sábado, 17 de octubre de 2015

Morfina, remifentanil, hiperalgesia

Octubre 17, 2015. No. 2117Octubre, mes de lucha contra cáncer de mama.
Anestesia y Dolor

Morfina intratecal atenúa tolerancia opioide aguda secundaria a remifentanil en cirugía espinal en adolescentes
Intrathecal morphine attenuates acute opioid tolerance secondary to remifentanil infusions during spinal surgery in adolescents.
J Pain Res. 2015 Sep 22;8:637-40. doi: 10.2147/JPR.S88687. eCollection 2015.
Abstract
INTRODUCTION: The unique pharmacokinetic properties of remifentanil with a context-sensitive half-life unaffected by length of infusion contribute to its frequent use during anesthetic management during posterior spinal fusion in children and adolescents. However, its intraoperative administration can lead to increased postoperative analgesic requirements, which is postulated to be the result of acute opioid tolerance with enhancement of spinal N-methyl-D-aspartate receptor function. Although strategies to prevent or reduce tolerance have included the coadministration of longer acting opioids or ketamine, the majority of these studies have demonstrated little to no benefit. The current study retrospectively evaluates the efficacy of intrathecal morphine (ITM) in preventing hyperalgesia following a remifentanil infusion. METHODS: We retrospectively analyzed 54 patients undergoing posterior spinal fusion with segmental spinal instrumentation, to evaluate the effects of ITM on hyperalgesia from remifentanil. Patients were divided into two groups based on whether they did or did not receive remifentanil during the surgery: no remifentanil (control group) (n=27) and remifentanil (study group) (n=27). Data included demographics, remifentanil dose and duration, Wong-Baker visual analog scale postoperative pain scores, and postoperative intravenous morphine consumption in the first 48 postoperative hours. RESULTS: The demographics of the two study groups were similar. There were no differences in the Wong-Baker visual analog scale pain scores in the postanesthesia care unit and on postoperative days 1 and 3. Pain scores were higher in the remifentanil group on postoperative day 2 (2.9 vs 3.8). Postoperative morphine requirements were similar between the two groups (0.029 vs 0.017 mg/kg/48 h for the control group and the study group, respectively). CONCLUSION: In patients receiving preincisional ITM during spinal surgery, intraoperative remifentanil does not increase postoperative analgesic requirements.
KEYWORDS: idiopathic scoliosis; intrathecal morphine; opioid tolerance; posterior spinal fusion; remifentanil; segmental spinal instrumentation
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Modulo CEEA Leon, Gto.      XII Congreso Virtual Mexicano de Anestesiologia


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015

martes, 13 de octubre de 2015

Combo de pediatría/Pediatric combo

Anestesia y Medicina del Dolor

CEEA Leon, Gto  
Guía basada en evidencias para la sedación preoperatoria en niños
An Evidence-Based Guideline for the Pre-Operative Sedation of Children
Fradkin DM, Scott-Warren VL, Vashisht R, Rolfe SE
J Pediatr Neonatal Care 2015;2(6): 00095. DOI: 10.15406/jpnc.2015.02.00095
 
Evaluación del propofol en niños y adolescentes con obesidad mórbida
Evaluation of propofol anesthesia in morbidly obese children and adolescents.
BMC Anesthesiol. 2013 Apr 21;13:8. doi: 10.1186/1471-2253-13-8. eCollection 2013.
Sedación pediátrica: Retos y oportunidades
Pediatric dental sedation: challenges and opportunities.
Clin Cosmet Investig Dent. 2015 Aug 26;7:97-106. doi: 10.2147/CCIDE.S64250. eCollection 2015.
 
Tendencias en la muerte asociadas con la sedación dental pediátrica y anestesia general.
Trends in death associated with pediatric dental sedation and general anesthesia.
Paediatr Anaesth. 2013 Aug;23(8):741-6. doi: 10.1111/pan.12210. Epub 2013 Jun 14.
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 Infiltración periamigdalina pre-emptiva con bupivacaína-tramadol mejora el dolor post amigdalectomía pediátrica mejor que bupivacaína o tramadol solos.
Preemptive peritonsillar infiltration with bupivacaine in combination with tramadol improves pediatric post-tonsillectomy pain better than using bupivacaine or tramadol alone: A randomized, placebo-controlled, double blind clinical trial.
Adv Biomed Res. 2015 Jul 27;4:132. doi: 10.4103/2277-9175.161518. eCollection 2015.
Revisión sobre sedación para endoscopias gastrointestinales en niños por no-anestesiólogos
Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists.
World J Gastrointest Endosc. 2015 Jul 25;7(9):895-911. doi: 10.4253/wjge.v7.i9.895.
PDF 
Modulo CEEA Leon, Gto. 


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015

Cannabis en cáncer

Anestesia y Medicina del Dolor

Cannabis en cáncer
Cannabis in cancer care.
Clin Pharmacol Ther. 2015 Jun;97(6):575-86. doi: 10.1002/cpt.108. Epub 2015 Apr 17.
Abstract
Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Cannabinoids, the active components of Cannabis sativa, mimic the effects of the endogenous cannabinoids (endocannabinoids), activating specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function. Delta-9-tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy-induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer-related pain, possibly synergistic with opioid analgesics. Cannabinoids have been shown to be of benefit in the treatment of HIV-related peripheral neuropathy, suggesting that they may be worthy of study in patients with other neuropathic symptoms. Cannabinoids have a favorable drug safety profile, but their medical use is predominantly limited by their psychoactive effects and their limited bioavailability.
Modulo CEEA Leon, Gto. Curso CEEA Tijuana  XII Congreso Virtual Mexicano de Anestesiologia


          
Anestesiología y Medicina del Dolor
52 664 6848905
vwhizar@anestesia-dolor.org
anestesia-dolor.org

Copyright © 2015