Mostrando entradas con la etiqueta Dexmedetomidina. Mostrar todas las entradas
Mostrando entradas con la etiqueta Dexmedetomidina. Mostrar todas las entradas

jueves, 11 de enero de 2018

Dexmedetomidina / Dexmedetomidine

Enero 12, 2018. No. 2961
Farmacocinética clínica y farmacodinamia de la dexmedetomidina.
Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine.
Clin Pharmacokinet. 2017 Aug;56(8):893-913. doi: 10.1007/s40262-017-0507-7.
Abstract
Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug's peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α2-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidinepharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.
Utilidad de la dexmedetomidina en diversos contextos en la medicina actual
Dr. Orlando Carrillo-Torres,* Dra. María Guadalupe Pliego-Sánchez,* Dra. María Mónica Gallegos-Allier,* Dra. Lourdes Carmen Santacruz-Martínez*
Rev Mex Anestesiol Vol. 37. No. 1 Enero-Marzo 2014 pp 27-34
Resumen 
En los últimos años se han creado fármacos para lograr una adecuada sedación y analgesia en los pacientes antes, durante y después de las intervenciones mé- dicas. Entre estos medicamentos se encuentra la dexmedetomidina, un fármaco altamente selectivo a los receptores alfa-2, que logra, en dosificación adecuada, analgesia, sedación y simpaticolisis sin efectos adversos importantes. Este fármaco se ha utilizado ampliamente en la terapia intensiva, para lo cual fue ideado, pero también se ha utilizado para diversos procedimientos anestesiológicos, ya sean en generales y regionales, así como para sedaciones superficiales y profundas, tanto en los adultos como en la población pediátrica. En esta revisión se abarcarán las generalidades de la dexmedetomidina, así como su uso en las diferentes especialidades hasta el día de hoy. Palabras clave: Alfa-2 agonista, dexmedetomidina, sedación, analgesia.
Dexmedetomidina: Rol Actual en Anestesia y Cuidados Intensivos
Joana Afonso 1, Flávio Reis 2 Resumen: Afonso J, Reis F
Rev Bras Anestesiol. 2012 Jan-Feb;62(1):118-33. doi: 10.1016/S0034-7094(12)70110-1.
Resumen
Justificativa y objetivos: Actualizar y analizar nuevamente la aplicación de la dexmedetomidina en la anestesia y en los cuidados intensivos. Este trabajo es una revisión bastante exhaustiva de los usos clínicos, farmacología, farmacocinética, mecanismo de acción, y de los efectos adversos de la dexmedetomidina. Contenido: El uso efectivo de los agentes sedativo-hipnóticos y analgésicos, forma parte integral de la comodidad y de la seguridad de los pacientes. La dexmedetomidina es un potente y altamente selectivo agonista de los adrenoceptores α-2 con propiedades simpaticolíticas, sedativas, amnésicas y analgésicas, que se ha venido describiendo como un adyuvante útil y seguro en varias aplicaciones clínicas. Proporciona una "sedación conciente" única, analgésica, y sin depresión respiratoria. Sus usos más comunes ya analizados, incluyen la sedación en la Unidad de Cuidados Intensivos (UCI) (adulta y pediátrica), en Urgencias, anestesia regional y general, neurocirugía, sedación para procedimientos pediá- tricos, intubación por fibra óptica en enfermos despiertos, cirugía cardíaca y cirugía bariátrica. Conclusiones: La dexmedetomidina ofrece la capacidad única de suministrar sedación y analgesia sin depresión respiratoria. Es un agente nuevo con un gran margen de seguridad, excelente capacidad sedativa y moderadas propiedades analgésicas. Aunque su amplio uso sea hoy por hoy, para pacientes de unidades de cuidados intensivos quirúrgicos y no quirúrgicos, la dexmedetomidina parece tener aplicaciones futuras promisorias en las áreas de neuroprotección, cardioprotección y renoprotección. Aunque de todas formas, son necesarios más estudios detallados para definir su rol como sedativo en los enfermos criticos, neuroquirúrgicos y pediátricos, como adyuvante en la anestesia y como sedativo durante los procedimientos. Descriptores: ANALGÉSICOS; Dexmedetomidina; ANALGESIA; ANESTESIA; Cuidados intensivos

