Safe administration of noradrenaline by the peripheral route: A systematic review. / Administración segura de noradrenalina por vía periférica: una revisión sistemática.

PURPOSE: To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety. METHODS: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1,040 articles were identified. Animal studies and studies written in languages other than English were excluded. Finally, 83 articles were included. RESULTS: NA can be administered peripherally. The risk of extravasation should be taken into account, with phentolamine being the first pharmacological line of treatment. It has also been related to the appearance of thrombophlebitis, cellulitis, tissue necrosis, limb ischemia and gangrene, although its incidence seems to be low. The use of peripheral NA in children seems to be carried out without obvious complications. The use of standard concentrations is suggested to reduce the risk of errors. It is recommended to use 0.9% saline as the default diluent for peripheral NA. CONCLUSIONS: Peripheral infusions of NA could be a safe and beneficial option in early resuscitation provided that a number of guidelines are followed that reduce the likelihood of complications associated with this route.

Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares / Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

Objetivo mostrar la efectividad y seguridad del sevoflurano tópico tras la administración ambulatoria y prolongada en los pacientes con úlceras vasculares refractarias. Métodos estudio observacional retrospectivo de pacientes con úlceras vasculares dolorosas refractarias a terapias habituales y que fueron tratados con sevoflurano tópico durante al menos 36 meses. Se recogieron las variables: edad, sexo, antecedentes médicos, comorbilidad asociada, etiología de úlcera y tratamiento médico. Se analizó la mejoría clínica y la variación de la superficie de las úlceras vasculares. Para cuantificar la intensidad del dolor basal e irruptivo antes y después del tratamiento se utilizó la escala visual analógica. Resultados del total de pacientes tratados, 9 cumplían los criterios de inclusión. La edad media fue de 74,8 ± 7,5 años. Los casos 2 y 9 fallecieron durante el seguimiento. La acción analgésica del sevoflurano tópico fue rápida (3,1 ± 2,1 min), intensa (escala visual analógica: 7 ± 1,1 a 1,4 ± 1,1 puntos) y duradera (de 6 a 24 h). Salvo el caso 4, todos experimentaron una reducción de la superficie (15,1 ± 5,0 a 2,7 ± 4,2) de las úlceras vasculares y no se observó tolerancia a lo largo del tiempo. Conclusión la aplicación de sevoflurano tópico es una estrategia analgésica y reepitelizante para las úlceras vasculares que presenta un perfil correcto de seguridad (AU)

Objective To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. Methods Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. Results Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. Conclusion Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile (AU)

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers. / Tratamiento crónico ambulatorio con sevoflurano tópico en pacientes con úlceras vasculares.

OBJECTIVE: To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers. METHODS: Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment. RESULTS: Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time. CONCLUSION: Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile.

Revisión de mezclas binarias, ternariasy cuaternarias para inducción y mantenimiento de anestesia libre de opiáceos / Review of binary, ternary and quaternary mixtures for induction and maintenance of opioid free anesthesia

Objetivo: Describir y estructurar la información actual disponible sobremezclas binarias, ternarias y/o cuaternarias empleadas en una “anestesialibre de opiáceos”, así como su estabilidad fisicoquímica, para facilitar sucorrecta administración, optimizar su uso y prevenir posibles problemasde efectividad o seguridad.Método: Revisión sistemática de la literatura sobre anestesia libre deopiáceos en PubMed/Medline, Trissel, Micromedex, Lexicomp, AHFS DrugInformation, Extended Stability for Parenteral Drugs y Stabilis Web. Artículos publicados en inglés o español hasta mayo de 2020 y con acceso atexto completo. Se emplearon los términos MeSH: “Drug Incompatibility”AND “Opioid Free Anesthesia” AND “Administration, Intravenous” AND“Dexmedetomidine” AND “Lidocaine” AND “Ketamine” AND “SulphateMagnesium” OR “Infusions, Intravenous”. Se realizó una primera búsquedaen PubMed/Medline incluyendo casos clínicos de anestesia general tipoanestesia libre de opiáceos. Los resultados obtenidos se estructuraron enuna base de datos. La segunda búsqueda fue sobre incompatibilidadesde las mezclas intravenosas. Se recogieron medicamentos compatibles/incompatibles; concentraciones de referencia; tiempo de estabilidad a temperatura ambiente (23 ± 2 °C) y en refrigeración (4 ± 2 °C); tipo de administración recomendada y resultados y conclusiones relevantes. Se crearon dos tablas bidimensionales de la compatibilidad de cada combinación defármacos para la administración en Y o en mezcla en una sola solución.Resultados: Se identificaron 780 artículos; se accedió al texto completo de 203. Se recogieron de forma cronológica los 4.762 casos tratados en 32 diferentes publicaciones con protocolos de anestesia librede opiáceos. El uso de dos fármacos fue la asociación más frecuente(42,4%). Los fármacos más empleados fueron dexmedetomidina (25 trabajos), clorhidrato de ketamina (25 trabajos) y lidocaína (14 trabajos). (AU)

