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1.
Rev. esp. anestesiol. reanim ; 69(8): 487-492, Oct. 2022. tab
Article in Spanish | IBECS | ID: ibc-210288

ABSTRACT

La dexmedetomidina (DEX) es un agente anestésico que mimetiza el sueño profundo natural y produce una mínima depresión cardiorrespiratoria, convirtiéndose en una opción muy valiosa en el manejo de un paciente tan exigente como es el pediátrico. El objetivo principal de esta mini revisión fue centrarse en el papel de la DEX como analgésico en el período perioperatorio de niños sometidos a anestesia. Se realizó una búsqueda bibliográfica, entre 2010 y 2021, en Google, Pubmed, Embase y Cochrane Library. Se repasaron diferentes aspectos como su farmacología, efectividad, seguridad y la evidencia más reciente sobre su uso clínico como analgésico en anestesia pediátrica. Igualmente se incluyó una estimación de coste del tratamiento analgésico perioperatorio con DEX.(AU)


Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.(AU)


Subject(s)
Humans , Infant , Child , Adolescent , Dexmedetomidine , Analgesia , Perioperative Period , Anesthesia , Pediatrics , Analgesics , Pain Management , Pharmacokinetics , Databases, Bibliographic , PubMed , Cardiopulmonary Resuscitation , Anesthesiology
3.
Rev Esp Anestesiol Reanim (Engl Ed) ; 69(8): 487-492, 2022 10.
Article in English | MEDLINE | ID: mdl-36100555

ABSTRACT

Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.


Subject(s)
Analgesia , Anesthesia , Dexmedetomidine , Analgesics , Child , Dexmedetomidine/pharmacology , Dexmedetomidine/therapeutic use , Humans
5.
Article in English, Spanish | MEDLINE | ID: mdl-34049712

ABSTRACT

Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.

6.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(3): 167-175, 2020 Mar.
Article in English, Spanish | MEDLINE | ID: mdl-32085919

ABSTRACT

The number of caesarean sections performed worldwide is increasing, and with it, the need for the optimal analgesia strategies. Deficient postoperative analgesia increases the need for opioids, delays recovery, and is associated with chronic pain and postpartum depression. It is essential to find good postoperative pain control strategies that facilitate early mobility, early recovery, and early hospital discharge with minimal side effects on the mother and infant. Multimodal analgesia based on neuroaxial anaesthesia with morphine in combination with non-opioids such as non-steroidal anti-inflammatory drugs and paracetamol, gives the best post-caesarean analgesia outcome, and allows anaesthesiologists to reserve opioids, corticoids, gabapentin, magnesium or ketamine for situations where neuroaxial anaesthesia cannot be performed, for high-risk patients, or when pain is difficult to control. Peripheral nerve block techniques can also be added, such as transverse abdominis plane block, erector spinae block, or continuous wound infiltration.


Subject(s)
Analgesia, Obstetrical/methods , Analgesics, Opioid/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cesarean Section , Morphine/administration & dosage , Pain, Postoperative/therapy , Acetaminophen/administration & dosage , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Opioid/adverse effects , Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Chronic Pain/therapy , Clonidine/administration & dosage , Epinephrine/administration & dosage , Female , Humans , Morphine/adverse effects , Neostigmine/administration & dosage , Nerve Block/methods , Pregnancy
7.
Rev Esp Anestesiol Reanim (Engl Ed) ; 66(9): 459-466, 2019 Nov.
Article in English, Spanish | MEDLINE | ID: mdl-31582277

ABSTRACT

INTRODUCTION: Quality improvement in health care entails the design of reliable processes which prevent and mitigate medical errors. Checklists are cognitive tools which reduce such errors. The primary objective of this study was to design an anesthetic checklist in Pediatrics to be implemented in our hospital. METHODS: Delphi technique was used, with 3 rounds of questionnaire surveys: a generic questionnaire to obtain dimensions and items; and 2 specific ones to score individual items and obtain an overall rating for the checklist (median), and to measure the level of consensus (relative interquartile range) and internal reliability (Wilcoxon signed-rank test). RESULTS: Final version of the checklist obtained a high overall score (Med 9) with a very high consensus (RIR 5%). Internal consensus was reached on all items (RIR ≤ 30%). Wilcoxon signed-rank test found no statistically significant differences, demonstrating reliability or consistency of responses between consecutive rounds. CONCLUSION: The Anesthetic checklist in Pediatrics has been methodically designed for implementation and use in our hospital.