Dexmedetomidine: current role in anesthesia and intensive care.
Rev Bras Anestesiol. 2012 Jan-Feb;62(1):118-33. doi: 10.1016/S0034-7094(12)70110-1.
Abstract
BACKGROUND AND OBJECTIVES: To update and review the application of dexmedetomidine in anesthesia and intensive care. This study is a comprehensive review of clinical uses, pharmacology, pharmacokinetics, mechanism of action and adverse effects of dexmedetomidine.CONTENT: The effective use of sedative-hypnotic agents and analgesics is an integral part of comfort and safety of patients. Dexmedetomidine is a potent and highly selective α-2 adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties, which has been described as a useful and safe adjunct in many clinical applications. It provides a unique "conscious sedation", analgesia, without respiratory depression. The current reviewed uses include sedation at Intensive Care Unit-ICU (both adult and pediatric), emergency department, regional and general anesthesia, neurosurgery, sedation for pediatric procedures, awake fiber-optic intubation, cardiac surgery and bariatric surgery. CONCLUSIONS: Dexmedetomidine offers a unique ability of providing both sedation and analgesia without respiratory depression. It is a new agent with a wide safety margin, excellent sedative capacity and moderate analgesic properties. Although its wide use is currently in patients of surgical and non-surgical intensive care units, dexmedetomidine seems to have promising future applications in neuroprotection, cardioprotection and renoprotection. More detailed studies are required to define its role as sedative in critical, neurosurgical and pediatric patients, as anesthesia adjunct and sedative during procedures.

Dexmedetomidina: un adyuvante que se adentra en la práctica clínica.
Dexmedetomidine: an adjuvant making large inroads into clinical practice.
Ann Med Health Sci Res. 2013 Oct;3(4):475-83. doi: 10.4103/2141-9248.122044.
Abstract
The introduction of newer more selective α(-2) adrenergic agonist, dexmedetomidine has made a revolution in the field of anesthesia owing to its varied application. The aim of the current review is to highlight the various clinical and pharmacological aspects of dexmedetomidine in daily routine practice of anesthesiology and intensive care besides its potential role in other clinical specialties. This review of dexmedetomidine was carried out after searching the medical literature in Pubmed, Science direct, Scopus, Google scholar and various text books and journal articles using keywords anesthesia, dexmedetomidine, neurosurgery, pediatric surgery, regional dexmedetomidine, anesthesia, regional, neurosurgery, and pediatric surgery. Dexmedetomidine has made its application from a novel sedating agent in the intensive care unit to its use as an adjuvant in various regional anesthetic techniques because of its "cooperative sedation" without any respiratory depression. It has a favorable pharmacokinetic profile suitable to be used in the perioperative period to reduce the requirements of opioids and anesthetic drugs. There are few side-effects of dexmedetomidine, which should always be kept in mind before choosing the patients for its use. The various side-effects associated with dexmedetomidine include, but are not limited to hypotension, bradycardia, worsening of heart block, dry mouth, and nausea. However, large scale randomized controlled trials are still needed to establish various effects of dexmedetomidine and to clearly define its safety profile.
KEYWORDS: Dexmedetomidine; General anesthesia; Regional anesthesia; α−2 adrenergic agonist

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Anestesiología y Medicina del Dolor

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miércoles, 13 de diciembre de 2017

