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. Lee LA1, Athanassoglou V1, Pandit JJ1. 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 PDF 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 http://wca2016.com/  Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org