miércoles, 13 de julio de 2016

Relajantes neuromusculares en el viejo / Neuromuscular blockade in the elderly

Julio 13, 2016. No. 2385




Bloqueo neuromuscular en el paciente viejo
Neuromuscular blockade in the elderly patient.
J Pain Res. 2016 Jun 17;9:437-44. doi: 10.2147/JPR.S85183. eCollection 2016.
Abstract
Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular blockade that may be altered in the elderly. Compartment distribution, metabolism, and excretion of drugs may vary due to age-related changes in physiology, altering the duration of action with a need for reduced dosage (eg, aminosteroids). Other drugs (atracurium, cisatracurium) have more reliable duration of action and should perhaps be considered for use in the elderly. The range of interpatient variability that neuromuscular blocking drugs may exhibit is then considered and drugs with a narrower range, such as cisatracurium, may produce more predictable, and inherently safer, outcomes. Ultimately, appropriate neuromuscular monitoring should be used to guide the administration of muscle relaxants so that the risk of residual neuromuscular blockade postoperatively can be minimized. The reliability of various monitoring is considered. This paper concludes with a reviewof the various reversal agents, namely, anticholinesterase drugs and sugammadex, and the alterations in dosing of these that should be considered for the elderly patient.
KEYWORDS: anesthesia; drugs; elderly; pharmacodynamics; pharmacokinetics

Comité Europeo de Enseñanza en Anestesiología
Curso de Actualización en Anestesiología
Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras
Agosto 5-7, 2016. Tijuana BC, México
Información Dr. Sergio Granados Tinajero granadosts@gmail.com 

16th World Congress of Anaesthesiologists

28 August - 2 September 2016 
Hong Kong Convention and Exhibition Centre
World Federation of Societies of Anaesthesiologists
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Anestesiología y Medicina del Dolor

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