Subject(s)
Anesthesia/standards , Checklist/standards , Medical Errors/prevention & control , Pediatrics/standards , Quality Improvement , Checklist/methods , Consensus , Delphi Technique , Feedback , Health Care Surveys/standards , Humans , Patient Safety , Quality of Health Care , Reproducibility of Results , Statistics, Nonparametric , Surveys and Questionnaires/standards
11.
Rev Esp Anestesiol Reanim ; 64(2): 79-85, 2017 Feb.
Article in English, Spanish | MEDLINE | ID: mdl-27400891

ABSTRACT

OBJECTIVES: Total knee arthroplasty is associated with severe postoperative pain. The aim of this study was to compare continuous ultrasound-guided femoral nerve block with continuous epidural analgesia, both with low concentrations of local anaesthetic after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomised, unblinded study of 60 patients undergoing total knee replacement, randomised into two groups. A total of 30 patients received continuous epidural block, while the other 30 received continuous ultrasound-guided femoral nerve block, as well as using 0.125% levobupivacaine infusion in both groups. Differences in pain control, undesirable effects, and complications between the two techniques were assessed, as well as the need for opioid rescue and the level of satisfaction with the treatment received during the first 48hours after surgery. RESULTS: No differences were found in demographic and surgical variables. The quality of analgesia was similar in both groups, although in the first six hours after surgery, patients in the epidural group had less pain both at rest and with movement (P=.007 and P=.011). This difference was not observed at 24hours (P=.084 and P=.942). Pain control at rest in the femoral block group was better at 48hours after surgery than in the epidural group (P=.009). The mean consumption of morphine and level of satisfaction were similar. Epidural analgesia showed the highest rate of side effects (P=.003). CONCLUSIONS: Continuous ultrasound-guided femoral nerve block provides analgesia and morphine consumption similar to epidural analgesia, with the same level of satisfaction, but with a lower rate of side effects after total knee arthroplasty.


Subject(s)
Analgesia, Epidural , Arthroplasty, Replacement, Knee , Femoral Nerve/drug effects , Nerve Block/methods , Pain Management/methods , Pain, Postoperative/prevention & control , Ultrasonography, Interventional , Aged , Analgesics, Opioid/therapeutic use , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Bupivacaine/analogs & derivatives , Female , Humans , Ketoprofen/administration & dosage , Ketoprofen/adverse effects , Ketoprofen/analogs & derivatives , Levobupivacaine , Male , Middle Aged , Nerve Block/adverse effects , Pain, Postoperative/drug therapy , Patient Satisfaction , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Tromethamine/administration & dosage , Tromethamine/adverse effects
14.
Rev Esp Anestesiol Reanim ; 63(5): 301-4, 2016 May.
Article in Spanish | MEDLINE | ID: mdl-26277650

ABSTRACT

Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.


Subject(s)
Arteriovenous Fistula/surgery , Fluid Therapy , Heart Failure/surgery , Arteriovenous Fistula/diagnosis , Cerebral Angiography , Craniotomy , Humans , Infant , Male
15.
Rev Esp Anestesiol Reanim ; 63(2): 91-100, 2016 Feb.
Article in Spanish | MEDLINE | ID: mdl-25866132

ABSTRACT

Pediatric neuraxial anesthesia is an effective tool that can be used as a supplement or alternative to general anesthesia. However, there have always been doubts about its usefulness and risk-benefit ratio. The purpose of this review is to describe the current role of central blockades in pediatric patients, upgrade practical and safety aspects, and review the latest technological advances applied to this procedure.


