Dolor postoperatorio en niños: Recomendaciones clínicas / Combinación de dexametasona y anestsésicos locales en nervios periféricos / Curso multimodal de ultrasonido perioperatorio para internos permite mejor adquisición y retención de habilidades y conocimiento

Noviembre 14, 2015. No. 2145

Dolor postoperatorio en niños: Recomendaciones clínicas Pain after surgery in children: clinical recommendations Walker, Suellen M. Current Opinion in Anaesthesiology: October 2015 - Volume 28 - Issue 5 - p 570-576 PDF  Combinación de dexametasona y anestsésicos locales en nervios periféricos. Un meta-análisis randomizado de estudios controlados Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: A meta-analysis of randomised controlled trials Huynh, Thi Mum; Marret, Emmanuel; Bonnet, Francis European Journal of Anaesthesiology November 2015 - Volume 32 - Issue 11 - p 751-758  PDF  Curso multimodal de ultrasonido perioperatorio para internos permite mejor adquisición y retención de habilidades y conocimiento Multimodal Perioperative Ultrasound Course for Interns Allows for Enhanced Acquisition and Retention of Skills and Knowledge Mitchell, John D. MD; Montealegre-Gallegos, Mario MD; Mahmood, Feroze MD; Owais, Khurram MD; Wong, Vanessa BS; Ferla, Brian MD; Chowdhury, Seema MD; Nachshon, Akiva MD; Doshi, Rajiv MD; Matyal, Robina MD A&A Case Reports: 1 October 2015 - Volume 5 - Issue 7 - p 119-123 PDF Metodología de investigación clínica 1. Diseño del estudio y fuentes metodológicas de error Clinical Research Methodology 1: Study Designs and Methodologic Sources of Error Sessler, Daniel I. MD; Imrey, Peter B. PhD Anesthesia & Analgesia October 2015 - Volume 121 - Issue 4 - p 1034-1042 PDF

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Cannabis en dolor crónico/Cannabis for chronic pain

Noviembre 13, 2015. No. 2144

El uso medicinal del cannabis parece ser en gran medida seguro para el tratamiento del dolor crónico, al menos en las personas que cuentan con alguna experiencia en la toma del fármaco. Un equipo de investigación canadiense comprobó que las personas que tomaban cannabis para aliviar su dolor no presentaban un riesgo mayor de sufrir efectos secundarios graves, en comparación con las personas con dolor que no lo consumían. Los investigadores siguieron a 215 pacientes adultos con dolor crónico que tomaron cannabis medicinal (con un contenido del 12,5% de tetrahidrocannabinol) durante un año, y los compararon con un grupo control de 216 pacientes con dolor crónico que no lo consumían. El estudio contó la colaboración de siete centros de tratamiento del dolor de Canadá. Las personas podía consumir la marihuana del modo en que desearan: fumarla, comerla con los alimentos o inhalarla con un vaporizador. Hubo poca diferencia en cuanto a efectos secundarios graves entre ambos grupos, según los investigadores, aunque los usuarios de cannabis presentaron un riesgo un 73% más alto de sufrir efectos secundarios leves, como dolores de cabeza, náuseas, somnolencia y mareos. (neurología.com)   Cannabis para el Manejo del Dolor: Evaluación del Estudio de Seguridad (COMPASS). Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). Ware MA, Wang T, Shapiro S, Collet JP; COMPASS study team. J Pain. 2015 Sep 16. pii: S1526-5900(15)00837-8. doi: 10.1016/j.jpain.2015.07.014. [Epub ahead of print] Abstract Cannabis is widely used as a self-management strategy by patients with a wide range of symptoms and diseases including chronic non-cancer pain. The safety of cannabis use for medical purposes has not been systematically evaluated. We conducted a prospective cohort study to describe safety issues among individuals with chronic non-cancer pain. A standardized herbal cannabis product (12.5% tetrahydrocannabinol) was dispensed to eligible individuals for a 1-year period; controls were individuals with chronic pain from the same clinics who were not cannabis users. The primary outcome consisted of serious adverse events and non-serious adverse events. Secondary safety outcomes included pulmonary and neurocognitive function and standard hematology, biochemistry, renal, liver, and endocrine function. Secondary efficacy parameters included pain and other symptoms, mood, and quality of life. Two hundred and fifteen individuals with chronic pain were recruited to the cannabis group (141 current users and 58 ex-users) and 216 controls (chronic pain but no current cannabis use) from 7 clinics across Canada. The median daily cannabis dose was 2.5 g/d. There was no difference in risk of serious adverse events (adjusted incidence rate ratio = 1.08, 95% confidence interval = .57-2.04) between groups. Medical cannabis users were at increased risk of non-serious adverse events (adjusted incidence rate ratio = 1.73, 95% confidence interval = 1.41-2.13); most were mild to moderate. There were no differences in secondary safety assessments. Quality-controlled herbal cannabis, when used by patients with experience of cannabis use as part of a monitored treatment program over 1 year, appears to have a reasonable safety profile. Longer-term monitoring for functional outcomes is needed. STUDY REGISTRATION: The study was registered with www.controlled-trials.com (ISRCTN19449752). PERSPECTIVE: This study evaluated the safety of cannabis use by patients with chronic pain over 1 year. The study found that there was a higher rate of adverse events among cannabis users compared with controls but not for serious adverse events at an average dose of 2.5 g herbal cannabis per day.  PDF

