https://www.eduardocaldelas-artroscopia.mx/blog/2023/01/26/beneficios-de-implementar-un-protocolo-mejorado-de-recuperacion-despues-de-la-cirugia-en-cirugia-ambulatoria/

Beneficios de implementar un protocolo mejorado de recuperación después de la cirugía en cirugía ambulatoria

26 enero 2023 por admin

Los protocolos de recuperación mejorada después de la cirugía con inyección periarticular intraoperatoria para pacientes que se someten a reconstrucción del LCA producen puntajes de dolor más bajos, menor consumo de opioides y menor tiempo de recuperación en la PACU.

https://journals.sagepub.com/doi/10.1177/23259671221133412

• Los protocolos de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) en cirugía ortopédica han obtenido un enfoque significativo debido a su capacidad para controlar el dolor adecuadamente en la ventana posoperatoria inmediata, lo que permite una movilización más temprana, estadías hospitalarias más cortas y menos complicaciones.
  Virginia Commonwealth University creó un enfoque de manejo del dolor multimodal en el que los pacientes reciben un bloqueo preoperatorio del nervio femoral seguido de una inyección local de anestesia periarticular intraoperatoria que consiste en bupivacaína, ketamina y ketorolaco.
• Los hallazgos del estudio sugieren que un protocolo de vías de recuperación mejoradas que incluye una inyección periarticular intraoperatoria estandarizada de bupivacaína, ketamina y ketorolaco mejora las puntuaciones de dolor en la ventana posoperatoria inmediata, disminuye el consumo de opioides y reduce el tiempo de recuperación en la PACU para los pacientes que se someten a una reconstrucción del LCA.

https://pubmed.ncbi.nlm.nih.gov/36452342/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703544/

https://journals.sagepub.com/doi/10.1177/23259671221133412

Hampton H, Torre M, Satalich J, Pershad P, Gammon L, O’Connell R, Brusilovsky I, Vap A. Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery. Orthop J Sports Med. 2022 Nov 23;10(11):23259671221133412. doi: 10.1177/23259671221133412. PMID: 36452342; PMCID: PMC9703544.

Copyright © The Author(s) 2022

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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 en niños / Pediatric anesthesia

Abril 23, 2018. No. 3060

Anestesia pediátrica para entornos de bajos recursos Paediatric anaesthesia for low-resource settings Ruth Barbour, Papari Deka BJA Education, 17 (11): 351-356 (2017) PDF Genética para el anestesiólogo pediátrico: introducción a las malformaciones congénitas, farmacogenética y proteómica Genetics for the Pediatric Anesthesiologist: A Primer on Congenital Malformations, Pharmacogenetics, and Proteomics Anesth Analg 2010;111:1264-74) PDF La seguridad y la eficacia del bloqueo continuo de nervios periféricos en la analgesia postoperatoria de pacientes pediátricos. The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients. Simić D1,2, Stević M1,2, Stanković Z1, Simić I1, Dučić S1,3, Petrov I1, Milenović M2,4. Author information Front Med (Lausanne). 2018 Mar 9;5:57. doi: 10.3389/fmed.2018.00057. eCollection 2018. Abstract Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects-from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment) to an increase in the incidence of death due to the onset of the systemic inflammatory response. The continuous peripheral block (CPNB) has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine) in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff. KEYWORDS: continuous peripheral nerve block; pain management; pediatric anesthesia; perineural catheters; postoperative analgesia 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

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

Anestesia en el espacio / Anesthesia in space

Abril 17, 2018. No. 3054

Anestesia en ambientes austeros: revisión de literatura y consideraciones para futuras misiones de exploración espacial. Anaesthesia in austere environments: literature review and considerations for future space exploration missions. Komorowski M1,2,3, Fleming S4, Mawkin M1, Hinkelbein J5. Author information NPJ Microgravity. 2018 Feb 23;4:5. doi: 10.1038/s41526-018-0039-y. eCollection 2018. Abstract Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia. PDF Intubación después de la inducción de secuencia rápida realizada por personal no médico durante las misiones de exploración espacial: un estudio piloto de simulación en un entorno analógico de Marte. Intubation after rapid sequence induction performed by non-medical personnel during space exploration missions: a simulation pilot study in a Mars analogue environment. Komorowski M1, Fleming S2. Author information Extrem Physiol Med. 2015 Nov 1;4:19. doi: 10.1186/s13728-015-0038-5. eCollection 2015. Abstract BACKGROUND: The question of the safety of anaesthetic procedures performed by non anaesthetists or even by non physicians has long been debated. We explore here this question in the hypothetical context of an exploration mission to Mars. During future interplanetary spacemissions, the risk of medical conditions requiring surgery and anaesthetic techniques will be significant. On Earth, anaesthesia is generally performed by well accustomed personnel. During exploration missions, onboard medical expertise might be lacking, or the crew doctor could become ill or injured. Telemedical assistance will not be available. In these conditions and as a last resort, personnel with limited medical training may have to perform lifesaving procedures, which could include anaesthesia and surgery. The objective of this pilot study was to test the ability for unassisted personnel with no medical training to perform oro-tracheal intubation after a rapid sequence induction on a simulated deconditioned astronaut in a Mars analogue environment. The experiment made use of a hybrid simulation model, in which the injured astronaut was represented by a torso manikin, whose vital signs and hemodynamic status were emulated using a patient simulator software. Only assisted by an interactive computer tool (PowerPoint(®) presentation), five participants with no previous medical training completed a simplified induction of general anaesthesia with intubation. RESULTS: No major complication occurred during the simulated trials, namely no cardiac arrest, no hypoxia, no cardiovascular collapse and no failure to intubate. The study design was able to reproduce many of the constraints of a space exploration mission. CONCLUSIONS: Unassisted personnel with minimal medical training and familiarization with the equipment may be able to perform advanced medical care in a safe and efficient manner. Further studies integrating this protocol into a complete anaesthetic and surgical scenario will provide valuable input in designing health support systems for space exploration missions. KEYWORDS: Anaesthesia; Medical training; Simulation; Space exploration; Space medicine 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

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