Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>In the immediate postoperative period, obese patients are more likely to exhibit hypoxaemia due to atelectasis and impaired respiratory mechanics, changes which can be attenuated by non-invasive ventilation (NIV). The aim of the study was to evaluate the duration of any effects of early initiation of short term pressure support NIV vs. traditional oxygen delivery via venturi mask in obese patients during their stay in the PACU.</p> <p>Methods</p> <p>After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-45) undergoing minor peripheral surgery. Half were randomly assigned to receive short term NIV during their PACU stay, while the others received routine treatment (supplemental oxygen via venturi mask). Premedication, general anaesthesia and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry and blood gas analysis on air breathing. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 1 h, 2 h, 6 h and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P < 0.05.</p> <p>Results</p> <p>There were no differences at the first assessment. During the PACU stay, pulmonary function in the NIV group was significantly better than in the controls (p < 0.0001). Blood gases and the alveolar to arterial oxygen partial pressure difference were also better (p < 0.03), but with the addition that overall improvements are of questionable clinical relevance. These effects persisted for at least 24 hours after surgery (p < 0.05).</p> <p>Conclusion</p> <p>Early initiation of short term NIV during in the PACU promotes more rapid recovery of postoperative lung function and oxygenation in the obese. The effect lasted 24 hours after discontinuation of NIV. Patient selection is necessary in order to establish clinically relevant improvements.</p> <p>Trial Registration#</p> <p>DRKS00000751; <url>http://www.germanctr.de</url></p

Impacto da atividade física e esportes sobre o crescimento e puberdade de crianças e adolescentes Linear growth and puberty in children and adolescents: effects of physical activity and sports

OBJETIVO: Apresentar revisão atualizada e crítica sobre o impacto do esporte e da atividade física no crescimento, desenvolvimento puberal e mineralização óssea de crianças e adolescentes. FONTES DE DADOS: Pesquisa bibliográfica nos bancos de dados Medline e Lilacs (1987-2007), selecionando os artigos escritos em inglês, português ou espanhol, a partir dos descritores "esportes" e "exercícios", em combinação com "crescimento", "puberdade" e "mineralização óssea". Foram examinados 252 artigos e 48 deles selecionados. SÍNTESE DOS DADOS: Diferentes modalidades esportivas não aumentam ou diminuem a estatura. Ocorre um viés de seleção, no qual fatores constitucionais determinam a seleção de biótipos privilegiados para determinados esportes. O exercício físico leve a moderado estimula o crescimento e deve ser incentivado. A atividade física extenuante, principalmente quando associada à restrição dietética, afeta o crescimento, o desenvolvimento puberal, a função reprodutiva e a mineralização óssea. A musculação praticada por jovens pré-púberes pode ser prejudicial, se não for realizada sob supervisão, já que há um potencial risco de lesão na cartilagem de crescimento. Entretanto, quando bem supervisionada, pode levar a um aumento de força e resistência muscular. CONCLUSÕES: Os efeitos deletérios dos esportes sobre o crescimento e desenvolvimento só foram observados em atletas de elite submetidos a treinamento intensivo e restrição alimentar. Alterações hormonais e de citocinas inflamatórias são parte da fisiopatologia desse processo. É necessário que estudos longitudinais avaliem as repercussões da atividade física recreacional sobre a estatura final.<br>OBJECTIVE: To present an up-to-date critical review about the impact of sports and physical activity on growth, pubertal development and bone mineralization of children and adolescents. DATA SOURCE: Bibliographic search of Medline and Lilacs databases (1987-2007) with selection of studies written in English, Portuguese or Spanish, with the descriptors "sports" and "exercise" in combination with "growth", "puberty" and "bone mineralization". A total of 252 articles were retrieved and 48 of them were selected. DATA SYNTHESIS: Light to moderate physical activity has a beneficial effect on growth and bone development, while intense physical training, specially if associated to dietary restrictions, may attenuate linear growth, pubertal development, reproductive function and bone mineralization. Different sports do not have specific effects on final height. There is a selection bias in which constitutional factors contribute to select favored biotypes to specific sports. Weight-training by pre-pubertal children may be harmful, if not supervised, due to the potential risk of injure to the growth plates; however, if performed under strict supervision, may provide muscle strength and resistance. CONCLUSIONS: Deleterious effects of sports in growth and development of children and adolescents were only observed in elite athletes submitted to intensive training and dietetic restriction. Longitudinal studies are neded to evaluate the effects of recreational physical activity upon linear growth

Role of active metabolites in the use of opioids

The opioid class of drugs, a large group, is mainly used for the treatment of acute and chronic persistent pain. All are eliminated from the body via metabolism involving principally CYP3A4 and the highly polymorphic CYP2D6, which markedly affects the drug's function, and by conjugation reactions mainly by UGT2B7. In many cases, the resultant metabolites have the same pharmacological activity as the parent opioid; however in many cases, plasma metabolite concentrations are too low to make a meaningful contribution to the overall clinical effects of the parent drug. These metabolites are invariably more water soluble and require renal clearance as an important overall elimination pathway. Such metabolites have the potential to accumulate in the elderly and in those with declining renal function with resultant accumulation to a much greater extent than the parent opioid. The best known example is the accumulation of morphine-6-glucuronide from morphine. Some opioids have active metabolites but at different target sites. These are norpethidine, a neurotoxic agent, and nordextropropoxyphene, a cardiotoxic agent. Clinicians need to be aware that many opioids have active metabolites that will become therapeutically important, for example in cases of altered pathology, drug interactions and genetic polymorphisms of drug-metabolizing enzymes. Thus, dose individualisation and the avoidance of adverse effects of opioids due to the accumulation of active metabolites or lack of formation of active metabolites are important considerations when opioids are used.Janet K. Coller, Lona L. Christrup, Andrew A. Somogy