Anestesia neuroaxial

Efectos circadianos sobre el bloqueo subaracnoideo con bupivacaína hiperbárica Circadian Effects on Neural Blockade of Intrathecal Hyperbaric Bupivacaine Cheol Lee, Deok Hwa Choi, and Soo Uk Chae. Departments of Anesthesiology and Pain Medicine, Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea Korean J Pain 2010; 23: 186-189.  Background: Circadian variations in the absorption, distribution, protein binding, elimination and metabolism of drugs account for many of the administration-time-dependent differences in their pharmacokinetics. The aim of this study is to determine whether the time of intrathecal injection influences spinal anesthesia. Methods: Ninety patients scheduled for orthopedic surgery were randomly assigned to three groups. Each group received spinal anesthesia with 0.5% bupivacaine 10 mg at different times; group AM (8 am to 12:00), group Noon (12:00 to 4:00 pm) and group PM (4:00 pm to 8:00 pm). Sensory and motor blockade were assessed by pinprick and a four-point modified Bromage scale. Time to first postoperative analgesic requirement and side effects such as hypotension, bradycardia, nausea, and shivering were recorded. Results: No significant differences were found among the three groups in peak sensory blockade, duration of motor block to Bromage 1 or side effects, but time to first postoperative analgesic requirement (P = 0.008), and recovery time of S1 sensation to pinprick were significantly prolonged in group Noon compared with the other groups (P = 0.03). Conclusions: The time of administration of spinal local anesthetics influences the duration of local anesthesia.. Artí­culo en PDF Sedación y anestesia regional en el paciente adulto Sedation and regional anaesthesia in the adult patient. Höhener D, Blumenthal S, Borgeat A. Department of Anaesthesiology, Orthopedic University Clinic Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. Br J Anaesth. 2008 Jan;100(1):8-16.  Abstract This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. Methods of assessing the level of sedation are discussed with emphasis on clinical measures. The pharmacology of the drugs involved in sedation is discussed, with propofol and remifentanil appearing to be the combination of choice for sedation in regional anaesthesia. The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred. Enlace para leer el artículo completo: http://bja.oxfordjournals.org/content/100/1/8.full.pdf

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