The American Academy of Pediatrics places emphasis on increasing breastfeeding in the United States. A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing. Such advice may not be warranted. This statement is intended to supply the pediatrician, obstetrician, and family physician with data, if known, concerning the excretion of drugs into human milk. Most drugs likely to be prescribed to the nursing mother should have no effect on milk supply or on infant well-being. This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacologic treatment of breastfeeding mothers. Nicotine, psychotropic drugs, and silicone implants are 3 important topics reviewed in this statement.

Transfer of drugs and other chemicals into human milk

A tomada de decisao do enfermeiro na sua pratica diaria necessita ser fundamentada em conhecimento cientifico. A pratica baseada em evidencias e uma abordagem que preconiza a utilizacao de resultados de pesquisas na pratica clinica, sendo a revisao integrativa um de seus recursos. A presente investigacao e uma revisao integrativa que teve como objetivo avaliar as evidencias disponiveis sobre as intervencoes eficazes de enfermagem para a prevencao de lesoes de pele no paciente cirurgico, no periodo transoperatorio, ou em decorrencia desse. Para a selecao dos artigos utilizou-se duas bases de dados, Cinalh e Medline, e a amostra desta revisao constituiu-se de 14 artigos. Apos analise dos artigos incluidos na revisao os resultados dos estudos apontaram que os dispositivos considerados mais eficazes na prevencao de lesoes de pele foram em ordem descrecente o colchao de ar micropulsante, cobertura de colchao de polimero de visco elastico seco e almofadas de gel, sucessivamente.

/pdf/prevencao-de-lesoes-de-pele-no-perioperatorio-revisao-2aagknr8k1.pdf

Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura

La toma de decisiones en la practica diaria del enfermero necesita ser basada en conocimiento cientifico. La practica basada en evidencias es una aproximacion que establece la utilizacion de resultados de investigaciones en la practica clinica, con la revision integradora como uno de sus recursos. La finalidad de esta revision integradora es buscar y evaluar las evidencias disponibles sobre las intervenciones eficaces de enfermeria para la prevencion de lesiones de piel en el paciente quirurgico, en el periodo transoperatorio, o como resultado del mismo. Utilizamos dos bases de datos, Cinahl y Medline, para la seleccion de los articulos, resultando en una muestra de 14 articulos. Tras el analisis de los articulos incluidos en la revision, los resultados de los estudios indicaron que los dispositivos considerados los mas eficaces en la prevencion de lesiones de piel fueron, sucesivamente, el sistema de colchon dinamico pulsante multi-celula, la almohada de polimero seco visco-elastico y almohadas con gel.

/pdf/prevencion-de-lesiones-de-piel-en-el-perioperatorio-revision-3i7si4l5sv.pdf

Prevención de lesiones de piel en el perioperatorio: revisión integradora de la literatura

To the Editor.— I read with interest the Committee on Drugs second report about transfer of drugs and other chemicals into human milk.1 Although the objective to categorize those drugs with reported harmful, or not, effects on children has been achieved with admirable brevity, the report fails to cite two useful areas of information. The WHO Task Force on Drugs in Human Milk reviewed the world literature and compiled a recently published book entitled Drugs and Human Lactation.2

Transfer of Drugs and Other Chemicals into Human Milk

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade "A" (strong recommendation), Grade "B" (recommendation) and Grade "0" (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

Surgical positions. Their effects on cardiovascular, respiratory systems.

Review of Chemical, Medication, and Anesthesia Toxicity in the OR

The purpose of this study was to measure the concentration of fentanyl in human colostrum after intravenous administration of an analgesic dose. Thirteen healthy women were given fentanyl 2 micrograms.kg-1 for analgesic supplementation during either Caesarean section or postpartum tubal ligation. Serum and colostrum were collected for 45 min, two, four, six, eight, and ten hours following administration of the drug. Radioimmunoassay showed that colostrum fentanyl concentrations were greatest at 45 min, the initial sampling time, reaching 0.40 +/- 0.059 ng.ml-1, but were virtually undetectable ten hours later. Fentanyl concentrations were always higher in colostrum than in serum. This concluded that with these small concentrations and fentanyl's low oral bioavailability, intravenous fentanyl analgesia may be used safely in breast-feeding women.

http://e-lactancia.org/media/papers/FentaniloBF-CanJAnest1992.pdf

Concentration of fentanyl in colostrum after an analgesic dose.

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Papers

Surgical positions. Their effects on cardiovascular, respiratory systems.

Review of Chemical, Medication, and Anesthesia Toxicity in the OR

Concentration of fentanyl in colostrum after an analgesic dose.