Más de relajantes neuromusculares en geriatría / More on neuromuscular blockade in geriatrics

Julio 14, 2016. No. 2386

Relación en la concentración efectiva en el sitio diana de rocuronio y el grado de recuperación de la relajación neuromuscular en ancianos The relationship between the target effective site concentration of rocuronium and the degree of recovery from neuromuscular blockade in elderly patients. Fan X1, Ma M1, Li Z1, Gong S1, Zhang W1, Wen Y1. Int J Clin Exp Med. 2015 Sep 15;8(9):16369-73. eCollection 2015. Abstract OBJECTIVE: To study the relationship between the target effective site concentration (Ce) of rocuronium and the degree of recovery fromneuromuscular blockade in elderly patients. METHODS:50 elderly patients (ASA grade II) scheduled for selective surgical procedure under general anaesthesia were randomly divided into two groups, A and B, with 25 cases in each group. The Ce of rocuronium for intubation was 3 μg·ml(-1) in both groups, and the Ce during operation were 0.8 and 1.0 μg·ml(-1) in group A and B, respectively. When target controlled infusion of rocuronium was stopped, without the administration of reversal agents for neuromuscular blockade, the relationship between Ce and the first twitch height (T1) was studied by regression analysis.RESULTS:There was a significant linear relationship between Ce and T1, and there was no statistical difference in regression coefficient and interception between group A and B (P>0.05).CONCLUSION:The degree of recovery from neuromuscular blockade could be judged by the target effective site concentration of rocuronium at the time of reversal from neuromuscular blockade in the elderly patients. KEYWORDS:Rocuronium; geriatrics; neuromuscular blockade; pharmacodynamics PDF Comparación entre los efectos de rocuronio, vecuronio y Cisatracurio utilizando tren de 4 y pruebas clínicas en ancianos Comparison between the Effects of Rocuronium, Vecuronium, and Cisatracurium Using Train-of-Four and Clinical Tests in Elderly Patients. Sagir O1, Yucesoy Noyan F, Koroglu A, Cicek M, Ilksen Toprak H. Anesth Pain Med. 2013 Spring;2(4):142-8. doi: 10.5812/aapm.8406. Epub 2013 Mar 26. Abstract BACKGROUND:Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients.OBJECTIVES:We aimed to investigate the safety of train-of-four ratio and clinical tests in the assessment of patient recovery, and to determine the effects of the rocuronium, vecuronium, and cisatracurium on intubation, extubation and recovery times in elderly patients undergoing abdominal surgery.PATIENTS AND METHODS:After obtaining institutional approval and informed consent, 60 patients over 60 years old and undergoing elective abdominal operations were included in this double-blind, randomized clinical trial. Following a standard anesthesia induction, 0.6mg kg-1 rocuronium, 0.1mg kg-1 vecuronium, and 0.1mg kg-1 cisatracurium were administered to the patients in Group R, Group V, and Group C, respectively. Train-of-four (TOF) ratios were recorded at 10-minute intervals during and after the operation. Modified Aldrete Score (MAS) and clinical tests were recorded in the recovery room at 10-minute intervals. In addition, intubation and extubation times, duration of recovery room stay, and any complications were recorded.RESULTS:Intubation time was found to be shorter in Group R than that in Groups V and C (P ˂ 0.001). Times to positive visual disturbances and grip strength tests were shorter in Group C than that in Group V (P = 0.016 and P = 0.011, respectively). In Group R and group C, time to TOF ≥ 0.9 was significantly longer than all positive clinical test times except grip strength (P < 0.05).CONCLUSIONS:We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients. KEYWORDS:Aged; Cisatracurium; Neuromuscular Blockade; Rocuronium; Vecuronium Bromide PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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Libro sobre adicción a drogas / Book on drugs addiction

