ABSTRACT
La anestesia neuroaxial en pacientes portadores de dispositivos de derivación de líquido cefalorraquídeo (LCR) se ha asociado clásicamente a un alto riesgo de complicaciones. Con el fin de recabar toda la evidencia disponible, se realizó una búsqueda estructurada de los trabajos publicados en usuarios portadores de estos dispositivos, sometidos a algún tipo de técnica neuroaxial para procedimientos obstétricos o quirúrgicos no relacionados con el mismo, valorando la eficacia de la técnica y las complicaciones perioperatorias. Solo se encontraron series de casos y casos clínicos (n = 72). Se identificó uno de insuficiente cobertura anestésica, que precisó una modificación de la técnica, así como una complicación intraoperatoria con compromiso de seguridad para el sujeto. No se describió ningún caso de infección ni disfunciones posoperatorias del dispositivo relacionadas con el método anestésico. La evidencia hallada es escasa y de baja calidad, lo que no permite establecer conclusiones significativas, aunque los pacientes podrían beneficiarse de una valoración individualizada. (AU)
Neuraxial anesthesia in patients with cerebrospinal fluid (CSF) shunt devices has traditionally been associated with a high risk of complications. In order to gather all available evidence, a structured search was conducted to include published studies involving users of these devices, undergoing any form of neuraxial technique for obstetric or surgical procedures unrelated to them. Effectiveness of the technique and perioperative complications were assessed. Only case series and case reports (n = 72) were identified. One patient was found to have insufficient anesthetic coverage, necessitating a modification of the technique, and another one had an intraoperative complication which compromised the subject's safety. No infection events or postoperative device dysfunction related to the anesthetic method were described. The evidence found is scarce and of low quality, preventing the establishment of significant conclusions. Nevertheless, patients may obtain benefit from an individualized evaluation. (AU)
Subject(s)
Humans , Cerebrospinal Fluid , Hydrocephalus , Anesthesia, Epidural , AnesthesiaABSTRACT
Neuraxial anesthesia in patients with cerebrospinal fluid (CSF) shunt devices has traditionally been associated with a high risk of complications. In order to gather all available evidence, a structured search was conducted to include published studies involving users of these devices, undergoing any form of neuraxial technique for obstetric or surgical procedures unrelated to them. Effectiveness of the technique and perioperative complications were assessed. Only case series and case reports (n = 72) were identified. One patient was found to have insufficient anesthetic coverage, necessitating a modification of the technique, and another one had an intraoperative complication which compromised the subject's safety. No infection events or postoperative device dysfunction related to the anesthetic method were described. The evidence found is scarce and of low quality, preventing the establishment of significant conclusions. Nevertheless, patients may obtain benefit from an individualized evaluation.
Subject(s)
Cerebrospinal Fluid Shunts , Humans , Cerebrospinal Fluid Shunts/adverse effects , Female , Anesthesia, Epidural/methods , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/methods , Postoperative Complications/prevention & control , Postoperative Complications/etiology , PregnancyABSTRACT
Introducción: La terapia con inmunoglobulina subcutánea (IgSC) es una alternativa a la terapia intravenosa (IgIV), muy utilizada en el extranjero desde hace varios años para el tratamiento de las inmunodeficiencias humorales. Se presenta la mayor experiencia clínica con este tipo de terapia en un hospital terciario español. Además, se analizan las dos técnicas principales de administración de gammaglobulina por vía subcutánea: bomba de infusión (pump therapy) y técnica manual(push therapy), de la que no existe experiencia previa en nuestro país. Pacientes y métodos: Se realizó un estudio retrospectivo de los pacientes en tratamiento sustitutivo con IgSC durante los 2 primeros años tras su implantación en nuestro centro, siguiendo un protocolo basado en la administración de dosis semanales de IgSC equivalentes a las dosis mensuales de IgIV, y se analizaron la eficacia, la seguridad y los costes. Resultados: La muestra estuvo constituida por 13 pacientes, ocho de ellos varones, con una media de edad de 18 años, y cuya patología de base más frecuente era la inmunodeficiencia común variable (9/13). Con la terapia con IgSC se obtuvo una media de inmunoglobulina G sérica valle un 37% mayor, mientras quela tasa de infecciones/paciente/año se mantuvo baja, la mayoría leves. No se registraron episodios adversos sistémicos, mientras que las reacciones locales fueron leves y transitorias. La técnica de administración más utilizada fue la técnica manual, o pushtherapy, más económica que la administración con bomba. Conclusiones: La terapia sustitutiva con IgSC se ha implantado satisfactoriamente en nuestro centro, con muy buenos resultados de eficacia y seguridad. Según nuestra experiencia, la técnica manual posee algunas ventajas respecto a la administración con bomba de infusión que la hacen preferible en la práctica clínica diaria, si bien son necesarios más estudios controlados con muestras más grandes(AU)
Background and objectives: The subcutaneous G immunoglobulin therapy (SCIg) is a common alternative to intravenous therapy (IVIg) in the treatment of humoral immunodeficiencies in many countries. We present the largest clinical experience with this type of therapy in a tertiary hospital in Spain. The two main techniques for subcutaneous administration are also analized: pump therapy, or infusion by pump, and push therapy, or manual infusion, emphasizing that there is no previous experience with the latter in our country. Patients and methods: A retrospective study was performed of the patients in SCIg therapy during the first two years after the establishment of the therapy in our center, following a protocol based in SCIg weekly doses equal to monthly IVIg doses, analyzing efficacy, security and costs. Results: 13 patients were recluted, 8 of them males, with a median age of 18, and the most frequent primary disease was CVID (9/13). SCIg therapy resulted in 37% higher seric gammaglobulin trough levels, while the infection rate remained low, most of them mild infections No systemic adverse events were registered, although local reactions where very common but mild and transient. The most commonly used technique was push therapy, which was more economic than pump therapy. Conclusions: The subcutaneous IgG replacement therapy has been satisfactorily established in our center, obtaining good results in efficacy and safety. Regarding our experience, the manual technique or push therapy has several advantages compared to the pump therapy that makes it preferable for the daily clinical practice, although larger series, randomized controlled trials are necessary(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Immunoglobulins/therapeutic use , Immunization, Passive , Immunologic Deficiency Syndromes/therapy , Immunoglobulins, Intravenous/therapeutic use , Infusion Pumps/trends , Infusion Pumps , Infusions, Intravenous , Costs and Cost Analysis/methods , Costs and Cost Analysis/standards , Immunity, Humoral/physiology , Retrospective Studies , Clinical Protocols/standards , Treatment Outcome , Evaluation of the Efficacy-Effectiveness of InterventionsABSTRACT
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