| Anestesia regional pediátrica |
Pediatric regional anesthesia. Ivani G, Mosseti V. Division of Pediatric Anesthesiology and Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy. gioivani@libero.itMinerva Anestesiol. 2009 Oct;75(10):577-83.Abstract Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. The long journey began many years ago; at that time, pediatric regional anesthesia was seen as an extravagant and useless technique, used by only a few and opposed by many detractors. Despite its well-known benefits, clinical failures can occur during the application of regional anesthetic techniques. Neurovascular anatomy is highly variable, and presently available nerve localization techniques provide little or no information regarding the anatomical spread of local anesthesia; furthermore, traditional nerve localization techniques (nerve stimulation) rely on anatomical assumptions that may be incorrect. Modern imaging techniques, such as computed tomography scanning and ultrasound, are now available for improving these procedures. The ultrasound technique is now widely applied in children and many reports confirm the efficacy and advantages of this method. In children, ultrasound guidance has been shown to improve block characteristics, resulting in shorter block performance time, higher success rates, shorter onset, longer block duration, reduction in volume of local anesthetic agents required, and better visibility of neuraxial structures. Clinical studies in children suggest that ultrasound guidance has some advantages for regional block over more traditional nerve stimulation-based techniques. However, with the exception of ilio-inguinal blocks, the advantage of ultrasound guidance over traditional with respect to safety has not been adequately demonstrated in children, since there are only a limited number of randomized control trials in children comparing ultrasound-guided peripheral nerve block with other techniques. Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services". http://www.minervamedica.it/en/getfreepdf/gvF25xhIp1Yz13e6vrpAHp4TFpUNyvrqcxXDIhmnh%252FHhnhNvVyAMmHJST%252B%252BrPmOkj141SdmYSKVc66lomYrAFA%253D%253D/R02Y2009N10A0577.pdf |
| Nuevos fármacos, nuevas técnicas, y nuevas indicaciones en anestesia regional pediátrica |
New drugs, new techniques, new indications in pediatric regional anesthesia. De Negri P, Ivani G, Tirri T, Favullo L, Nardelli A. Department of Anaesthesia, Intensive Care and Pain Management, CROB, Cancer Center, Rionero in Vulture (Potenza), Italy. pdnegri@crob.itMinerva Anestesiol. 2002 May;68(5):420-7.Abstract The use of regional anesthesia in children represents one of the most effective methods for perioperative analgesia and postoperative pain control. Things have been dramatically changed in the last two decades due to the appearance of new safer drugs and new tools; moreover new techniques were introduced showing their efficacy. In this paper we briefly describe the efficacy of new local anesthetics and adjuvants; we review the use of continuous peripheral blocks and other not very diffused techniques of regional anesthesia. http://www.minervamedica.it/en/getfreepdf/k5DObBCvViERSXQCmcKN6gpU7VxgnTUS1%252BQmHFbgv4QpzBEqfyX2rrD2COJP7S9cZ%252BIPJFiCV2rmgnuwoQxCHg%253D%253D/R02Y2002N05A0420.pdf |
| Manejo del dolor agudo en niños |
Acute pain management in children. Verghese ST, Hannallah RS. The George Washington University Medical Center, Division of Anesthesiology, Children's National Medical Center, Washington, DC, USA. J Pain Res. 2010 Jul 15;3:105-23.Abstract The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal. http://www.dovepress.com/articles.php?article_id=4853 |
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