Manejo anestésico para cirugía tiroidea. Una revisión no sistemática / Anesthetic management for thyroid surgery. A non-systematic review

Resumen: Las hormonas tiroideas forman parte fundamental del mantenimiento de la homeostasia, se encuentra particularmente relacionado con la función cardiovascular. Los estados distiroideos clínicos o subclínicos pueden comprometer este sistema en forma significativa durante los procedimientos quirúrgicos. Existen múltiples fármacos que pueden modificar la patología tiroidea en mayor o menor medida, disminuyendo el riesgo de complicaciones en la eventualidad de una cirugía. La utilización de anestesia general, ya sea balanceada o total endovenosa, se ha convertido en el estándar de oro, por la menor tasa de complicaciones asociadas. Durante el período perioperatorio se debe mantener un monitoreo estricto de la función cardiovascular para detectar alteraciones en forma temprana e iniciar las correcciones necesarias.

Abstract: Thyroid hormones are a fundamental part of the maintenance of homeostasis, it is particularly related to cardiovascular function. Clinical or subclinical dysthyroid states can significantly compromise this system during surgical procedures. There are multiple drugs that can modify the thyroid pathology to a greater or lesser extent, reducing the risk of complications in the event of surgery. The use of general anesthesia, whether balanced or total intravenous, has become the Gold standard, due to the lower rate of associated complications. During the perioperative period, strict monitoring of cardiovascular function must be maintained to detect alterations early and initiate the necessary corrections.

Clínicas de ketamina: usos actuales según la evidencia / Ketamine clinics: current uses based on evidence

Resumen: La ketamina es un medicamento conocido por sus bondades como inductor anestésico y para disminuir la posibilidad de complicaciones, por ejemplo, exacerbación del dolor neuropático e hiperalgesia asociada a opioides. En esta revisión nos enfocaremos en otras indicaciones en las que también ha demostrado ser útil y que, bajo observación e instrucción adecuadas en una infraestructura diseñada para ello (clínicas de ketamina), mejora la calidad en el comportamiento y disminuye el estrés, ansiedad y dolor. Entre las indicaciones para su uso se encuentran los trastornos depresivos, el trastorno de ansiedad, el trastorno obsesivo compulsivo y los relacionados con traumas emocionales; el trastorno bipolar, anormalidades en conducta e ingesta alimentaria, al igual que los trastornos adictivos.

Abstract: Ketamine is a drug known for its benefits as an anesthetic inducer and to reduce the possibility of complications such as exacerbation of neuropathic pain and hyperalgesia associated with opioids. In this review we will focus on other indications in which it has also proven to be useful and that, under adequate observation and instruction in an infrastructure designed for it (ketamine clinics), improves the quality of behavior and decreases stress, anxiety and pain. Among the indications for its use are depressive disorders, anxiety disorder, obsessive-compulsive disorder and those related to emotional trauma; bipolar disorder, abnormalities in behavior and eating intake as well as addictive disorders.

Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study.

INTRODUCTION: NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. OBJECTIVE: To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). METHODS: We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. RESULTS: We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. CONCLUSIONS: The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily.

El resurgimiento del metoxiflurano en México / The resurgence of methoxyflurane in Mexico

Resumen: El metoxiflurano es un anestésico halogenado que se utilizó hace varias décadas para anestesia general balanceada y que actualmente está indicado para otorgar sedación controlada por el paciente. Este medicamento se encuentra actualmente a la venta en la República Mexicana, por lo que recordar las características que lo hacen diferente a otros halogenados, su farmacocinética y su utilidad para distintos escenarios proporciona el conocimiento adecuado para su uso en la práctica clínica.

Abstract: Methoxyflurane is a halogenated anesthetic that was used decades ago for a balanced general anesthesia and is currently indicated for patient-controlled sedation. This drug is currently on sale in the Mexican Republic, so remembering the characteristics that make it different from other halogenated drugs, its pharmacokinetics and its usefulness for different scenarios provides knowledge for use in clinical practice.

