Sufentanil reduces emergence delirium in children undergoing transthoracic device closure of vsd after sevoflurane-based cardiac anesthesia

Abstract Objective: The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods: From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results: There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F (P<0.05). No serious anesthesia or drug-related side effects occurred. Conclusions: Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.

El bloqueo terapéutico de ganglio estrellado en el contexto actual / The therapeutic block of the stellate ganglion in the current setting

Introducción: El bloqueo terapéutico de ganglio estrellado es un procedimiento para aliviar dolores crónicos de miembros superiores, cabeza y cuello. Actualmente se realiza con anestésicos locales más adyuvantes; pero en Cuba sólo se usan anestésicos locales para este bloqueo. Objetivo: Cotejar información reciente sobre la pertinencia del uso de anestésicos locales con adyuvantes, para estimular la actualización de su práctica nacional acorde a las rutinas y los resultados de esta pericia en el contexto internacional. Métodos: Se revisaron más de 150 informes científicos en línea, referentes a esta técnica a nivel mundial, respecto al uso de drogas y resultados terapéuticos, en bases de datos en inglés, español y portugués. Desarrollo: El bloqueo anestésico precisa conocimientos de farmacología y habilidades prácticas para efectuarlo. La necesidad de anestésicos locales y adyuvantes varía, y depende del paciente y tipo de bloqueo. Para tratar el dolor crónico se usan también opioides, solos y con anestésicos locales. Se publican además beneficios razonables con el uso de ketamina y esteroides en combinación con anestésicos locales. Conclusión: Los resultados terapéuticos más intensos y duraderos que se obtienen al aplicar anestésico local más adyuvante, sugieren actualizar estas prácticas a nivel nacional(AU)

Introduction: The therapeutic block of the stellate ganglion is a procedure for relieving chronic pain of the upper limbs, head, and neck. It is currently performed with more adjuvant local anesthetics, but in Cuba only local anesthetics are used for this block. Objective: To compare recent information about the relevance of using local anesthetics with adjuvants to stimulate the updating of their practice nationally, according to the routines and the outcomes of this expertise in the international setting. Methods: More than 150 scientific reports were reviewed online, referring to this technique worldwide, regarding drug use and therapeutic outcomes, in databases in English, Spanish, and Portuguese. Development: The anesthetic block requires knowledge about pharmacology and practical skills to perform it. The need for local anesthetics and adjuvants varies, and depends on the patient and type of block. Opioids are also used to treat chronic pain, alone or with local anesthetics. Reasonable benefits are also published regarding the use of ketamine and steroids in combination with local anesthetics. Conclusion: The most intense and lasting therapeutic outcomes obtained by applying more adjuvant local anesthetic suggest updating these practices nationally(AU)

The role of NMDA receptor antagonists, amantadine and memantine, in schizophrenia treatment: a systematic review

Abstract Objective Schizophrenia is a complex and chronic psychiatric disorder. In recent years, studies have found glutamatergic system participation in its etiopathogenesis, especially through aberrant NMDA receptors functioning. Thus, drugs that modulate this activity, as amantadine and memantine, could theoretically be used in its treatment. To perform a systematic literature review about memantine and amantadine use as adjunct in schizophrenia treatment. Methods A systematic review of papers published in English indexed in the electronic database PubMed ® using the terms "memantine", "amantadine" and "schizophrenia" published until October 2016. Results We found 144 studies, 8 selected for analysis due to meet the objectives of this review. Some of these have shown benefits from such drug use, especially in symptoms measured by PANSS and its subdivisions, while others do not. Discussion: The data in the literature about these drugs use for schizophrenia treatment is still limited and have great heterogeneity. Thus, assay with greater robustness are needed to assess real benefits of these drugs as adjuvant therapy.

Eficacia de la dexametasona como coadyuvante en bloqueo interescalénico / Efficacy of dexamethasone as an adjuvant anesthetic in interscalene block

Introducción: El dolor posterior a una cirugía ortopédica de hombro puede ser intenso. La anestesia regional, en la forma de bloqueo interescalenico del plexo braquial, con frecuencia es empleada ya sea como coadyuvante de la anestesia general o como técnica anestésica única. Objetivo: Determinar si la prolongación de la analgesia postoperatoria obtenida con el uso de la dexametasona como coadyuvante a los anestésicos locales se genera por un efecto local sobre la vaina nerviosa o por un efecto de absorción sistémica. Materiales y Métodos: Ensayo clínico prospectivo, comparativo, aleatorizado, simple ciego. Se estudiaron 70 pacientes sometidos a cirugías artroscópicas de hombro divididos en dos grupos, empleando dos vías de administración de dexametasona: Grupo N1 (Sistémico I.M, 34 pacientes) y Grupo N2 (Vaina, 36 pacientes). Se registraron: edad, sexo, peso, talla, IMC, A.S.A, tipo y duración de la cirugía, confort postoperatorio, E.V.A en S.R.PA, necesidad de analgésicos en internación, duración de analgesia postoperatoria y duración del bloqueo motor. Resultados: La duración de la analgesia postoperatoria fue significativamente mayor en el grupo N2 con un promedio de 17,8 ± 6,2 hs vs. 13,9 ± 5,8 hs (p= 0,0045). La duración del bloqueo motor en el grupo N2 fue superior comparado al Grupo N1 (11,8 ± 4,5 hs vs 10,1 ± 4 hs; p= 0,048). El confort registrado fue similar en ambos grupos (p= 0,56). Hasta el alta hospitalaria el 94,4 por ciento de los pacientes en el grupo N2 no recibió analgésicos de rescate, mientras que para el grupo N1 el 85,3 por ciento no requirió del mismo (p= 0,38). Conclusión: La dexametasona, como coadyuvante administrada en el bloqueo interescalenico del plexo braquial, prolonga la duración de la analgesia postoperatoria como la del bloqueo motor, por un mecanismo de acción local y directo sobre la transmisión nociceptiva. Diseño del estudio: Terapéutico. Nivel de evidencia: I.

