Ketamina / Ketamine

Noviembre 29, 2016. No. 2523 ¿La profilaxis con haloperidol reduce el delirio inducido por ketamina en los niños? Does haloperidol prophylaxis reduce ketamine-induced emergence delirium in children? Amr MA1, Shams T, Al-Wadani H. Sultan Qaboos Univ Med J. 2013 May;13(2):256-62. Epub 2013 May 9.Abstract OBJECTIVES: Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium (ED). This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. METHODS: Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. RESULTS: A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol (49.7%). There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm (P ≤0.01) and less irritable (P ≤0.01), with a lower incidence of crying (P ≤0.01) and disorientation (P ≤0.01). CONCLUSION: We found that preoperative administration of haloperidol decreases the incidence of postoperative delirium in a sample of Egyptian children undergoing minor surgery. This is congruent with earlier work conducted in adults. This work carries great hope to decrease and even prevent ED in hospitalised, non-surgical patients. KEYWORDS: Anesthesia; Children; Delirium; Egypt; Haloperidol; Ketamine PDF Ketamina en dolor crónico. Riesgos y beneficios Ketamine for chronic pain: risks and benefits. Niesters M1, Martini C, Dahan A. Br J Clin Pharmacol. 2014 Feb;77(2):357-67. doi: 10.1111/bcp.12094. Abstract The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamineis increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain. PDF Epidemiología y patrones de la toxicidad crónica y aguda asociados al uso recreacional de ketamina The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use. Kalsi SS1, Wood DM, Dargan PI. Emerg Health Threats J. 2011 Apr 15;4:7107. doi: 10.3402/ehtj.v4i0.7107. Abstract Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. However, there is increasing evidence of non-medical recreational use of ketamine, particularly in individuals who frequent the night-time economy. The population-level and sub-population (clubbers) prevalence of recreational use of ketamine is not known but is likely to be similar, or slightly lower than, that of other recreational drugs such as cocaine, MDMA, and amphetamine. The predominant features of acute toxicity associated with the recreational use of ketamine are neuro-behavioural abnormalities such as agitation, hallucinations, anxiety, and psychosis. Secondary to these, individuals put themselves at greater risk of physical harm/trauma. Cardiovascular features (hypertension and tachycardia) occur less frequently and the risk of death from recreational use is low and is predominately due to the physical harm/trauma. Long-term recreational use of ketamine can be associated with the development of psychological dependence and tolerance. There are reports of gastro-intestinal toxicity, particularly abdominal pain and abnormal liver function tests, and of neuropsychiatric disorders, typically a schizophrenia-like syndrome, in long-term users. Finally, there are increasing reports of urological disorders, particularly haemorrhagic cystitis, associated with long-term use. The management of these problems associated with the long-term use of ketamine is largely supportive and abstinence from ongoing exposure to ketamine. In this review we will collate the available information on the epidemiology of recreational use of ketamine and describe the patterns of acute and chronic toxicity associated with its recreational use and the management of this toxicity. KEYWORDS: 2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone; acute toxicity; chronic toxicity; dependence; epidemiology; haemorrhagic cystitis; ketamine; recreational drugs PDF Segundo Curso-Taller de Anestesia y Dolor Zapopan Jalisco, México Dic 1-2, 2016 Informes gmoarechiga@hotmail.com  California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Remifentanil

Noviembre 26, 2016. No. 2520

Efecto del remifentanilo y fentanilo sobre la función cognitiva postoperatoria y el nivel de citoquinas en ancianos con cirugía abdominal mayor Effect of remifentanil and fentanyl on postoperative cognitive function and cytokines level in elderly patients undergoing major abdominal surgery Germano De Cosmo, Flaminio Sessa MD, Federico Fiorini MD, Elisabetta Congedo MD, PhD Journal of Clinical Anesthesia (2016) 35, 40-46. Abstract Purpose: Postoperative cognitive dysfunction is a frequent complication occurring in geriatric patients. Type of anesthesia and the patient's inflammatory response may contribute to postoperative cognitive dysfunction (POCD). In this prospective randomized double-blinded controlled study we hypothesized that intraoperative remifentanil may reduce immediate and early POCD compared to fentanyl and evaluated if there is a correlation between cognitive status and postoperative inflammatory cytokines level. Methods: Six hundred twenty-two patients older than 60 years undergoing major abdominal surgery were randomly assigned to two groups and treated with different opioids during surgery: continuous infusion of remifentanil or fentanyl boluses. Twenty-five patients per group were randomly selected for the quantitative determination of serum interleukin (IL)-1β, IL-6, and IL-10 to return to the ward and to the seventh postoperative day. Results: Cognitive status and its correlation with cytokines levels were assessed. The groups were comparable regarding to POCD incidence; however, IL-6 levels were lower the seventh day after surgery for remifentanil group (P= .04). No correlation was found between POCD and cytokine levels. Conclusions: The use of remifentanil does not reduce POCD PDF Efectos del remifentanilo vs óxido nitroso en la náusea postoperatoria, el vómito y en dolor después de tiroidectomía Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy: Propensity score matching analysis. Kim MK1, Yi MS, Kang H, Choi GJ. Medicine (Baltimore). 2016 Oct;95(41):e5135. PDF Efectos de un bolo de fentanil y de infusión de remifentanail sobre náusea y vómito postoperatorios Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting. Lim H1, Doo AR1, Son JS1, Kim JW1, Lee KJ1, Kim DC1, Ko S1. Korean J Anesthesiol. 2016 Feb;69(1):51-6. doi: 10.4097/kjae.2016.69.1.51. Epub 2016 Jan 28. Abstract BACKGROUND: Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS: Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 µg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS: Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS: A single bolus administration of fentanyl 2 µg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV. KEYWORDS: Fentanyl; Intraoperative period; Postoperative nausea and vomiting; Remifentanil PDF Segundo Curso-Taller de Anestesia y Dolor Zapopan Jalisco, México Dic 1-2, 2016 Informes gmoarechiga@hotmail.com  California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

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