martes, 29 de septiembre de 2015

Pancreatitis y anestesia/Pancreatitis and anesthesia

Septiembre 29, 2015. No. 2099
Anestesia y Medicina del Dolor

Papel de la anestesia epidural torácica en pancreatitis aguda grave
The role of thoracic epidural anesthesia in severe acute pancreatitis.
Crit Care. 2014 Feb 7;18(1):106. doi: 10.1186/cc13718.
In animal studies of severe acute pancreatitis, thoracic epidural anesthesia appears to enhance the splanchnic circulation, improve end-organ perfusion, and favorably influence mortality. The application of thoracic epidurals in the critically ill human patient is less clear. Methodological difficulties in reliably assessing mesenteric flow have hampered progress, and clinical concerns surrounding this potentially attractive therapeutic modality remain unanswered. Future research needs to focus on the impact of epidural anesthesia on basic human physiological parameters to help direct further randomized studies in human disease.
Efecto de la anestesia epidural torácica en la sobrevida y la microcirculación en pancreatitis grave. Estudio randomizado experimental
Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial.
Crit Care. 2013 Dec 5;17(6):R281. doi: 10.1186/cc13142.
Bloqueo del espacio perirrenal restaura la función gastrointestinal en pacientes con pancreatitisaguda grave.
Perirenal space blocking restores gastrointestinal function in patients with severe acute pancreatitis.
World J Gastroenterol. 2013 Dec 14;19(46):8752-7. doi: 10.3748/wjg.v19.i46.8752
AIM: To investigate effects of perirenal space blocking (PSB) on gastrointestinal function in patients with severe acute pancreatitis (SAP). METHODS: Forty patients with SAP were randomly allocated to receive PSB or no PSB (NPSB). All the SAP patients received specialized medical therapy (SMT). Patients in the PSB group received PSB + SMT when hospitalized and after diagnosis, whereas patients in the NPSB group only received SMT. A modified gastrointestinal failure (GIF) scoring system was used to assess the gastrointestinal function in SAP patients after admission. Pain severity (visual analog scale, 0 to 100) was monitored every 24 h for 72 h. RESULTS: Modified GIF score decreased in both groups during the 10-d study period. The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was performed. During the 72-h study period, pain intensity decreased in both groups. The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points. Patients in the PSB group had significantly lower incidences of hospital mortality, multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection, and stayed in the intensive care unit for a shorter duration. However, no difference in terms of operation incidence was found between the two groups.
CONCLUSION: PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP. Moreover, PSB administration could improve prognosis and decrease the mortality of SAP patients.
KEYWORDS: Gastrointestinal function; Perirenal space blocking; Prognosis; Severe acute pancreatitis; Therapeutics
Modulo CEEA Leon, Gto. Curso CEEA Tijuana  XII Congreso Virtual Mexicano de Anestesiologia

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