| Analgesia postoperatoria en el neonato |
A. Mart í n e z - Tellería, J. A. Delgado, M. E. Cano, J. Núñez y R. Gálvez
R e v. Soc. Esp. Dolor 9: 317-327, 2002
R E S U M E N
Sabemos desde hace tiempo que el neonato siente dolor, y que los mecanismos álgicos en el recién nacido están suficientemente desarrollados. Aunque el empleo de métodos analgésicos en el postoperatorio de la cirugía neonatal es actualmente una práctica habitual, no lo es tanto en el dolor asociado a otros procedimientos. En la actualidad disponemos de métodos adecuados y objetivos para la valoración del dolor neonatal y de estrategias adecuadas para tratarlo, amén de un gran número de fármacos y procedimientos analgésicos seguros para la edad. El dolor postoperatorio es minimizado tomando actitudes previas en quirófano, empleando analgésicos o bien bloqueos con continuidad analgésica en el postoperatorio. En el dolor por procedimientos disponemos desde medidas conductuales, métodos no farmacológicos muy efectivos así como métodos analgésicos seguros.
Palabras clave: Dolor postoperatorio. Dolor procedimientos. Recién nacido. Neonato .
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| Analgesia epidural para cirugía neonatal mayor |
Epidural analgesia for major neonatal surgery
A D R I A N T. B OS E N B E R G FFA (SA)
Department of Anaesthetics, University of Natal, Private Bag 7, Congella 4013, Durban, South Africa
Paediatric Anaesthesia 1998 8: 479-483
Summary
Safe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9-5.8kg body weight (lumbar n=211, thoracic n=29) is reviewed. Dural puncture (n=1), convulsion (n=1) and intravascular migration of catheter (n=1) were the only complications. In all cases effective analgesia was established intraoperatively. Postoperatively analgesia was maintained by intermittent 'top-ups' (n=170) and continuous infusion (n=10). Skin epidural distance ranged between 3 and 12mm (mean 6.0±1.7mm) and did not correlate with the patients' weight. Patients remained haemodynamically stable except occasional bradycardia below 100 (n=15) which was successfully managed with nticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent 'top-up' doses rather than continuous infusions presented.
Keywords: neonatal; anaesthetic technique; epidural
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| Anestesia combinada epidural y espinal para reparación de gastriquisis |
Combined spinal epidural anaesthesia for gastroschisis repair. Gore M, Joshi K, Dave N. Lecturer, Department of Anaesthesiology, T N Medical College & B Y L Nair Hospital, Mumbai. Indian J Anaesth. 2009 Apr;53(2):223-5. Abstract SUMMARY: Gastroschisis is a congenital anomaly with a high perioperative mortality. Administration of general anaesthesia to these high risk neonates is associated with several problems including postoperative apnoea and the need for mechanical ventilation. Central neuraxial blocks, and more recently, combined spinal epidural have been administered for major abdominal surgery in neonates. We present the case of a neonate posted for gastroschisis repair conducted under combined spinal epidural anaesthesia and discuss the several advantages of this technique.
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