Asistolia tras terapia electroconvulsiva / Asistole after electroconvusise therapy

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Analgesia basada en infusión continua de anestésico local a nivel interfascial tras cirugía de colon laparoscópico: ensayo clínico / Analgesia with interfascial continuous wound infiltration after laparoscopic colon surgery: a randomized clinical trial

Objetivos. Tanto para cirugía laparoscópica como para cirugía abierta la analgesia multimodal puede ayudar a controlar el dolor postoperatorio. La colocación de un catéter en la herida quirúrgica de manera intraoperatoria tras cirugía de colon podría optimizar el control del dolor con menor consumo de opiáceos y menos efectos secundarios. Método. Realizamos un estudio prospectivo, aleatorizado de pacientes reclutados para cirugía de colon laparoscópica en el Hospital de Galdakao-Usansolo de enero de 2012 a enero de 2013. Los pacientes fueron asignados aleatoriamente al grupo del catéter o al grupo de la analgesia postoperatoria estándar. Un miembro de la Unidad de dolor agudo monitorizó todos los pacientes a lo largo de 48 h tras la cirugía. Las variables principales analizadas fueron la escala numérica verbal y la cantidad de morfina intravenosa utilizada por cada paciente mediante PCA. Resultados. Se incluyeron 92 pacientes en el estudio, 43 en el grupo con catéter y 49 en el estándar. Se observaron diferencias estadísticamente significativas en el consumo de morfina entre ambos grupos a lo largo de todo el periodo. La cantidad total de morfina consumida en el grupo del catéter fue de 5,63 ± 5,02 mg y de 21,86 ± 17,88 mg en el grupo de analgesia estándar (p = 0,0001). Los pacientes con catéter presentaban menores valores en la escala numérica verbal. No se encontraron efectos adversos asociados a la colocación del catéter y la administración de anestésico local. El grupo de catéter presentó menor estancia hospitalaria respecto al otro grupo (p = 0,02). Conclusión. En los pacientes intervenidos de cirugía de colon laparoscópico una infusión continua de anestésico local a través de un catéter interfascial durante 48 h tras la cirugía reduce la percepción del dolor y el consumo de morfina intravenosa, disminuyendo la estancia hospitalaria (AU)

Objectives. For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. Methods. We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion. Results. 92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63 ± 5.02 mg among wound catheter patients and 21. 86 ± 17.88 mg among control patients (P = .0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P = .02). Conclusions. In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48 h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays (AU)

Analgesia with interfascial continuous wound infiltration after laparoscopic colon surgery: A randomized clinical trial.

OBJECTIVES: For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. METHODS: We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion. RESULTS: 92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63±5.02mg among wound catheter patients and 21. 86±17.88mg among control patients (P=.0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P=.02). CONCLUSIONS: In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays.

Fospropofol: un nuevo profármaco del propofol / Fospropofol: a new prodrug of propofol

En la última década el desarrollo de las nuevas formulaciones de propofol ha avanzado rápidamente, llegando hasta la comercialización de un profármaco de propofol: el fospropofol, farmacológicamente diferente al compuesto original. Se trata de un compuesto hidrosoluble que precisa de la metabolización del profármaco en propofol, lo que conlleva un decalaje de tiempo entre el momento de su administración y la aparición del efecto farmacológico. Sus características farmacocinéticas y farmacodinámicas son diferentes a la fórmula original. Debido a su formulación no produce dolor a la inyección intravenosa, ni produce hiperlipidemia, y no favorece el sobrecrecimiento bacteriano. Aunque actualmente no está disponible en España, está aprobado por la FDA (Food and Drug Administration) para la sedación en procedimientos monitorizados tanto diagnósticos como terapéuticos en adultos y debe de ser administrado únicamente por personal cualificado para la administración de anestesia y, los pacientes deben de ser monitorizados durante todo el procedimiento(AU)

The development of new propofol formulations has advanced rapidly in the last ten years with the achievement of the marketing a new prodrug of propofol: fospropofol, pharmacologically different from the original compound. It is a water soluble compound that requires metabolism of the prodrug to propofol, which leads to a time delay between its administration and the appearance of its pharmacological effect. Its pharmacokinetic and pharmacodynamic characteristics are different to the original formula. Due to its formulation it does not cause pain on intravenous injection, does not lead to hyperlipidaemia or excess bacterial growth. Although it is currently unavailable in Spain, it has been approved by the FDA (American Food and Drug Administration) for sedation in controlled care in diagnostic and therapeutic procedures in adults. It must only be administered by personnel qualified to administer anaesthesia, and the patients must be monitored throughout the whole procedure(AU)

[Fospropofol: A new prodrug of propofol]. / Fospropofol: un nuevo profármaco del propofol.

