viernes, 15 de junio de 2012

Farmacología en el muy joven: implicaciones anestésicas


Farmacología en el muy joven: implicaciones anestésicas
Pharmacology in the very young: anaesthetic implications
Anderson, Brian J.
European Journal of Anaesthesiology June 2012 - Volume 29 - Issue 6 - p 261-270
doi: 10.1097/EJA.0b013e3283542329

Abstract:
Anaesthesia dosing in infants (0-2 years) should be based on pharmacokinetic-pharmacodynamic considerations and adverse effects profiles. Disease processes and treatments in this group are distinct from those in adults. Absorption, distribution and clearance change dramatically during this period because of maturation of anatomical and physiological processes as well as behavioural changes. Pharmacogenomic expression also matures in this period. Population-based and physiological-based pharmacokinetic modelling has improved the understanding of maturation and subsequent dose approximation. Postmenstrual, rather than postnatal, age is a reasonable measure for maturation. There remains a need for clinically applicable tools to assess pharmacodynamics which can provide response feedback; this has been achieved for neuromuscular monitoring, but not yet fully for depth of anaesthesia, sedation or pain. Morbidity and mortality associated with paediatric anaesthesia have historically been highest in this age group and continue to be so. Some of this morbidity was attributable to a poor understanding of developmental pharmacology; this facet continues to plague the specialty.
http://journals.lww.com/ejanaesthesiology/Fulltext/2012/06000/
Pharmacology_in_the_very_young___anaesthetic.3.aspx  

 
Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor

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