Fentanil intranasal en niños / Intranasal fentanyl in children

Enero 17, 2016. No. 2209

Manejo del dolor después de miringotomía y colocación de tubos: dexmedetomidina versus fentanil intranasal Pain management following myringotomy and tube placement: intranasal dexmedetomidine versus intranasal fentanyl. Dewhirst E, Fedel G, Raman V, Rice J, Barry N, Jatana KR, Elmaraghy C, Merz M, Tobias JD. Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1090-4. doi: 10.1016/j.ijporl.2014.04.014. Epub 2014 Apr 16 Abstract PURPOSE: Despite the brevity of the procedure, bilateral myringotomy and tympanostomy tube placement (BMT) can result in significant postoperative pain and discomfort. As the procedure is frequently performed without intravenous access, non-parenteral routes of administration are frequently used for analgesia. The current study prospectively compares the efficacy of intranasal (IN) dexmedetomidine with IN fentanyl for children undergoing BMT. METHODS: This prospective, double-blinded, randomized clinical trial included pediatric patients undergoing BMT. The patients were randomized to receive either IN dexmedetomidine (1 μg/kg) or fentanyl (2 μg/kg) after the induction of general anesthesia with sevoflurane. All patients received rectal acetaminophen (40 mg/kg) and the first 50 patients also received premedication with oral midazolam. Postoperative pain and recovery were assessed using pediatric pain and recovery scales, and any adverse effects were monitored for. RESULTS: The study cohort included 100 patients who ranged in age from 1 to 7.7 years and in weight from 8.6 to 37.4 kg. They were divided into 4 groups with 25 patients in each group: (1) midazolam premedication+IN dexmedetomidine; (2) midazolam premedication+IN fentanyl; (3) no premedication+IN dexmedetomidine; and (4) no premedication+IN fentanyl. Pain scores were comparable when comparing groups 2, 3 and 4, but were higher in group 1 (midazolam premedication with IN dexmedetomidine). There was no difference in total time in the post-anesthesia care unit (PACU) or time from arrival in the PACU until hospital discharge between the 4 groups. The heart rate (HR) was significantly lower in group 3 when compared to the other groups at several different times after arrival to the PACU. No clinically significant difference was noted in blood pressure. CONCLUSION: Following BMT, when no premedication is administered, there was no clinical advantage when comparing IN dexmedetomidine (1 μg/kg) to IN fentanyl (2 μg/kg). The addition of oral midazolam as a premedication worsened the outcome measures particularly for children receiving IN dexmedetomidine. PDF  Fentanil intranasal para el tratamiento del dolor agudo en niños Intranasal fentanyl for the management of acute pain in children. Murphy A1, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Hom J,Kandamany N. Cochrane Database Syst Rev. 2014 Oct 10;10:CD009942. doi: 10.1002/14651858.CD009942.pub2. PDF

