Prácticas de anestesia y sedación entre neurointervencionistas durante la terapia endovascular durante ataques agudos de isquemia |
Anesthesia and Sedation Practices Among Neurointerventionalists during Acute Ischemic Stroke Endovascular Therapy.
McDonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A, Zaidat OO.
Department of Anesthesiology, Duke University Medical Center Durham, NC, USA.
Front Neurol. 2010 Nov 11;1:118.
Abstract
Background and Purpose: Intra-arterial reperfusion therapies are expanding frontiers in acute ischemic stroke (AIS) management but there is considerable variability in clinical practice. The use of general anesthesia (GA) is one example. We aimed to better understand sedation practices in AIS. Methods: An online survey was distributed to the 68 active members of the Society of Vascular and Interventional Neurology (SVIN). Survey development was based on discussions at the SVIN Endovascular Stroke Round Table Meeting (Chicago, IL, 2008). The final survey contained 12 questions. Questions were developed as single and multiple-item responses; with an option for a free-text response. Results: There was a 72% survey response rate Respondents were interventional neurologists in practice 1 to 5 years. The mean AIS interventions performed per year at the respondents' institutions was 42.5, median 35.0. The most frequent anesthesia type used was GA (anesthesia team), then conscious sedation (nurse administered), monitored anesthesia care (anesthesia team), and finally local analgesia alone. There was a preference for GA because of eliminating movement, perceived procedural safety), and improved procedural efficacy. However, cited limitations to GA included risk of time delay of propagating cerebral ischemia due to hypoperfusion or other complications and lack of adequate anesthesia workforce). Conclusions: The most frequent type of anesthesia used by Neurointerventionalists for AIS interventions is GA. Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.
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| El efecto de la anestesia local en la calidad de las características de recuperación después de la rehabilitación dental bajo anestesia general en niños |
The effect of local anesthetic on quality of recovery characteristics following dental rehabilitation under general anesthesia in children. Townsend JA, Ganzberg S, Thikkurissy S. LSU School of Dentistry, Department of Pediatric Dentistry, New Orleans, Louisiana 70119, USA. jtown2@lsuhsc.eduAnesth Prog. 2009 Winter;56(4):115-22. Abstract
This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug (NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA). Twenty-seven healthy children aged 3-5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3-5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4-6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3-5.5 years.
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Un ensayo controlado aleatorio que compara técnicas de anestesia mandibular local en niños que recibieron sedación con óxido nitroso y oxígeno |
A randomized controlled trial comparing mandibular local anesthesia techniques in children receiving nitrous oxide-oxygen sedation.
Naidu S, Loughlin P, Coldwell SE, Noonan CJ, Milgrom P.
Department of Dental Public Health Sciences, University of Washington, Seattle, Washington 98195-7475, USA.
Anesth Prog. 2004;51(1):19-23. Abstract
The aim of this study was to test the hypothesis that dental pain control using infiltration/intrapapillary injection was less effective than inferior alveolar block/long buccal infiltration anesthesia in children. A total of 101 healthy children, aged 5-8 years, who had no contraindication for local anesthetic and who needed a pulpotomy treatment and stainless steel crown placement in a lower primary molar were studied. A 2-group randomized blinded controlled design was employed comparing the 2 local anesthesia techniques using 2% lidocaine, 1:100,000 epinephrine. All children were given 40% nitrous oxide. Children self-reported pain using the Color Analogue Scale. The study was conducted in a private pediatric dental practice in Mount Vernon, Wash. Overall pain levels reported by the children were low, and there were no differences between conditions at any point in the procedure. Pain reports for clamp placement were block/long buccal 2.8 and infiltration/intrapapillary 1.9 (P = .1). Pain reports for drilling were block/long buccal 2.0 and infiltration/intrapapillary 1.8 (P = .7). Nine percent of children required supplementary local anesthetic: 4 of 52 (7.7%) in the block/long buccal group and 5 of 49 (10.2%) in the infiltration/intrapapillary group (P = .07). The hypothesis that block/long buccal would be more effective than infiltration/intrapapillary was not supported. There was no difference in pain control effectiveness between infiltration/intrapapillary injection and inferior alveolar block/long buccal infiltration using 2% lidocaine with 1:100,000 epinephrine when mandibular primary molars received pulpotomy treatment and stainless steel crowns.
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