Opioides en pediatría

Prescribiendo medicación controlada a adolescentes y adultos jóvenes en los Estados Unidos  Prescribing of controlled medications to adolescents and young adults in the United States. Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Rd, Rochester, NY 14609, USA. robert_fortuna@urmc.rochester.edu Pediatrics. 2010 Dec;126(6):1108-16. Epub 2010 Nov 29. Abstract OBJECTIVE: The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana, yet little is known about prescribing patterns. We examined the prescribing of controlled medications to adolescents aged 15 to 19 and young adults aged 20 to 29. METHODS: We used cross-sectional data from the National Ambulatory Medical Care Survey (N = 4304 physicians) and the National Hospital Ambulatory Medical Care Survey (N = 2805 clinics; N = 1051 emergency departments) between 2005 and 2007. We also used consecutive data from 1994 to describe trends. RESULTS: A controlled medication was prescribed at 2.3 million visits by adolescents and 7.8 million visits by young adults in 2007. Between 1994 and 2007, controlled medications were prescribed at an increasing proportion of visits from adolescents (6.4%-11.2%) and young adults (8.3%-16.1%) (P < .001 for trend). This increase was seen among males and females, in ambulatory offices and emergency departments, and for injury-related and non-injury-related visits (all P < .001). A controlled medication was prescribed during 9.6% of all adolescent visits and 13.8% of young-adult visits for non-injury-related indications and at 14.5% of adolescent visits and 27.0% of young-adult visits for injury-related reasons. Controlled medications were prescribed at a substantial proportion of visits for common conditions, such as back pain, to both adolescents (23.4%) and young adults (36.9%). CONCLUSIONS: Controlled medications are prescribed at a considerable proportion of visits from adolescents and young adults, and prescribing rates have nearly doubled since 1994. This trend and its relationship to misuse of medications warrants further study. http://pediatrics.aappublications.org/content/126/6/1108.full.pdf   OPIOIDES EN NIÑOS  Opioides en la práctica médica, editado por la Asociación Colombiana para el Estudio del Dolor, ACED. Bogotá, Colombia 2009. SANDRA PATRICIA FLÓREZ ROJAS INTRODUCCIÓN Debido a múltiples características de los opioides, entre las que se encuentran su potencia, su eficacia y el bajo perfil de efectos secundarios, los opioides son el estándar para el control del dolor en múltiples escenarios, entre los que cabe destacar el control del dolor agudo postoperatorio y el dolor por cáncer principalmente. En la población pediátrica hay consideraciones importantes para su uso, especialmente en la población neonatal. El conocimiento de las diferencias farmacocinéticas y farmacodinámicas, asociado a un juicioso monitoreo, permite que esta población se beneficie de su uso. La presente revisión pretende definir las características de los principales opioides de uso en la población pediátrica, las dosis y vías de administración más usadas y recomendaciones generales para su manejo. http://www.dolor.org.co/libros/opioides/2-opioides_ninos.pdf

Atentamente Dr. Enrique Hernández-Cortez Anestesiología y Medicina del Dolor www.anestesia-dolor.org