.001). Quality assessed with post-anesthesia recovery sleep, ambulation and reintegration into the diet, was significantly better in the group receiving epidural analgesia (P < 0.001). There was no significant difference in postoperative complications such as nausea, vomiting, hypotension and respiratory depression occurred in both Buprenorphine + K group and the epidural catheter group. Discussion. Postoperative analgesia with epidural catheter is a useful scheme for the control of postoperative pain and an adequate quality of recovery in patients undergoing open cholecystectomy. DeCS: QUALITY OF RECOVERY AND ANALGESIA, EPIDURAL CATHETER, SINGLE-BLIND RANDOMIZED DESIGN EPIDURAL ANALGESIA, PARENTERAL ANALGESIA, QUALITY OF RECOVERY, RECOVERY SLEEP, AMBULATION; REINTEGRATION DIET
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    Eficacia de analgesia post cesárea con bupivacaína 10 mg + morfina 150 µg vs. bupivacaína 10 mg + morfina 100 µg por via intratecal. hospital vicente corral moscoso. Cuenca – Ecuador. 2013.
    (2014) Sánchez Jiménez, Mónica Patricia; Palacios Reinoso, Carlos Santiago; Morocho Malla, Manuel Ismael
    Introduction: The use of Intrathecal morphine is very effective as post-cesarean section analgesia. However, the optimal dose is not determined yet. The objective of this study was to evaluate the efficacy of intrathecal bupivacaine 10 mg + 150 µg of morphine vs intrathecal bupivacaine 10 mg + 100 µg of morphine as an analgesic method in patients after caesarean section at the Vicente Corral Moscoso Hospital of the city of Cuenca – Ecuador in 2013. Methods: A controlled blind clinical trial. 64 Patients who were treated with bupivacaine 10 mg + 150 µg of morphine and 64 who received bupivacaine 10 mg + 100 µg of morphine were studied. The quality of analgesia, efficacy and side effects of the two techniques were also studied. Results: The dose of 150 µg morphine + 10 mg of bupivacaine was more effective than the 100 µg + 10 mg of bupivacaine in the evaluation of analgesia between 12 and 24 hours after the surgery. There were no differences in the hemodynamic behavior between the two groups. Conclusions: The group that received the treatment based on bupivacaine 10mg + 150 µg of morphine had better results in the analgesic control after the surgery. Only one patient suffered vomiting as a secondary effect. Key words: MORPHINE CESAREAN SECCION, POSTOPERATIVE PAIN, ANALGESIA.  
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    Eficacia y seguridad del sulfato de magnesio como coadyuvante en la analgesia postoperatoria de histerectomía abdominal, bajo anestesia general balanceada. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca. 2013
    (2016) Ilbay Gómez, Ana del Rocío; Viteri León, Octavio Enrique; Morocho Malla, Manuel Ismael
    Background: this becomes a pressing problem in Ecuador, where there are still inconclusive aspects to be considered. Objective: to determine the effectiveness and safety of intravenous magnesium sulfate as an coadyuvant to postoperative analgesia for abdominal hysterectomy under general anesthetics. Vicente Corral Moscoso Hospital and Hospital José Carrasco Arteaga Cuenca, 2013. Material and Methods: a clinical, randomized, single-blind study was performed; it was formed by two equal groups of 78 patients that were scheduled for abdominal hysterectomy. Group "A" was administered 50mg / kg Magnesium sulphate, and 15 minutes of balanced general anesthesia. In addition, analgesics such as tramadol 2 mg / kg at the time of aponeurotic closure; after that 1 mg / kg was first given every 6 hours during postoperative care and after that ketorolac 30 mg trans-surgical.; while "Group B" was given balanced general anesthesia using the before mentioned parameters with the exception of administering magnesium sulfate. Pain intensity was measured by visual analog scales. Results: group A showed mild pain average 3.76 + 1.22 compared to the group B which recorded moderate pain average 5.05 + 1.42; this difference is statistically significant up to 4 hours postoperatively with p = 0.000. No group reported cases of anaphylactic reaction, hypotension; nausea, vomiting or respiratory depression: bradycardia occurs in the two groups, having no significant statistical difference. Conclusions: magnesium sulphate proved effective as adjunctive analgesia until 4 hours postoperatively, its administration is safe