Subject(s)
Anesthesia, General , Anesthesia, Conduction , Child , Humans , Risk Assessment
17.
Rev Esp Anestesiol Reanim ; 61(10): 549-56, 2014 Dec.
Article in Spanish | MEDLINE | ID: mdl-24742791

ABSTRACT

OBJECTIVE: To determine the prevalence of pain in medical and surgical patients admitted to reference hospitals in Andalusia, as well as their features and the most population groups most affected. MATERIAL AND METHODS: A cross-sectional, multicenter epidemiological study was conducted simultaneously on the population admitted to 5 hospitals. Using a structured questionnaire the demographics, hospital area, presence of pain at the time of the interview, and pre- and post-variables related to the intensity of pain and its treatment at 24h were investigated. All patients over 18 years old were included, except those patients with difficulty in understanding the questionnaire, and psychiatric and obstetric patients. Pain intensity was assessed by simple verbal scale. RESULTS: Of the 1,236 patients included, 54.2% were male, with 51.1% of patients aged 65 years, and 69.17% were admitted to medical areas. Pain was observed in 52.9% of patients admitted to the surgical area compared to 29.4% in the medical area. Of the 19.4% who reported having had pain in the last 24h prior to the questionnaire, 57.7% of them were surgical patients and 32% were medical, P<.005), and of the 42.2% who had pain at the time of study, 52.7% were female. The incidence of pain on movement was higher than that observed at rest. The mean resting pain was 1.8 and 1.4 for the surgical and medical patients, respectively (P<.01). The mean pain on movement was 2.2 and 1.6 for the surgical and medical patients, respectively (P<.01). More than one quarter (25.8%) of surgical patients and 16.5% of medical patients had difficulty sleeping (P<.005). Some 12.8% of all patients had no analgesic regimen, and 66.2% and 85.6% of surgical and medical patients, respectively, did not request analgesics (P<.005). The main drugs were prescribed paracetamol analgesic and metamizole, and in 54.4% of patients. CONCLUSIONS: We believe that the presence of pain in patients admitted to our study population is high and it is essential to encourage an improvement in the pain management of both acute and chronic pain processes.


Subject(s)
Pain/epidemiology , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Hospitals, Public , Humans , Male , Middle Aged , Pain/complications , Pain Management , Prevalence , Spain , Young Adult
18.
Rev. Soc. Esp. Dolor ; 19(5): 264-272, sept.-oct. 2012. ilus
Article in Spanish | IBECS | ID: ibc-107394

ABSTRACT

El hombro doloroso es una entidad que encontramos en nuestra práctica diaria con relativa frecuencia. Con la introducción de la ultrasonografía, se abre un campo novedoso ya que podemos explorar, localizar e infiltrar exactamente la zona lesionada. La ecografía permite una exploración en la misma consulta, así como la capacidad de realizar una exploración dinámica. El hombro se compone de 5 articulaciones: 3 verdaderas (esternoclavicular, acromioclavicular y glenohumeral) y 2 denominadas falsas (subacromial y escapulotorácica). Siempre que sea posible, intentaremos realizar la punción en plano, intentando visualizar el trayecto completo de la aguja y la punta de la misma. En el intervencionismo del hombro esto es bastante fácil de conseguir puesto que se trata de estructuras muy superficiales. Es muy poco probable que se produzcan daños graves durante la infiltración del hombro. Tendremos especial cuidado de no puncionar estructuras vasculares (AU)


Painful shoulder is an entity that we find in our daily practice with relative frequency. With the introduction of ultrasound, opens a new field that we can explore, locate and exactly infiltrate the injured area. Ultrasound allows an exploration in the same act, as well as the ability to make a dynamic scanning. The shoulder is made up of 5 joint: true 3 (sternoclavicular, acromioclavicular and glenohumeral) and 2 known as false (subacromial and thoracic scapula). Wherever possible, we will try to puncture in plane, trying to display the full path of the needle and the tip of it. In the interventionism of the shoulder, this is quite easy to get since it’s very superficial structures. It is highly unlikely any serious damage during the infiltration of the shoulder. Take special care of non piercing vascular structures (AU)


