Combo sobre ketamina / Combo on ketamine

Febrero 16, 2018. No. 2996

Special K sin licencia para matar: sobredosis accidental de ketamina en la inducción de anestesia general. Special K with No License to Kill: Accidental Ketamine Overdose on Induction of General Anesthesia. Warner LL1, Smischney N1. Author information Am J Case Rep. 2018 Jan 3;19:10-12. Abstract BACKGROUND. Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT; The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration). After the ketamine was given, there were no signs to any involved provider that a mistake had occurred until the wake-up appeared to be unusually prolonged. CONCLUSIONS; Despite this, the patient did not demonstrate any systemic effects such as hemodynamic or CNS perturbations other than prolonged awakening. This case highlights one (drug overdose) of many causes of delayed emergence from anesthesia and reminds the provider caring for the patient to be mindful of drug concentrations used when preparing to sedate a patient, as relying on effects of the parent drug is not always adequate. PDF Experiencia en el uso de ketamina para controlar la abstinencia de opiáceos en una mujer adicta: informe de un caso. Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report. Lalanne L1,2, Nicot C3, Lang JP3, Bertschy G3,4, Salvat E5,6. Author information BMC Psychiatry. 2016 Nov 10;16(1):395. Abstract BACKGROUND: Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. CASE PRESENTATION: We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. CONCLUSION: Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal. KEYWORDS: Ketamine; Opioid addiction; Opioid withdrawal; Painkillers PDF Tratamiento exitoso del prurito asociado al nevo epidérmico con ketamina-amitriptilina-lidocaína tópicas. Successful Treatment of Epidermal Nevus-associated Pruritus with Topical Ketamine-Amitriptyline-Lidocaine. Jaller JA1, Yosipovitch G. Acta Derm Venereol. 2018 Jan 12;98(1):121-122. doi: 10.2340/00015555-2811. Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare, linear, unilateral, pruritic eruption that usually presents during childhood. It is more commonly seen on an extremity, although cases on the head and neck area have been reported in the past (1). It is considered a variant of keratinocytic epidermal nevus; however, it has a significant histological similarity with psoriasis. Patients who have this condition usually complain of intense pruritus (2). Treatments that are regularly effective in psoriasis have shown low efficacy on the management of these lesions, as well as their related symptoms (3). We present here a case of successful treatment of pruritus associated with an epidermal nevus with the use of topical Ketamine 10% - Amitriptyline 5% - Lidocaine 5% in lipoderm base (TKAL). The preparation is widely used in the US for nociceptive pain and is prepared by a compounding pharmacy. All ingredients are FDA approved PDF Combinación de ketamina/bupivacaína tópica versus caudal para la analgesia postoperatoria en niños sometidos a herniotomía inguinal. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy. Abdel-Ghaffar HS1, Moeen SM1, Moeen AM2. Author information Saudi J Anaesth. 2017 Jan-Mar;11(1):41-48. doi: 10.4103/1658-354X.197338. Abstract BACKGROUND: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. PATIENTS AND METHODS: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topicalgroup). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. RESULTS: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. CONCLUSION: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair. KEYWORDS: Analgesia; caudal; day-case anesthetic techniques; ketamine; pediatrics; postoperative; topical PDF Modulación de la Actividad del Receptor NMDA en la Fibromialgia. Modulation of NMDA Receptor Activity in Fibromyalgia. Littlejohn G1, Guymer E2. Author information Biomedicines. 2017 Apr 11;5(2). pii: E15. doi: 10.3390/biomedicines5020015. Abstract Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer-term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia. KEYWORDS: NMDA receptor; drugs; fibromyalgia; ketamine; memantine PDF La ketamina en el tratamiento del dolor crónico según medicina basada en la evidencia F. Neira Reina y J. L. Ortega García Rev Soc Esp Dolor 2016; 23(6): 292-306. Resumen: La ketamina es un antagonista no competitivo de los receptores NMDA y tiene un amplio mecanismo de acción que involucra, además, a los receptores AMPA, kainato, ácido gamma-aminobutírico, opioides, monoaminérgicos, muscarínicos y nicotínicos. Actúa sobre los canales de calcio y sodio voltaje-dependientes, interviene en la síntesis y liberación del óxido nítrico e inhibe la recaptación de serotonina. La interacción con todos estos mecanismos de acción hace que tenga una importante participación sobre mecanismos del dolor, inflamación, neuroprotección y tolerancia de opioides .... PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Avances en anestesia regional / Advances in regional anaesthesia

