sábado, 5 de diciembre de 2015

Relajantes neuromusculares en pediatría/Neuromuscular block in infants

Diciembre 5 2015. No. 2166

Existe pocas guías y literatura disponibles para el uso seguro de relajantes musculares en pediatría
Limited professional guidance and literature are available to guide the safe use of neuromuscular block in infants.
Acta Paediatr. 2014 Sep;103(9):e370-3. doi: 10.1111/apa.12682. Epub 2014 Jun 20.
Abstract
AIM: Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range. METHODS: We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK. RESULTS: No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.CONCLUSION: There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.
KEYWORDS: Critical care; Neonatology; Neuromuscular blockade; Neuromuscular monitoring; Pharmacology
     XII Congreso Virtual Mexicano de Anestesiologia


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015

martes, 1 de diciembre de 2015

Pregabalina en DPO/Pregabaline and POP

Diciembre 1, 2015. No. 2162

Eficacia de pregabalina en dolor agudo postoperatorio en diferentes categorías quirúrgicas. Un meta-análisis
Efficacy of Pregabalin in Acute Postoperative Pain Under Different Surgical Categories: A Meta-Analysis.
Medicine (Baltimore). 2015 Nov;94(46):e1944. doi: 10.1097/MD.0000000000001944.
Gabapentina perioperatoria reduce el consume de opioides por 24 horas y mejora la rehabilitación en el hospital pero no la evolución después del alta en artroplastia de rodilla con bloqueos periféricos
Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block.
Br J Anaesth. 2014 Nov;113(5):855-64. doi: 10.1093/bja/aeu202. Epub 2014 Jun 30.
Abstract
BACKGROUND: This study was designed to determine whether a 4 day perioperative regimen of gabapentin added to celecoxib improves in-hospital rehabilitation and physical function on postoperative day 4 and 6 weeks and 3 months after total knee arthroplasty (TKA). METHODS: After Research Ethics Board approval and informed consent, 212 patients were enrolled in a randomized, double-blinded, placebo-controlled study. Two hours before surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either gabapentin 600 mg or placebo p.o. Two hours later, patients received femoral, sciatic nerve blocks, and spinal anaesthesia. After operation, patients received gabapentin 200 mg or placebo three times per day (TID) for 4 days. All patients also received celecoxib 200 mg q12 h for 72 h and i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, during hospitalization, on postoperative day 4 (POD4), and 6 weeks and 3 months after surgery. RESULTS: The gabapentin group used less morphine in the first 24 h after surgery [G=38.3 (29.5 mg), P=48.2 (29.4 mg)] (P<0.0125) and had increased knee range of motion compared with the placebo group in-hospital (P<0.05). There were no differences between groups in favour of the gabapentin group for pain or physical function on POD 4 [95% confidence interval (CI): pain: -1.4, 0.5; function: -6.3, 2.0], 6 weeks (95% CI: pain: 0.1, 1.9; function: -0.2, 6.5) or 3 months (95% CI: pain: -0.2, 1.7; function: -2.2, 4.3) after TKA. CONCLUSIONS: In the context of celecoxib, spinal anaesthesia, femoral and sciatic nerve blocks, a dose of gabapentin 600 mg before operation followed by 4 days of gabapentin 200 mg TIDdecreased postoperative analgesic requirements and improved knee range of motion after TKA. Gabapentin provided no improvement in pain or physical function on POD4 and 6 weeks or 3 months after surgery.
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     XII Congreso Virtual Mexicano de Anestesiologia


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015

Imagen del mes/Imagen of the month





Ependimomas medulares. Parte 1. Ependimonas intramedulares
Spinal ependymomas. Part 1: Intramedullary ependymomas.
Neurosurg Focus. 2015 Aug;39(2):E6. doi: 10.3171/2015.5.FOCUS15161.

Ependimomas medulares. Parte 2. Ependimomas del filum terminale
Spinal ependymomas. Part 2: Ependymomas of the filum terminale
Jörg Klekamp, MD
Neurosurgical Focus Aug 2015 / Vol. 39 / No. 2, Page E7
Evolución a largo plazo de la resección quirúrgica con y sin radiación en el tratamiento de ependimomas medulares. Estudio retrospectivo multicéntrico del grupo Korea Spinal OncologyResearch
Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group.
Neuro Oncol. 2013 Jul;15(7):921-9. doi: 10.1093/neuonc/not038. Epub 2013 Apr 10.
La diferenciación entre ependimoma espinal intramedular y astrocitoma: análisis de resonancia magnética comparativa.
Differentiation between intramedullary spinal ependymoma and astrocytoma: comparative MRI analysis.
Clin Radiol. 2014 Jan;69(1):29-35. doi: 10.1016/j.crad.2013.07.017. Epub 2013 Sep 10.
Resección con microcirugía de ependimoma intramedular
Microsurgical resection of intramedullary spinal cord ependymoma.
Neurosurg Focus. 2014 Sep;37 Suppl 2:Video 9. doi: 10.3171/2014.V3.FOCUS14276.Abstract
Manejo y evolución de tumores intramedulares en adultos. Experiencia de 20 años
Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience.
BMC Res Notes. 2014 Dec 15;7:908. doi: 10.1186/1756-0500-7-908.
Ependimoma lumbar se manifiesta con una raquiaanestesia no usual
Lumbar ependymoma presenting with an unusual spinal anaesthetic.
Anaesthesia. 2012 Jun;67(6):676-7. doi: 10.1111/j.1365-2044.2012.07143.x.
Ependimoma lumbar se manifiesta con paraplegia después de un intento de anestesia raquídea
Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia.
Br J Anaesth. 2002 Mar;88(3):438-40.
Manifestación atípica de un tumor medular después de anestesia peridural
An unusual presentation of spinal cord tumor after epidural anesthesia.
Anesth Analg. 1992 Nov;75(5):844-6.
Pronóstico por la localización de ependimomas espinales en adultos
Prognosis by tumor location in adults with spinal ependymomas.
J Neurosurg Spine. 2013 Mar;18(3):226-35. doi: 10.3171/2012.12.SPINE12591. Epub 2013 Jan 11.
Ependimomas intramedulares medulocervicales. Manejo operatorio, recuperación funcional y evolución a largo plazo
Intramedullary medullocervical ependymoma--surgical treatment, functional recovery, and long-term outcome.
Neurol Med Chir (Tokyo). 2013;53(10):663-75. Epub 2013 Sep 27.
  


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015