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    Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiración manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013
    (2013) Espinoza Juela, Miguel Ignacio; Pacheco Baculima, Juan Pablo; Morocho Malla, Manuel Ismael
    Objective. To decrease the pain caused by the the Manual Vacuum Aspiration (MVA) in patients undergoing surgery from paracervical block. Methodology. With a blind randomized controlled trial, eighty patients -two groups of forty- were selected for the treatment of incomplete abortion by Manual Vacuum Aspiration in the Department of Gynecology and Obstretrics in Vicente Corral Moscoso Hospital. Group “B” (n=40) underwent the paracervical block procedure. Besides paracervical block treatment, group “A” (n=40) received 1mcg/kg of intravenous remifentanil as an initial dose followed by 0,5mcg/ kg of bolus every four minutes. Pain intensity was measured using the visual analog scale of 10 points, haemodynamic changes and side effects. Results. There is not a significant difference between the study groups related to age (p=0,118), weight (p = 0,522), height (p = 0,114), IMC (p = 0,668), level of education (p = 0,699). The use of remifentanil decreased the pain according to the visual analog scale (VAS) from 7,58 group “B” to 2,98 in group “A” (p = 0,000). There were not significant changes regarding mean arterial pressure and heart rate (p > 0,05). The side effect that showed a significant difference between the groups was the nausea (p = 0,001) which was higher in group “B” Discussion. The use of remifentanil to paracervical block decresaed the VAS pain by 46% with major changes in hemodynamics and with fewer side effects than the control group having nausea (92.3% with p 0.001) KEY WORDS. INCOMPLETE ABORTION, ANALGESIA, INTERMITTENT BOLUS, REMIFENTANIL, PARACERVICAL BLOCK LIDOCAINE, MVA, VAS PAIN
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    Sedo-analgesia para colonoscopía. Comparación entre midazolam + fentanil versus propofol + fentanil. Hospital Vicente Corral Moscoso y Hospital José Carrasco Arteaga, Cuenca 2014
    (2016) Vanegas Mendieta, Gabriela Vanessa; Palacios Reinoso, Carlos Santiago; Arévalo Peláez, Carlos Eduardo
    Introduction. Colonoscopy is the endoscopic examination of the large intestine, a procedure that is usually performed on an outpatient basis and it is unpleasant and painful. Commonly, is performed with general anesthesia or with sedatives or over-the-counter pain relievers which separately do not guarantee benefit for the patient. Objective. Compare the sedative and analgesic effect of midazolam/fentanyl versus propofol/fentanyl in colonoscopy. Methodology. Controlled clinical trial randomized single-blind study that included 216 patients randomly assigned to two equal groups. Group A (n = 108) received midazolam plus fentanyl and group B (n = 108) propofol more fentanyl. Assessed the degree of sedation with the scale of Ramsay and the pain through indirect parameters such as blood pressure and heart rate. Other parameters assessed were the saturation of oxygen. Averages were compared using analysis of variance, was considered to be statistically significant values of p<0.05. Results: The degree of sedation valued by the scale of Ramsay-Hunt , demonstrated statistically significant differences in the 5 minutes, not as well, 15, 30 and 45 minutes. The biggest differences between the two groups are for grade IV sedation was obtained after 5 minutes in 2 patients in group A, unlike the group B, where 18 patients had a higher level of the desired sedation (Ramsay 2 or 3). No significant differences were observed in the values of the arterial blood pressure, heart rate, oxygen saturation and respiratory rate, p-values>0.05 . Conclusions: With the use of midazolam are fewer cases of deep sedation, without which there are significant differences in cardiovascular and respiratory parameters among the groups studied