| La seguridad y eficacia de la circuncisión masculina no terapéutica: una revisión sistemática |
Safety and efficacy of nontherapeutic male circumcision: a systematic review.
Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ.
ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
Ann Fam Med. 2010 Jan-Feb;8(1):64-72.
Abstract
PURPOSE: We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. METHODS: We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. RESULTS: Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43-0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32-0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. CONCLUSIONS: Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.
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| Comparación entre EMLA® versus el bloqueo del nervio dorsal del pene en la circuncisión neonatal |
Leticia Valenzuela García, Bárbara Gabriela Cárdenas del Castillo, Isaías Rodríguez Balderrama, José Ramón Barragán Lee, José Guillermo Martínez Flores.
Medicina Universitaria 2006;8(30):32-38
Resumen
Objetivo: Comparar la crema EMLA® contra el bloqueo del nervio dorsal del pene (BNDP) en la circuncisión neonatal. Pacientes y métodos. Estudio aleatorizado, prospectivo, experimental, comparativo. Se incluyeron todos los recién nacidos mayores de 37 semanas de gestación y de 2500 g, nacidos en esta institución, entre 1 y 7 días de edad y que aceptaran el procedimiento; se asignaron en forma aleatoria a dos grupos: A (BNDP) y B (EMLA®). El procedimiento se dividió en cuatro etapas: liberación de sinequias, colocación de pinza recta, anudar campana y corte de prepucio. El dolor se evaluó con la medición de los signos vitales (frecuencia cardiaca,
frecuencia respiratoria, tensión arterial media, sistólica y diastólica), pulsooximetría y una escala de actividad facial, además del porcentaje de llanto por etapa. Resultados: se incluyeron 21 pacientes: 12 en el grupo control (BNDP) y 9 en el grupo de estudio (EMLA® tópica). Ambos grupos fueron similares en peso, edad gestacional y trofismo. No hubo diferencia estadística de las variables estudiadas en la liberación de sinequias, colocación de pinza recta, y al cortar el prepucio (p = NS). Al anudar la campana el grupo A tuvo una tensión arterial sistólica más elevada (p < 0.05) sin afectar la tensión arterial media y el grupo B tuvo mayor actividad facial de dolor (p < 0.05), pero con el mismo porcentaje de llanto. Conclusiones: el uso de la crema EMLA® es una buena alternativa como anestésico local para la circuncisión neonatal y evita las potenciales complicaciones del bloqueo.
Palabras clave: circuncisión, dolor, neonato.
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| Potencia relativa de bupivacaína, levobupivacaína y ropivacaína para anestesia espinal neonatal |
Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia.
Frawley G, Smith KR, Ingelmo P.
Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Anaesthesia Research, Murdoch Childrens Research Institute, Melbourne, Australia.
Br J Anaesth. 2009 Nov;103(5):731-8. Epub 2009 Sep 18.
Abstract
BACKGROUND: Comparing the relative potency of new local anaesthetics such as levobupivacaine and ropivacaine with bupivacaine by the minimum local analgesic concentration model has not been described for neonatal spinal anaesthesia. This information is important to compare agents and to determine the most effective spinal dose. METHODS: We performed a two-stage study to determine the ED50, the ED95, and the relative analgesic potency of isobaric spinal bupivacaine, levobupivacaine, and ropivacaine in infants. In phase 1, 81 infants were randomized in a Dixon-Massey study to describe the minimum local analgesic dose. In phase 2, a further 70 patients were randomly allocated to receive spinal anaesthesia with doses in the upper dose-response range to define the ED95. RESULTS: The ED50 doses for bupivacaine, levobupivacaine, and ropivacaine were estimated by isotonic regression to be 0.30 mg kg(-1) [95% confidence interval (CI) 0.25-0.43], 0.55 mg kg(-1) (0.50-0.64), and 0.50 mg kg(-1) (0.43-0.64), respectively. The ED(95), respectively, of bupivacaine, levobupivacaine, and ropivacaine were 0.96 mg kg(-1) (95% CI 0.83-0.98), 1.18 mg kg(-1) (1.05-1.22), and 0.99 mg kg(-1) (0.73-1.50). The relative potency ratios at the ED(50) were bupivacaine:levobupivacaine 0.55 (95% CI 0.39-0.88), upivacaine:ropivacaine 0.61 (0.41-1.00), and levobupivacaine:ropivacaine 1.09 (0.84-1.45). CONCLUSIONS: Appropriate doses for infant spinal anaesthesia are 1 mg kg(-1) of isobaric 0.5% bupivacaine and ropivacaine and 1.2 mg kg(-1) of isobaric 0.5% levobupivacaine.
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| Presentación en Power Point |
| Anestesia en Cirugía Neonatal Dr. Juan Francisco Anzorena-Vallarino
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