The development of new propofol formulations has advanced rapidly in the last ten years with the achievement of the marketing a new prodrug of propofol: fospropofol, pharmacologically different from the original compound. It is a water soluble compound that requires metabolism of the prodrug to propofol, which leads to a time delay between its administration and the appearance of its pharmacological effect. Its pharmacokinetic and pharmacodynamic characteristics are different to the original formula. Due to its formulation it does not cause pain on intravenous injection, does not lead to hyperlipidaemia or excess bacterial growth. Although it is currently unavailable in Spain, it has been approved by the FDA (American Food and Drug Administration) for sedation in controlled care in diagnostic and therapeutic procedures in adults. It must only be administered by personnel qualified to administer anaesthesia, and the patients must be monitored throughout the whole procedure.

Mastocitosis sistémica: manejo perioperatorio. A propósito de dos casos / No disponible

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[Fascia iliaca compartment block for analgesia following total hip replacement surgery]. / Bloqueo iliofascial para analgesia postoperatoria de prótesis total de cadera.

OBJECTIVE: The objective of this pilot study was to evaluate the effectiveness of the fascia iliaca compartment block to control pain following total hip replacement by assessing pain intensity 24 hours after surgery and recording the use of opiates for rescue analgesia. MATERIAL AND METHODS: We performed a prospective observational study of 41 patients undergoing total hip replacement surgery. The patients were divided into 2 groups: a group that received a fascia iliaca compartment block with 0.45% ropivacaine at a dosage of 0.3 mL/kg (maximum dose, 30 mL) and a control group in which no block was performed. Patients were enrolled consecutively as they entered the postanesthetic recovery unit. Postoperative pain was assessed on a visual analog scale (VAS) immediately after surgery and 24 hours later. Other variables recorded were opiate use for rescue analgesia and adverse effects due to the use of opiates. RESULTS: The VAS scores recorded in the postanesthetic recovery unit were significantly different in the 2 groups, with lower scores in the group receiving the fascia iliaca compartment block (P < .001). However, no significant between-group differences were observed in VAS scores recorded on the ward 24 hours after surgery (P = .57). CONCLUSIONS: A single-injection fascia iliaca compartment block was effective in controlling initial postoperative pain in a postanesthetic recovery unit. It was effective on the ward in the first few hours after surgery but not for the entire 24-hour period because of the limited duration of the block.

Bloqueo iliofascial para analgesia postoperatoria de prótesis totalde cadera / Fascia iliaca compartment block for analgesia following total hip replacement surgery

OBJETIVO: El objetivo de este estudio preliminar esmedir la efectividad del bloqueo iliofascial en el controldel dolor postoperatorio tras la colocación de prótesistotal de cadera, en cuanto a la intensidad del dolor 24horas tras la intervención y el consumo de opiáceos derescate.MATERIAL Y MÉTODOS: Estudio observacional, prospectivo,de cohortes, en el que se han incluido a 41 pacientesoperados de prótesis total de cadera, los cuales fuerondivididos en 2 grupos según se les practicara (grupo bloqueo)o no (grupo control) bloqueo iliofascial con ropivacaínaal 0,45%, 0,3 ml/kg (dosis máxima 30 ml). Se realizóun muestreo consecutivo simple según iban ingresandoen la Unidad de Recuperación Postanestésica. El dolorpostoperatorio se midió inmediatamente tras la intervencióny 24 horas después mediante una escala visual analógica.Otras variables de resultado evaluadas fueron elconsumo de opiáceos de rescate y la presencia de efectossecundarios derivados del uso de opiáceos.RESULTADOS: Se han encontrado diferencias estadísticamentesignificativas en las puntuaciones de la escalavisual analógica en la unidad de recuperación postanestésicaentre ambos grupos, obteniendo el grupo bloqueouna puntuación en la escala visual analógica menor queel grupo control (p < 0,001). Sin embargo, no hubo diferenciassignificativas entre ambos grupos respecto a laspuntuaciones de la escala visual analógica en la sala dehospitalización a las 24 horas (p = 0,57).CONCLUSIONES: El bloqueo iliofascial en inyecciónúnica es efectivo para el control del dolor postoperatorioinicial en la unidad de recuperación postanestésica. Posteriormenteen la sala es eficaz en las primeras horas deestancia, aunque no llega a cubrir las 24 horas por lalimitación de duración del bloqueo (AU)

