Revisiones_bibliográficas TyO

lunes, 11 de septiembre de 2017

Demanda de opioides antes y después de la reconstrucción del ligamento cruzado anterior

http://www.reemplazoprotesico.com.mx/academia/demanda-de-opioides-antes-y-despues-de-la-reconstruccion-del-ligamento-cruzado-anterior/

Opioid Demand Before and After Anterior Cruciate Ligament Reconstruction

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/28806097

http://journals.sagepub.com/doi/10.1177/0363546517719226

De:

Anthony CA1,Westermann RW1,Bedard N1,Glass N1,Bollier M1,

Hettrich CM1,Wolf BR1.

Am J Sports Med.

2017 Aug 1:363546517719226. doi: 10.1177/0363546517719226. [Epub ahead of print]

Abstract

BACKGROUND:

Surgeons and health care systems have received a call to action in an effort to curtail the current opioid epidemic.

PURPOSE:

To (1) define the natural history of opioid demand after anterior cruciate ligament reconstruction (ACLR), (2) consider how filling preoperative opioid prescriptions affects opioid demand after ACLR, and (3) evaluate the effect of additional procedures during ACLR and patient age on postoperative opioid demand.

CONCLUSION:

Opioid demand after ACLR dropped significantly in the vast majority of patients by the third postoperative month. Surprisingly, 35% of patients undergoing ACLR were observed to be using opioid medication preoperatively, and this study found preoperative opioid use to be a strong predictor of postoperative opioid demand with a 5- to 7-fold increased risk in this patient population. Patients who were filling opioid prescriptions 1 to 3 months from their surgical date were at the highest risk for postoperative opioid utilization. Patients undergoing ACLR with microfracture were at an increased risk of filling opioid prescriptions. Patients less than 25 years of age were at an elevated risk of filling opioid prescriptions at all time points postoperatively.

KEYWORDS:

ACL; narcotic; opioid

Resumen

ANTECEDENTES:
Los cirujanos y los sistemas de atención de la salud han recibido un llamado a la acción en un esfuerzo por reducir la actual epidemia de opioides.

PROPÓSITO:
(1) definir la historia natural de la demanda de opioides después de la reconstrucción del ligamento cruzado anterior (ACLR), (2) considerar cómo llenar las prescripciones de opioides preoperatorias afecta la demanda de opioides después de ACLR y (3) evaluar el efecto de procedimientos adicionales durante la ACLR y la edad del paciente en la demanda de opioides postoperatorios.
.
CONCLUSIÓN:
La demanda de opioides después de la ACLR disminuyó significativamente en la gran mayoría de los pacientes en el tercer mes postoperatorio. Sorprendentemente, se observó que el 35% de los pacientes sometidos a ACLR estaban usando medicación opioide preoperatoria, y este estudio encontró que el uso de opioides en el preoperatorio es un fuerte predictor de la demanda de opioides postoperatorio con un riesgo 5 a 7 veces mayor en esta población de pacientes. Los pacientes que estaban llenando recetas de opioides 1 a 3 meses desde su fecha quirúrgica estaban en el mayor riesgo de utilización de opioides postoperatorios. Los pacientes sometidos a ACLR con microfractura tenían un mayor riesgo de llenar las recetas de opioides. Los pacientes con menos de 25 años tenían un riesgo elevado de recetar opiáceos en todos los momentos postoperatorios.

PALABRAS CLAVE:
ACL; narcótico; opioide

PMID: 28806097 DOI:

10.1177/0363546517719226

#ACL #LCA #narcótico #opioide

Nausea y vomito / Nausea and vomiting

Septiembre 9, 2017. No. 2806

Prevención de náuseas y vómitos en mujeres sometidas a anestesia regional para cesárea: desafíos y soluciones.

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions.

Jelting Y1, Klein C1, Harlander T1, Eberhart L2, Roewer N1, Kranke P1.

Author information

Local Reg Anesth. 2017 Aug 9;10:83-90. doi: 10.2147/LRA.S111459. eCollection 2017.

Abstract

BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS: Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION: Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

KEYWORDS: PONV; antiemetics; hypotension; neuraxial anesthesia; obstetrics

PDF

Administración profiláctica del ondansetrón en la prevención del prurito inducido por morfina intratecal y náuseas y vómitos postoperatorios en pacientes sometidos a cesárea

Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section.

Koju RB1,2, Gurung BS3, Dongol Y4.

Author information

BMC Anesthesiol. 2015 Feb 17;15:18. doi: 10.1186/1471-2253-15-18.Abstract

BACKGROUND:

Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequently associated with the incidence of troublesome side effects such as nausea, vomiting and pruritus. Various mechanisms have been postulated for the opioid-induced pruritus, with a variety of medications with different mechanisms of actions formulated for the prevention and treatment. But, the results are inconsistent and hence the prevention and treatment of opioid-induced pruritus still remains a challenge. Ondansetron which is antiemetic, non-sedative and has no antianalgesic effect is an antagonist to 5-HT3 receptor, the receptor with which opioids interacts and imparts its effects. Ondansetron, thus, would be an attractive treatment strategy for both opioid-induced pruritus and post-operative nauseaand vomiting. METHODS: After the approval from institutional review committee and written consent received from the patient, 50 healthy parturients of ASA I and II physical status undergoing caesarean section under spinal anaesthesia were enrolled for the study. They were randomly categorized into placebo group (2 ml normal saline) and treatment group (2 ml of 4 mg ondansetron), each group containing 25 patients. Pruritus and post-operative nausea and vomiting scores were recorded up to 24 hours after the administration of intrathecal morphine. Statistical analysis was performed using chi-square test. RESULTS: The incidence, severity and necessity of treatment for pruritus in the treatment group was significantly reduced compared to the placebo group (16% vs 88%). Similarly, the risk of post-operative nausea and vomiting in the treatment group was less compared to the placebo group (8% vs 56%). CONCLUSION: Prophylactic administration of ondansetron to parturients receiving intrathecal morphine for post-operative analgesia provides a significant reduction of intrathecal morphine-induced pruritus and nausea and vomiting.

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

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