Dr. José Emmanuel Vargas Jasso Ortopedista, Traumatólogo

Anaesthesia. 2014 Oct;69(10):1163-71. doi: 10.1111/anae.12717. Epub 2014 May 19.

Abstract

We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.

Evaluación de la eficacia analgésica de la melatonina en pacientes sometidas a cesárea bajo anestesia espinal: un estudio prospectivo aleatorizado doble ciego.

Evaluation of the Analgesic Efficacy of Melatonin in Patients Undergoing Cesarean Section Under Spinal Anesthesia: A Prospective Randomized Double-blind Study.

Beigom Khezri M1, Delkhosh Reihany M2, Oveisy S3, Mohammadi N4.

Iran J Pharm Res. 2016 Fall;15(4):963-971.

Abstract

Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesiawere randomly allocated to one of three groups of 40 each to receive melatonin 3 milligram (mg) (group M3), melatonin 6 mg (group M6) or placebo (group P) sublingually 20 min before the spinal anesthesia. The time to first analgesic request, analgesic requirement in the first 24 h after surgery, hemodynamic variables, anxiety scores nd the incidence of adverse events were recorded. The duration of anesthesia and analgesia didn't show significant differences between three groups. Total analgesic request during 24 h after surgery was different among the three groups (P = 0.035). The incidence of headache in group M6 was significantly higher than others (P<0.001). However, after adjusting headache between groups of the study, we were unable to show the significant difference in the total analgesic request during 24 h after surgery among the three groups (p = 0.058). Although premedication of patients with 3 mg sublingual melatonin prolonged time to first analgesic request after cesarean delivery compared to placebo group, the difference was not statistically significant. Meanwhile increasing dose of melatonin to 6 mg failed to enhance analgesia and also increase the incidence of headache in patients undergoing cesarean section under spinal anesthesia.

KEYWORDS: Analgesia; Cesarean section; Melatonin; Spinal anesthesia

Concentraciones de melatonina CSF preoperatoria y la aparición de delirium en pacientes con fractura de cadera anterior: un estudio preliminar.

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study.

Scholtens RM1, de Rooij SE1,2, Vellekoop AE3, Vrouenraets BC4, van Munster BC2,5.

PLoS One. 2016 Dec 9;11(12):e0167621. doi: 10.1371/journal.pone.0167621. eCollection 2016.

Abstract

BACKGROUND: Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium. METHODS: Prospective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained. RESULTS: Seventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age.

CONCLUSION: Preoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation.

Efectos analgésicos, ansiolíticos y anestésicos de la melatonina. Novedosos usos potenciales en pediatría

Analgesic, anxiolytic and anaesthetic effects of melatonin: new potential uses in pediatrics.

Marseglia L1, D'Angelo G2, Manti S3, Aversa S4, Arrigo T5, Reiter RJ6, Gitto E7.

Int J Mol Sci. 2015 Jan 6;16(1):1209-20. doi: 10.3390/ijms16011209.

Abstract

Exogenous melatonin is used in a number of situations, first and foremost in the treatment of sleep disorders and jet leg. However, the hypnotic, antinociceptive, and anticonvulsant properties of melatonin endow this neurohormone with the profile of a drug that modulates effects of anesthetic agents, supporting its potential use at different stages during anesthetic procedures, in both adults and children. In light of these properties, melatonin has been administered to children undergoing diagnostic procedures requiring sedation or general anesthesia, such as magnetic resonance imaging, auditory brainstem response tests and electroencephalogram. Controversial data support the use of melatonin as anxiolytic and antinociceptive agents in pediatric patients undergoing surgery. The aim of this review was to evaluate available evidence relating to efficacy and safety of melatonin as an analgesic and as a sedative agent in children. Melatonin and its analogs may have a role in antinociceptive therapies and as an alternative to midazolam in premedication of adults and children, although its effectiveness is still controversial and available data are clearly incomplete.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

Primer Congreso Nacional de Residentes de Anestesiología

Ecuador, Agosto 2018

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

viernes, 18 de mayo de 2018

Más de obstetricia / More on obstetrics

Mayo 18, 2018. No. 3084

Comparando el efecto de agregar fentanilo, sufentanilo y placebo con bupivacaína intratecal en la duración de la analgesia y las complicaciones de la anestesia espinal en pacientes programados para cesárea

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section.

Farzi F1, Mirmansouri A2, Naderi Nabi B3, Atrkar Roushan Z4, Ghazanfar Tehran S5, Nematollahi Sani M6, Makhlooghi Azad S6, Nemati M6.

Anesth Pain Med. 2017 Aug 27;7(5):e12738. doi: 10.5812/aapm.12738. eCollection 2017 Oct.

Abstract

BACKGROUND: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. METHODS: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. RESULTS: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). CONCLUSIONS: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesareansection surgery.