OBJECTIVE: The objective of this pilot study was toevaluate the effectiveness of the fascia iliaca compartmentblock to control pain following total hip replacement byassessing pain intensity 24 hours after surgery andrecording the use of opiates for rescue analgesia.MATERIAL AND METHODS: We performed a prospectiveobservational study of 41 patients undergoing total hipreplacement surgery. The patients were divided into 2groups: a group that received a fascia iliaca compartmentblock with 0.45% ropivacaine at a dosage of 0.3 mL/kg(maximum dose, 30 mL) and a control group in which noblock was performed. Patients were enrolledconsecutively as they entered the postanesthetic recoveryunit. Postoperative pain was assessed on a visual analogscale (VAS) immediately after surgery and 24 hours later.Other variables recorded were opiate use for rescueanalgesia and adverse effects due to the use of opiates.RESULTS: The VAS scores recorded in thepostanesthetic recovery unit were significantly differentin the 2 groups, with lower scores in the group receivingthe fascia iliaca compartment block (P<.001). However,no significant between-group differences were observedin VAS scores recorded on the ward 24 hours aftersurgery (P=.57).CONCLUSIONS: A single-injection fascia iliacacompartment block was effective in controlling initialpostoperative pain in a postanesthetic recovery unit. Itwas effective on the ward in the first few hours aftersurgery but not for the entire 24-hour period because ofthe limited duration of the block (AU)

Reflexión sobre la situación actual de los tutores docentes y la docencia de anestesiología y reanimación en nuestro país / No disponible

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Oxicodona en el dolor crónico no oncológico / Oxycodone for the treatment of chronic noncancer pain

En nuestro país, más de 4 millones y medio sufren dolor crónico y de este porcentaje, más de la mitad sufren dolor intenso. La artritis reumatoide y la artrosis son las principales causas de este dolor según la Encuesta Europea del Dolor. La elección del fármaco analgésico adecuado para el control del dolor moderado-severo es importante para aumentar la calidad de vida de estos pacientes cada vez más longevos. Como nueva opción terapéutica tenemos a la Oxicodona, según la OMS la clasifica como un fármaco que se utilizaría en el segundo escalón cuando se combina con AINES (ampliamente utilizado en EEUU desde 1950), ya que le proporciona un efecto techo (1) y como tercer escalón cuando se utiliza sola, tanto la oxicodona de liberación. controlada como la de liberación inmediata (2). La oxicodona se usa desde 1917 y ha sido utilizada en humanos de forma intravenosa, intramuscular, intranasal, subcutánea, rectal, epidural y oral. La vía transdérmica ha sido testada en animales. Hoy en día la oxicodona de liberación prolongada es utilizada en el dolor crónico y la de liberación inmediata es usada más para el tratamiento del dolor agudo y el dolor irruptivo. La oxicodona parenteral (no disponible en nuestro país todavía) parece ser una buena alternativa cuando no es posible utilizar la vía oral

Chronic pain is suffered by over 4 and a half million persons in Spain, and over half of these persons suffer intense pain. According to the European Pain Questionnaire, rheumatoid arthritis and arthrosis are the principal cause of this type of pain. It is important to choose a suitable analgesic drug for moderatesevere pain control, thus increasing the quality of life of these patients who are increasingly long living. Oxycodone offers a new therapeutic option. It is classified by the WHO as a drug to be used as a step two drug when combined with a NSAID (widely used in the US since 1950), since it has a ceiling effect (1), and as a step three drug when used alone, in both controlled-release and immediate-release formulations alike. (2) Oxycodone has been used since 1917 and has been given to humans in intravenous, intramuscular, intranasal, subcutaneous, rectal, epidural and oral routes. Transdermal administration has been tested in animals. Nowadays controlled-release oxycodone is used in chronic pain and immediate-release oxycodone is used more to treat acute pain and breakthrough pain. Parenteral oxycodone (not yet available in this country) appears to offer a good alternative when it is not possible to use the oral route

[Propofol: new formulations]. / Propofol: nuevas formulaciones.

Few pharmacologically new anesthetics have appeared in recent years, but great progress has been made toward improving some existing ones. Such is the case with propofol. New formulations have been developed to reduce or avoid adverse side effects associated with the original drug produced by Astra-Zeneca. The unwanted effects for which solutions have been sought are pain upon intravenous injection of the drug, elevated serum concentrations of triglycerides, and the risk of bacterial contamination. Some new formulations contain excipients with bactericidal action, such as propofol with ethylenediaminetetraacetic acid or metabisulfite, and others use lipuro rather than intralipid. Other more advanced products are propofol in cyclodextrin or IDD-D propofol, which makes use of nanoparticle technology. A grasp of the pharmacokinetics and pharmacodynamics of the original formulation must be the basis for understanding the differences between these new products.

