martes, 5 de abril de 2011

Detección de efectos secundarios asociados con la administración de tramadol y dipirona en un hospital de alta complejidad


Detección de efectos secundarios asociados con la administración de tramadol y dipirona en un hospital de alta complejidad.
Adverse events associated with tramadol and dipirona administration in a level III hospital.
Montoya GA, Vaca C, Parra MF.
Departamento de Farmacia, Hospital Universitario de La Samaritana, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.gamontoyapi@unal.edu.co <gamontoyapi@unal.edu.co>
Biomedica. 2009 Sep;29(3):369-81.
Abstract
INTRODUCTION: The efficacy and safety of pharmaceutical drugs such as dipirone and tramadol must be a primary objective in the post-marketing period and as they are used in specific population groups. OBJECTIVES: The frequency of adverse effects (including therapeutic failure) with the medications tramadol and dipirona were described and estimated.
MATERIAL AND METHODS: At the Hospital Universitario de la Samaritana, Bogotá, D.C., Colombia, adverse events associated with dipirone and tramadol were rigorously tracked in patients hospitalized in the internal medicine, as well as the orthopedics and surgery departments. For a period of six months, data were collected by means of the Instituto Nacional de Vigilancia Médica y Alimentos (INVIMA) standard report form. Direct costs of adverse event treatment to the patient were calculated. RESULTS: Adverse reactions were detected 213 times in 171 (8.4%) of the 2,547 patients admitted to the services (incidence rate. Of these instances, 53.4% were rated as possible for dipirone and 46.82% for tramadol. Of the total, 0.6% (16 cases) were classes as serious adverse events. The gastrointestinal system was the most affected, with the incidences of adverse events for dipirone of 27%) and tramadol of 42.9%. The total cost generated by the medical response to the 213 adverse events was estimated to be US$14,346.53.
CONCLUSIONS: An unacceptable level of preventable adverse events was described that impacted the well-being of patients, as well as the costs associated with remedial treatment. These data recommend that institutional pharmacovigilance programs be required.

Manejo de la sedoanalgesia y de los relajantes musculares en las unidades de cuidados intensivos pediátricos españolas.
Sedative, analgesic and muscle relaxant management in Spanish paediatric intensive care units.
Mencía S, Botrán M, López-Herce J, Del Castillo J; Grupo de Estudio de Sedoanalgesia de la SECIP.
Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España.
An Pediatr (Barc). 2011 Feb 23
Abstract
OBJECTIVE: The aim of the study was to define the strategies for the use and monitoring of sedative, analgesic, and muscle relaxant medication in Spanish paediatric intensive care units (PICU). MATERIAL AND METHODS: A questionnaire with 102 questions was sent by e-mail to all Spanish PICUs. RESULTS: Replies were received from 36 of the 45 PICUs (80%). A written protocol for sedation and analgesia was used in 64%; this medication was adjusted according to the diagnosis and clinical status of the patient in 30% of the units. Midazolam was the most widely used drug for sedation, followed by ketamine and propofol. Fentanyl was the most widely used drug for analgesia, followed by paracetamol and metamizole. The combination of midazolam and fentanyl in continuous infusion was used most frequently in patients on mechanical ventilation (MV), followed by propofol. Scales to monitor sedation and analgesia were employed in 45% of PICUs, most used the Ramsay scale. The bispectral index (BIS) was used in 50% of PICUs. Muscle relaxants were administered to 26% of patients on MV; the most common indications for MV were head injury and severe respiratory disease. The principal methods for avoiding withdrawal syndrome were a progressive withdrawal of the drugs and morphine chloride. CONCLUSIONS: Although there is insufficient scientific evidence to determine the ideal drugs for sedation and analgesia in the critically ill child and the methods for monitoring and control, the production of guidelines and written treatment and monitoring protocols could help to improve the management and control of sedation and analgesia.

http://www.elsevier.es/sites/default/files/elsevier/eop/S1695-4033(10)00581-3.pdf
 
La adición de metimazol a la morfina y paracetamol mejora la analgesia postoperatoria temprana y la satisfacción del paciente después de cirugía de discos lumbares
The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery.
Uzun S, Aycan IO, Erden IA, Sahin A, Aypar U.
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey. sennuruzun@superonline.com
Turk Neurosurg. 2010 Jul;20(3):341-7. doi: 10.5137/1019-5149.JTN.3081-10.3.
Abstract
AIM: Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery. MATERIAL AND METHODS: After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated. RESULTS: NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups. CONCLUSION: Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction

Metamisol no es tan seguro como pensamos o asumimos
Metamizole is not as safe as we think or assume.
Tekkok IH
Turk Neurosurg. 2011 Jan;21(1):116-7.
I have read the article by Uzun et al with great interest (Turkish Neurosurgery 20:341-347, 2010). The authors have designed a double-blind randomized clinical research with 63 patients undergoing surgery for lumbar disc disease. The patients were allocated into 3 groups. Group I patients received 1 gm of intravenous paracetamol and 1 gm of intravenous metamizole at the end of the operation whereas patients in Group II received only 1 gm of paracetamol at the end of the operation. Group III was the placebo group and did not receive paracetamol or metamizole. All three groups of patients were also given morphine through patient controlled
analgesia (PCA) pumps. All patients were evaluated in terms of pain (evaluated using the Numeric Pain Rating Scale [0-3]), morphine consumption and patient satisfaction at postoperative 15 and 30 minutes and 1st, 2nd, 6th and 24th hours. The graphs depicting morphine consumption showed that Group III patients consumed more than those who were given paracetamol plus metamizole or paracetamol alone. The authors concluded that addition of metamizole to paracetamol along with morphine PCA offered an advantage over single morphine PCA and paracetamol with respect to early postoperative pain treatment and patient satisfaction......

http://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_830.pdf
 

Consenso de un grupo de expertos mexicanos. Eficacia y seguridad del Metamizol (Dipirona).
Heriberto Arcila-Herrera, Sergio Barragán-Padilla, José Rafael Borbolla-Escoboza, Antonio Canto-Solís, Gilberto Castañeda-Hernández, Maximiliano de León-González, Miguel Ángel Genis-Rondero, Vinicio Granados-Soto, José Luis Gutiérrez-García,  Sonia Hernández-Hernández, Alicia Kassian-Rank, Víctor Lara-Perera, Jorge Bernardo Vargas-Correa.
Gac Méd Méx 2004;140:99-101

Antecedentes
El metamizol, también conocido como dipirona, es un agente analgésico y antipirético utilizado en México y otros países desde hace más de siete décadas. Una de las principales ventajas del metamizol es que permite un adecuado control del dolor y/o la fiebre a un costo reducido. Sin embargo, en países como los Estados Unidos, el metamizol no está disponible debido a algunos
reportes que sobre su seguridad se publicaron en el pasado. En algunas ocasiones los medios masivos de comunicación han retomado estos reportes dando información, frecuentemente anecdótica y sin el debido apoyo científico, que puede inducir a confusiones. Por lo tanto, se formó un grupo de trabajo, con médicos de distintas especialidades e investigadores básicos de diversas ciudades del país, cuyo propósito fue generar y difundir información científicamente válida sobre el metamizol en México. El grupo se ha reunido en varias ocasiones, la última en agosto de 2002, cuando llegó al consenso, que se presenta a continuación.

Atentamente
Anestesiología y Medicina del Dolor
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