Sedación inhalada / Volatil sedation

Abril 20, 2018. No. 3057

Sedación volátil en terapia intensiva. Revisión sistemática y meta-análisis Volatile sedation in the intensive care unit: A systematic review and meta-analysis. Kim HY1, Lee JE, Kim HY, Kim J. Author information Medicine (Baltimore). 2017 Dec;96(49):e8976. doi: 10.1097/MD.0000000000008976. Abstract BACKGROUND: Volatile sedation in the intensive care unit (ICU) may reduce the number of adverse events and improve patient outcomes compared with intravenous (IV) sedation. We performed a systematic review and meta-analysis comparing the effects of volatile and IV sedation in adult ICU patients. ..... CONCLUSION: Compared with IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times. Considering the difference in serum troponin levels between both arms, volatile anesthetics might have a myocardial protective effect after cardiac surgery even at a subanesthetic dose. Because the included studies used small sample sizes with high heterogeneity, further large, high-quality prospective clinical trials are needed to confirm our findings. PDF Seguridad y eficacia de los agentes anestésicos volátiles en comparación con la sedación estándar intravenosa con midazolam / propofol en pacientes con ventilación mecánica en cuidados intensivos ventilados: un metanálisis y revisión sistemática de ensayos prospectivos. Safety and Efficacy of Volatile Anesthetic Agents Compared With Standard Intravenous Midazolam/Propofol Sedation in Ventilated Critical Care Patients: A Meta-analysis and Systematic Review of Prospective Trials. Jerath A1, Panckhurst J, Parotto M, Lightfoot N, Wasowicz M, Ferguson ND, Steel A, Beattie WS. Author information Anesth Analg. 2017 Apr;124(4):1190-1199. doi: 10.1213/ANE.0000000000001634. Abstract BACKGROUND: Inhalation agents are being used in place of intravenous agents to provide sedation in some intensive care units. We performed a systematic review and meta-analysis of prospective randomized controlled trials, which compared the use of volatile agents versus intravenous midazolam or propofol in critical care units. METHODS: A search was conducted using MEDLINE (1946-2015), EMBASE (1947-2015), Web of Science index (1900-2015), and Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials comparing inhaled volatile (desflurane, sevoflurane, and isoflurane) sedation to intravenous midazolam or propofol. Primary outcome assessed the effect of volatile-based sedation on extubation times (time between discontinuing sedation and tracheal extubation). Secondary outcomes included time to obey verbal commands, proportion of time spent in target sedation, nausea and vomiting, mortality, length of intensive care unit, and length of hospital stay. Heterogeneity was assessed using the I statistic. Outcomes were assessed using a random or fixed-effects model depending on heterogeneity. RESULTS: Eight trials with 523 patients comparing all volatile agents with intravenous midazolam or propofol showed a reduction in extubation times using volatile agents (difference in means, -52.7 minutes; 95% confidence interval [CI], -75.1 to -30.3; P < .00001). Reductions in extubation time were greater when comparing volatiles with midazolam (difference in means, -292.2 minutes; 95% CI, -384.4 to -200.1; P < .00001) than propofol (difference in means, -29.1 minutes; 95% CI, -46.7 to -11.4; P = .001). There was no significant difference in time to obey verbal commands, proportion of time spent in target sedation, adverse events, death, or length of hospital stay. CONCLUSIONS: Volatile-based sedation demonstrates a reduction in time to extubation, with no increase in short-term adverse outcomes. Marked study heterogeneity was present, and the results show marked positive publication bias. However, a reduction in extubation time was still evident after statistical correction of publication bias. Larger clinical trials are needed to further evaluate the role of these agents as sedatives for critically ill patients. PDF Agentes volátiles en la sedación de cuidados críticos: ¿sí, no o tal vez? Volatile agents in critical care sedation: yes, no or maybe? Page V1,2, Carraretto M3. Minerva Anestesiol. 2017 Jul;83(7):679-681. doi: 10.23736/S0375-9393.17.12141-3. Epub 2017 May 19. PDF Rabdomiólisis de esfuerzo e insolación: tenga cuidado con la sedación anestésica volátil. Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation. Heytens K1, De Bleecker J1, Verbrugghe W1, Baets J1, Heytens L1. Author information World J Crit Care Med. 2017 Feb 4;6(1):21-27. doi: 10.5492/wjccm.v6.i1.21. eCollection 2017 Feb 4. Abstract In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units (ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension. KEYWORDS: Congenital myopathies; Exertional rhabdomyolysis; Heat stroke; Inhalational anesthetics; Intensive care sedation; Malignant hyperthermia PDF Agentes volátiles en la sedación de cuidados críticos: ¿sí, no o tal vez? Volatile agents in critical care sedation: yes, no or maybe? Page V1,2, Carraretto M3. Minerva Anestesiol. 2017 Jul;83(7):679-681. doi: 10.23736/S0375-9393.17.12141-3. Epub 2017 May 19. PDF Anestésicos volátiles halogenados en la unidad de cuidados intensivos: conocimiento actual sobre una práctica próxima. Halogenated volatile anesthetics in the intensive care unit: current knowledge on an upcoming practice. Laferriere-Langlois P1, d'ARAGON F2, Manzanares W3. Author information Minerva Anestesiol. 2017 Jul;83(7):737-748. doi: 10.23736/S0375-9393.17.11735-9. Epub 2017 Mar 8. Abstract The aim of this narrative review was to highlight key points of volatile anesthetics administration in the intensive care unit (ICU), including AnaConDa® and Mirus® devices characteristics and the reported findings on clinical outcomes in critically ill patients. Intravenous sedation in the ICU is associated with issues, such as over- and under-sedation. Halogenated compounds, which can be safely administered by inserting a device in any ICU ventilation circuit, have interesting pharmacodynamic and pharmacokinetic profiles for patients with multi-organ failure. Moreover, analysis of the concentration of exhaled volatile compounds could help evaluation of sedation depth. A recent meta-analysis confirmed that rapid washout of the volatile anesthetics improved both extubation readiness and quality of awakening when compared to intravenous sedation. When administered for a long period, volatile anesthetics improved sedation stability with fewer dose adjustments. Pre- and post-conditioning properties of halogenated compounds are interesting and long-term exposition to this compound is investigated for a potential impact on mortality rate and ICU/hospital length of stay. For now, psychomotor side effects have been reported, mostly in infants, but there were no hepatic or renal injuries. Findings regarding hemodynamic stability are conflicting. Apart from sedation, volatile anesthetics were therapeutic in case reports of status asthmaticus and epilepticus and data are cumulating for benefits in cases of acute respiratory distress syndrome. According to current literature, they should be withheld in cerebral injury. To summarize, the use of volatile anesthetics for sedation is yet only approved by German guidelines, but could spread due to its potential benefits. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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Sedación en niños / Pediatirc sedation

