Sueño, melatonina, UCI / ICU, sleep, and melatonine

Mayo 21, 2018. No. 3087

Calidad del sueño y alteraciones del ritmo circadiano en UCI. Una revisión Sleep quality and circadian rhythm disruption in the intensive care unit: a review. Boyko Y1, Jennum P2, Toft P1. Author information Nat Sci Sleep. 2017 Nov 10;9:277-284. doi: 10.2147/NSS.S151525. eCollection 2017. Abstract Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients. KEYWORDS: critically ill patients; environmental factors; mechanical ventilation; melatonin; polysomnography; sedation; sleep patterns PDF Patrón de secreción de melatonina en paciente graves. Estudio piloto descriptivo Melatonin Secretion Pattern in Critically Ill Patients: A Pilot Descriptive Study. Boyko Y1, Holst R2, Jennum P3, Oerding H4,5, Nikolic M6, Toft P1. Author information Crit Care Res Pract. 2017;2017:7010854. doi: 10.1155/2017/7010854. Epub 2017 May 11. Abstract Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any effect of remifentanil on melatonin secretion. We found that the risk of atypical sleep compared to normal sleep was significantly lower (p < 0.001) under remifentanil infusion. Rapid Eye Movement (REM) sleep was only observed during the nonsedation period. We found preserved diurnal pattern of melatonin secretion in these patients. Remifentanil did not affect melatonin secretion but was associated with lower risk of atypical sleep pattern. REM sleep was only registered during the period of nonsedation. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Melatonina en anestesia / Melatonine in anaesthesia

Mayo 20, 2018. No. 3086

Revisión sistemática sobre melatonina perioperatoria A systematic review of peri-operative melatonin. Andersen LP1, Werner MU, Rosenberg J, Gögenur I. Author information Anaesthesia. 2014 Oct;69(10):1163-71. doi: 10.1111/anae.12717. Epub 2014 May 19. Abstract We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements. PDF Evaluación de la eficacia analgésica de la melatonina en pacientes sometidas a cesárea bajo anestesia espinal: un estudio prospectivo aleatorizado doble ciego. Evaluation of the Analgesic Efficacy of Melatonin in Patients Undergoing Cesarean Section Under Spinal Anesthesia: A Prospective Randomized Double-blind Study. Beigom Khezri M1, Delkhosh Reihany M2, Oveisy S3, Mohammadi N4. Author information Iran J Pharm Res. 2016 Fall;15(4):963-971. Abstract Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesiawere randomly allocated to one of three groups of 40 each to receive melatonin 3 milligram (mg) (group M3), melatonin 6 mg (group M6) or placebo (group P) sublingually 20 min before the spinal anesthesia. The time to first analgesic request, analgesic requirement in the first 24 h after surgery, hemodynamic variables, anxiety scores nd the incidence of adverse events were recorded. The duration of anesthesia and analgesia didn't show significant differences between three groups. Total analgesic request during 24 h after surgery was different among the three groups (P = 0.035). The incidence of headache in group M6 was significantly higher than others (P<0.001). However, after adjusting headache between groups of the study, we were unable to show the significant difference in the total analgesic request during 24 h after surgery among the three groups (p = 0.058). Although premedication of patients with 3 mg sublingual melatonin prolonged time to first analgesic request after cesarean delivery compared to placebo group, the difference was not statistically significant. Meanwhile increasing dose of melatonin to 6 mg failed to enhance analgesia and also increase the incidence of headache in patients undergoing cesarean section under spinal anesthesia. KEYWORDS: Analgesia; Cesarean section; Melatonin; Spinal anesthesia PDF Concentraciones de melatonina CSF preoperatoria y la aparición de delirium en pacientes con fractura de cadera anterior: un estudio preliminar. Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study. Scholtens RM1, de Rooij SE1,2, Vellekoop AE3, Vrouenraets BC4, van Munster BC2,5. Author information PLoS One. 2016 Dec 9;11(12):e0167621. doi: 10.1371/journal.pone.0167621. eCollection 2016. Abstract BACKGROUND: Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium. METHODS: Prospective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained. RESULTS: Seventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age. CONCLUSION: Preoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation. PDF Efectos analgésicos, ansiolíticos y anestésicos de la melatonina. Novedosos usos potenciales en pediatría Analgesic, anxiolytic and anaesthetic effects of melatonin: new potential uses in pediatrics. Marseglia L1, D'Angelo G2, Manti S3, Aversa S4, Arrigo T5, Reiter RJ6, Gitto E7. Author information Int J Mol Sci. 2015 Jan 6;16(1):1209-20. doi: 10.3390/ijms16011209. Abstract Exogenous melatonin is used in a number of situations, first and foremost in the treatment of sleep disorders and jet leg. However, the hypnotic, antinociceptive, and anticonvulsant properties of melatonin endow this neurohormone with the profile of a drug that modulates effects of anesthetic agents, supporting its potential use at different stages during anesthetic procedures, in both adults and children. In light of these properties, melatonin has been administered to children undergoing diagnostic procedures requiring sedation or general anesthesia, such as magnetic resonance imaging, auditory brainstem response tests and electroencephalogram. Controversial data support the use of melatonin as anxiolytic and antinociceptive agents in pediatric patients undergoing surgery. The aim of this review was to evaluate available evidence relating to efficacy and safety of melatonin as an analgesic and as a sedative agent in children. Melatonin and its analogs may have a role in antinociceptive therapies and as an alternative to midazolam in premedication of adults and children, although its effectiveness is still controversial and available data are clearly incomplete. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  Primer Congreso Nacional de Residentes de Anestesiología Ecuador, Agosto 2018 Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org