Anestesia y analgesia en neonatos

Debate Pro Con: Uso de anestesia regional versus analgesia sistémica en cirugía neonatal


Pro con debate: the use of regional vs systemic analgesia for neonatal surgery.
Bösenberg AT, Jöhr M, Wolf AR.
Department Anesthesiology and Pain Management, Faculty Health Sciences, University Washington, Seattle, WA, USA.
Paediatr Anaesth. 2011 Dec;21(12):1247-58. doi: 10.1111/j.1460-9592.2011.03638.x. Epub 2011 Jul 1.
Abstract
In recent years the inclusion of regional techniques to pediatric anesthesia has transformed practice. Simple procedures such as caudal anesthesia with local anaesthetics can reduce the amounts of general anesthesia required and provide complete analgesia in the postoperative period while avoiding large amounts of opioid analgesia with potential side effects that can impair recovery. However, the application of central blocks (epidural and spinal local anesthesia) via catheters in the younger infant, neonate and even preterm neonate remains more controversial. The potential for such invasive maneuvers themselves to augment risk, can be argued to outweigh the benefits, others would argue that epidural analgesia can reduce the need for postoperative ventilation and that this not only facilitates surgery when intensive care facilities are limited, but also reduces cost in terms of PICU stay and recovery profile. Currently, opinions are divided and strongly held with some major units adopting this approach widely and others maintaining a more conservative stance to anesthesia for major neonatal surgery. In this pro-con debate the evidence base is examined, supplemented with expert opinion to try to provide a balanced overall view.
http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2011.03638.x/pdf

¿Es el tiempo necesario para obtener estabilización preoperatoria de un índice predictivo del resultado en hernia neonatal diafragmática congénita?
Is the time necessary to obtain preoperative stabilization a predictive index of outcome in neonatal congenital diaphragmatic hernia?
Gentili A, De Rose R, Iannella E, Bacchi Reggiani ML, Lima M, Baroncini S.
Department of Paediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi Hospital, University of Bologna, 40183 Bologna, Italy.
Int J Pediatr. 2012;2012:402170. Epub 2012 Jan 4.
Abstract
Background. The study aims to verify if the time of preoperative stabilization (≤24 or >24 hours) could be predictive for the severity of clinical condition among patients affected by congenital diaphragmatic hernia. Methods. 55 of the 73 patients enrolled in the study achieved presurgical stabilization and underwent surgical correction. Respiratory and hemodynamic indexes, postnatal scores, the need for advanced respiratory support, the length of HFOV, tracheal intubation, PICU, and hospital stay were compared between patients reaching stabilization in ≤24 or >24 hours. Results. Both groups had a 100% survival rate. Neonates stabilized in ≤24 hours are more regular in the postoperative period and had an easier intensive care path; those taking >24 hours showed more complications and their care path was longer and more complex. Conclusions. The length of preoperative stabilization does not affect mortality, but is a valid parameter to identify difficulties in survivors' clinical pathway
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259488/pdf/IJPED2012-402170.pdf





Experiencia preliminar con dexmedetomidina en anestesia neonatal


Preliminary experience with dexmedetomidine in neonatal anesthesia.
Dilek O, Yasemin G, Atci M.
Çukurova University Faculty of Medicine Department of Anaesthesiology, Adana/Turkey.
J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):17-22.
Abstract
BACKGROUND: In paediatric patients dexmedetomidine has been reported to be effective in various clinical settings including provision of sedation during mechanical ventilation, prevention of emergence delirium after general anaesthesia, sedation during non invasive radiological procedures. However very few data of its use in newborn is available. PATIENTS #ENTITYSTARTX00026; METHODS: Sixteen new born patients of age 2-28 days were studied. Anaesthesia was induced with 1 mgkg(-1) ketamine intravenously. Dexmedetomicline 1 μgkg(-1) was infused within ten minutres. Maintenance infusion was started as 0.5-0.8 μg kg(-1)h(-1) until the end of surgery ortrcheel intubation was done all patients were mechanical ventelated with O(2)+H(2)O safberane 0.1-0.2%. Non invasive systolic & chastake blood pressure, heart rate, SPO(2), DETCO(2), inhated & end trial sevophrame conc and body temperature were monitored. RESULTS: No significant difference was observed in the measured values of haemodynamic parameter at different intervals and the base line values. No patient had hypotension bradycardia hypertension hypoxia or respiratory depression. Patients had mild hypothermia during post-operative period. CONCLUSION: Dexmedetomidine 1 μgkg(-1) followed by maintenance dose of 0.5 μg kg(-1)h(-1) as an adjacent to sevoflurane anaesthesia in new born undergoing laparatomy provides haemodynamic stability during heightened surgical stimulate.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146151/



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