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1.
Nurs Womens Health ; 27(3): 231-236, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37116542

RESUMO

The care of breastfeeding patients who require anesthesia presents unique challenges; therefore, caregivers must be knowledgeable regarding drugs' pharmacodynamic and pharmacokinetic profiles to ensure the safety of the breastfed infant. Although most anesthetic drugs are compatible with breastfeeding, health care providers continue to advise patients to "pump and dump." This advice can lead to undesirable outcomes, including interruption or cessation of breastfeeding, creating possible physical and psychological challenges for parents and their neonates. This article outlines best practices for the care of breastfeeding patients receiving anesthesia.


Assuntos
Anestésicos , Aleitamento Materno , Lactente , Recém-Nascido , Feminino , Humanos , Leite Humano , Anestésicos/efeitos adversos , Anestésicos/farmacocinética , Anestesia Geral/efeitos adversos , Lactação
2.
Curr Opin Anaesthesiol ; 33(1): 109-113, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789903

RESUMO

PURPOSE OF REVIEW: With the growing of the aging population, increased and new methods of anesthesia and surgery allow for surgery and other interventions in older adults.Pharmacokinetics and pharmacodynamics of drugs in older adults differ from those in younger and middle-aged adults. However, the geriatric population is frequently neglected in the context of clinical trials. The present review focuses on the consequences of multimorbidity and pharmacokinetic and pharmacodynamic alterations and their implications on anesthesia. RECENT FINDINGS: Physiologically based pharmacokinetic and pharmacodynamic modeling may serve as an option to better understand the influence of age on drugs used for anesthesia. However, difficulties to adequately characterize geriatric patients are described. SUMMARY: Further research of drug effects in the aging population may include physiologically based pharmacokinetic and pharmacodynamic complex models and randomized controlled trials with thoroughly conducted geriatric assessments.


Assuntos
Anestesia , Anestesiologia , Anestésicos , Idoso , Anestésicos/farmacocinética , Anestésicos/farmacologia , Avaliação Geriátrica , Humanos , Pessoa de Meia-Idade
3.
J Vet Pharmacol Ther ; 42(6): 713-721, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31435964

RESUMO

Pharmacokinetics and pharmacodynamics of alfaxalone was performed in mallard ducks (Anas platyrhynchos) after single bolus injections of 10 mg/kg administered intramuscularly (IM; n = 10) or intravenously (IV; n = 10), in a randomized cross-over design with a washout period between doses. Mean (±SD) Cmax following IM injection was 1.6 (±0.8) µg/ml with Tmax at 15.0 (±10.5) min. Area under the curve (AUC) was 84.66 and 104.58 min*mg/ml following IV and IM administration, respectively. Volume of distribution (VD ) after IV dose was 3.0 L/kg. The mean plasma clearance after 10 mg/kg IV was 139.5 (±67.9) ml min-1  kg-1 . Elimination half-lives (mean [±SD]) were 15.0 and 16.1 (±3.0) min following IV and IM administration, respectively. Mean bioavailability at 10 mg/kg IM was 108.6%. None of the ducks achieved a sufficient anesthetic depth for invasive procedures, such as surgery, to be performed. Heart and respiratory rates measured after administration remained stable, but many ducks were hyperexcitable during recovery. Based on sedation levels and duration, alfaxalone administered at dosages of 10 mg/kg IV or IM in mallard ducks does not induce clinically acceptable anesthesia.


Assuntos
Anestésicos/farmacocinética , Patos/sangue , Pregnanodionas/farmacocinética , Anestésicos/administração & dosagem , Anestésicos/sangue , Animais , Área Sob a Curva , Feminino , Meia-Vida , Injeções Intramusculares , Injeções Intravenosas , Masculino , Pregnanodionas/administração & dosagem , Pregnanodionas/sangue
4.
Mol Pharm ; 16(9): 3948-3956, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31361498

