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sábado, 2 de julio de 2011

Una encuesta nacional de la American Pediatric Anesthesiologists: analgesia controlada por el paciente y otras terapias con opioides intravenosos en dolor agudo pediátrico



A national survey of American Pediatric Anesthesiologists: patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management.
Nelson KL, Yaster M, Kost-Byerly S, Monitto CL.
Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Anesth Analg. 2010 Mar 1;110(3):754-60.
Abstract
BACKGROUND: The influence of patient characteristics, institutional demographics, and published practice guidelines on the provision of IV opioid analgesia, particularly as delivered through a patient-controlled analgesia (PCA) delivery device, to pediatric patients is unknown.
METHODS: We sent a national, web-based, descriptive survey of pediatric pain management practice to select members of the Society for Pediatric Anesthesia to assess institutional demographics, availability and implementation of IVPCA and PCA by proxy, and recalled occurrence of serious and life-threatening opioid-related side effects. RESULTS: Data from respondents at 252 institutions throughout the United States were collected and analyzed. Sixty-nine percent of respondents practiced in a children's hospital or children's center within a general hospital, and 51% of institutions had a pediatric pain service. Virtually all pediatric pain services (91%) were administered by departments of anesthesiology. Pediatric pain service availability correlated with the number of pediatric beds. IVPCA was available to pediatric patients at 96% of institutions surveyed, whereas IVPCA by proxy was available at only 38%. Eleven percent of respondents reported that their hospital no longer provided IVPCA by proxy as a result of the 2004 Joint Commission on Accreditation of Hospitals Sentinel Event Warning. Instructional material concerning IVPCA was provided to patients or their families by 40% of institutions. IVPCA orders were handwritten by 55% of respondents, despite 39% having computerized provider order entry systems. Ninety percent of respondents reported using pulse oximetry monitoring when patients were administered IVPCA. Forty-two respondents recalled patients having received naloxone to counteract the cardiopulmonary side effects of opioids during the year before receipt of the survey. Eight respondents recalled patient deaths having occurred over the past 5 years in patients receiving IVPCA, IVPCA by proxy, and continuous non-IVPCA opioid infusions. CONCLUSIONS: Although IVPCA was available to pediatric patients at most institutions surveyed, prescribing practices and supervision of pediatric pain management were influenced by patient characteristics, institutional demographics, and published national guidelines. Recalled life-threatening events were reported in conjunction with all modes of opioid infusion therapy. Interventions that might diminish the incidence of adverse events but are not used to their fullest extent include improved education and implementation of systems designed to minimize human error involved in the prescribing of opioids. Providing a more accurate accounting of complications would require institutions to participate in a prospective data-collecting consortium designed to track both the incidence of therapy and associated complications
http://www.anesthesia-analgesia.org/content/110/3/754.full.pdf+html  
Atentamente
Dr. Enrique Hernández-Cortez 
Anestesiología y Medicina del Dolor
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opioides en pediatría


Auditoría nacional de la Association of Paedriatic Anaesthetists sobre infusiones de opioides en pediatría
APA national audit of pediatric opioid infusions.
Morton NS, Errera A.
Pediatric Anesthesia & Pain Management, Royal Hospital for Sick Children, Glasgow, Scotland. neilmorton@mac.com
Paediatr Anaesth. 2010 Feb;20(2):119-25. Epub 2009 Nov 3.
Abstract
INTRODUCTION: A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated with the techniques of continuous opioid infusion, patient-controlled analgesia, and nurse-controlled analgesia in patients aged 0-18. METHODS: The audit was funded by the Association of Paediatric Anaesthetists (APA) and performed by the acute pain services of 18 centers throughout the United Kingdom. Data were submitted weekly via a web-based return form designed by the Document Capture Company that documented data on all patients receiving opioid infusions and any SCIs. Eight categories of SCI were identified in advance, and the reported SCIs were graded in terms of severity (Grade 1 (death/permanent harm); Grade 2 (harm but full recovery and resulting in termination of the technique or needing significant intervention); Grade 3 (potential but no actual harm). Data were collected over a period of 17 months (25/06/07-25/11/08) and stored on a secure server for analysis. RESULTS: Forty-six SCIs were reported in 10 726 opioid infusion techniques. One Grade 1 incident (1 : 10,726) of cardiac arrest occurred and was associated with aspiration pneumonitis and the underlying neurological condition, neurocutaneous melanosis. Twenty-eight Grade 2 incidents (1 : 383) were reported of which half were respiratory depression. The seventeen Grade 3 incidents (1 : 631) were all drug errors because of programming or prescribing errors and were all reported by one center. CONCLUSIONS: The overall incidence of 1 : 10,000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse-controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on relative risks to help the process of informed consent.
http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2009.03187.x/pdf 
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BIBLIOTECA MEDICA


BIBLIOTECA MEDICA


Posted: 01 Jul 2011 06:00 PM PDT
El Cromo es un oligoelemento esencial que potencia la acción de la insulina e interviene en el metabolismo de los hidratos de carbono, las grasas y las proteínas. Algunos estudios demuestran que podría utilizarse como complemento parafacilitar el control del azúcar en la sangre en las personas que padecen diabetes. El Cromo está presente, como otros oligoelementos, en los alimentos que
Posted: 01 Jul 2011 05:59 PM PDT
El Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires informó que el domingo 10 de julio se realizará una campaña para la donación de órganos, durante el desarrollo de las elecciones a jefe de Gobierno porteño. La iniciativa estará destinada a informar y recabar la voluntad de los ciudadanos respecto a la donación de órganos durante el desarrollo del acto eleccionario, en
Posted: 01 Jul 2011 05:58 PM PDT
El presidente de Venezuela fue operado a comienzos de junio tras detectársele en Cuba esta afección. Luego, se le diagnosticó un cáncer absesado en la región pélvica. Algunos trascendidos afirman que sería un tumor intestinal. A continuación, todo sobre el absceso pélvico, según especialistas Un absceso intraabdominal es una acumulación circunscrita de pus aislada del resto de la cavidad
Posted: 01 Jul 2011 05:57 PM PDT
El 30 por ciento de los trabajadores rurales encargados de la aplicación de pesticidas sufre exposición acumulada a agrotóxicos y no cumple con los requisitos básicos de protección, según señala un grupo de investigadores en Epidemiología Ambiental Un grupo de investigadores en Epidemiología Ambiental elaboró escalas que indican que el 30 por ciento de los aplicadores de pesticidas
Publicado por Bibliomanazteca en 7:44 0 comentarios
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Documento de consenso sobre "Tratamiento antimicrobiano de la faringoamigdalitis"



Publicado en Acta Otorrinolaringol Esp. 2003;54:369-83. - vol.54 núm 5
Publicado por Bibliomanazteca en 7:42 0 comentarios
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