RESUMEN
BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children. METHODS: During sevoflurane-nitrous oxide atracurium anaesthesia for minor abdominal or genito-urinary surgery, three groups of children aged 0-8 yr received 25 microg kg(-1) alfentanil intravenously (n = 28), or peripheral nerve blockade using 1 mLkg(-1) ropivacaine 0.475% (n = 24), or 12.5 microg kg(-1) alfentanil intravenously with peripheral nerve blockade using 1 mL kg(-1) ropivacaine 0.475% (n = 30). Changes in blood pressure and heart rate were measured during the procedures. Postoperative pain was assessed using the face, legs, activity, cry, consolability (FLACC) observational tool for quantifying pain behaviour and a numerical scale scored by nurses, doctors, parents and children. RESULTS: There was no significant difference in intra- or postoperative analgesic efficacy among the three groups. Patients who received alfentanil had significantly lower heart rates than those who received nerve blockade only (96.0+/-15.6 vs. 115.9+/-23.2 beats min(-1), P < 0.001). FLACC and numerical scale scores did not differ among the groups. There were no significant differences in incidence of vomiting or use of pain medications. CONCLUSIONS: It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.
Asunto(s)
Abdomen/cirugía , Alfentanilo/uso terapéutico , Analgésicos Opioides/uso terapéutico , Dolor/prevención & control , Procedimientos Quirúrgicos Urogenitales/métodos , Amidas/uso terapéutico , Anestésicos Locales/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Lactante , Procedimientos Quirúrgicos Menores/métodos , Bloqueo Nervioso/métodos , Dimensión del Dolor/métodos , Ropivacaína , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Anestesia General/métodos , Atracurio/análogos & derivados , Deleción Cromosómica , Trastornos de los Cromosomas/cirugía , Circuncisión Masculina/métodos , Anomalías Múltiples/genética , Alfentanilo/uso terapéutico , Anestésicos por Inhalación/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Atracurio/uso terapéutico , Preescolar , Humanos , Intubación Intratraqueal/métodos , Ketorolaco/uso terapéutico , Masculino , Éteres Metílicos/uso terapéutico , Neostigmina/uso terapéutico , Bloqueantes Neuromusculares/uso terapéutico , Parasimpaticomiméticos/uso terapéutico , Sevoflurano , SíndromeRESUMEN
Pallister-Killian syndrome is characterized by tetrasomy of the short arm of chromosome 12p, which produces mental retardation of varying degrees and dysmorphic characteristics. We describe anaesthesia in a 2-year-old child affected by this syndrome who underwent surgery for orchidopexy. Anaesthetic consisted of an inhalation mixture of O2, N2O and sevoflurane, together with an inguinal block with ropivacaine and administration of alfentanil plus ketorolac. Tracheal intubation was uneventful. No complications of any type were observed.
Asunto(s)
Anomalías Múltiples/fisiopatología , Anestesia por Inhalación , Cromosomas Humanos Par 12/genética , Discapacidad Intelectual/fisiopatología , Mosaicismo/genética , Preescolar , Humanos , Discapacidad Intelectual/genética , Masculino , Monitoreo Intraoperatorio , Mosaicismo/patología , Síndrome , Testículo/anomalías , Testículo/cirugíaAsunto(s)
Anomalías Múltiples , Anestesia General , Criptorquidismo/cirugía , Humanos , Lactante , Masculino , SíndromeRESUMEN
The potential for using external applied energy to rectify or ameliorate musculoskeletal disorders has been explored for decades. A shock wave is a pressure disturbance: tissue effect is cavitation, producing microtrauma or microfracture and haematoma formation, inducing, as to date is thought, increase in vascularization, increased soft callus and faster enchondral ossification. Anaesthesiological interest in this field is focused in non-union or delayed osseous union, joint stiffness or osteochondrosis and femoral head necrosis in adults. Actually, because of the pain associated with high energy extracorporeal shock wave therapy on bones, anaesthesia is necessary, but, since almost all patients have no complaint after treatment, there is no need of postoperative analgesia. Therefore, short duration anaesthetic techniques and agents should be preferred. Loco-regional anaesthesia or general anaesthesia are both suitable to the purpose. Fifty patients have been treated nowadays in our Institution with shock wave therapy needing anaesthesia. 18 patients (36%) received general anaesthesia. Since patient's stay in hospital was expected to be short, short duration agents have been used, avoiding those causing unpleasent side effects, first emesis. We used Propofol or Remifentanil by continuous infusion, titrated to maintain stable haemodynamics and an appropriate level of anaesthesia. The short duration of action of Propofol depends on its rapid elimination, whereas Remifentanil undergoes rapid biotransformation to minimally active metabolites. 32 patients (64%) received regional anaesthesia. We avoided long acting agents or high concentration drugs. Spinal blocks have been performed with 0.5% hyperbaric bupivacaine; brachial plexus blocks, sciatic-femoral blocks and an epidural block have been performed with 0.5-1% xylocaine or 1% mepivacaine. Shock Wave Therapy has been done during a 3-day hospital stay. With suitable anaesthesiological treatment and preparation, almost all patients could be treated as outpatients or with an overnight hospital stay.
Asunto(s)
Anestesia General , Enfermedades Musculoesqueléticas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Necrosis de la Cabeza Femoral/terapia , Humanos , Masculino , Persona de Mediana Edad , Osteocondritis/terapiaRESUMEN
Damage to spinal cord and subsequent neurological deficit is a recognised complication of major spinal surgery. It may be produced by a number of causes, not last excessive stretching when surgical instrumentation is positioned; it is easy to understand that early intraoperative warning of potential damage is highly desiderable. Wake-up test is a simple, safe and reliable method of recognition of such a complication, allowing rapid neurological recovery by reduction of spinal distraction. Remifentanil belongs to a new pharmacokinetic class of opioids (EMO: Esterase Metabolised Opioid) undergoing rapid biotransformation to minimally active metabolites, showing a short and predictable duration of action with no effect of accumulation. Authors describe a first 10 patient series subjected to wake-up-test during spinal surgery under remifentanil balanced anaesthesia. The protocol the authors set up allowed a very rapid intraoperative neurological examination (in average less than 5 min), without pain and/or disagreement for the patient and no complication related to the test was observed. Authors conclude that the use of Remifentanil for intraoperative awakening during major spinal surgery seems to be a safe, reliable and pratictical method to detect very quickly any potential neurological damage during the operation.