RESUMO

Many oral mucosal conditions cause considerable and prolonged pain that to date has been difficult to alleviate via topical delivery, and the use of injection causes many patients dental anxiety and needle-prick pain. Therefore, developing a noninjectable drug delivery system as an alternative administration procedure may vastly improve the health and wellbeing of these patients. Recent advances in the development of mucoadhesive electrospun patches for the direct delivery of therapeutics to the oral mucosa offer a potential solution, but as yet, the release of local anesthetics from this system and their uptake by oral tissue have not been demonstrated. Here, we demonstrate the fabrication of lidocaine-loaded electrospun fiber patches, drug release, and subsequent uptake and permeation through the porcine buccal mucosa. Lidocaine HCl and lidocaine base were incorporated into the electrospun patches to evaluate the difference in drug permeation for the two drug compositions. Lidocaine released from the lidocaine HCl-containing electrospun patches was significantly quicker than from the lidocaine base patches, with double the amount of drug released from the lidocaine HCl patches in the first 15 min (0.16 ± 0.04 mg) compared to that from the lidocaine base patches (0.07 ± 0.01 mg). The permeation of lidocaine from the lidocaine HCl electrospun patches through ex vivo porcine buccal mucosa was also detected in 15 min, whereas permeation of lidocaine from the lidocaine base patch was not detected. Matrix-assisted laser desorption ionization-mass spectrometry imaging was used to investigate localization of lidocaine within the oral tissue. Lidocaine in the solution as well as from the mucoadhesive patch penetrated into the buccal mucosal tissue in a time-dependent manner and was detectable in the lamina propria after only 15 min. Moreover, the lidocaine released from lidocaine HCl electrospun patches retained biological activity, inhibiting veratridine-mediated opening of voltage-gated sodium channels in SH-SY5Y neuroblastoma cells. These data suggest that a mucoadhesive electrospun patch may be used as a vehicle for rapid uptake and sustained anesthetic drug delivery to treat or prevent oral pain.


Assuntos
Anestésicos/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Lidocaína/farmacocinética , Mucosa Bucal/efeitos dos fármacos , Absorção pela Mucosa Oral/fisiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Bloqueadores do Canal de Sódio Disparado por Voltagem/farmacocinética , Administração Bucal , Anestésicos/administração & dosagem , Animais , Linhagem Celular Tumoral , Liberação Controlada de Fármacos , Dor Facial/tratamento farmacológico , Humanos , Lidocaína/administração & dosagem , Mucosa Bucal/metabolismo , Neuroblastoma/metabolismo , Neuroblastoma/patologia , Suínos , Distribuição Tecidual , Veratridina/farmacologia , Agonistas do Canal de Sódio Disparado por Voltagem/farmacologia , Bloqueadores do Canal de Sódio Disparado por Voltagem/administração & dosagem
5.
Kyobu Geka ; 71(10): 725-728, 2018 09.
Artigo em Japonês | MEDLINE | ID: mdl-30310016

RESUMO

Although there is no remarkable change of anesthetics or anesthesia methods in recent years, several new technologies are used for safety management of cardiac, lung or thoracic surgery. Stroke volume variation (SVV) monitoring indicates SVV, a parameter to optimize fluid infusion and is used to avoid edema or congestive heart damage due to over hydration. SmartPilot View, a pharmacokinetic simulator during anesthesia, represents the measured effective site concentration of anesthetics and contributes the optimization of induction and maintenance of anesthesia. Pressure controlled ventilation-volume guarantee (PCV-VG) is a ventilation mode that can secure preset tidal volume even under PCV to avoid hypoxemia and hypercapnia, even when unexpected airway pressure raised. AutoFlow system supplies tidal volume at the lowest airway pressure and has the function of maintaining tidal volume while keeping low airway pressure according to the change of pulmonary compliance. In 2017, we modified the position of cuff air delivery lumen while maintaining the strength and elasticity of double-lumen tube (DLT) made by a company to avoid deflation failure of bronchial cuff by our team.


