RNM y sugammadex/Neuromuscular relaxants and sugammadex

Monitoreo neuromuscular, uso de relajantes musculares, y su reversión en un hospital de enseñanza de tercer nivel 2.5. años después de introducir sugammadex. Cambios de opinión y práctica clínica Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice. Ledowski T, Ong JS, Flett T. Anesthesiol Res Pract. 2015;2015:367937. doi: 10.1155/2015/367937. Epub 2015 Jan 22. PDF   Parálisis residual. ¿Influencia la evolución después de cirugía ambulatoria? Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? Farhan H1, Moreno-Duarte I1, McLean D1, Eikermann M1. Curr Anesthesiol Rep. 2014 Dec;4(4):290-302. Abstract Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice. KEYWORDS: Ambulatory surgery; Calabadion; NMBA; Neostigmine; PORC; Residual paralysis; Respiratory complications; Sugammadex PDF

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

Mortalidad pediátrica en anestesia/Paediatric anaesthetic-related mortalit

Revisión de mortalidad pediátrica relacionada con anestesia. Eventos adversos severos y incidentes críticos A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents Larissa Cronje South Afr J Anaesth Analg 2015; DOI: 10.1080/22201181.2015.1119503 Abstract Anaesthetists increasingly face questions from parents on the long-term outcomes of anaesthesia, and yet more immediate anaesthetic risks are not understood, nor explained to families. This review focused on paediatric anaesthetic-related mortality, cardiac arrest and anaesthetic-related serious adverse events and critical incidents during general anaesthesia, and within 24 hours of anaesthesia ending. Anaesthetic-related mortality is rare in the developed world, and is approximately 1 per 10 000 anaesthetics, but increases in high-risk children. Serious anaesthetic-related adverse events occur in 1.4 per 1 000 anaesthetics in the developed world. Data are lacking from the developing world but anaesthetic mortality is 2-3 times higher in middle-income countries and may be up to 100-fold greater in low-income countries. A critical incident occurs in 3-8% of anaesthetics and this figure is double that in low-income countries. Anaesthetic-related events are predominantly preventable. Brief recommendations on preventative strategies are made and research goals outlined. PDF

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

Dolor neonatal

Dolor neonatal Neonatal pain. Walker SM. Paediatr Anaesth. 2014 Jan;24(1):39-48. doi: 10.1111/pan.12293. Epub 2013 Nov 13. Abstract Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. KEYWORDS:NICU; neonate; neurodevelopment; opioids; pain; regional analgesia PDF Valoración clínica del dolor en unidades de cuidados intensivos neonatales españolas Clinical assessment of pain in Spanish Neonatal Intensive Care Units. [Article in Spanish] Avila-Alvarez A, Carbajal R, Courtois E, Pertega-Diaz S, Anand KJ, Muñiz-Garcia J; Grupo español del proyecto Europain. An Pediatr (Barc). 2015 Nov 6. pii: S1695-4033(15)00381-1. doi: 10.1016/j.anpedi.2015.09.019. [Epub ahead of print] Abstract INTRODUCTION:Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales. METHODS: A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included. RESULTS: Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1-20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7,189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I-Increased vital signs; E-Expression; S-Sleeplessness) scale was that used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P=.042). DISCUSSION: The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate. KEYWORDS: Analgesia; Dolor; Neonate; Neonato; Pain; Sedación; Sedation PDF  Dolor neonatal. ¿Es necesario evaluar el dolor por punciones transcutáneas? María Hernández-Trejo, Bernarda Sánchez-Jiménez, Rosalba Barbosa-Ángeles Perinatología y reproducción humana 2011                     PDF

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

Anafilaxia al látex / Latex anaphylaxis

Prevalencia de los signos de sensibilidad al látex en pacientes con múltiples cirugías por mielomengocele Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures. Yeh WS, Kiohara PR, Soares IS, Carmona MJ, Rocha FT, Galvão CE. Rev Bras Anestesiol. 2012 Jan-Feb;62(1):56-62. doi: 10.1016/S0034-7094(12)70103-4. Abstract BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p=0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it. PDF Perfil molecular de sensibilización en personas con exposición ocupacional breve al látex Molecular profile of sensitization in subjects with short occupational exposure to latex. Lamberti M, Buonanno R, Ritonnaro C, Giovane G, Crispino V, Feola A, Medici N, Sannolo N, Di Carlo A, Di Domenico M. Int J Occup Med Environ Health. 2015;28(5):841-8. doi: 10.13075/ijomeh.1896.00413. Abstract OBJECTIVES: We examined the prevalence of latex allergy in subjects with occupational exposure to latex allergens for less than 5 years, determining the disease spectrum in symptomatic workers. We identified the most frequent molecular allergens by Immuno- CAP (ICAP), correlating the findings with skin prick test (SPT) results. MATERIAL AND METHODS: Seven hundred twenty-three healthcare students using latex gloves on a regular basis were invited to participate in a baseline questionnaire screening. An ICAP serum test was performed only when a possible latex allergy was indicated by the questionnaire. RESULTS: The total number of participants responding to the baseline survey was 619. Glove-related symptoms were indicated by 4% (N = 25) of the students. The most common symptom was contact dermatitis (N = 18, 72%). In 12 subjects, ICAP revealed a real sensitization to latex, with a recombinant latex allergen profile showing a high frequency for rHev b 6.01 specific immunoglobulin E (sIgE) (N = 9, 67%). In these individuals, skin symptoms were more prevalent than other types (88%). CONCLUSIONS: The combined positivity for rHev b 6.01, rHev 8 and rHev b 5 determined by ICAP identified 92% of latex-allergic subjects with short-term exposure to latex. PDF La alergia al látex en anestesiólogos : son los trabajadores de salud pacientes de alto riesgo? Latex allergy on anaesthesiologist and anaesthesia managements: are the health workers high risk patients? Bigat Z, Kayacan N, Ertugrul F, Karsli B. J Pak Med Assoc. 2014 Apr;64(4):453-6. Abstract Anaphylaxis is defined as a severe, life threating, generalized or systemic hypersensitivity reaction. The most common agent involved in intraoperative anaphylactic reactions is muscle relaxant (61-70%); natural rubber latex (NRL) is the second most implicated agent and the incidence of latex-related anaphylactic reactions is increasing despite increasing awareness and preventive measures taken. Latex is a ubiquitous part of life today. Medical products which contain latex are present in our environment, especially in the hospital setting. This study focuses on our experience with two different anaesthetic techniques performed on the same patient who had latex hypersensitivity reaction and underwent surgery for myomectomy twice in 5 years. This case report aims to point out to latex hypersensitivity on health workers. The patient described had latex allergy and strategy of management during perioperative period is detailed. PDF Alergia al latex Dres. Claudio A. Parisi, Beatrice Biló, Floriano Bonifazzi, Sergio Bonini, José F. Máspero Arch Argent Pediatr 2006; 104(6):520-529 PDF

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