Resultados imediatos da herniorrafia inguinal com anestesia local associada com sedaçäo / Immediate results of inguinal hernia repair with local anesthesia associated with sedation

OBJETIVO: Avaliar os resultados imediatos da herniorrafia inguinal com anestesia local associada com sedaçäo. MÉTODOS: Foram operados 30 pacientes portadores de hérnia inguinal, sendo 26 (86,6 por cento) do sexo masculino e 4 (13,4) do sexo feminino. Os anestésicos utilizados foram lidocaína a 1 por cento e bupivacaína a 0,5 por cento sem adrenalina, tendo sido adicionado 1mL de bicarbonato de sódio para cada 9mL da soluçäo anestésica. A sedaçäo foi realizada com midazolan. As hérnias mais freqüentes, de acordo com a classificaçäo de Nyhus, foram as do tipo I, encontradas em 16 (53,3 por cento) pacientes. Praticou-se o reparo da parede posterior a em 17 (56,6 por cento) e em 13 (43,2 por cento) o reparo com prótese. Para a análise estatística utilizou-se o teste de McNemar para avaliar a correlaçäo entre os escores de dor na escala E.V.A. agrupada. RESULTADOS: Em nenhum paciente houve necessidade de mudança da técnica anestésica. Entre as complicações, observaram-se: 1 (3,3 por cento) hematoma; 1 (3,3 por cento) sangramento e 1 (3,3 por cento) infecçäo da ferida operatória. A deambulaçäo foi precoce em 28 (93,3 por cento) pacientes, assim como a alimentaçäo oral. O tempo de internaçäo médio foi 18 horas, e o escore de dor na escala visual analógica (E.V.A.) foi menor ou igual a 3 em 80 por cento dos pacientes. CONCLUSÄO: A anestesia local com sedaçäo é um método seguro, eficaz, com baixos índices de complicações imediatas, e alto índice de satisfaçäo para pacientes selecionados, portadores de hérnia inguinal

Anestesia para cirugía laparoscópica: rol del N2O / Anesthesic for laparoscopic surgery: the N2O role

El advenimiento de la laparoscopia ha sido un hito en la evolución científica de la anestesiología. Desde la publicación por Steptoe en 1967 sobre la técnica de laparoscopia ginecológica se incician las investigaciones en anestesia para los procedimientos endoscópicos. La creación del neumoperitoneo alertó al anestesiólogo sobre las consecuencias hemodinámicas y alteraciones de la función respiratoria ocasionadas por la insuflación de dióxido de carbono (CO2) en la cavidad abdominal. El uso de óxido nitroso (N2O) durante la laparoscopia ha sido debatido ampliamente. En términos generales hoy podemos aseverar que el uso de N2O como coadyuvante de la técnica anestésica general ofrece ventajas y disminuye los efectos negativos derivados de la Cirugía Laparoscópica.

Respiratory mechanics and morphometric changes during anesthesia with ketamine in normal rats

Ketamine is believed to reduce airway and pulmonary tissue resistance. The aim of the present study was to determine the effects of ketamine on the resistive, elastic and viscoelastic/inhomogeneous mechanical properties of the respiratory system, lungs and chest wall, and to relate the mechanical data to findings from histological lung analysis in normal animals. Fifteen adult male Wistar rats were assigned randomly to two groups: control (N = 7) and ketamine (N = 8). All animals were sedated (diazepam, 5 mg, ip) and anesthetized with pentobarbital sodium (20 mg/kg, ip) or ketamine (30 mg/kg, ip). The rats were paralyzed and ventilated mechanically. Ketamine increased lung viscoelastic/inhomogeneous pressure (26 percent) compared to the control group. Dynamic and static elastances were similar in both groups, but the difference was greater in the ketamine than in the control group. Lung morphometry demonstrated dilation of alveolar ducts and increased areas of alveolar collapse in the ketamine group. In conclusion, ketamine did not act at the airway level but acted at the lung periphery increasing mechanical inhomogeneities possibly resulting from dilation of distal airways and alveolar collapse

Comparative study of intrathecal pethidine versus lignocaine as an anaesthetic and a postoperative analgesic for perianal surgery.

100 patients with ASA risk I & II and undergoing perianal surgery were studied for anaesthetic effects and postoperative analgesia following either intrathecal pethidine or lignocaine. Saddle block was performed either with intrathecal pethidine 5% (50 mg/ml) 0.5 mg/kg or 1 ml of 5% lignocaine. Sensory and motor block postoperative analgesia, need for additional analgesia were studied. The onset of sensory and motor blockade with lignocaine was faster than pethidine. However the sensory and motor blockade lasted longer with pethidine. The duration of postoperative analgesia was 15.39 +/- 5.14 hours as against duration of postoperative analgesia with lignocaine which was 1.3 +/- 0.53 hours. Only 10% of patients in the pethidine group required intramuscular analgesic supplementation whereas 30% of patients in the lignocaine group required intramuscular analgesic supplementation.