Assuntos
Anestesia/métodos , Anestesia/efeitos adversos , Anestesiologia/instrumentação , Anestésicos/farmacocinética , Brônquios , Hidratação/métodos , Humanos , Respiração Artificial/métodos , Volume Sistólico/fisiologia , Volume de Ventilação Pulmonar
6.
Presse Med ; 47(5): 453-463, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29609909

RESUMO

Obesity is often associated with obstructive sleep apnea (OSA), which increases the risk of intraoperative and postoperative complications. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications. Cardiovascular risk is also increased in the obese patient. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. Appropriate prophylaxis against venous thromboembolism (VTE) after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese.


Assuntos
Anestésicos/efeitos adversos , Cirurgia Bariátrica/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Anestesia Geral/efeitos adversos , Anestésicos/farmacocinética , Cirurgia Bariátrica/métodos , Humanos , Doença Iatrogênica , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
7.
J Dtsch Dermatol Ges ; 16(3): 268-276, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29431909

RESUMO

BACKGROUND: Children undergoing dermatosurgical procedures require, unlike adults, particular attention; the administration of various analgesics, anesthetics or sedatives requires a thorough knowledge of drug pharmacokinetics and pharmacodynamics. Furthermore, there are concerns that drugs used for sedation/general anesthesia may result in anesthetic/analgesic complications in children undergoing surgery, with a risk of impaired mental development. OBJECTIVES: Based on our clinical experience and a literature review, we illustrate the most commonly used analgesic, anesthetic and sedative drugs in pediatric dermatosurgery, and identify risk factors and complications following dermatosurgical procedures. RESULTS: Topical anesthetics can be used in children for superficial dermatologic procedures or prior to infiltration anesthesia. Maximum recommended doses based on body weight should be calculated in order to avoid overdosage of local anesthetics. General anesthesia in dermatosurgery is considered safe and has a low rate of side effects. However, caution is advised in children under the age of one due to potential long-term neurological side-effects. NSAIDs and opioids play a significant role in analgesia for children. CONCLUSIONS: This article reviews currently available data on analgesia, anesthesia and complications that may arise in pediatric dermatosurgery. These data may be useful in optimizing the safety and quality of care and in improving parent counseling.


Assuntos
Analgesia/métodos , Anestesia/métodos , Procedimentos Cirúrgicos Dermatológicos/métodos , Assistência Perioperatória/métodos , Dermatopatias/cirurgia , Adolescente , Analgesia/efeitos adversos , Analgésicos/efeitos adversos , Analgésicos/farmacocinética , Analgésicos/uso terapêutico , Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Anestésicos/farmacocinética , Anestésicos/uso terapêutico , Criança , Pré-Escolar , Hemangioma/congênito , Hemangioma/cirurgia , Humanos , Lactente , Nevo/congênito , Nevo/cirurgia , Mancha Vinho do Porto/cirurgia , Fatores de Risco , Dermatopatias/congênito , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/cirurgia
8.
J Clin Anesth ; 45: 39-50, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29275265

RESUMO

PURPOSE: Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children. SOURCE: MEDLINE and PubMed peer-reviewed manuscripts in obesity and pediatric anesthesia. When there was no information in pediatric literature, we included adult studies in our review. PRINCIPAL FINDINGS: Defining obesity in a growing child is based on body mass index percentiles specific to age and sex. The precursors of adult obesity-related comorbidities are often seen in obese children. Respiratory and cardiovascular comorbidities increase perioperative risk in the severely obese child [>99th percentile]. Obstructive sleep apnea is highly prevalent and requires consideration of opioid sparing techniques and careful postoperative disposition. A detailed discussion on the effect of obesity on pharmacokinetics of different commonly used anesthetics and analgesics is presented, with current recommendations on dosing. CONCLUSION: Optimal and safe anesthetic management of an obese child requires thoughtful pre-procedure assessment and meticulous perioperative management tailored to associated comorbidities, with heightened awareness of potential perioperative complications. There remains a need for improved guidelines for risk stratification, drug dosing and postoperative disposition in this patient population.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia/métodos , Anestésicos/administração & dosagem , Obesidade/complicações , Assistência Perioperatória/métodos , Analgésicos Opioides/farmacocinética , Anestesia/efeitos adversos , Anestésicos/farmacocinética , Criança , Humanos , Obesidade/fisiopatologia , Período Perioperatório , Prevalência , Medição de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia
9.
Anesthesiol Clin ; 35(2): e95-e113, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28526163

