Características del dolor crónico en el anciano: tratamiento / Characteristics of chronic pain among the elderly: management

Chronic pain is a worldwide problem that has a particular significance, prevalence and relevance among the elderly, since it is associated to chronic diseases that incre ase with age. Pain is suffered by 50-80 por ciento of the population older than 65. Chronic pain, also in the elderly, becomes a tiring experience linked to a psychological suffering associated to anxiety and depression that determines and increases pain perception. Despite the above, a high perc e n t age of patients do not receive an appropriate tre a t m e n t . Management of chronic pain among the elderly is based on the WHO analgesic scale: NSAIs, opiates, coadjuvant drugs (antidepressants, anticonvulsants...) and psychological support, the latter being very important, since pain and d e p ression are symptoms frequently associated and overlapped, thus being very difficult to differentiate between both symptoms, and determining not only the type of treatment, but also its outcomes El dolor crónico es un problema universal que tiene especial importancia y prevalencia en el anciano ya que se asocia a enfermedades crónicas que aumentan con la edad. En t re un 50-80 por ciento de la población mayor de 65 años pre s e nta dolor. El dolor crónico, también en el anciano, es una experiencia agotadora, unida a un sufrimiento psicológico con síntomas de ansiedad y depresión que condicionan y aumentan la percepción dolorosa. A pesar de ello un gran núm e ro de pacientes, no recibe el tratamiento adecuado. El tratamiento del dolor crónico en el anciano se basa en la escalera analgésica de la OMS: AINEs, opiáceos, medicación coadyuvante (antidepresivos, anticonvulsivantes, etc.) y apoyo psicológico, punto este muy importante puesto que el dolor y depresión son síntomas que se asocian y se solapan con gran frecuencia, siendo muy difícil diferenciar un síntoma de otro, condicionando no sólo el tipo de tratamiento sino también sus resultados (AU)

[Occupational exposure of the anesthesiologist to nitrous oxide and halothane. Control measures]. / Exposición laboral del anestesiólogo al óxido nitroso y halotano. Medidas de control.

Anesthetic gas spillage does occur in the operating room. Anesthesiologists and other operating room personnel are likely exposed to health hazards caused by chronic exposure to anesthetic gases and vapours. The aim of the present study is to elucidate the possible relationship between the chronic exposure to anesthetic gases and their adverse effects on the health. Present data, while controversial, do not establish a cause-effect relationship. Nevertheless, until solid data refutes the existence of a health hazard for operating room personnel, the anesthesiologist must try to reduce the anesthetic contamination level, with preventive and technical measures.

[Determination of subanesthetic concentrations of halothane in the environment of operating and recovery rooms]. / Determinación de las concentraciones subanestésicas de halotano en el ambiente de los quirófanos y salas de despertar.

Concentrations of halothane in parts per million (ppm) in the air were determined during 4 days in the operating rooms and the recovery room of pediatric surgery during the course of surgical anesthesia by inhalation. The operating rooms did not have an anesthetic gas scavenging system. Eighteen samples of air were taken by passive diffusion in sampling tubes of activated charcoal (mode Dräger Orsa 5). The samples were analysed by gas chromatography). We found concentrations between 4.7 ppm and 34.2 ppm that exceed those considered as admissible that range from 2 to 5 ppm. Our present recommendations to reduce the atmospheric contaminating anesthetic gases are the use of scavenging equipment, air-conditioned rooms and routine inspection and leak detection of apparatus and anesthetic circuits.