Dexmedetomidina peridural / epidural dexmedetomidine

Diciembre 13, 2017. No. 2931
Estsudio comparativo de dexmedetomidina y fentanil como coadyuvantes peridurales de bupivacaína en cirugía de extremidades inferiores
A comparative study of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries.
Paul A, Nathroy A, Paul T.
J Med Sci 2017;37:221-6
Abstract
Background: Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in patients undergoing lower limb surgeries. Fentanyl as an adjuvant to epidural local anesthetic has been used for a long time. Dexmedetomidine is a potent and highly selective α-2-adrenoceptor agonist with analgesic potency. Aim: The aim of the present study was to compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. Materials and Methods: Sixty patients belonging to the American Society of Anesthesiologists' Grade I or II who were undergoing lower limb surgery were randomly divided into two groups. Group BD: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 1 ml of 100 μg dexmedetomidine + 1 ml of normal saline. Group BF: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 2 ml of 100 μg fentanyl. Onset and maximum level of sensory blockade, time to attain maximum sensory level, time to complete motor blockade, time for two-segment regression, duration of analgesia and motor block, heart rate, and blood pressure were observed. Pain and sedation were assessed by numerical rating scale and Ramsay Sedation Scale, respectively. Data were recorded and statistically analyzed. Results:The onset of sensory blockade and time to attain maximum sensory level in Group BD were earlier than that of Group BF (P < 0.001). Duration of analgesia and motor blockade in Group BD were significantly more than that of Group BF (P < 0.001). Postoperative visual analog scale was reduced statistically significantly in Group BD (P < 0.001). Conclusion: Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl with higher analgesic property.
Keywords: Dexmedetomidine, fentanyl, epidural, anesthesia

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Anestesiología y Medicina del Dolor

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lunes, 1 de mayo de 2017

Dexmedetomidina / Dexmedetomidine

Mayo 1, 2017. No. 2676






La neuroprotección inducida por dexmedetomidina: ¿es translacional?
Transl Perioper Pain Med. 2016;1(4):15-19.
Dexmedetomidine-induced neuroprotection: is it translational?
Wang Y1, Han R2, Zuo Z3.
Abstract
Dexmedetomidine is often used in anesthesia and critical care medicine practice to sedate patients. Its neuroprotective effects have been shown in various ischemic and hemorrhagic brain injury models of animals. Randomized clinical trials have indicated that dexmedetomidine can improve outcome of patients under intensive care. Clinical trials are needed to determine whether dexmedetomidine can provide neuroprotection against ischemic and hemorrhagic stroke.
KEYWORDS: Dexmedetomidine; ICU; ischemic stroke; neuroprotection

Vacante para Anestesiología Pediátrica
El Hospital de Especialidades Pediátricas de León, Guanajuato México 
ofrece un contrato laboral en el departamento de anestesiología 
Informes con la Dra Angélica García Álvarez 
angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028
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Anestesiología y Medicina del Dolor

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lunes, 23 de enero de 2017

Enero 23, 2017. No. 2578



  



Dexmedetomidina versus midazolam en sedación para procedimientos. Revisión sistemática de eficacia y seguridad
Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.
PLoS One. 2017 Jan 20;12(1):e0169525. doi: 10.1371/journal.pone.0169525. eCollection 2017.
Abstract
OBJECTIVES: To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. MATERIALS AND METHODS: We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications. RESULTS: We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar. CONCLUSIONS: Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.

Comparación de sedación con midazolam-ketamina versus propofol-fentanil durante endoscopía en niños
A comparison of sedation with midazolam-ketamine versus propofol-fentanyl during endoscopy in children: a randomized trial.
Eur J Gastroenterol Hepatol. 2017 Jan;29(1):112-118.
Abstract
PURPOSE: We aimed to compare the efficacy and safety of midazolam plus ketamine versus fentanyl plus propofol combination administered to children undergoing upper gastrointestinal endoscopy (UGE) and to determine the most appropriate sedation protocol.
CONCLUSION: In children, UGE procedures can be quite comfortable when using the midazolam-ketamine combination. However, adverse effects related to ketamine were observed during recovery.

Concentraciones plasmáticas de midazolam después de premedicación anestésica en la rutina clínica.
Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study : Midazolam plasma concentration after anesthesia premedication.
BMC Anesthesiol. 2016 Oct 24;16(1):105.
Abstract
BACKGROUND: Midazolam is commonly used as a pre-anesthesia anxiolytic. It`s elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction. 
CONCLUSIONS: The elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia.
KEYWORDS: Anesthesia; Anxiolysis; Midazolam; Premedication
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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