Propofol: nuevas formulaciones / Propofol: new formulations

Desde el punto de vista farmacológico en los últimosaños no han aparecido nuevos fármacos anestésicos,pero si se han producido grandes avances en la farmacologíade alguno de ellos, es el caso del propofol. Estosavances se han producido en aras de minimizar o evitarlos efectos adversos colaterales que van asociados a laadministración de la formulación original de propofol(comercializada por Astra-Zéneca). Los efectos no deseadosque se han intentado solventar son: el dolor a lainyección intravenosa del fármaco, la elevación de laconcentración sérica de triglicéridos y el riesgo de contaminaciónbacteriana. Para ello han aparecido formulacionesque contienen excipientes con acción bactericidacomo es el propofol con EDTA o con metabisulfito, formulacionesque sustituyen el intralipid por lipuro, o formulacionesmás avanzadas como es el propofol en ciclodextrinao que utilizan tecnología de nanopartículascomo el IDD-propofol. Para llegar a comprender lasdiferencias farmacológicas de las distintas formulacioneses preciso conocer las características farmacocinéticas yfarmacodinámicas de la fórmula original, que es la basede estudio del resto de ellas

Few pharmacologically new anesthetics have appearedin recent years, but great progress has been madetoward improving some existing ones. Such is the casewith propofol. New formulations have been developed toreduce or avoid adverse side effects associated with theoriginal drug produced by Astra-Zeneca. The unwantedeffects for which solutions have been sought are painupon intravenous injection of the drug, elevated serumconcentrations of triglycerides, and the risk of bacterialcontamination. Some new formulations contain excipientswith bactericidal action, such as propofol withethylenediaminetetraacetic acid or metabisulfite, andothers use lipuro rather than intralipid. Other moreadvanced products are propofol in cyclodextrin or IDDDpropofol, which makes use of nanoparticle technology.A grasp of the pharmacokinetics and pharmacodynamicsof the original formulation must be the basisfor understanding the differences between these newproducts

Influence of formulation on propofol pharmacokinetics and pharmacodynamics in anesthetized patients.

BACKGROUND: In anesthesia with propofol, variability persists besides sophisticated effect targeting. Drug formulation may be another factor. We have analyzed, retrospectively, the pharmacokinetics (PK) and pharmacodynamics (PD) in monitored surgery patients anesthetized with one each of five formulations of propofol. METHODS: Propofol 1% ('form' 1: Diprivan(Zeneca Limited, Macclesfield, UK), 2: Recofol(Schering Espana, Madrid, Spain), 3: Ivofol(Juste, Madrid, Spain), 4: Propofol Abbott (Abbott Laboratories, Madrid, Spain), 5: Fresenius (Fresenius Kabi Espana, Barcelona, Spain)) was administered to 77 ASA I-II patients of age [mean (range) 44 (18-65) years]. Induction of anesthesia was with varying propofol doses up to endpoints of either 60 on the Bispectral Index system (BIS) in group I (n = 48, model development) or standard clinical signs in group II (n = 29, validation). Maintenance was with three 10-min infusions of 10, 8 and 6 mg kg(-1) h(-1). Three blood samples were obtained from each subject, immediately after induction, and at 15 and 30 min on maintenance, with BIS and hemodynamic variables recorded at these times also. Total and free blood concentrations (Cb) of propofol were determined with HPLC. Pharmacokinetic and PD models with link equilibration rate ke0, were studied with a mixed-effects procedure (NONMEM). RESULTS: The induction dose (group I) showed large interindividual variability [mean (range) 163 (90-290 mg)] that correlated significantly with age, basal systolic blood pressure and formulation. The PK of propofol (basic model) was described by a one-compartment model with (typical value [interindividual coefficient of variation percent (CV%)]) CL=2.30 l min(-1) (27%) and V=8.40 l (80%). Weight (WT) and formulation, within NONMEM, were found to be significant covariates for CL and V, reducing their CV% to 25% and 74%, respectively. The final PK/PD model, which includes formulation, showed a 50% reduction in the CV% for both the ke0 and the residual error. This PK/PD model was validated in group II with 33% precision and no bias. CONCLUSION: The PK and PD are not equal for all formulations, which contributes to an increase in variability of the observed effect.