lunes, 27 de marzo de 2017

Bloqueo neuromuscular en ancianos / Neuromuscular blockade in geriatris

Marzo 27, 2017. No. 2641

Bloqueo neuromuscular en el paciente anciano
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 review of 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

Relajantes neuromusculares en el anciano
Neuromuscular blockade in the elderly.
Anaesthesiol Intensive Ther. 2016;48(4):257-260. doi: 10.5603/AIT.2016.0045.
The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.
KEYWORDS: elderly patients; muscle relaxants; neuromuscular block; postoperative residual curarization; reversal

Relación entre la concentración efectiva el sitio diana de rocuronio y el grado de recuperación del bloqueo neuromuscular en pacientes de edad avanzada.
The relationship between the target effective site concentration of rocuronium and the degree of recovery from neuromuscular blockade in elderly patients.
Fan X1, Ma M1, Li Z1, Gong S1, Zhang W1, Wen Y1.
Int J Clin Exp Med. 2015 Sep 15;8(9):16369-73. eCollection 2015.
OBJECTIVE: To study the relationship between the target effective site concentration (Ce) of rocuronium and the degree of recovery from neuromuscular blockade in elderly patients. METHODS: 50 elderly patients (ASA grade II) scheduled for selective surgical procedure under general anaesthesia were randomly divided into two groups, A and B, with 25 cases in each group. The Ce of rocuronium for intubation was 3 μg·ml(-1) in both groups, and the Ce during operation were 0.8 and 1.0 μg·ml(-1) in group A and B, respectively. When target controlled infusion of rocuronium was stopped, without the administration of reversal agents for neuromuscular blockade, the relationship between Ce and the first twitch height (T1) was studied by regression analysis. RESULTS: There was a significant linear relationship between Ce and T1, and there was no statistical difference in regression coefficient and interception between group A and B (P>0.05). CONCLUSION: The degree of recovery from neuromuscular blockade could be judged by the target effective site concentration of rocuronium at the time of reversal from neuromuscular blockade in the elderly patients.
KEYWORDS: Rocuronium; geriatrics; neuromuscular blockade; pharmacodynamics

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

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