Relajantes neuromusculares en UCI/Neuromuscular blocking agents in ICU

Diciembre 7 2015. No. 2168

Relajantes neuromusculares en pacientes con ARDS. Sumario de las evidencias actuales de tres estudios aleatorizados y controlados Neuromuscular blocking agents in patients with acute respiratory distress syndrome: a summary of the current evidence from three randomized controlled trials. Neto AS1, Pereira VG, Espósito DC, Damasceno MC, Schultz MJ. Ann Intensive Care. 2012 Jul 26;2(1):33. doi: 10.1186/2110-5820-2-33. CONCLUSIONS: The use of NMBA in the early phase of ARDS improves outcome. PDF Mejor evidencia en cuidados intensivos. Papel de los relajantes neuromusculares en la etapa temprana del síndrome de dificultad respiratoria aguda Best evidence in critical care medicine: The role of neuromuscular blocking drugs in early severe acute respiratory distress syndrome. Needham CJ, Brindley PG. Can J Anaesth. 2012 Jan;59(1):105-8. doi: 10.1007/s12630-011-9615-2. Epub 2011 Nov 1. CONCLUSIONS: Treatment in early severe ARDS with the NMBA, cisatracurium, for 48 hr was associated with lower adjusted 90-day mortality. It was also associated with decreased morbidity, which included increased ventilator-free days, increased ICU-free days, and increased organ failure-free days. These benefits occurred without increasing the incidence of ICU-acquired weakness. PDF Sedación y parálisis Sedation and paralysis. Piriyapatsom A1, Bittner EA, Hines J, Schmidt UH. Respir Care. 2013 Jun;58(6):1024-37. doi: 10.4187/respcare.02232. Abstract Sedation is used almost universally in the care of critically ill patients, especially in those who require mechanical ventilatory support or other life-saving invasive procedures. This review will focus on the sedation strategies for critically ill patients and the pharmacology of commonly used sedative agents. The role of neuromuscular blocking agents in the ICU will be examined and the pharmacology of commonly used agents is reviewed. Finally a strategy for rational use of these sedative and neuromuscular blocking agents in critically ill patients will be proposed. KEYWORDS: critical illness; mechanical ventilation; neuromuscular blocking agent; sedation; sedatives PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Cisatracurium

Diciembre 6 2015. No. 2167

Edad y los efectos de bloqueo neuromuscular del cisatracurio Age and the neuromuscular blockading effects of cisatracurium. Guo J, Zhou X, Yuan X, Shen H, Zhang Y. Int J Clin Exp Med. 2015 Sep 15;8(9):16664-16669. Abstract PURPOSE: To investigate the influence of age on the neuromuscular blocking effect of cisatracurium. METHODS: 90 patients with ASA I and II were assigned to the following groups according to their age: adults, children, and infants. Each group was subdivided into three subgroups according to the first dose of cisatracurium. Patients were administrated at a first dose of cisatracurium randomly, and their responses to train-of-four (TOF) stimulation were observed. When the same degree of the first response (T1) continuously repeats three times, the percentage of T1 inhibition was recorded, and the curve of dose-effect relationship and ED95 were calculated. A second dose of cisatracurium was then administrated (total volume 100 μg/kg). The recovery phase in each patient was observed upon T1 reaching the maximum blocking effect (100%). RESULTS: Once the maximum blocking effect was reached, patients were intubated. There were 83 cases (92.2%) of patients with grade 1 and 7 (7.8%) patients with grade 2 intubating conditions. ED95 was 59.29, 55.88 and 45.39 μg/kg in adults, children, and infants, respectively. ED95 positively correlated with age. The clinical duration of neuromuscular blockade, effective action duration of neuromuscular blockade, and in vivo action duration of neuromuscular blockade in adults was longer than that in children (P<0.05), but shorter than in infants (P<0.05). However, there were no significant differences in the recovery index among groups (P>0.05). CONCLUSION: Age influences the neuromuscular blocking effects of cisatracurium to a certain extent. KEYWORDS: Cisatracurium; age; dose-effect relationship; recovery phase PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Relajantes neuromusculares en pediatría/Neuromuscular block in infants

Diciembre 5 2015. No. 2166

Existe pocas guías y literatura disponibles para el uso seguro de relajantes musculares en pediatría Limited professional guidance and literature are available to guide the safe use of neuromuscular block in infants. Honsel M, Giugni C, Brierley J. Acta Paediatr. 2014 Sep;103(9):e370-3. doi: 10.1111/apa.12682. Epub 2014 Jun 20. Abstract AIM: Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range. METHODS: We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK. RESULTS: No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.CONCLUSION: There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies. KEYWORDS: Critical care; Neonatology; Neuromuscular blockade; Neuromuscular monitoring; Pharmacology PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Pregabalina en DPO/Pregabaline and POP

Diciembre 1, 2015. No. 2162

Eficacia de pregabalina en dolor agudo postoperatorio en diferentes categorías quirúrgicas. Un meta-análisis Efficacy of Pregabalin in Acute Postoperative Pain Under Different Surgical Categories: A Meta-Analysis. Lam DM, Choi SW, Wong SS, Irwin MG, Cheung CW. Medicine (Baltimore). 2015 Nov;94(46):e1944. doi: 10.1097/MD.0000000000001944. PDF Gabapentina perioperatoria reduce el consume de opioides por 24 horas y mejora la rehabilitación en el hospital pero no la evolución después del alta en artroplastia de rodilla con bloqueos periféricos Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. Clarke HA, Katz J, McCartney CJ, Stratford P, Kennedy D, Pagé MG, Awad IT, Gollish J7, Kay J. Br J Anaesth. 2014 Nov;113(5):855-64. doi: 10.1093/bja/aeu202. Epub 2014 Jun 30. Abstract BACKGROUND: This study was designed to determine whether a 4 day perioperative regimen of gabapentin added to celecoxib improves in-hospital rehabilitation and physical function on postoperative day 4 and 6 weeks and 3 months after total knee arthroplasty (TKA). METHODS: After Research Ethics Board approval and informed consent, 212 patients were enrolled in a randomized, double-blinded, placebo-controlled study. Two hours before surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either gabapentin 600 mg or placebo p.o. Two hours later, patients received femoral, sciatic nerve blocks, and spinal anaesthesia. After operation, patients received gabapentin 200 mg or placebo three times per day (TID) for 4 days. All patients also received celecoxib 200 mg q12 h for 72 h and i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, during hospitalization, on postoperative day 4 (POD4), and 6 weeks and 3 months after surgery. RESULTS: The gabapentin group used less morphine in the first 24 h after surgery [G=38.3 (29.5 mg), P=48.2 (29.4 mg)] (P<0.0125) and had increased knee range of motion compared with the placebo group in-hospital (P<0.05). There were no differences between groups in favour of the gabapentin group for pain or physical function on POD 4 [95% confidence interval (CI): pain: -1.4, 0.5; function: -6.3, 2.0], 6 weeks (95% CI: pain: 0.1, 1.9; function: -0.2, 6.5) or 3 months (95% CI: pain: -0.2, 1.7; function: -2.2, 4.3) after TKA. CONCLUSIONS: In the context of celecoxib, spinal anaesthesia, femoral and sciatic nerve blocks, a dose of gabapentin 600 mg before operation followed by 4 days of gabapentin 200 mg TIDdecreased postoperative analgesic requirements and improved knee range of motion after TKA. Gabapentin provided no improvement in pain or physical function on POD4 and 6 weeks or 3 months after surgery. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015