RESUMO

Since the public demonstration of ether as a novel, viable anesthetic for surgery in 1846, the field of anesthesia has continually sought the ideal anesthetic-rapid onset, potent sedation-hypnosis with a high therapeutic ratio of toxic dose to minimally effective dose, predictable clearance to inactive metabolites, and minimal side effects. This article aims to review current progress of novel induction agent development and provide an update on the most promising drugs poised to enter clinical practice. In addition, the authors describe trends in novel agent development, implications for health care costs, and implications for perioperative care.


Assuntos
Hipnóticos e Sedativos , Anestesia/tendências , Anestésicos/química , Anestésicos/farmacocinética , Anestésicos/uso terapêutico , Humanos , Hipnóticos e Sedativos/química , Hipnóticos e Sedativos/farmacocinética , Hipnóticos e Sedativos/uso terapêutico
10.
Anaesthesia ; 72(4): 452-460, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28188621

RESUMO

Laparoscopic ventral hernia repair is an operation associated with significant postoperative pain, and regional anaesthetic techniques are of potential benefit. The erector spinae plane (ESP) block performed at the level of the T5 transverse process has recently been described for thoracic surgery, and we hypothesised that performing the ESP block at a lower vertebral level would provide effective abdominal analgesia. We performed pre-operative bilateral ESP blocks with 20-30 ml ropivacaine 0.5% at the level of the T7 transverse process in four patients undergoing laparoscopic ventral hernia repair. Median (range) 24-h opioid consumption was 18.7 mg (0.0-43.0 mg) oral morphine. The highest and lowest median (range) pain scores in the first 24 h were 3.5 (3.0-5.0) and 2.5 (0.0-3.0) on an 11-point numerical rating scale. We also performed the block in a fresh cadaver and assessed the extent of injectate spread using computerised tomography. There was radiographic evidence of spread extending cranially to the upper thoracic levels and caudally as far as the L2-L3 transverse processes. We conclude that the ESP block is a promising regional anaesthetic technique for laparoscopic ventral hernia repair and other abdominal surgery when performed at the level of the T7 transverse process. Its advantages are the ability to block both supra-umbilical and infra-umbilical dermatomes with a single-level injection and its relative simplicity.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Bloqueio Nervoso , Vértebras Torácicas , Abdome/cirurgia , Músculos Abdominais , Dor Abdominal/etiologia , Dor Abdominal/terapia , Idoso de 80 Anos ou mais , Analgesia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos/administração & dosagem , Anestésicos/farmacocinética , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico
11.
Curr Pharm Des ; 21(39): 5650-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26323414

RESUMO

Obesity represents one of the most important public health issues according to the World Health Organization. Additionally, in a recent National Health and Nutrition Survey of 2011-2012, approximately 17 % of children and adolescents in the United States were considered obese. The obesity rate is higher within the adolescent age group as compared to preschool children. Childhood obesity is particularly problematic, because the co-morbid disease states which accompany obesity may require frequent pharmacotherapy and/ or surgical intervention. Despite the potential for increased pharmacotherapy among obese patients, there is a paucity of dosing guidelines for this special population. Optimal drug dosing in obese pediatric patients has not been sufficiently explored as the present data available are mostly specific for obese adults. In this review, we present an overview concerning what is currently known about the pharmacokinetics and pharmacogenetics of frequently used drugs including midazolam, fentanyl and its newer derivatives, morphine, ketamine, acetaminophen, dexmedetomidine and enoxaparin in obese adolescents undergoing bariatric surgery. We will also summarize the current dosing recommendations of anesthetic drugs in bariatric anesthesia.