Ultrasound meal accommodation test in critically ill patients with and without feeding intolerance UMAT-ICU.

BACKGROUND: Gastrointestinal dysfunction (GID) is one of the leading causes of nonavoidable discontinuing or delayed enteral feeding in critically ill patients. The ultrasound meal accommodation test (UMAT) has been used in ambulatory patients to evaluate dyspepsia. The objective of this study was to determine differences in the UMAT scores of critically ill patients with and without feeding intolerance (FI). METHODS: A prospective, observational, two-centre study was conducted between June and August 2019. We included subjects who met the criteria for enteral nutrition. Patients and their subrogates provided signed consent for intervention. The independent variables were cross-sectional area (CSA) and calculated gastric volume (CGV). Dependent variables were changes in the UMAT at Time 1 and Time 2 and gastric residue in those with and without FI. After that, patients were divided into two groups, depending on the development of GID over the following 48 h after inclusion in the study group A, subjects without FI; and group B, subjects with FI. According to the normal distribution in parametric or non-parametric tests. Differences between groups were determined using a Student's T-test. A p-value of ≤0.05 was established for the statistical difference between groups. At 60 min, a change cut-off point of 52% has a sensitivity of 50%, specificity of 88.9%, a positive likelihood ratio of 4.50 and a negative likelihood ratio of 0.56. With a pretest probability of 85% for feeding tolerance in intensive care unit patients, the posttest probability increased to 96% with a positive test with the ΔCSA. RESULTS: 61 patients were included in the study; 52 (85%) in Group A and 9 (15%) in Group B. However, at time 0 (fasting), there were statistical differences in CSA and CGV between groups (p = 0.001). During Time 1 (dynamic changes), there were statistical differences between the groups (p = 0.008 for CSA and p = 0.011 for CGV). At time 3 (Delta), there were statistical differences between groups at minute 10 (p = 0.023 for CSA and p = 0.008 for CGV). CONCLUSION: Our study showed statistical differences in the UMAT test between patients with and without FI. TRIAL REGISTRATION: Clinical trials registry NCT03851354. February 22, 2019.

SASA: una escala sencilla de mortalidad postoperatoria explorada en un centro de atención de tercer nivel en México / SASA: a simple scale of postoperative mortality explored in a third-level care center in Mexico

Resumen: Introducción: Las complicaciones postquirúrgicas han sido causa importante de muerte. Por lo tanto, el uso de predictores sencillos de mortalidad con una nueva escala llamada SASA podría indicar un riesgo postoperatorio de mortalidad a los 30 días aplicado en una muestra en población mexicana. Material y métodos: Exploramos una asociación entre la clasificación de estado físico de la Sociedad Americana de Anestesiólogos (ASA-PS), el Apgar quirúrgico (sAs) y la puntuación de SASA con un análisis univariado en 371 pacientes estimando la relación de probabilidades (OR) y graficando las curvas de operación característica del receptor (receiver-operating-characteristic [ROC]) para cada escala. Resultados: Obtuvimos los valores de dos; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 40.56% (IC del 95%: 35.44-45.83)], 6; [sensibilidad; 81.82% (IC del 95 %: 48.2-97.72), especificidad; 77.5% (IC del 95%: 72.83-81.71)] y 10; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 83.6% (IC del 95%: 78.77-86.78)] como los mejores puntos de corte para el ASA-PS, sAs y SASA respectivamente. Conclusiones: el cálculo de SASA obtuvo la misma sensibilidad, pero mejor especificidad y área bajo la curva cuando se comparó con el ASA-PS y el sAs.