Marzo 10, 2018. No. 3018 Protocolo de sedación durante la inyección intravítrea de bevacizumab en recién nacidos prematuros con retinopatía de la prematuridad. Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity. Miller JL, Johnson PN, Harkey K, Siatkowski RM. J Pediatr Pharmacol Ther. 2018 Jan-Feb;23(1):34-40. doi: 10.5863/1551-6776-23.1.3 4Abstract OBJECTIVES: This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity. METHODS: This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions. RESULTS: Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2-3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients. CONCLUSIONS: Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure. KEYWORDS: bevacizumab; fentanyl; midazolam; neonatal intensive care unit; retinopathy of prematurity PDF Resultados del tratamiento del uso de sedación por inhalación para la atención dental integral. Treatment outcomes of using inhalation sedation for comprehensive dental care. Madouh M1, BaniHani A2, Tahmassebi JF2. Author information Eur Arch Paediatr Dent. 2018 Feb;19(1):33-37. doi: 10.1007/s40368-017-0318-4. Epub 2018 Jan 11. Abstract AIM: To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. METHODS: This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia(LA), (5) child failed to return to complete treatment. RESULTS: In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. CONCLUSIONS: The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment. KEYWORDS: Children; General analgesia; Inhalation sedation; Treatment outcomes PDF Remifentanil para sedación y analgesia durante la división despierta de colgajo de lengua en niños: un informe de dos casos. Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases. Kuroiwa KK1, Nishizawa M1, Kondo N1, Nakazawa H1, Hirabayashi T1. Author information JA Clin Rep. 2017;3(1):43. doi: 10.1186/s40981-017-0114-5. Epub 2017 Aug 23. Abstract BACKGROUND: The tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation. CASE PRESENTATION: Twelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons' verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures. CONCLUSIONS: During the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion. KEYWORDS: Cleft palate; Remifentanil; Tongue flap PDF Curso Regional de Anestesiología en Obstetricia y Pediatría Colegio de Anestesiólogos de León AC y FMCA, AC Mayo 17-19, 2018. León Guanajuato, México Informes con el Dr. Enrique Hernández Cortez kikinhedz@gmail.com Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Sedación en urgencias / Sedation in emergency department