Assuntos
Cirurgia Bariátrica , Obesidade/cirurgia , Adolescente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacocinética , Anestésicos/administração & dosagem , Anestésicos/farmacocinética , Benzodiazepinas/administração & dosagem , Benzodiazepinas/farmacocinética , Dexmedetomidina/administração & dosagem , Dexmedetomidina/farmacocinética , Enoxaparina/administração & dosagem , Enoxaparina/farmacocinética , Humanos , Infusões Intravenosas , Obesidade/epidemiologia , Farmacogenética , Estados Unidos/epidemiologia
12.
Surg Clin North Am ; 95(2): 391-415, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25814114

RESUMO

The older population only represents 13.7% of the US population but has grown by 21% since 2002. The centenarian population is growing at a faster rate than the total US population. This unprecedented growth has significantly increased surgical demand. The establishment of quality and performance improvement data has allowed researchers to focus attention on the older patient population, resulting in an exponential increase in studies. Although there is still much work to be done in this field, overlying themes regarding the perioperative management of elderly patients are presented in this article based on a thorough literature review.


Assuntos
Assistência Perioperatória , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos/farmacocinética , Anestésicos/farmacocinética , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Avaliação Geriátrica , Humanos , Medição de Risco
13.
Minerva Anestesiol ; 81(11): 1163-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25598294

RESUMO

BACKGROUND: The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted effects of combined anesthetic drugs, and should facilitate more precisely their titration. Our aim was to evaluate if Navigator® or SmartPilot® View guided anesthesia was associated with a good quality of analgesia, depth of hypnosis and may reduce anesthetic requirements. METHODS: We performed a prospective non-randomized study. Sixty ASA I-II patients undergoing balanced general anesthesia for abdominal and plastic surgery were enrolled. Patients were divided in 4 groups. Group 1 (N. 15) and group 3 (N. 15) were cases in whom anesthesia was performed with standard monitoring plus the aid of Navigator® (Nav) or SmartPilot® View (SPV) display. Group 2 (N. 15) and group 4 (N. 15) were controls in whom anesthesia was performed with standard monitoring (heart rate, NIBP, SpO2, end-tidal CO2, end-expired sevoflurane concentration, train of four, Bispectral Index [Aspect Medical Systems, Natick, MA, USA] or Entropy [GE Healthcare]). Patients' vital parameters and end-expired sevoflurane concentration were recorded during anesthesia. RESULTS: All patients recovered uneventfully and showed hemodynamic stability. End-tidal sevoflurane concentrations values [median (min-max)], during maintenance of anesthesia, were significantly (P<0.05) lower in SPV [1.1% (0.8-1.5)] and Nav [1%(0.8-1.8)] groups compared to SPV-control group [1.5%(1-2.5)] and Nav-control group [1.5%(0.8-2)]. BIS and entropy values were respectively higher in the SPV group [53 (46-57)] compared to the control group [43 (37-51)] (P<0.05) and Nav group [53 (43-60)] compared to the control group [41 (35-51)] (P<0.05). No significant differences in Remifentanil dosing were observed in the four groups. CONCLUSION: Navigator® and SmartPilot® View may be of clinical use in monitoring adequacy of anesthesia. Both displays can optimize the administration and monitoring of anesthetic drugs during general anesthesia and may reduce the consumption of volatile anesthetic agents.


Assuntos
Anestesia Geral/métodos , Anestesiologia/instrumentação , Anestésicos/administração & dosagem , Anestésicos/farmacocinética , Adolescente , Adulto , Idoso , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/farmacocinética , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Feminino , Humanos , Masculino , Éteres Metílicos/administração & dosagem , Éteres Metílicos/farmacocinética , Pessoa de Meia-Idade , Monitorização Intraoperatória , Piperidinas/administração & dosagem , Piperidinas/farmacocinética , Estudos Prospectivos , Remifentanil , Sevoflurano , Adulto Jovem
14.
Br J Clin Pharmacol ; 79(1): 72-84, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24251846