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Opioides espinales en DPO/Spinal opioids for POP

Noviembre 11, 2015. No. 2142

Las evidencias actuales para la selección de opioides espinales en el dolor postoperatorio. Current evidence for spinal opioid selection in postoperative pain. Bujedo BM. Korean J Pain. 2014 Jul;27(3):200-9. doi: 10.3344/kjp.2014.27.3.200. Epub 2014 Jun 30. Abstract BACKGROUND: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. METHODS: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. RESULTS: Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. CONCLUSIONS: Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security. PDF

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Más de anestesia en odontopediatría/more on pediatric dental anesthesia

Noviembre 12, 2015. No. 2143

Eventos adversos después de alta de sedación oral en pacientes pediátricos odontológicos Oral Sedation Postdischarge Adverse Events in Pediatric Dental Patients. Huang A, Tanbonliong T. Anesth Prog. 2015 Fall;62(3):91-9. doi: 10.2344/0003-3006-62.3.91. Abstract The study investigated patient discharge parameters and postdischarge adverse events after discharge among children who received oral conscious sedation for dental treatment. This prospective study involved 51 patients needing dental treatment under oral conscious sedation. Each patient received one of various regimens involving combinations of a narcotic (ie, morphine or meperidine), a sedative-hypnotic (ie, chloral hydrate), a benzodiazepine (ie, midazolam or diazepam), and/or an antihistamine (ie, hydroxyzine HCl). Nitrous oxide and local anesthesia were used in conjunction with all regimens. After written informed consent was obtained, each guardian was contacted by phone with specific questions in regard to adverse events following the dental appointment. Out of 51 sedation visits, 46 were utilized for analysis including 23 boys and 23 girls ranging from 2 years 2 months to 10 years old (mean 5.8 years). 60.1% of patients slept in the car on the way home, while 21.4% of that group was difficult to awaken upon reaching home. At home, 76.1% of patients slept; furthermore, 85.7% of patients who napped following the dental visit slept longer than usual. After the appointment, 19.6% exhibited nausea, 10.1% vomited, and 7.0% experienced a fever. A return to normal behavior was reported as follows: 17.4% in <2 hours, 39.1% in 2-6 hours, 28.3% in 6-10 hours, and 15.2% in >10 hours. Postdischarge excessive somnolence, nausea, and emesis were frequent complications. The time to normality ranged until the following morning demonstrating the importance of careful postdischarge adult supervision. KEYWORDS: Chloral hydrate; Conscious sedation; Dental treatment; Diazepam; Hydroxyzine; Meperidine; Midazolam; Morphine; Postdischarge adverse event PDF Comparación de sedación con midazolam/ketamina oral versus intranasal en pacientes dentales no cooperadores de 3-6 años de edad Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. J Dent Res Dent Clin Dent Prospects. 2015 Spring;9(2):61-5. doi: 10.15171/joddd.2015.013. Epub 2015 Jun 10. Abstract Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety. Materials and methods. A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt's scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test. Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004). Conclusion. . Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children. KEYWORDS: Anxiety; intranasal; ketamine; midazolam; oral sedation PDF

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