Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
1.
Rev. esp. anestesiol. reanim ; 64(4): 206-213, abr. 2017. tab, graf
Article in Spanish | IBECS | ID: ibc-160995

ABSTRACT

Introducción. El objetivo de este estudio fue evaluar el efecto de diferentes dosis de carga de dexmedetomidina (formulación Dexdor®) en el tiempo para lograr y mantener un nivel óptimo de sedación, y su repercusión hemodinámica. Material y métodos. Estudio observacional aprobado por el CEIC-Navarra en pacientes programados para cirugía oral y maxilofacial ambulatoria con dexmedetomidina en la Clínica Universidad de Navarra entre febrero de 2013 y noviembre de 2014. En función de la dosis de carga los pacientes fueron agrupados en 3 categorías:<0,5; 0,5; y>0,5μg/kg. El nivel óptimo de sedación se definió como un índice biespectral<85. Los datos se analizaron utilizando técnicas de análisis de supervivencia. Los requerimientos de fármacos vasoactivos fueron evaluados mediante regresión logística exacta. Resultados. Ochenta y un pacientes fueron evaluados. La hazard ratio de alcanzar un índice biespectral<85 para los pacientes de los grupos de 0,5 y>0,5μg/kg fue de 1,5 (IC 95% 0,9; 2,6) y 1,8 (IC 95% 0,8; 3,9), respectivamente, en comparación con el grupo inferior. Cinco pacientes (6,2%) precisaron de atropina. Los pacientes en el grupo de>0,5μg/kg mostraron mayor riesgo de requerir atropina respecto al grupo de<0,5μg/kg (odds ratio 2,2; IC 95% 0,03; 183). Conclusión. Una dosis de carga de Dexdor®>0,5μg/kg parece reducir el tiempo necesario para alcanzar y mantener un nivel óptimo de sedación durante los primeros 60min de procedimiento. La posible relación entre la dosis de carga y los requerimientos de atropina precisa una investigación más exhaustiva (AU)


Introduction. Dexdor® do not include the possibility of loading dose, which could increase time to achieve adequate sedation for ambulatory procedures. The objective of this study was to evaluate the effect of several loading dose of dexmedetomidine in the time to achieve and maintain an optimal level of sedation and its clinical hemodynamic repercussion. Material and methods. The IRB approved this observational study for patients that underwent oral and maxillofacial ambulatory surgery under dexmedetomidine at the University of Navarra Clinic from February 2013 to November 2014. According to the loading dose the patients were grouped into 3 categories:<0.5, 0.5, and>0.5μg/kg. Optimal level of sedation was defined as bispectral index<85. Data were analyzed using survival analysis techniques. Vasoactive drugs requirements was evaluated using exact logistic regression. Results. Eighty-one patients were evaluated. Hazard ratios for patients in 0.5 and >0.5μg/kg loading dose categories for achieving a bispectral index<85 were 1.5 (95% CI 0.9, 2.6) and 1.8 (95% CI 0.8, 3.9), respectively, compared with the lowest category. Five patients (6.2%) required atropine for bradycardia. Patients in the group>0.5μg/kg showed greater risk of requiring atropine compared with the group<0.5μg/kg (odds ratio 2.2; 95% CI 0.03, 183). Conclusion. Loading dose of dexmedetomidine>0.5μg/kg appears minimize the time to achieve and maintain an optimal level of sedation during the first 60min of procedure. Further investigation to elucidate the association between loading dose of dexmedetomidine and subsequent atropine requirements may be warranted (AU)


Subject(s)
Humans , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Conscious Sedation/methods , Surgery, Oral/methods , Surgery, Oral , Dexmedetomidine/therapeutic use , Dose-Response Relationship, Drug , Vasodilator Agents/therapeutic use , Oral Surgical Procedures/methods , Spectrum Analysis/methods , Ambulatory Care/methods , Atropine/therapeutic use , Odds Ratio
2.
Rev Esp Anestesiol Reanim ; 64(4): 206-213, 2017 Apr.
Article in English, Spanish | MEDLINE | ID: mdl-27825666