RESUMO

Anaesthesiologists adjust drug dosing, administration system and kind of drug to the characteristics of the patient. They then observe the expected response and adjust dosing to the specific requirements according to the difference between observed response, expected response and the context of the surgery and the patient. The approach above can be achieved because on one hand quantification technology has made significant advances allowing the anaesthesiologist to measure almost any effect by using noninvasive, continuous measuring systems. On the other the knowledge on the relations between dosing, concentration, biophase dynamics and effect as well as detection of variability sources has been achieved as being the benchmark specialty for pharmacokinetic-pharmacodynamic (PKPD) modelling. The aim of the review is to revisit the most common PKPD models applied in the field of anaesthesia (i.e. effect compartmental, turnover, drug-receptor binding and drug interaction models) through representative examples. The effect compartmental model has been widely used in this field and there are multiple applications and examples. The use of turnover models has been limited mainly to describe respiratory effects. Similarly, cases in which the dissociation process of the drug-receptor complex is slow compared with other processes relevant to the time course of the anaesthetic effect are not frequent in anaesthesia, where in addition to a rapid onset, a fast offset of the response is required. With respect to the characterization of PD drug interactions different response surface models are discussed. Relevant applications that have changed the way modern anaesthesia is practiced are also provided.


Assuntos
Anestésicos/farmacocinética , Simulação por Computador , Modelos Biológicos , Anestésicos/administração & dosagem , Relação Dose-Resposta a Droga , Vias de Administração de Medicamentos , Interações Medicamentosas , Humanos
15.
Foot Ankle Spec ; 7(3): 226-31, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24771018

RESUMO

The prevalence of breastfeeding among women in the United States is increasing along with the understanding of the importance of continually and exclusively breastfeeding an infant in the first half year of life. Modern necessities and problems evoke questions about what medications can be safely utilized by a breastfeeding mother and which procedures she may safely undergo. Planning elective surgery for a patient who is breastfeeding is a challenge because of insufficient studies regarding medication safety, apprehension among patients, and inadequate information from care providers. Nonetheless, information on the pharmacokinetics of drugs in the maternal system, the possible adverse effects to the infant, and how to minimize drug exposure to the infant is easily accessible to both patients and their surgeons. Positively informed providers and breastfeeding mothers who elect to undergo surgery, willing to take the proper steps and precautions, ensure healthy outcomes postoperatively.


Assuntos
Anestésicos/farmacocinética , Aleitamento Materno , Lactação/fisiologia , Adulto , Disponibilidade Biológica , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Midazolam/farmacocinética , Dor Pós-Operatória/prevenção & controle
16.
Anesth Analg ; 118(4): 809-17, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24413548

RESUMO

BACKGROUND: Postoperative delirium in the intensive care unit (ICU) is a frequent complication after cardiac or thoracic surgery and is associated with increased morbidity and mortality. METHODS: In this single-center substudy of the BAG-RECALL trial (NCT00682825), we screened patients after cardiac or thoracic surgery in the ICU twice daily for delirium using the Confusion Assessment Method for the ICU. The primary outcome was the incidence of delirium in patients who had been randomized to intraoperative Bispectral Index (BIS)-guided and end-tidal anesthetic concentration-guided depth of anesthesia protocols. As a secondary analysis, a Bayesian stochastic search variable selection strategy was used to rank a field of candidate risk factors for delirium, followed by binary logistic regression. RESULTS: Of 310 patients assessed, 28 of 149 (18.8%) in the BIS group and 45 of 161 (28.0%) in the end-tidal anesthetic concentration group developed postoperative delirium in the ICU (odds ratio 0.60, 95% confidence interval, 0.35-1.02, P= 0.058). Low average volatile anesthetic dose, intraoperative transfusion, ASA physical status, and European System for Cardiac Operative Risk Evaluation were identified as independent predictors of delirium. CONCLUSIONS: A larger randomized study should determine whether brain monitoring with BIS or an alternative method decreases delirium after cardiac or thoracic surgery. The association between low anesthetic concentration and delirium is a surprising finding and could reflect that patients with poor health are both more sensitive to the effects of volatile anesthetic drugs and are also more likely to develop postoperative delirium. Investigation of candidate methods to prevent delirium should be prioritized in view of the established association between postoperative delirium and adverse patient outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Delírio/etiologia , Delírio/psicologia , Complicações Pós-Operatórias/psicologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Anestesia Geral , Anestésicos/farmacocinética , Teorema de Bayes , Intervalos de Confiança , Confusão/induzido quimicamente , Confusão/psicologia , Monitores de Consciência , Feminino , Humanos , Período Intraoperatório , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Resultado do Tratamento
17.
Breastfeed Med ; 7(6): 547-53, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23215911

RESUMO

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.