Abstract: Introduction: Post-surgical complications have been a significant cause of death. Therefore, the use of easy preoperative mortality predictors is recommended. A new SASA score could indicate a perioperative risk more globally at 30-days of the postoperative period applied in a Mexican sample. Material and methods: 371 patients were analyzed. We explore an association between the American Society of Anesthesiologists physical status classification (ASA-PS), the surgical Apgar score (sAs), and the new SASA score to assess 30-days mortality after surgery using univariate analysis to estimate the odds ratio (OR). Receiver-operating-characteristic (ROC) curves were plotted for each scale. Results: We obtained values of two; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 40.56% (95% CI: 35.44-45.83)] 6; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 77.5% (95% CI: 72.83-81.71)] and 10; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 83.6% (95% CI: 78.77-86.78)] as the best cut-off points for ASA-PS, sAs and SASA respectively. Conclusions: To predict postoperative 30-days mortality, SASA calculation as a new score obtained the same sensitivity but better specificity and area under the curve (AUC) for the ROC compared with the ASA-PS and the sAs.

Eficacia terapéutica de la buprenorfina para tratamiento de dolor agudo postoperatorio en cirugía torácica por toracoscopía / Therapeutic efficacy of buprenorphine for treatment of acute postoperative pain in thoracic surgery by thoracoscopy

Resumen: Introducción: El dolor postoperatorio en toracoscopía tiene una incidencia del 80%. Estos procedimientos se realizan bajo anestesia general o sedoanalgesia. La buprenorfina en dosis de 4 μg/kg o más es un fármaco pilar para el tratamiento de dolor postoperatorio; sin embargo, dosis menores pueden ser suficientes. El objetivo de este estudio fue demostrar que dosis de 1-3 μg/kg de buprenorfina aporta una adecuada analgesia con menores efectos adversos durante el postoperatorio en pacientes sometidos a cirugía toracoscópica. Material y métodos: Se realizó el estudio prospectivo, transversal y doble ciego en 48 pacientes sometidos a toracoscopía, divididos en 3 grupos: A (1 μg/kg), B (2 μg/kg) y C (3 μg/kg) tratados con buprenorfina, se evaluaron efectos adversos, intensidad de dolor por escala verbal numérica (EVN) y sedación con escala de agitación-sedación de Richmond (RASS) de los 0 a los 120 minutos postanestesia. Resultados: Las dosis de 1 a 3 μg/kg de buprenorfina no ocasionaron efectos adversos. El mantenimiento de analgesia es mayor con 2 μg/kg (p = 0.019) y 3 μg/kg (p = 0.045). Las dosis de 1 y 2 μg/kg presentan un nivel de sedación menor. Conclusiones: La analgesia multimodal disminuyó un 200% el dolor postquirúrgico inmediato. Las dosis de 2-3 μg/kg de buprenorfina son efectivas para el control del dolor con menor incidencia de efectos adversos y un nivel de sedación superficial durante el postoperatorio.

Abstract: Introduction: Posterior pain in thoracoscopy has an 80% incidence. These procedures are done under general anesthesia or sedoanalgesia. The buprenorphin in dosage of 4 μg/kg it's the foundation for post-operatory pain treatment, nevertheless, smaller dosage can be sufficient. The objective of this study is to demonstrate that a dosage of buprenorphin from 1-3 μg/kg provides suitable analgesia with less side effects during post-operatory in patients who underwent thoracoscopic surgery. Material and methods: We conducted a double-blind, prospective, transversal study, in 48 patients which underwent a thoracoscopy divided in 3 groups: A (1 μg/kg), B (2 μg/kg), and C (3 μg/kg) treated with buprenorphin. We studied side effects, pain intensity (NVE), and sedative effect (RASS) from 0 to 120 minutes postanesthesia. Results: Dosage from 1 to 3 μg/kg did not generate side effects. The analgesia effect is higher with 2 μg/kg (p = 0.019) and 3 μg/kg (p = 0.045). Dosage of 1 and 2 μg/kg have lower sedative effect. Conclusion: The multimodal analgesia was diminished by 200% inmidiate postsurgical pain. Dosage from 2-3 μg/kg of buprenorphine are effective for pain control with less side effects and a superficial sedative effect during post-operatory.