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

Analgesia pre-emptiva / Pre-emptive analgesia

Enero 18, 2016. No. 2210

Efecto de analgesia pre-emptiva con parecoxib en pacientes con resección radical de cáncer pulmonar Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer. Lu J, Liu Z, Xia K, Shao C, Guo S, Wang S, Li K. Int J Clin Exp Med. 2015 Aug 15;8(8):14115-8. eCollection 2015. Abstract OBJECTIVE: To discuss the effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer. METHODS:115 cases of lung cancer patients with American society of anesthesiologists class (ASA) grade I~II who received selective operation were randomly divided into the research group and the control group. The research group patients were given preoperative parecoxib sodium 40 mg plus postoperative normal saline 2 ml, while the control group patients were treated with preoperative normal saline 2 ml plus postoperative parecoxib sodium 40 mg. The pain condition at postoperative 1, 2, 4, 8, 12, 24 and 48 h were evaluated by visual analogue scale (VAS), and emergence agitation was tested by agitation score. RESULTS: Finally there were 56 cases and 57 cases can be used for evaluation in the research group and control group. The VAS scores after 1, 2, 4, 8, 12, 24 and 48 h in the research group and control group were [2.23±0.45, 2.35±0.48, 2.51±0.51, 2.41±0.45, 2.28±0.42, 2.16±0.39, 2.11±0.40] and [3.80±0.62, 4.01±0.64, 4.31±0.67, 4.10±0.64, 3.65±0.70, 3.12±0.66, 2.46±0.53], respectively. The research group were obviously lower than the control group, the difference were statistically significant (P<0.05). The rate of agitation was 24.44% (11/56) in the research group, significantly lower than the control group of 59.65% (34/57) (P<0.05). CONCLUSION: Preemptive analgesia with parecoxib sodium can obviously relieve acute pain using in patients undergoing radical resection of lung cancer, and is helpful to reduce the incidence of emergence agitation. KEYWORDS: Parecoxib sodium; preemptive analgesia; radical resection of lung cancer; visual analogue scale PDF  Efecto de bolo preinducción de dosis bajas de ketamina sobre la analgesia intraoperatoria y los requerimientos postoperatorios de analgésicos en cirugía ambulatoria. Effect of preinduction low-dose ketamine bolus on intra operative and immediate postoperative analgesia requirement in day care surgery: A randomized controlled trial. Siddiqui KM, Khan FA. Saudi J Anaesth. 2015 Oct-Dec;9(4):422-7. doi: 10.4103/1658-354X.159468. Abstract BACKGROUND: Availability of narcotics is an issue in developing countries, and low-dose ketamine offers an alternative to these drugs. OBJECTIVE: The objective of this study is to evaluate the effect of a preemptive dose of low-dose ketamine on intra operative and the immediate postoperative analgesic requirements. DESIGN: Randomized double-blind control trial. SETTINGS: This study has been performed in the operating rooms and postanesthesia care unit at Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: Totally, 60 adult American Society of Anesthesiologists I and II patients undergoing day care surgery were randomly allocated into two groups, Group A (ketamine group) and Group B (saline group). INTERVENTION: All patients underwent general anesthesia. Propofol 2 mg/kg was used as an induction agent; laryngeal mask airway (size 3 for females and 4 for males) was inserted. Following induction patients in Group A received ketamine 0.3 mg/kg and Group B saline bolus in a blinded manner. All patients were administered injection fentanyl 1 μg/kg as an analgesic and anesthesia was maintained with oxygen 40%, nitrous oxide 60% and isoflorane 1-2 minimum alveolar concentration. Patients breathed spontaneously on Lack circuit. Postoperatively rescue analgesia was provided with intravenous morphine 0.1 mg/kg when patient complained of pain. MAIN OUTCOME MEASURES: We observed analgesic effects of low-dose ketamine intra operatively and narcotic requirements in immediate postoperative period for day care surgeries. RESULTS: There was no significant difference in demographic data in between groups. Saline group required more rescue analgesia (morphine) postoperatively (P < 0.001). No significant psychotomimetic symptoms were noted in either group. CONCLUSION: Low-dose ketamine 0.3 mg/kg provided adequate co-analgesia with fentanyl 1 μg/kg and was effective in a reduction of morphine requirement in the postoperative phase with minimal adverse effects. KEYWORDS: Day care surgery; low-dose ketamine; postoperative analgesia PDF Efecto de pregabalina preoperatoria sobre el alivio del dolor postoperatorio en tiroidectomía Effect of preoperative pregabalin on postoperative pain relief in thyroidectomy patients: A prospective observational study. Bindu M, Kumar AA, Kesavan M, Suresh V. Anesth Essays Res. 2015 May-Aug;9(2):161-6. doi: 10.4103/0259-1162.156292. Abstract BACKGROUND: Effective management of postoperative pain leads to increased patient satisfaction, earlier mobilization, reduced hospital stay and costs. One of the methods used for management of postoperative pain is preemptive analgesia-blockade of afferent nerve fibers before a painful stimulus. It modifies peripheral and central nervous system processing of noxious stimuli and reduces postoperative opioid consumption. In this study, we sought to determine whether the preoperative use of pregabalin reduced postoperative pain and morphine consumption in thyroidectomy. MATERIALS AND METHODS: The observation was conducted on patients undergoing thyroidectomy surgery in two groups of 30 each. Of the two groups, one received a single oral dose of pregabalin 1 h preoperatively. Both the group of patients undergoes anesthesia in a similar manner. Following surgery the efficacy of the preoperative dose of pregabalin is observed by measuring the total opioid consumption 6 h postoperatively and assessing verbal numeric pain scales. RESULTS: The mean time to request of rescue analgesia in pregabalin group was 322.07 ± 69.106 min when compared to morphine group 256.33 ± 111.978 min (P < 0.05). The mean pain scores in the postoperative period were also significantly lower in patients receiving pregabalin. CONCLUSION: Single oral dose of pregabalin was effective in reducing acute postoperative pain in thyroidectomy patients. It prolongs the time to the request of rescue analgesia and also results in lower postoperative pain scores in the immediate postoperative period. However a statistically significant low opioid consumption could not be proved. KEYWORDS: Preemptive analgesia; pregabalin; verbal numeric scores  PDF

