ABSTRACT
En los últimos años se ha observado un incremento notable en el uso de los opioides en España, por lo que queda ampliamente superada nuestra tradicional posición en el furgón de cola de los prescriptores de opioides en Europa. Este crecimiento se ha reflejado también en el tratamiento de uno de los síndromes dolorosos de mayor prevalencia: el dolor raquídeo. Sin embargo, la eficacia de los opioides administrados de forma crónica para el tratamiento del dolor raquídeo no está clara, aunque cada vez sí son más patentes los riesgos que hemos de asumir: adicción, conductas aberrantes, probable incremento en el tiempo de incapacidad laboral y múltiples efectos secundarios, como la hiperalgesia o el estreñimiento rebelde al tratamiento. Teniendo en cuenta una relación riesgo/beneficio estrecha para este tratamiento, planteamos que estos fármacos sólo los han de prescribir facultativos que puedan realizar un seguimiento atento de los pacientes, pacientes en los que se han agotado otras opciones terapéuticas, incluidas diferentes técnicas antiálgicas y a los cuales habremos informado ampliamente de su correcta utilización y posibles efectos secundarios (AU)
In the last few years there has been a notable increase in the use of opioids in our country, overcoming our traditional position at the end of the queue of opioid prescribers in Europe. This growth has also been reflected in the treatment of highly prevalent pain syndromes, such as spinal pain. However, the efficacy of opioids administered chronically for spinal pain is not clear, due to the risks that have to be assumed being obvious: addiction, aberrant behaviour, probable increase in time off sick and the many secondary effects, such as hyperalgesia or persistent constipation with treatment. Taking into account the narrow risk/benefit ratio for this treatment, we assume that these drugs have been prescribed only by physicians who can closely follow up the patients, patients in whom other options are exhausted, including different analgesic techniques and those who will have been amply informed on their correct use and possible side effects (AU)
Subject(s)
Humans , Medulla Oblongata , Low Back Pain/drug therapy , Analgesics, Opioid/pharmacokinetics , Analgesia/methods , Risk FactorsABSTRACT
INTRODUCTION: Generally, high-grade gliomas and head and neck tumors have decreased loco-regional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increases in radiation resistance to radiotherapy. The aim of this study was to analyze the effect of cervical spinal cord electrical stimulation (cSCS) on cerebral blood flow in patients with those tumors. PATIENTS AND METHODS: We have evaluated 27 cancer patients with 12 with high grade gliomas and 15 with advanced head and neck tumors, who had cSCS devices placed after tumor diagnoses and before the commencement initiating of radio-chemotherapy. They were 12 high grade gliomas and 15 advanced head and neck tumors. Before and after cSCS, cerebral blood flow was assessed bilaterally by transcranial Doppler. RESULTS: During cSCS there was a significant (p<0.001) increase in systolic (mean > 22%) and diastolic (> 29%) blood-flow velocities in both, healthy and tumor middle cerebral arteries. The analyses by subgroup of tumors showed similarly significant outcomes findings. CONCLUSIONS: The results suggest that neuro-stimulation spinal cord electrical stimulation can increase cerebral blood flow in cancer patients. The implication is that this technique could be useful in modifying locoregional ischemia in brain tumors thus improving the outcomes of after radio-chemotherapy. Further research is in progress to confirm the advantages of the technique.
Subject(s)
Brain Neoplasms/blood supply , Cerebrovascular Circulation , Electric Stimulation Therapy , Glioma/blood supply , Head and Neck Neoplasms/blood supply , Middle Cerebral Artery/physiopathology , Spinal Cord/physiopathology , Adult , Aged , Antineoplastic Agents/pharmacokinetics , Blood Flow Velocity , Brain Neoplasms/physiopathology , Brain Neoplasms/therapy , Female , Glioma/physiopathology , Glioma/therapy , Head and Neck Neoplasms/physiopathology , Head and Neck Neoplasms/therapy , Hemoglobins/analysis , Humans , Male , Middle Aged , Neck , Radiation Tolerance , Research Design , Treatment Outcome , Ultrasonography, Doppler, TranscranialABSTRACT
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Subject(s)
Male , Female , Middle Aged , Humans , Anesthesiology/legislation & jurisprudence , Intubation, Intratracheal/adverse effects , Lacerations/etiology , Malpractice , Trachea/injuries , Equipment Failure , Internship and Residency , Intubation, Intratracheal/instrumentation , Professional-Family Relations , Risk Factors , Rupture/etiology , Truth Disclosure , Vocal Cord Paralysis/etiologyABSTRACT
We report the case of a man diagnosed with cervical spinal stenosis who underwent a C3-C6 bilateral laminectomy. In the immediate postoperative period he developed subcutaneous emphysema and pneumomediastinum caused by tracheal laceration. Continuous airflow (1 L x min(-1)) through the outer cuff was applied during the operation to compensate for air leak when loss of balloon cuff pressure was detected.
Subject(s)
Intubation, Intratracheal/adverse effects , Pulmonary Ventilation , Trachea/injuries , Aged , Humans , Intubation, Intratracheal/instrumentation , MaleABSTRACT
Exponemos el caso de un paciente diagnosticado deestenosis del canal medular cervical y sometido a laminectomíabilateral C3-C6, que en el postoperatorioinmediato desarrolló un enfisema subcutáneo y neumomediastinoocasionado por una laceración traqueal.Durante la intervención, al detectar pérdida de presiónen el balón de neumotaponamiento, aplicamos un flujocontinuo de aire (1 L min-1) a través del manguito externopara evitar la fuga aérea
We report the case of a man diagnosed with cervicalspinal stenosis who underwent a C3-C6 bilateral laminectomy.In the immediate postoperative period he developedsubcutaneous emphysema and pneumomediastinumcaused by tracheal laceration. Continuous airflow (1L·min-1) through the outer cuff was applied during theoperation to compensate for air leak when loss of ballooncuff pressure was detected
Subject(s)
Male , Aged , Humans , Intubation, Intratracheal/adverse effects , Pulmonary Ventilation , Trachea/injuries , Intubation, Intratracheal/instrumentationABSTRACT
BACKGROUND: Tumour ischaemia leads to decreased delivery of oxygen, chemotherapy and radiosensitisers. Hypoxia in head and neck (H&N) tumours is an important adverse prognostic factor. Spinal cord stimulation (SCS) is a well-established neurosurgical technique in the treatment of several ischaemic syndromes. This prospective study evaluated the effect of cervical-SCS on common carotid artery (CCA) blood flow and tumour oxygenation in patients with advanced H&N cancer. PATIENTS AND METHODS: Sixteen patients with advanced H&N tumours were enrolled. Cervical-SCS devices were inserted subcutaneously prior to commencement of scheduled chemoradiotherapy. Pre- and post-SCS measurements were as follows: (i) tumour oxygenation (mmHg) using polarographic probes; (ii) blood flow quantification (ml/min) and diastolic and systolic velocimetry (cm/s) in the CCA using colour Doppler. RESULTS: After SCS, median tumour oxygenation increased in two-thirds of patients (34%; P = 0.023), all patients had improved CCA blood flow (50%; P <0.001) and almost all patients showed an increased CCA diastolic velocity (26%; P = 0.003) and systolic velocity (20%; P = 0.011). CONCLUSIONS: Cervical-SCS increased tumour oxygenation and CCA blood flow, and could enhance the loco-regional delivery of oxygen, radiosensitising and chemotherapeutic drugs. Cervical-SCS as adjuvant in chemoradiotherapy of these tumours warrants further investigation.