ABSTRACT

INTRODUCTION: Dexdor® do not include the possibility of loading dose, which could increase time to achieve adequate sedation for ambulatory procedures. The objective of this study was to evaluate the effect of several loading dose of dexmedetomidine in the time to achieve and maintain an optimal level of sedation and its clinical hemodynamic repercussion. MATERIAL AND METHODS: The IRB approved this observational study for patients that underwent oral and maxillofacial ambulatory surgery under dexmedetomidine at the University of Navarra Clinic from February 2013 to November 2014. According to the loading dose the patients were grouped into 3 categories:<0.5, 0.5, and>0.5µg/kg. Optimal level of sedation was defined as bispectral index<85. Data were analyzed using survival analysis techniques. Vasoactive drugs requirements was evaluated using exact logistic regression. RESULTS: Eighty-one patients were evaluated. Hazard ratios for patients in 0.5 and >0.5µg/kg loading dose categories for achieving a bispectral index<85 were 1.5 (95% CI 0.9, 2.6) and 1.8 (95% CI 0.8, 3.9), respectively, compared with the lowest category. Five patients (6.2%) required atropine for bradycardia. Patients in the group>0.5µg/kg showed greater risk of requiring atropine compared with the group<0.5µg/kg (odds ratio 2.2; 95% CI 0.03, 183). CONCLUSION: Loading dose of dexmedetomidine>0.5µg/kg appears minimize the time to achieve and maintain an optimal level of sedation during the first 60min of procedure. Further investigation to elucidate the association between loading dose of dexmedetomidine and subsequent atropine requirements may be warranted.


Subject(s)
Deep Sedation/methods , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Oral Surgical Procedures , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Surgical Procedures , Female , Humans , Male , Middle Aged , Time Factors , Young Adult
3.
Rev. esp. anestesiol. reanim ; 59(supl.1): 25-37, nov. 2012. tab, ilus
Article in Spanish | IBECS | ID: ibc-138628

ABSTRACT

La cirugía de fosa posterior y/o región craneorraquídea presenta una elevada tasa de morbimortalidad postoperatoria, escasamente descrita en la literatura científica. El propósito de esta revisión es describir las evidencias disponibles en la bibliografía respecto a las complicaciones asociadas y su manejo neuroanestesiológico y/o neurocrítico; así como resaltar los factores predisponentes que pueden influir en el incremento de la tasa de complicaciones.El conocimiento de las complicaciones relacionadas con la patología neuroquirúrgica de la fosa posterior, puede ayudar a su prevención o a la instauración de un tratamiento adecuado que permita minimizar sus consecuencias. Con este objetivo, en las diferentes bases de datos bibliográficos se realizó una búsqueda sistemática, en castellano e inglés, con los artículos comprendidos entre 1966 y 2012. Además se revisaron los manuscritos que se consideraron relevantes en las pesquisas bibliográficas identificadas. La emesis y el dolor postoperatorio son las complicaciones postoperatorias más frecuentemente descritas, seguida por el edema de la lengua y/o vía aérea, la afectación de pares craneales y la aparición de fístula de líquido cefalorraquídeo durante el postoperatorio. El resto de complicaciones fueron referidas como poco frecuentes. La cirugía de fosa posterior y craneorraquídea cervical posterior tiene mayor morbilidad y mortalidad que la cirugía del compartimento supratentorial. Además de las complicaciones de toda craneotomía, la cirugía infratentorial presenta complicaciones específicas. El trabajo en equipo entre todas las especialidades y estamentos implicados en la atención al paciente es fundamental para disminuir la morbimortalidad asociada a estos procedimientos (AU)


Surgery of the posterior fossa and/or craniospinal region has a high rate of postoperative morbidity and mortality, which has rarely been described in the scientific literature. This review aims to describe the available evidence in the literature on the complications associated with this type of surgery and its neuroanesthesiological and/or neurocritical management, as well as to highlight the predisposing factors that can increase the complications rate. Knowledge of the complications related to neurosurgical disorders of the posterior fossa could aid in their prevention or help in the selection of appropriate treatment that would minimize their consequences. A systematic literature search was made in Spanish and English for articles published between 1966 and 2012 in various databases. Articles considered important in the identified literature were reviewed. The most frequently described postoperative complications were vomiting and postoperative pain, followed by edema of the tongue and/or airway, involvement of the cranial nerves, and the development of cerebrospinal fluid fistulas. The remaining complications were reported as being uncommon. Posterior fossa and posterior cervical surgery produces higher morbidity and mortality than surgery of the supratentorial space. In addition to the complications involved in all craniotomies, infratentorial surgery has specific complications. Team work among all the specialties and staff involved in the care of these patients is essential to reduce the morbidity and mortality associated with these procedures (AU)


