Infiltración amigdalar de bupivacaína y adrenalina comparada con sueron fisiolótico en cirugía amigdalar pediátrica / Tonsil infiltration of bupivacaine and adrenaline compared with physiological serum in pediatric tonsil surgerys

INTRODUCCIÓN: La cirugía adenoamigdalar constituye una de las intervenciones quirúrgicas más frecuentes en la edad pediátrica. El dolor posoperatorio, junto con la hemorragia amigdalar, son complicaciones relativamente frecuentes que aumentan la morbilidad. El empleo de infiltración de anestésicos locales en el lecho quirúrgico ha sido ampliamente utilizado para reducir el dolor posoperatorio y las comorbilidades. OBJETIVO: El objetivo de este estudio es demostrar que la infiltración de anestésico local en combinación con adrenalina reduce tanto el dolor posoperatorio como el sangrado posquirúrgico en pacientes pediátricos sometidos a cirugía amigdalar. MATERIALES Y MÉTODOS: Estudio observacional prospectivo, doble ciego y aleatorizado con 90 pacientes entre 6 y 14 años, ASA I y II, divididos en dos grupos: 45 pacientes fueron sometidos a una infiltración periamigdalar con bupivacaína 0,25 % y adrenalina y otros 45 pacientes fueron sometidos a infiltración amigdalar son suero fisiológico. Se evaluó la eficacia analgésica, así como los efectos secundarios presentados durante las primeras 6 horas del posoperatorio inmediato. RESULTADOS Y ANÁLISIS: Durante su estancia en la unidad de recuperación posanestésica (URPA) el 80 % de los pacientes que recibieron infiltración de suero salino necesitaron analgesia suplementaria frente al 13,4 % de los que recibieron infiltración con bupivacaína, siendo esta diferencia estadísticamente significativa (p < 0,05). En nuestro estudio, tres pacientes presentaron sangrado posoperatorio, todos ellos procedentes del grupo que había recibido suero salino. Dentro de los 90 pacientes incluidos, de estos tres solo dos tuvieron que ser reintervenidos para controlar el sangrado. Así, la incidencia de sangrado en este estudio fue del 3,33 %, ligeramente inferior a los hallazgos de otros estudios de la literatura actual. CONCLUSIÓN: La infiltración periamigdalar de bupivacaína con vasoconstrictor es un método seguro y eficaz para el control analgésico posoperatorio en población pediátrica sometida a cirugía amigdalar en comparación con la terapia analgésica convencional. El impacto de esta medida en la reducción del sangrado arroja nuevos estudios para aclarar el papel de los vasoconstrictores en la reducción del sangrado posoperatorio

INTRODUCTION: The adenotonsillar surgery constitutes one of the most frequent surgical interventions in the pediatric age. Postoperative pain (1) together with tonsillar hemorrhage are two relatively frequent complications that increase morbidity. The use of local anesthetic infiltration in the surgical bed has been widely used to reduce postoperative pain and comorbidities. OBJECTIVE: The objective of this study is to demonstrate that infiltration of local anesthetic in combination with adrenaline reduces both postoperative pain and post-surgical bleeding in pediatric patients undergoing tonsillar surgery.Materials and methods: Prospective, double-blind, randomized observational study with 90 patients between 6 and 14 years old, ASA I and II, divided into two groups: 45 patients underwent periamigdalar infiltration with 0.25 % bupivacaine and adrenaline and 45 other patients underwent tonsillar infiltration with physiological saline.The analgesic efficacy was evaluated, as well as the side effects presented during the first 6 hours of the immediate postoperative period. RESULTS: During their stay in the post-anesthesia recovery unit (PACU), 80 % of patients who received saline infiltration needed supplemental analgesia com-pared to 13.4 % of those who received infiltration with bupivacaine, this difference being statistically significant (p < 0.05). In our study, 3 patients presented postoperative bleeding, all of them from the group that had received saline. Within the 90 patients included, of these 3 only 2 had to be reoperated to control bleeding. Thus, the incidence of bleeding in this study was 3.33%, slightly lower than the findings of other studies in the current literature (2,3). CONCLUSION: Periamigdalar infiltration of bupivacaine with vasocontrictor is a safe and effective method for postoperative analgesic control in pediatric popu-lation undergoing tonsillar surgery compared to conventional analgesic therapy. The impact of this measure on the reduction of bleeding yields no significant results, although it is true that there seems to be a lower incidence of bleeding in patients treated with adrenaline. New studies are needed to clarify the role of vasoconstrictors in the reduction of postoperative bleeding

Characterization of the pelagic fish community of the north-western and northern Spanish shelf waters.

This study demonstrates the utility of trawl data, collected during acoustic surveys of pelagic fish stocks as a way of confirming fish identification, to characterize the pelagic community, as well as allowing description and prediction of fish distribution patterns, based on data from Spanish Atlantic Ocean shelf surveys during spring 2005-2011. The composition of the pelagic community is described, as well as spatial and temporal patterns of variation in both the community composition and the presence and importance of two of the main exploited pelagic species, sardine Sardina pilchardus and anchovy Engraulis encrasicolus. The most important species in terms of both frequency of occurrence and standardized mass in hauls were mackerel Scomber scombrus, hake Merluccius merluccius, horse mackerel Trachurus trachurus, S. pilchardus and bogue Boops boops. Multivariate analysis indicated significant effects of depth, geographical area and year on haul composition. Descriptive generalized additive models (GAM), with latitude, longitude and depth as predictors, identified clear spatial patterns in the occurrence and abundance of both S. pilchardus and E. encrasicolus, with abundance being highest closer to the coast and, in the case of E. encrasicolus, higher near the French and Portuguese borders. Further GAM analysis, using environmental variables to explain spatial patterns, revealed significant effects of depth and sea surface temperature (SST) gradient and depth on S. pilchardus importance, while E. encrasicolus importance was related to SST. The importance of both species in hauls was higher in the years of higher spawning stock biomass (SSB) and E. encrasicolus also appeared to expand its range when SSB was higher.