Reacciones adversas en geriatría/Adverse drug reactions in geriatrics

Octubre 22, 2015. No. 2122Octubre, mes de lucha contra cáncer de mama.

Reacciones adversas en poblaciones especiales. El anciano Adverse drug reactions in special populations - the elderly. Davies EA, O'Mahony MS. Br J Clin Pharmacol. 2015 Oct;80(4):796-807. doi: 10.1111/bcp.12596. Epub 2015 May 22. Abstract The International Conference on Harmonization considers older people a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations. The majority of ADRs in older people are Type A, potentially avoidable and associated with commonly prescribed medications. Several ADRs are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with benzodiazepines, neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to delirium, another multifactorial syndrome resulting in excess mortality particularly in frail older people. Clostridium difficile associated with use of broad spectrum antibiotics mainly affects frail older people and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of stroke by more than three-fold in patients with dementia. Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing ADRs. PDF

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

Raquia vs bloqueos periféricos en cirugía de cadera/Spinal vs peripheral nerve blocks for hip surgery

Octubre 20, 2015. No. 2120Octubre, mes de lucha contra cáncer de mama.

Comparación entre raquia unilateral y bloqueo paravertebral  L1 combinado con bloqueo compartamental del psoas y nervio ciático en pacientes con prótesis parcial de cadera Comparison of unilateral spinal anesthesia and L1 paravertebral block combined with psoas compartment and sciatic nerve block in patients to undergo partial hip prosthesis. Demirel I1, Ozer AB, Duzgol O, Bayar MK, Karakurt L, Erhan OL. Eur Rev Med Pharmacol Sci. 2014;18(7):1067-72. Abstract OBJECTIVES: Just as hip prosthesis, most of the patients undergoing orthopedic lower extremity surgery (OLES) belong to the advanced age group. Sciatic nerve block combined with psoas compartment block is used as a technique alternative to central neuraxial block and GA. In geriatric patients that will undergo partial hip prosthesis, the effects of the methods of unilateral spinal anesthesia (SA) and L1 paravertebral block combined with psoas compartment block (PCB) and sciatic nerve block (PCSL) on peroperative hemodynamic parameters and the duration of need for postoperative analgesia were studied. PATIENTS AND METHODS: Fifty patients from the ASA III-IV group were randomly divided into two groups. Group SA was administered spinal anesthesia with hyperbaric bupivacaine (2 ml, 0.5%) from the selected intervertebral distance (L4-L5 or L3-L4) in lateral position. Group PCSL was administered L1 paravertebral block combined with PCB and sciatic nerve block with bupivacaine hydrochloride (total 35 ml). Hemodynamic parameters (HR: heart rate and MAP: mean artery pressure) were recorded in pre- and post-intervention 5-minute intervals. The initial time of the need for analgesia of patients were evaluated postoperatively. RESULTS: Any failure in methods implemented on patients in either group was not observed. Times of anesthesia and surgical preparation ofpatients were observed to have significantly prolonged in the PCSL compared to Group SA (p < 0.005). Hundred and 5th and 110th min. mean arterial pressures of patients was found to be significantly higher in Group SA compared to Group PCSL (p < 0.05). The initial time of the need for analgesia was observed to be significantly prolonged in Group PCSL (432.80 ± 236.77 min) compared to Group SA (185.40 ± 171.40 min) (p < 0.001). CONCLUSIONS: Unilateral SA conducted with bupivacaine hydrochloride and PCSL block technique provided a hemodynamically similar activity in the perioperative period in patients that underwent partial hip operation. However, PCSL block implementation extended the initial time of the need for analgesia in postoperative period. PCSL method could be selected in cases belonging to such group of patients. PCSL block can be a alternative anesthetic tecniques in patients that underwent partial hip operation. PDF

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

Info preoperatoria en pediatria / Preop information in pediatrics

Octubre19, 2015. No. 2119Octubre, mes de lucha contra cáncer de mama.

¿Que información preopoeratoria desean los padres de los niños que se serán operados? What preoperative information do the parents of children undergoing surgery want? Sartori J, Espinoza P, Díaz MS, Ferdinand C, Lacassie HJ, González A. Rev Chil Pediatr. 2015 Oct 8. pii: S0370-4106(15)00182-5. doi: 10.1016/j.rchipe.2015.06.021. Abstract INTRODUCTION: Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. OBJECTIVE: To determine the preoperative information needs of parents of children undergoing elective surgery. PATIENTS AND METHOD: A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. RESULTS: Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. CONCLUSIONS: Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance. PDF

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

Analgésicos opioides / Opioids analgesics

Octubre 18, 2015. No. 2118Octubre, mes de lucha contra cáncer de mama.

Analgésicos opioides Opioid Analgesics. Jamison RN, Mao J. Mayo Clin Proc. 2015 Jul;90(7):957-68. doi: 10.1016/j.mayocp.2015.04.010. Abstract Chronic pain is an international health issue of immense importance that is influenced by both physical and psychological factors. Opioids are useful in treating chronic pain but have accompanying complications. It is important for clinicians to understand the basics of opioid pharmacology, the benefits and adverse effects of opioids, and related problematic issues of tolerance, dependence, and opioid-induced hyperalgesia. In this article, the role of psychiatric comorbidity and the use of validated assessment tools to identify individuals who are at the greatest risk for opioid misuse are discussed. Additionally, interventional treatment strategies for patients with chronic pain who are at risk for opioid misuse are presented. Specific behavioral interventions designed to improve adherence with prescription opioids among persons treated for chronic pain, such as frequent monitoring, periodic urine screens, opioid therapy agreements, opioid checklists, and motivational counseling, are also reviewed. Use of state-sponsored prescription drug monitoring programs is also encouraged. Areas requiring additional investigation are identified, and the future role of abuse-deterrent opioids and innovative technology in addressing issues of opioid therapy and pain are presented. PDF

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