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Bibliotecas. Noticias

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Finalizan las obras de mejora de la accesibilidad en la biblioteca municipal
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Un millón de escolares serán beneficiados con nuevas bibliotecas de educación inicial
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Con la finalidad de acercar a los niños al universo del mundo escrito, el Ministerio de Educación (Minedu) renovará este año las bibliotecas de aula ...

Cefalea en niños / Paediatric headache

Descripción general del diagnóstico y manejo de la cefalea en niños. Parte I:diagnóstico. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. Ozge A, Termine C, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl C. J Headache Pain. 2011 Feb;12(1):13-23. doi: 10.1007/s10194-011-0297-5. Epub 2011 Feb 27. Abstract Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life. PDF  Descripción general del diagnóstico y manejo de la cefalea en niños. Parte I: Manejo terapéutico. Overview of diagnosis and management of paediatric headache. Part II: therapeutic management. Termine C, Ozge A, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl C. J Headache Pain. 2011 Feb;12(1):25-34. doi: 10.1007/s10194-010-0256-6. Epub 2010 Dec 18. Abstract A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment. In part 1 of this article (Özge et al. in J Headache Pain, 2010), we reviewed the diagnosis of headache in children and adolescents. In the present part, we will discuss therapeutic management of primary headaches. An appropriate management requires an individually tailored strategy giving due consideration to both non-pharmacological and pharmacological measures. Non-pharmacological treatments include relaxation training, biofeedback training, cognitive-behavioural therapy, different psychotherapeutic approaches or combinations of these treatments. The data supporting the effectiveness of these therapies are less clear-cut in children than in adults, but that is also true for the data supporting medical treatment. Management of migraine and TTH should include strategies relating to daily living activities, family relationships, school, friends and leisure time activities. In the pharmacological treatment age and gender of children, headache diagnosis, comorbidities and side effects of medication must be considered. The goal of symptomatic treatment should be a quick response with return to normal activity and without relapse. The drug should be taken as early as possible and in the appropriate dosage. Supplementary measures such as rest in a quiet, darkened room is recommended. Pharmaco-prophylaxis is only indicated if lifestyle modification and non-pharmacological prophylaxis alone are not effective. Although many prophylactic medications have been tried in paediatric migraine, there are only a few medications that have been studied in controlled trials. Multidisciplinary treatment is an effective strategy for children and adolescents with improvement of multiple outcome variants including frequency and severity of headache and school days missed because of headache. As a growing problem both children and families should be informed about medication overuse and the children's drug-taking should be checked. PDF Cefalea en niños Olga L. Casasbuenas Asociación Colombiana de Neurología PDF

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