Complicaciones postoperatorias por descontrol lipídico perioperatorio. Revisión sistemática / Postoperative complications due to perioperative lipid decontrol. Systematic review

Resumen: Introducción: La alteración en el metabolismo de los lípidos se ha involucrado en la patogénesis de complicaciones postoperatorias, primordialmente por inducir procesos inflamatorios que pueden afectar la morbilidad, además se ha observado un aumento en la vulnerabilidad/sensibilidad por isquemia reperfusión implicada por apoptosis por estrés mediado por el retículo endoplásmico. Durante el procedimiento anestésico los niveles séricos de lípidos pueden afectar la farmacocinética de varios agentes anestésicos. Objetivo: Determinar si existe evidencia científica que compruebe o refute el desarrollo de complicaciones en pacientes postoperados que cursan con descontrol lipídico en el período preoperatorio. Metodología: Se realizó una revisión en la literatura mediante los buscadores PUBMED, ScienceDirect y BioMed Central. Resultados: Con los criterios de búsqueda se revisaron 17 estudios (ensayos clínicos controlados, estudios de casos y controles, cohortes y estudios experimentales básicos). Conclusiones: Aunque es necesario mejorar la metodología de varios artículos revisados y aumentar la cantidad de los mismos, en la mayor parte de ellos se encontró relación entre dislipidemia con alteraciones postoperatorias que inciden en un aumento de morbilidad o mortalidad.

Abstract: Introduction: The alteration in lipid metabolism has been involved in the pathogenesis of postoperative complications primarily by inducing inflammatory processes that may affect morbidity, in addition an increase in vulnerability/sensitivity for ischemia reperfusion has been observed involved apoptosis by stress mediated by the endoplasmic reticulum. During the anesthetic procedure, serum lipid levels can affect the pharmacokinetics of various anesthetic agents. Objective: To determine if there is scientific evidence to prove or refute the development of complications in post-operated patients who present with lipid decontrol in the preoperative period. Methodology: A review was made in the literature through the search engines PubMed, ScienceDirect, and BiomedCentral. Results: With the search criteria, 17 studies were reviewed (controlled clinical trials, case and control studies, cohorts and basic experimental studies). Conclusions: Although it is necessary to improve the methodology of several articles reviewed and increase the number of them, in most of them a relationship was found between dyslipidemia with postoperative alterations that affect an increase in morbidity or mortality.

Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT.

OBJECTIVE: This was a pre-post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management. METHODS: PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥6/10 between project phases was the primary outcome. RESULTS: Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one's own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%. CONCLUSIONS: Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.

Problemática actual de dolor crónico por insuficiente manejo de dolor agudo postoperatorio / Current problem of chronic pain due to insufficient management of acute postoperative pain

Resumen En la actualidad, la mayor parte del tratamiento para los pacientes intervenidos quirúrgicamente se centra en el manejo nociceptivo transanestésico y en la modulación del dolor en el postanestésico; pero existe una problemática existente llamada dolor crónico postoperatorio, que presenta aún una necesidad de mejora en la terapéutica médica.

Abstract At present, most of the treatment for surgically treated patients is focused on transanesthetic nociceptive management and modulation of pain in the postanesthetic; but there is an existing problem called postoperative chronic pain that still presents a need for improvement in medical therapy.

Manejo del dolor en cirugía vascular periférica / Pain management in peripheral vascular surgery

Resumen: En cirugía vascular periférica, el manejo multimodal del dolor permite una movilización temprana, lo cual conlleva a una rápida recuperación y satisfacción del paciente. El fracaso en el control del dolor postoperatorio aumenta los costos, los días de estancia hospitalaria y el riesgo de complicaciones como infecciones y tromboembolismo. Antes de la cirugía, el uso de dexametasona, gabapentina y paracetamol mejora los niveles de analgesia postoperatoria. La analgesia peridural es la técnica que mayor alivio de dolor presenta en el postoperatorio, provocando una incidencia menor de dolor crónico; limitar el uso de opioides neuroaxiales disminuye el tiempo de bloqueo motor, permitiendo la movilización temprana y evitando las complicaciones asociadas con la postración (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: In peripheral vascular surgery, multimodal pain management allows early mobilization, which leads to rapid recovery and patient satisfaction. Failure to control postoperative pain increases costs, days of hospital stay and increases the risk of complications such as infections and thromboembolism. Before surgery, using dexamethasone, gabapentin and paracetamol improves higher leves of postoperative analgesia. Epidural analgesia is the technique that provides the greatest pain relief in the postoperative period, causing a lower incidence of chronic pain; limiting the use of neuroaxial opioids decreases the motor block time, allowing early mobilization and avoiding complications associated with prostration (visit http://www.painoutmexico.com to see the full article and diagram of overall recommendations).