Diciembre 4, 2017. No. 2922

Incidencia de eventos adversos en adultos sometidos a sedación para procedimientos en el servicio de urgencias: revisión sistemática y metaanálisis. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Bellolio MF1,2, Gilani WI1, Barrionuevo P3,2, Murad MH3,2, Erwin PJ4, Anderson JR1, Miner JR5,6, Hess EP1,2. Acad Emerg Med. 2016 Feb;23(2):119-34. doi: 10.1111/acem.12875. Epub 2016 Jan 22. Author information Abstract OBJECTIVES: This was a systematic review and meta-analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED). METHODS: Eight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta-analysis was performed using a random-effects model and reported as incidence rates with 95% confidence intervals (CIs). RESULTS: The search yielded 2,046 titles for review. Fifty-five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately. CONCLUSIONS: Serious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision-making, risk communication, and informed consent. PDF Ketamina-Propofol versus propofol para la sedación de procedimiento en el servicio de urgencias: una revisión sistemática y metanálisis. Ketamine-Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Yan JW1,2, McLeod SL1,2, Iansavitchene A2. Author information Acad Emerg Med. 2015 Sep;22(9):1003-13. doi: 10.1111/acem.12737. Epub 2015 Aug 20. Abstract OBJECTIVES: Propofol is an agent commonly used for procedural sedation and analgesia (PSA) in the emergency department (ED), but it can cause respiratory depression and hypotension. The combination of ketamine-propofol (K-P) is an alternative that theoretically provides a reduction in adverse events compared to propofol. The primary objective of this review was to determine if K-P has a lower frequency of adverse respiratory events in patients undergoing PSA in the ED than propofol alone. Secondary objectives were to compare the proportion of overall adverse events, sedation time, procedure time, and recovery time between K-P and propofol. METHODS: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) published in English comparing the use of K-P to propofol alone for PSA in the ED were included. RESULTS: Six RCTs were included with a combined total of 932 patients (K-P = 520, propofol = 412). Five RCTs reported the proportion of adverse respiratory events; the pooled estimate revealed fewer adverse respiratory events with K-P compared to propofol (29.0% vs. 35.4%; risk ratio [RR] = 0.82; 95% confidence interval [CI] = 0.68 to 0.99). There was no significant difference with respect to the proportion of overall adverse events (38.8% vs. 42.5%; RR = 0.88; 95% CI = 0.75 to 1.04). Procedure time was similar when the groups were compared. CONCLUSIONS: The premise of combining ketamine with propofol is based on the many synergies that theoretically exist between these two agents. In this study, K-P had a lower frequency of adverse respiratory events in patients undergoing PSA in the ED compared to propofol alone. PDF Jornadas de Trabajo Social y Psicología en los Cuidados Paliativos Dicienbre 7-8, 2017. Guadalajara, México Informes en tszoquipan@hotmail.com XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo International Anesthesia Research Society Annuals Meetings USA Informes / Information

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