Subject(s)
Female , Humans , Male , Neuropharmacology/methods , Neuropharmacology/trends , /methods , Postoperative Nausea and Vomiting/chemically induced , Postoperative Nausea and Vomiting/prevention & control , Postoperative Complications/drug therapy , Cerebrospinal Fluid , Macroglossia/drug therapy , Mutism/drug therapy , Meningitis/drug therapy , Indicators of Morbidity and Mortality , Cranial Nerve Diseases/complications
4.
Rev Esp Anestesiol Reanim ; 50(2): 77-9, 2003 Feb.
Article in Spanish | MEDLINE | ID: mdl-12712869

ABSTRACT

OBJECTIVE: To evaluate the efficiency of a formula for predicting the optimal length of catheter inserted through the right internal jugular vein. PATIENTS AND METHOD: A prospective study in which the length of catheter to insert was calculated by the following formula: (height in cm/10)-1 cm. Punctures were approximately at the cricoid cartilage and length was measured from the point of insertion. Catheter tip placement was confirmed by anteroposterior chest film, read by a radiologist blinded as to the objective of the study. The position was considered optimal if the catheter tip was in the distal portion of the superior vena cava. Patients enrolled required insertion of a central venous line for therapy or monitoring and were excluded if they had risk factors that could predispose them to poor placement. RESULTS: Fifty-eight catheterizations were performed. Three of them were excluded due to poor positioning in the contralateral subclavian vein. Among the 55 remaining patients, we observed the catheter tip in the superior vena cava in 52 cases and in the right atrium in 3. CONCLUSIONS: The aforementioned formula predicted appropriate placement of the catheter tip in 94.54% of the patients.


Subject(s)
Algorithms , Catheterization, Central Venous , Jugular Veins , Catheterization, Central Venous/instrumentation , Equipment Design , Female , Heart Atria/diagnostic imaging , Humans , Jugular Veins/diagnostic imaging , Male , Prospective Studies , Radiography , Single-Blind Method , Vena Cava, Superior/diagnostic imaging
5.
Rev. esp. anestesiol. reanim ; 50(2): 77-79, feb. 2003.
Article in Es | IBECS | ID: ibc-22435

ABSTRACT

OBJETIVO: Evaluar la eficiencia de una fórmula para predecir la longitud óptima de inserción de un catéter a través de la vena yugular interna derecha. PACIENTES Y MÉTODO: Estudio prospectivo en el que se insertaba los catéteres una longitud calculada con la fórmula: (Talla en cm/10) - 1 cm. Las punciones se realizaron aproximadamente a nivel del cartílago cricoides. Las longitudes se midieron desde la inserción en piel. Las posiciones de la puntas de los catéteres fueron confirmadas mediante una placa de tórax anteroposterior, e informadas por un radiólogo que desconocía los fines del estudio. La posición se consideró óptima si la punta del catéter estaba situada en la porción distal de la vena cava superior. Se incluyeron en el estudio pacientes que requerían una vía venosa central para terapia o monitorización. Se excluyeron del estudio aquellos pacientes con factores que podrían predisponer a la malposición del catéter venoso. RESULTADOS: Se realizaron un total de 58 canulaciones, 3 de las cuales se excluyeron del estudio por malposicionamiento en vena subclavia contralateral. De las 55 restantes, 52 se hallaron con la punta del catéter en vena cava superior, y 3 con la punta dentro de la aurícula derecha. CONCLUSIONES: Mediante la fórmula anteriormente descrita, se predijo la adecuada colocación de la punta del catéter en el 94,54 por ciento de los pacientes (AU)


Subject(s)
Male , Female , Humans , Catheterization, Central Venous , Algorithms , Jugular Veins , Vena Cava, Superior , Prospective Studies , Equipment Design , Heart Atria , Single-Blind Method
SELECTION OF CITATIONS
SEARCH DETAIL
...