Blancos terapéuticos en dolor postoperatorio / Therapeutic targets in postoperative pain

Resumen: Las dianas terapéuticas para el control en el dolor postoperatorio son cada vez más conocidas. Entre ellas se encuentran las implicadas en canales de voltaje, iónicos, transportadores, ligadas a proteínas G, de reconocimiento molecular, peptídicos, neutróficos, enzimáticos, citoquínicos, celular, epigenético y genético. Además, podemos dividir a las dianas terapéuticas en tres grandes grupos dependiendo de su injerencia: las que actúan en el dolor agudo, aquéllos que irrumpirán en la generación de dolor crónico y los enfocados a la hiperalgesia. Claro está que casi todos están implicados en el mecanismo de los tres grupos de dolor, aunque infieren de manera más concisa en uno de ellos.

Abstract: The therapeutic targets for control in postoperative pain are increasingly well known. Among them are those involved in voltage, ion, transporter, G-protein, molecular recognition, peptide, neutrophic, enzymatic, cytokinic, cellular, epigenetic and genetic channels. We can also divide the therapeutic targets into three large groups depending on their interference; those that act in acute pain, those that will break into the chronic pain generation and those focused on hyperalgesia. Of course, almost everyone is involved in the mechanism of the three pain groups although they infer more concisely in one of them.

Respondiendo a la interrogante: ¿el metamizol es o no un antiinflamatorio no esteroideo? / Answering the question: is metamizole a non-steroidal anti-inflammatory or not?

Resumen: El objetivo de este artículo es determinar la importancia del metamizol como analgésico en México, al conocer la frecuencia de su uso y los mecanismos de acción y así clasificar adecuadamente al medicamento dentro de la farmacopea de analgésicos. Pocos fármacos generan discusión sobre su filiación, pero el metamizol, desde que salió al mercado en 1922 hasta el día de hoy, se mantiene sin definirse claramente. Comúnmente cuando se busca una clasificación de los antiinflamatorios no esteroideos (AINE), se clasifica al metamizol dentro de los mismos como derivados de la pirazolona. Se debe comenzar entonces con los aspectos farmacológicos para relacionar las semejanzas y diferencias con otros AINEs y poder sacar conclusiones adecuadas. Aun así, el medicamento es de los más utilizados por los médicos en los hospitales de segundo y tercer nivel (82%), aunque la mayoría no sabe en realidad cuál es su mecanismo de acción (91%), por ello, la importancia de conocer el mecanismo de acción de este fármaco.

Abstract: The aim of this article is to know the importance of metamizol as analgesic in Mexico, knowing the frequency of their use and the mechanisms of action and to adequately classify the drug in the pharmacopoeia of painkillers. Few drugs generate discussion about their parentage but metamizol from that hits the market in 1922 until today, it has no clearly defined. Commonly when NSAIDs rated seeks to metamizol is classified within the same as pyrazolone derivatives. We then start with the pharmacological aspects and later to know the similarities and differences with other NSAIDs and can draw appropriate conclusions. Even so, the medicine is one of the most used by physicians in second and third level hospitals (82%), although most do not really know what their mechanism of action is (91%), so the importance of knowing the mechanism of action of this drug.