Assuntos
Analgésicos/uso terapêutico , Anestésicos/uso terapêutico , Aleitamento Materno , Leite Humano/efeitos dos fármacos , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Analgésicos/efeitos adversos , Analgésicos/farmacocinética , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Anestésicos/efeitos adversos , Anestésicos/farmacocinética , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/farmacocinética , Hipnóticos e Sedativos/uso terapêutico , Recém-Nascido , Leite Humano/química , Manejo da Dor/métodos , Cuidado Pós-Natal , Gravidez , Procedimentos Cirúrgicos Operatórios
18.
Curr Clin Pharmacol ; 7(2): 78-101, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22432844

RESUMO

The incidence and potential for serious adverse drug reactions (SADRs) in anesthesia are high due to the narrow therapeutic indices of anesthetic and analgesic drugs and high interindividual variability in drug responses. Genetic factors contribute to a majority of these SADRs. Pharmacogenetics (PG), the study of genetic effects on drug action, is strongly related to the field of anesthesia; historically, succinylcholine apnea and malignant hyperthermia were among the first PG disorders reported. Recent years have strengthened this affiliation with an emerging wide base of knowledge of the effects of genetic variations on the pharmacodynamics and pharmacokinetics of anesthetic drugs. Here, we review the history of anesthetic PG, the important genes influencing enzymes involved in anesthetic drug metabolism, the influence of genotypic expression and the potential ramifications of recent discoveries on the practice of clinical anesthesia. Epigenetics and functional genomics are also discussed. The article also addresses various critical deficits in our current knowledge of PG related to anesthesia that account for the minimal clinical translation of the findings in this area in the present time. The review concludes that in addition to enhanced data generation facilitated by rapidly evolving genetic techniques, robust clinical study designs in a large sample and sound statistical analyses are essential prerequisites for the successful clinical implementation of research findings to individual perioperative care for every patient.


Assuntos
Anestesia/efeitos adversos , Anestésicos/farmacologia , Farmacogenética , Anestesia/métodos , Anestésicos/efeitos adversos , Anestésicos/farmacocinética , Animais , Epigênese Genética , Variação Genética , Genômica/métodos , Genótipo , Humanos
19.
Paediatr Anaesth ; 22(1): 88-92, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22077146

RESUMO

Abdominal wall blocks are an effective regional anesthetic technique to provide sufficient analgesia in abdominal surgery. This article reviews the use of abdominal wall blocks in pediatric regional anesthesia.


Assuntos
Parede Abdominal , Anestesia por Condução/métodos , Bloqueio Nervoso/métodos , Abdome/cirurgia , Anestésicos/farmacocinética , Criança , Humanos , Plexo Hipogástrico , Nervos Periféricos
20.
Best Pract Res Clin Anaesthesiol ; 25(3): 355-65, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21925401

RESUMO

In developed countries, a growing proportion of patients presenting for anesthesia and surgery are elderly. Despite this, and the fact that aging is known to be associated with alterations in drug pharmacokinetics and dynamics, there is little detailed information about the impact of aging on the pharmacology of commonly used anesthetic agents. In this review, we discuss existing current knowledge on the physiological changes that occur with age and the way these changes affect the pharmacokinetics and dynamics of anesthetic agents. Also, an overview of up-to-date PK-PD modeling concepts and their usefulness and limitations in modern anesthesiologic practice with respect to the elderly population is given. Finally, newer agents such as sugammadex, remifentanyl, ropivacaine and desflurane are discussed in detail with emphasis on current evidence concerning dosing, safety and efficacy of their use in the elderly.


Assuntos
Envelhecimento/fisiologia , Anestésicos/farmacologia , Idoso , Anestésicos/farmacocinética , Humanos , Modelos Biológicos
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