Subject(s)
Humans , Male , Female , Shoulder Joint , Shoulder Pain/therapy , Shoulder Pain , Shoulder/pathology , Shoulder , Tendons/pathology , Tendons , Pulsed Radiofrequency Treatment/trends , Pulsed Radiofrequency Treatment
20.
Rev. Soc. Esp. Dolor ; 18(5): 283-290, sept.-oct. 2011. tab, ilus
Article in Spanish | IBECS | ID: ibc-93642

ABSTRACT

Desde la introducción en España de la primera morfina de administración oral, en el año 1988, se ha ido evolucionando en la biodisponibilidad de fármacos opioides potentes no administrados por vía endovenosa. Las formulaciones que permiten la absorción de estos fármacos por la piel o por la mucosa oral han supuesto un antes y un después en la administración de medicación analgésica. Posteriormente, las nuevas formas de liberación inmediata o liberación controlada han acabado de perfilar la seguridad y eficacia de estos nuevos fármacos opioides. Tapentadol retard es un fármaco analgésico de acción central de última generación, aprobado tanto por la EMA (“European Medicines Agency”) en 2010 como recientemente por la Agencia Española de Medicamentos y Productos Sanitarios (“AEMPS”) para el tratamiento del dolor crónico intenso. La sinergia de sus dos mecanismos de acción, el agonismo μ-opioide y la inhibición de la recaptación de noradrenalina permite abordar el dolor desde diferentes mecanismos fisiológicos. Tapentadol retard se absorbe rápidamente tras su administración oral y es excretado casi exclusivamente vía renal. Así como la eficacia analgésica de otros opioides, como codeína y tramadol dependen de su actividad metabólica, la analgesia producida por tapentadol se debe a la acción de la molécula principal, sin metabolitos farmacológicamente activos. Los trabajos analizados en esta revisión demuestran la eficacia de tapentadol retard en el tratamiento del dolor de moderado a intenso en pacientes con dolor lumbar crónico, dolor crónico por artrosis de rodilla o cadera y también en pacientes con dolor por neuropatía diabética. En aspectos de seguridad, este fármaco presenta un perfil de tolerabilidad superior al de los analgésicos opioides actuales, lo cual le confiere un potencial importante en el tratamiento de dolor por procesos crónicos. En esta revisión bibliográfica se hace análisis del mecanismo de acción de tapentadol retard, de su farmacocinética y farmacodinamia, eficacia y seguridad y de su intercambiabilidad respecto a analgésicos opioides (AU)


Since the first orally administered morphine was introduced in Spain back in 1988 the bioavailability of potent opioid drugs to be administered via a route other than the intravenous one has increasingly evolved. Formulations allowing these drugs to be absorbed via the skin or oral mucosa have made a major difference in the administration of analgesic medication. Later still, novel immediate-release or controlled-release forms have finished off the positive efficacy and safety profile of these new opioid drugs. Tapentadol retard is a latest-generation, central-acting pain killer that was approved by the EMA (European Medicines Agency) in 2010 and recently by Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) for the treatment of severe chronic pain. The synergy between its two mechanisms of action -- μ-opioid agonism and noradrenalineuptake inhibition -- allows approaching pain from two different physiological aspects. Tapentadol retard is rapidly absorbed following oral administration, and excreted almost exclusively by the kidneys. While the analgesic efficacy of other opioids, including codeine and tramadol, depend upon their metabolic actions, the analgesia resulting from tapentadol administration derives from its primary molecule’s action, with no active metabolites involved. The papers analyzed in this review show the efficacy of tapentadol retard in the management of moderate to severe pain in patients with chronic low-back pain, chronic knee or hip osteoarthritis, and diabetic neuropathy. Regarding safety, this drug has a superior tolerability profile when compared to current opioid analgesics, which confers a significant potential for the treatment of pain resulting from chronic conditions. This literature review analyzes tapentadol retard’s mechanism of action, pharmacokinetics, pharmacodynamics, efficacy, and safety, as well as its exchangeability for opioid pain killers (AU)


Subject(s)
Humans , Male , Female , Pain/drug therapy , Analgesics, Opioid/therapeutic use , Receptors, Opioid , Oxycodone/therapeutic use , Tramadol/therapeutic use , Opioid Peptides/pharmacology , Opioid Peptides/pharmacokinetics , Opioid Peptides/therapeutic use
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