KEYWORDS: Bupivacaine; Cesarean Sections; Fentanyl; Spinal Anesthesia; Sulfentanil

Anestesia espinal continua para anestesia y analgesia obstétrica

Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia.

Veličković I1, Pujic B2, Baysinger CW3, Baysinger CL4.

Front Med (Lausanne). 2017 Aug 15;4:133. doi: 10.3389/fmed.2017.00133. eCollection 2017.

Abstract

The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.

KEYWORDS: intrathecal catheters; labor analgesia; neuraxial blockade; obstetric anesthesia; post-dural puncture headache; spinal catheters

El enfoque de control óptimo del dolor para el trabajo de parto: una revisión de la literatura actual.

The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature.

Kelly A1, Tran Q1.

Abstract

Cureus. 2017 May 10;9(5):e1240. doi: 10.7759/cureus.1240.

There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia. The use of various adjuvants such as opioids, clonidine, and neostigmine in conjunction with local anesthetics solution can significantly reduce the severity of motor blockade and the need for assisted vaginal delivery.

KEYWORDS: labor analgesia; labor epidural; regional anesthesia

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

X Foro Internacional de Medicina del Dolor y Paliativa

Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Ciudad de México, 7 al 9 de junio de 2018.

Información / Information

V Congreso Internacional de Vía Aérea, EVALa, México

Junio 7-9, 2018. Guadalajara. México

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

Compartir el gusto por seguir en la enseñanza de la cirugía ortopédica..Rodilla y Cadera

http://www.ortotrauma.xyz/academia/compartir-el-gusto-por-seguir-en-la-ensenanza-de-la-cirugia-ortopedica-rodilla-y-cadera/

miércoles, 16 de mayo de 2018

Laringoespasmo / Laryngospasm

Mayo 16, 2018. No. 3082

Actualización en el manejo del laringoespasmo

Update on the management of laryngospasm.

Hernández-Cortez E.

J Anesth Crit Care Open Access. 2018;8(2):1-6. DOI: 10.15406/jaccoa.2018.08.00327

Introduction

Laryngospasm is defined as the sustained closure of the vocal cords. It is a primitive protective airway reflex, which happens to safeguard the integrity of the airway by protecting it from tracheobronchial aspiration.1 Laryngospasm is also defined as an exaggerated response of the closure reflex or glottic muscle spasm. Essentially is a protective reflex, which acts to prevent the entry of any foreign material into the tracheobronchial tree. The presence of this reflex results in an impediment to adequate breathing, under these conditions it becomes a sudden obstruction of upper airway. A feature of laryngospasm is that the airway closure is maintained even after the initial causal stimulus disappears. In any of the situations mentioned above, we face a partial or total loss of the airway, and therefore an anesthetic urgency. Forty % of the airway obstructions are secondary to laryngospasm, and this may result in a life-threatening complication, and is a major cause of cardiac arrest in the pediatric patient.

Eficacia de lidocaína para prevenir laringoespasmo en niños: Revisión sistemática y meta-análisis

The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis.

Mihara T1, Uchimoto K, Morita S, Goto T.

Anaesthesia. 2014 Dec;69(12):1388-96. doi: 10.1111/anae.12788. Epub 2014 Jul 3.

Abstract

The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. We included randomised controlled trials reporting the effects of intravenous and/or topical lidocaine on the incidence of laryngospasm during general anaesthesia. Nine studies including 787 patients were analysed. The combined results demonstrated that lidocaine is effective in preventing laryngospasm (risk ratio (RR) 0.39, 95% CI 0.24-0.66; I(2) = 0). Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.

Espasmo en la vía aérea pediátrica: ¿Qué hacer?
Dra. Liliana Ramírez-Aldana, Dr. David Ángel Pablo García-Arreola, Dra. Deoselina Hernández-Gutiérrez
Rev Mex Anestesiol Vol. 35. Supl. 1 Abril-Junio 2012 pp S159-S163
RESUMEN
Los niños poseen características anatómicas y funcionales de la vía aérea que los diﬁ eren de los adultos. Estas diferencias son suﬁ cientes para provocar que al presentarse un espasmo de la vía aérea superior o inferior, si no se resuelve adecuadamente, el acto anestésico puede terminar en una catástrofe. Por lo que en el presente artículo revisaremos en forma breve las diferencias anatómicas y funcionales de la vía aérea pediátrica en relación con el adulto y dos entidades: el laringoespasmo y el broncoespasmo haciendo énfasis en la deﬁ nición, ﬁ siopatología, etiología, formas de prevención y sugerencias de tratamiento. Palabras clave: Vía aérea pediátrica, espasmo, extubación, laringoespasmo, broncoespasmo.
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Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

Congreso Nacional de Residentes de Anestesiología

7 al 9 de junio, 2018. Lima, Perú

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people