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Background: Intravenous remifentanil may be the preferred analgesic when regional techniques are contraindicated., Objective: To perform a systematic review on the use of remifentanil for analgesia in labor., Methods: We searched MEDLINE (January 1995-August 2007) for studies on obstetric analgesia with remifentanil., Results: We found 32 references representing the use of remifentanil in 257 women in labor. In most cases, patients reported relief of pain and a high level of satisfaction, with no severe side effects in mothers or neonates. When compared with meperidine and nitrous oxide in clinical trials, remifentanil provided better analgesia with fewer adverse effects., Conclusion: Analgesia with intravenous remifentanil is more effective and safer than other alternatives to regional analgesic techniques in obstetrics. Nevertheless, the optimum system for infusing the drug must b e established and further studies of maternal and fetal safety should be carried out.

Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.

Introduction and Aim: Sedation of patients is an important complement to endoscopic procedures. The aim of this study was to analyze tolerance, complications and cost-effectiveness in patients undergoing diagnostic upper gastrointestinal endoscopy., Patients and Method: A total of 357 patients were prospectively studied: 138 non-sedated, 116 sedated with midazolam and 103 sedated with midazolam and meperidine. Subjective tolerance, tolerance perceived by the endoscopist, complications, and cost-effectiveness were evaluated. The Chi-square test was used for the statistical analysis. P-values of less than 0.05 were considered statistically significant., Results: Subjective tolerance was greater in patients sedated with midazolam and meperidine than in the other groups (p < 0.05). Tolerance perceived by the endoscopist was greater in the group sedated with both drugs than in the group sedated with midazolam (p < 0.05). Subjective tolerance was better in sedated men and women but there was no association between sedation and perceived tolerance according to sex. Subjective tolerance was better in sedated patients older than 70 years than in those younger than 40 years (p < 0.05). Complications were more frequent in sedated patients and the most frequent complication in all the groups studied was mild desaturation; there was a significant difference between the group sedated with midazolam and meperidine and the non-sedated group (p < 0.05). Non-sedation had the best cost-effectiveness ratio but sedation with midazolam and meperidine was the most effective alternative., Conclusion: From the point of view of the endoscopist, endoscopy can be performed without sedation, although subjective tolerance is greater in patients sedated with midazolam and meperidine. Non-sedation is more cost-effectiveness than sedation but if sedation is required midazolam and meperidine achieve better results in terms of effectiveness than midazolam alone.

Objectives: To ascertain the side effects of intravenous meperidine in patient-controlled analgesia under two levels of surveillance: one in the recovery room and one in the hospital's surgical ward., Patients and Methods: Patient-controlled analgesia with meperidine was made available to 80 patients who had undergone cholecystectomy by laparotomy. Instances of nausea/vomiting, pruritus, urinary retention and technical problems were recorded, as well as arterial gas levels (cooximetry) on the first, third, twelfth and twenty-fourth hours after surgery. We also recorded meperidine consumption and its relationship to side affects., Results: Side effects were associated with higher consumption of meperidine (437.0 +/- 117.7 mg vs 297.7 +/- 135.9 mg in those experiencing no side effects), with more episodes of PO2 < 70 mmHg and SO2 < 90% on the ward than in the recovery room (24 and 10 as compared to 85 and 30, respectively). Patients presenting adverse side effects were significantly older (76.6 +/- 13.5 vs 58.1 +/- 11.1 years)., Conclusions: Given that age and higher meperidine consumption were associated with more frequent occurrence of hypoxic episodes, patients should receive greater surveillance on the ward, with oxygen therapy, monitoring of accumulated consumption and caution used with older patients.

Jaundice appearing in the first 24 hours of life, usually called early jaundice, is regarded as pathologic. On the opposite, one of the defining criteria of physiologic jaundice is its' occurrence after the first day of postnatal life. Authors, starting from repeated clinical observations of early jaundice of unknown etiology in preterm newborns, bring about a retrospective study of 1,527 clinical records in order to identify the cases of early jaundice of unknown origin. After known early jaundice-producing causes were excluded, 11 "unknown origin" cases were left. On comparing them with 11 other cases of similar characteristics (gestational age, weight at birth, year and season) who had presented physiologic jaundice, it turned out that the evolution of jaundice was comparable in both groups, except for age of appearance. Early jaundice group bilirubinemia was X = 7.4 (SD +/- 1.59 mg./dl. at 14 (+/- 6.6) hours of age, and physiologic jaundice group bilirubinemia was X = 9.8 (SD +/- 2.25) mg./dl. at 53 (+/- 21.3) hours at age. Since according to selection criteria both groups were made up by healthy preterm newborns, without any perinatal pathology, a study of the drugs administered to the mothers within 24 hours prior to birth was performed: not any reason for early appearance of jaundice was found. Authors' hypothesis support that the chronological criteria used to define physiologic jaundice in full-term newborns cannot always be applied to preterm newborns.