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1.
Nefrologia (Engl Ed) ; 2024 Aug 09.
Artículo en Inglés | MEDLINE | ID: mdl-39127583

RESUMEN

The multidimensional view of disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide a multidisciplinary approach tailored to the needs of each individual. Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute situations, potentially irreversible or interventions that do not improve life expectancy. To ensure excellence in care, it is important to assess indicators of palliative care and kidney support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families. Palliative and kidney care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.

2.
BMJ Support Palliat Care ; 13(e3): e968-e970, 2024 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-37225396

RESUMEN

Optimal pain management in patients with advanced cancer often requires multiple pharmacological interventions and multimodal approach. Ketamine is an anaesthetic agent with increasing evidence supporting its use for pain. Due to its N-methyl-D-aspartate antagonism and its activity at opioid receptors, it is an adjuvant to traditional analgesics. Ketamine has a safety profile with limited experience of oral prolonged use in patients with cancer. We report a case of a 40-year-old man with refractory neuropathic cancer-related pain. Opioid rotation to methadone was previously performed, coanalgesics were added, the patient was reluctant to invasive anaesthetic techniques and his pain was poorly controlled. Ketamine was added to attenuate pain keeping functionality. This is a report of a patient with refractory cancer pain treated with methadone and ketamine orally during months, without reported side effects. Ketamine's use to treat pain is increasing along with its evidence of efficacy for long-term oral use.


Asunto(s)
Anestésicos , Dolor en Cáncer , Ketamina , Neoplasias , Neuralgia , Dolor Intratable , Adulto , Humanos , Masculino , Analgésicos , Analgésicos Opioides/uso terapéutico , Anestésicos/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Ketamina/uso terapéutico , Metadona , Neoplasias/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Neuralgia/etiología , Dolor Intratable/tratamiento farmacológico , Dolor Intratable/etiología
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