Revisiones_bibliográficas TyO

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)

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.

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

Información / Information

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

lunes, 12 de marzo de 2018

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

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.

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

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.

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

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

miércoles, 3 de enero de 2018

Anestesia general y desarrollo cerebral en niños / General anesthesia and pediatric brain development

Enero 3, 2018. No. 2952

La anestesia general de larga duración influye en la inteligencia de los niños en edad escolar.

Long-duration general anesthesia influences the intelligence of school age children.

Zhang Q1, Peng Y1, Wang Y2.

BMC Anesthesiol. 2017 Dec 19;17(1):170. doi: 10.1186/s12871-017-0462-8.

Abstract

BACKGROUND: General anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated. CONCLUSIONS: More than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth.

TRIAL REGISTRATION: Chinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497 retrospectively registered on 11/23/2017.

KEYWORDS: Children; Cognition; General anesthesia; Intelligence; Orthopedic surgery

Efectos de la anestesia en el cerebro en desarrollo. Infantes y fetos

Effect of Anesthesia on the Developing Brain: Infant and Fetus.

Andropoulos DB1.

Fetal Diagn Ther. 2017 Jun 7. doi: 10.1159/000475928. [Epub ahead of print]

Abstract

The potential for commonly used anesthetics and sedatives to cause neuroapoptosis and other neurodegenerative changes in the developing mammalian brain has become evident in animal studies over the past 15 years. This concern has led to a number of retrospective studies in human infants and young children, and some of these studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. This association is particularly evident for prolonged or repeated exposures. Because of the significant growth of fetal interventions requiring sedation and analgesia for the fetus, or because of maternal anesthetic effects, this concern about anesthetic neurotoxicity is relevant for the fetus. The potential for anesthetic neurotoxicity is the most important clinical and research problem in the field of pediatric anesthesiology. This review will first briefly summarize the rapid brain growth and development in the fetus and neonate. Next, animal model data of anesthetic neurotoxicity in the fetus and neonate will be presented, followed by a review of recent human clinical anesthetic neurotoxicity trials. Finally, the rationale for studying dexmedetomidine as a potential neuroprotectant agent in anesthetic neurotoxicity will be reviewed along with study design for two human clinical trials involving dexmedetomidine.

KEYWORDS: Anesthetic neurotoxicity; Dexmedetomidine; Fetus; Isoflurane; Neonate; Sevoflurane

Efectos de la anestesia sobre el desarrollo cerebral de los niños

Effects of Anesthesia on Children's Brain Development

Hernández-Cortez Enrique

J Anesth Crit Care Open Access 2015, 2(6): 00079

Summary

Nowadays, the administration of most of the anesthetics is being questioned. The quality of reversibility of these medications is being questioned, especially when administered to children under 3 years old. The administration of isoflurane elevates intracellular calcium levels which are critical for cell damage resulting in apoptosis. The NMDA and GABA receptors are indirectly involved in the effect of immature brains. The immaturity of the central nervous system associated to the administration of anesthetic agents such as inhaled anesthetics, ketamine, midazolam, nitrous oxide, and others, produces important changes in the brain that have an impact in the child's later life. There are two important elements in the neurotoxicity of anesthetics, dosage and time administration. Repeating anesthetics produces more brain changes. These modifications have resulted in serious behavioral and memory changes in experiments in animals. It is suspected that a similar situation may arise in children who manifest learning disabilities in later stages.

Keywords: Apoptosis; Anesthetics; Children

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

World Congress on Regional Anesthesia & Pain Medicine

April 19-21, 2018, New York City, USA

International Anesthesia Research Society Annuals Meetings

USA