Julio 16, 2016. No. 2388

Avances recientes en la investigación y aplicación clínica sobre la adicción a drogas Recent Advances in Drug Addiction Research and Clinical Applications Edited by William M. Meil and Christina L. Ruby, ISBN 978-953-51-2492-4, Print ISBN 978-953-51-2491-7, 228 pages, Publisher: InTech, Chapters published July 14, 2016 under CC BY 3.0 license DOI: 10.5772/61445 Edited Volume Although it is well-accepted that drug addiction is a major public health concern, how we address it as a society continues to evolve as recent advances in the lab and clinic clarify the nature of the problem and influence our views. This unique collection of eight chapters reviews key findings on the neurobiology and therapeutics of addiction while capturing the diversity of perspectives that shape these concepts, which range from evolutionary biology to psychiatry to the legal system. This book discusses in depth how technological advances have led to important discoveries and how these discoveries, in turn, are increasingly being translated into clinical practice. It also presents avenues for future study that hold promise for the many affected by addiction. Libro / Book Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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Anestesia en el viejo / Geriatric anesthesia

Julio 17, 2016. No. 2389

Cuidado el paciente Viejo: auditoría prospectiva de la prevalencia de hipotensión y el uso del BIS intraoperatorio en 25 hospitales londinenses Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London. Wickham A1, Highton D2, Martin D3; Pan London Perioperative Audit and Research Network (PLAN). Perioper Med (Lond). 2016 May 27;5:12. doi: 10.1186/s13741-016-0036-1. eCollection 2016. Abstract BACKGROUND:Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK.METHODS: We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth ofanaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.RESULTS:Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.CONCLUSIONS:IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group. KEYWORDS:Depth of anaesthesia; Elderly; Intraoperative hypotension PDF Influencia de diferentes anestesias y métodos de analgesia sobre la función cognitiva en ancianos en cirugía no cardiaca Influence of different anesthetic and analgesic methods on early cognitive function of elderly patients receiving non-cardiac surgery. Wang Y1, Zhang J2, Zhang S3. Pak J Med Sci. 2016 Mar-Apr;32(2):369-72. doi: 10.12669/pjms.322.9555. Abstract OBJECTIVE:To discuss over influence of two different anesthetic and analgesic methods on early cognitive function of elderly patients who received non-cardiac surgery.METHODS:Two hundred and six elderly patients who underwent non-cardiac surgery were selected as research subjects. They were randomly divided into observation group (103 cases) and control group (103 cases). Patients in observation group were given combined spinal and epiduralanesthesia and epidural analgesia, while patients in control group adopted general anesthesia and intravenous analgesia. Neurological function test was carried out one day before surgery and on the 7(th) day after surgery. Moreover, changes of postoperative pain degree, neuropsychological function and cognitive function were observed and compared.RESULTS:On the 7(th) day after surgery, incidence of cognition impairment in observation group and control group was 48.50% (50/103 cases) and 44.70% (46/103 cases), and difference between groups had no statistical significance. Visual Analogue Scale (VAS) Score of observation group was much lower than control group in the 12(th), 24(th) and 48(th) h after surgery (p < 0.05). Logistic regression analysis suggested that, short education years and general surgery were independent risk factors for early cognition impairment.CONCLUSION:About 46.60% elderly patients undergoing non-cardiac surgery developed cognition impairment, but influence of different anesthetic and analgesic methods on incidence of postoperative cognition impairment of elderly patients had no significant difference. KEYWORDS:Anesthesia; Neurological function; Postoperative cognition impairment PDF Efecto de una dosis de dexametasona antes de cirugía no cardiaca y no neurológica con anestesia general sobre la disfunción cognitiva Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and GeneralAnesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial. Valentin LS1, Pereira VF1, Pietrobon RS2, Schmidt AP3,4, Oses JP5, Portela LV3, Souza DO3, Vissoci JR2, Luz VF1, Trintoni LM1, Nielsen KC6, Carmona MJ1. PLoS One. 2016 May 6;11(5):e0152308. doi: 10.1371/journal.pone.0152308. eCollection 2016. Abstract Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS:One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100β was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant.RESULTS:On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100β serum levels.CONCLUSION:Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100β might be related with some degree of neuroprotection. PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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