Consideraciones anestésicas para cirugía toracoscópica / Anesthetic considerations for thoracoscopic surgery

Resumen: La cirugía toracoscópica ha evolucionado hasta convertirse en una pieza clave en el diagnóstico y tratamiento de diversas patologías de índole torácica; entre éstas se encuentran la bulectomía, simpatectomía, fenestración pericárdica, resección pulmonar parcial, lobectomías y decorticaciones toracoscópicas. La clave del éxito es el proporcionar una adecuada visualización del tórax con los nuevos lentes de alta definición, disminución en el dolor postquirúrgico, mínima invasión, herida quirúrgica pequeña, entre otros. La anestesiología a la par de la evolución de la técnica quirúrgica ha progresado a saltos abismales, tanto que ahora cada vez con mayor frecuencia se realizan procedimientos con el paciente despierto y con una adecuada sedoanalgesia. Sea cual sea el procedimiento elegido, la toracoscopía desplaza cada vez más a las toracotomías; por ello, el anestesiólogo debe conocer las formas de manejar a los pacientes tanto intubados (selectivamente o no) como a los pacientes despiertos.

Abstract: Thoracoscopic surgery has evolved into a key player in the diagnosis and treatment of various pathologies of thoracic nature. Among these an examples are bullectomy, sympathectomy, pericardial fenestration, partial lung resection; thoracoscopic lobectomy and decortications. The key to success is to provide an adequate visualization of the chest with the new HD lenses, decrease postoperative pain, minimal invasion surgery, and small wound among others. Now increasingly frequent anesthetics procedures are performed with the patient awake and with adequate analgesia and sedation. Increasingly frequent thoracoscopy patient awake and adequate analgesia and sedation. Whatever the procedure chosen, thoracoscopy is more frequent than thoracotomy, so the anesthesiologist must know the ways to handle safely intubated patients (either selectively or not) of intubated patients as awake.

Gabapentine 300 mg vs. 450 mg as anesthetic premedication for reactive hypertension, anxiety and analgesia / Gabapentina a dosis de 300 vs. 450 mg como premedicación anestésica para hipertensión reactiva, ansiedad y analgesia.

Objective: Observe the behavior of gabapentin to reduce reactive hypertension secondary to anxiety and pain in patients undergoing ophthalmic surgery as well as opioid consumption between groups. Method: Clinical randomized double blind controlled trial that analyzed 125 patients divided into three groups: Group A, gabapentin 300 mg; Group B, gabapentin 450 mg; and Group C, amaranth dragees as a control 2 h before the surgical procedure. Chi-squared test was used in sociodemographic variables and one-way ANOVA for continuous numeric variables. It was considered as significant a p < 0.05 for a study of two tails with a power of 80% beta. Results: Anxiety and analgesia intraoperative and postoperative had significant differences between groups. Lower consumption of opioid was found in the groups that used gabapentin. Conclusions: Gabapentin orally 300 or 450 mg h prior to surgery reduces pain, anxiety and postoperative opioid consumption in patients undergoing ophthalmic surgery.

Objetivo: Observar el comportamiento de la gabapentina para aminorar la hipertensión reactiva secundaria a ansiedad y dolor en pacientes sometidos a cirugía oftálmica, así como el consumo de opiáceos entre los grupos. Método: Ensayo clínico controlado aleatorizado y doble ciego que analizó a 125 pacientes divididos en tres grupos: grupo A, gabapentina 300 mg; grupo B, gabapentina 450 mg; grupo C, amaranto en grageas como control 2 horas antes del procedimiento quirúrgico. Se utilizó la prueba de ji al cuadrado para variables sociodemográficas y ANOVA de un factor para variables numéricas continuas. Se consideró como significativo un valor de p < 0.05 para un estudio de dos colas con un poder beta del 80%. Resultados: La ansiedad y la analgesia transoperatoria y posoperatoria tuvieron diferencias significativas entre los grupos. Se encontró menor consumo de opiáceos en los grupos que usaron gabapentina. Conclusiones: La gabapentina por vía oral, 300 o 450 mg, 2 horas antes de la cirugía, reduce el dolor, la ansiedad y el consumo de opiáceos durante el posoperatorio en pacientes sometidos a cirugía oftalmológica.