sábado, 26 de noviembre de 2016


Noviembre 26, 2016. No. 2520

Efecto del remifentanilo y fentanilo sobre la función cognitiva postoperatoria y el nivel de citoquinas en ancianos con cirugía abdominal mayor
Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery
Germano De Cosmo, Flaminio Sessa MD, Federico Fiorini MD, Elisabetta Congedo MD, PhD
Journal of Clinical Anesthesia (2016) 35, 40-46.
Purpose: Postoperative cognitive dysfunction is a frequent complication occurring in geriatric patients. Type of anesthesia and the patient's inflammatory response may contribute to postoperative cognitive dysfunction (POCD). In this prospective randomized double-blinded controlled study we hypothesized that intraoperative remifentanil may reduce immediate and early POCD compared to fentanyl and evaluated if there is a correlation between cognitive status and postoperative inflammatory cytokines level. Methods: Six hundred twenty-two patients older than 60 years undergoing major abdominal surgery were randomly assigned to two groups and treated with different opioids during surgery: continuous infusion of remifentanil or fentanyl boluses. Twenty-five patients per group were randomly selected for the quantitative determination of serum interleukin (IL)-1β, IL-6, and IL-10 to return to the ward and to the seventh postoperative day. Results: Cognitive status and its correlation with cytokines levels were assessed. The groups were comparable regarding to POCD incidence; however, IL-6 levels were lower the seventh day after surgery for remifentanil group (P= .04). No correlation was found between POCD and cytokine levels. Conclusions: The use of remifentanil does not reduce POCD
Efectos del remifentanilo vs óxido nitroso en la náusea postoperatoria, el vómito y en dolor después de tiroidectomía
Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy: Propensity score matching analysis.
Medicine (Baltimore). 2016 Oct;95(41):e5135.
Efectos de un bolo de fentanil y de infusión de remifentanail sobre náusea y vómito postoperatorios
Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting.
Lim H1, Doo AR1, Son JS1, Kim JW1, Lee KJ1, Kim DC1, Ko S1.
Korean J Anesthesiol. 2016 Feb;69(1):51-6. doi: 10.4097/kjae.2016.69.1.51. Epub 2016 Jan 28.
BACKGROUND: Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS: Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 µg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS: Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS: A single bolus administration of fentanyl 2 µg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV.
KEYWORDS: Fentanyl; Intraoperative period; Postoperative nausea and vomiting; Remifentanil
Segundo Curso-Taller de Anestesia y Dolor
Zapopan Jalisco, México
Dic 1-2, 2016
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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