Febrero 17, 2018. No. 2997

Avances en anestesia regional: una revisión de la práctica actual, técnicas más nuevas y resultados Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes Wahal C, Kumar A, Pyati S. Indian J Anaesth 2018;62:94-102 Abstract Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance. PDF Evaluar los avances en anestesia regional mediante sus representaciones en los metanálisis: una visión alternativa del progreso reciente Assessing advances in regional anesthesia by their portrayals in meta-analyses: an alternative view on recent progress Vlassakov and Kissin BMC Anesthesiology (2017) 17:112 DOI 10.1186/s12871-017-0406-3 Abstract Background: The aim of this study was to delineate research reflecting advances in regional/local anesthesia where recent clinical progress was clearly defined by meta-analysis. Methods: We conducted a search to identify all articles with meta-analyses of randomized clinical trials related to the field of regional/local anesthesia. From 279 titles, after multiple exclusions, 16 meta-analyses on important clinical practice developments with high potential for a positive conclusion on the effectiveness of the treatment were left for the assessment. The assessment was performed in two steps. The first step was related to verification of proof-of-concept: the effect is statistically reliable (p-value, effect size, heterogeneity across different RCTs) and the risk of bias not too high. The second step was devoted to attempts to form an opinion on the real clinical benefits of a new development. Results: The assessment revealed that seven recent developments passed the proof-of-concept step. At the same time, positive conclusion on real clinical benefits was reached only by one of these seven developments: ultrasound guidance for peripheral nerve blocks (at least with some of the blocks). Meaningful clinical improvements with other developments remains uncertain. The assessment of the relationships between analyzed advancements over the past 30 years and earlier similar developments indicated that their evolution was usually incremental. The most original advancement was found to be the introduction of the transversus abdominis plane block. Conclusion: The assessment of recent advances in regional/local anesthesia, based on the evaluation of related metaanalyses, revealed only incremental progress with mostly marginal benefits. The progress was the most notable with ultrasound guidance for some of peripheral nerve blocks. Keywords: Epidural anesthesia, Spinal anesthesia, Nerve blocks, Minimal clinically important difference, Real-world evidence PDF Epidemiología, tendencias y disparidades en anestesia regional para cirugía ortopédica Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery C. Cozowicz, J. Poeran and S. G. Memtsoudis British Journal of Anaesthesia, 115 (S2): ii57-ii67 (2015) Abstract Recent studies have linked the use of regional anaesthesia to improved outcomes. Epidemiological research on utilization, trends, and disparities in this field is sparse; however, large nationally representative database constructs containing anaesthesia-related data, demographic information, and multiyear files are now available. Together with advances in research methodology and technology, these databases provide the foundation for epidemiological research in anaesthesia. We present an overview of selected studies that provide epidemiological data and describe current anaesthetic practice, trends, and disparities in orthopaedic surgery in particular. This literature suggests that that even among orthopaedic surgical procedures, which are highly amenable to regional anaesthetic techniques, neuraxial anaesthetics and peripheral nerve blocks are used in only a minority of procedures. Trend analyses show that peripheral nerve blocks are gaining in popularity, whereas use of neuraxial anaesthetics is remaining relatively unchanged or even declining over time. Finally, significant disparities and variability in anaesthetic care seem to exist based on demographic and health-care-related factors. With anaesthesia playing an increasingly important part in population-based health-care delivery and evidence indicating improved outcome with use of regional anaesthesia, more research in this area is needed. Furthermore, prevalent disparities and variabilities in anaesthesia practice need to be specified further and addressed in the future. Key words: anaesthesia; anaesthesia, spinal; epidemiological data; epidemiology; healthcare disparities; regional anaesthesia; trends PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Dolor neuropático / Neurophatic pain

Febrero 18, 2018. No. 2998

Fenotipo sensorial y factores de riesgo para la neuropatía diabética dolorosa: un estudio observacional transversal. Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Raputova J1, Srotova I, Vlckova E, Sommer C, Üçeyler N, Birklein F, Rittner HL, Rebhorn C, Adamova B, Kovalova I, Kralickova Nekvapilova E, Forer L, Belobradkova J, Olsovsky J, Weber P, Dusek L, Jarkovsky J, Bednarik J. Author information Pain. 2017 Dec;158(12):2340-2353. doi: 10.1097/j.pain.0000000000001034. Abstract Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials. PDF Tratamientos tópicos para dolor neuropático localizado Topical Treatments for Localized Neuropathic Pain. Casale R1, Symeonidou Z2,3, Bartolo M4. Author information Curr Pain Headache Rep. 2017 Mar;21(3):15. doi: 10.1007/s11916-017-0615-y. Abstract PURPOSE OF REVIEW: Topical therapeutic approaches in localized neuropathic pain (LNP) syndromes are increasingly used by both specialists and general practitioners, with a potentially promising effect on pain reduction. In this narrative review, we describe the available compounds for topical use in LNP syndromes and address their potential efficacy according to the literature. RECENT FINDINGS: Local anaesthetics (e.g., lidocaine, bupivacaine and mepivacaine), as well as general anaesthetic agents (e.g., ketamine), muscle relaxants (e.g., baclofen), capsaicin, anti-inflammatory drugs (e.g., diclofenac), salicylates, antidepressants (e.g., amitriptyline and doxepin), α2 adrenergic agents (e.g., clonidine), or even a combination of them have been tested in various applications for the treatment of LNP. Few of them have reached a sufficient level of evidence to support systematic use as treatment options. Relatively few systemic side effects or drug-drug interactions and satisfactory efficacy seem to be the benefits of topical treatments. More well-organized and tailored studies are necessary for the further conceptualization of topical treatments for LNP. KEYWORDS: Localized neuropathic pain; Topical amitriptyline; Topical baclofen; Topical clonidine; Topical ketamine; Topical lidocaine PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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