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

Anestesia para cirugía de invasión mínima / Anaesthesia for minimally invasive surgery

Septiembre 10, 2017. No. 2807

Anestesia para cirugía de invasión mínima Anaesthesia for minimally invasive surgery. Dec M1, Andruszkiewicz P1. Author information Wideochir Inne Tech Maloinwazyjne. 2016 Jan;10(4):509-14. doi: 10.5114/wiitm.2015.56411. Epub 2015 Dec 15. Abstract Minimally invasive surgery (MIS) is rising in popularity. It offers well-known benefits to the patient. However, restricted access to the surgical site and gas insufflation into the body cavities may result in severe complications. From the anaesthetic point of view MIS poses unique challenges associated with creation of pneumoperitoneum, carbon dioxide absorption, specific positioning and monitoring a patient to whom the anaesthetist has often restricted access, in a poorly lit environment. Moreover, with refinement of surgical procedures and growing experience the anaesthetist is presented with patients from high-risk groups (obese, elderly, with advanced cardiac and respiratory disease) who once were deemed unsuitable for the laparoscopic technique. Anaesthetic management is aimed at getting the patient safely through the procedure, minimizing the specific risks arising from laparoscopy and the patient's coexisting medical problems, ensuring quick recovery and a relatively pain-free postoperative course with early return to normal function. KEYWORDS: general anaesthesia; minimally invasive surgery; perioperative management PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).  Informes / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

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

Diabetes y anestesia / Diabetes and anaesthesia

Julio 7, 2017. No. 2742

Efecto de los diferentes tipos de anestesia en la glucosa intraoperatoria en sangre de pacientes diabéticos Effect of different types of anesthesia on intraoperative blood glucose of diabetic patients: A PRISMA-compliant systematic review and meta-analysis. Li X1, Wang J, Chen K, Li Y, Wang H, Mu Y, Chen Y. Medicine (Baltimore). 2017 Mar;96(13):e6451. doi: 10.1097/MD.0000000000006451. Abstract BACKGROUND: Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetespatients. METHODS: We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis. RESULTS: We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD -1.26, 95% confidence interval [CI] -1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD -0.74, 95% CI 4.41-2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD -0.28, 95% CI -1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels CONCLUSION:: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels. PDF Relación entre el momento de las visitas médicas preoperatorias y la glucosa  del día de la cirugía en la diabetes mal controlada. Relationship between the timing of preoperative medical visits and day-of-surgery glucose in poorly controlled diabetes. Patel SI1, Thompson BM1, McLemore RY1, Temkit M1, Schlinkert RT2, Apsey HA2, Cook CB1. Future Sci OA. 2016 Jun 2;2(2):FSO123. doi: 10.4155/fsoa-2016-0009. eCollection 2016 Jun.Abstract BACKGROUND: This study evaluated referral patterns for preoperative evaluations of patients with poorly controlled diabetes mellitus (DM) and determined whether intervals between evaluations and surgery day were associated with preoperative glucose levels. RESULTS/METHODOLOGY: In this retrospective analysis of DM patients with a hemoglobin A1c level greater than 8.0%, of the 163 patients who underwent preoperative medical evaluation, only 45% were evaluated by endocrinology. Patients who had surgery earlier than 10 days after the preoperative medical evaluation had preoperative glucose levels 18% higher than those of patients who waited more than 10 days. Preoperative outpatient contact with endocrinology was not associated with preoperative glucose level (p = 0.90). CONCLUSION: For poorly controlled DM, more than 10 days are needed to achieve preoperative glycemic control. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

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