Objective: To describe and organize the current information availableon binary, ternary and/or quaternary mixtures used in opioid-free anesthesia (OFA), as well as their physicochemical stability, in order to facilitate itscorrect administration, optimize its use, and prevent potential effectivenessand safety issues.Method: A systematic review of the literature on OFA was conductedin PubMed/Medline, Trissel, Micromedex, Lexicomp, www.ahfsdruginformation.com, ASHP’s Extended Stability for Parenteral Drugs, and www.stabilis.org. Only articles published in English or Spanish until May 2020and with access to full text were considered. MeSH terms used included:“drug incompatibility” AND “opioid-free anesthesia” AND “administration,intravenous” AND “dexmedetomidine” AND “lidocaine” AND “ketamine”AND “magnesium sulphate” OR “infusions, intravenous. A first search wascarried out in PubMed/Medline that included OFA clinical cases. Theresults obtained were collected in a database. A second search wascarried out on the incompatibilities of intravenous mixtures. Informationwas compiled on mutually-compatible/incompatible drugs, reference concentrations, stability time at room temperature (23 ± 2 °C) and under refrigeration (4 ± 2 ºC), type of administration recommended, and relevantresults and conclusions. Two two-dimensional tables on the compatibility of each drug combination were created for administration as Y-site infusionor as a mixture in a single solution. (AU)

Review of binary, ternary and quaternary mixtures for induction and maintenance of opioid free anesthesia.

OBJECTIVE: To describe and organize the current information available on  binary, ternary and/or quaternary mixtures used in opioid-free anesthesia (OFA), as well as their physicochemical stability, in order to  facilitate its correct administration, optimize its use, and prevent potential  effectiveness and safety issues. METHOD: A systematic review of the literature on OFA was conducted in  PubMed/Medline, Trissel, Micromedex, Lexicomp,  ww.ahfsdruginformation.com, ASHP's Extended Stability for Parenteral Drugs, and www.stabilis.org. Only articles published in English or Spanish until May 2020 and with  access to full text were considered. MeSH terms used included: "drug  incompatibility" AND "opioid-free anesthesia" AND "administration, intravenous" AND "dexmedetomidine" AND "lidocaine"  AND "ketamine" AND "magnesium sulphate" OR "infusions, intravenous. A  first search was carried out in PubMed/Medline that included OFA clinical cases. The results obtained were collected in a database. A second search  was carried out on the incompatibilities of intravenous mixtures.  Information was compiled on mutually-compatible/incompatible drugs,  reference concentrations, stability time at room temperature (23 ± 2 °C)  and under refrigeration (4 ± 2 ºC), type of administration recommended,  and relevant results and conclusions. Two two-dimensional tables on the  compatibility of each drug combination were created for administration as  Y-site infusion or as a mixture in a single solution. RESULTS: Seven hundred and eighty articles were identified, with the full  text of 203 being accessed. A total of 4,762 cases treated with OFA  protocols were chronologically collected from 32 different publications. Administration of two concomitant drugs was the most usual  regimen (42.4%). The most frequently drugs were dexmedetomidine (25  studies), ketamine hydrochloride (25 studies) and lidocaine (14 studies).  Compatibility/incompatibility data was collected for 11 drugs, associated to  7 pharmacological groups; compatibility with Y-site administration was  found in 43 of 55 combinations (78.18%) and with integration into one  single solution in 13 of 55 drug combinations (23.63%). None of the  sources reviewed reported any adverse results related to potential  pharmacological incompatibilities. CONCLUSIONS: Despite the availability of multiple OFA protocols, few studies analyze the compatibility between binary drug mixtures. No  information exists as yet regarding compatibilities in the context of ternary and quaternary mixtures.  Despite the availability of multiple OFA  protocols, few studies analyze the compatibility between binary drug  mixtures. No information exists as yet regarding compatibilities in the  context of ternary and quaternary mixtures.

Objetivo: Describir y estructurar la información actual disponible sobre mezclas binarias, ternarias y/o cuaternarias empleadas en una  "anestesia libre de opiáceos", así como su estabilidad fisicoquímica, para  facilitar su correcta administración, optimizar su uso y prevenir posibles  problemas de efectividad o seguridad.Método: Revisión sistemática de la literatura sobre anestesia libre de opiáceos en PubMed/Medline, Trissel, Micromedex, Lexicomp, AHFS  Drug Information, Extended Stability for Parenteral Drugs y Stabilis Web.  Artículos publicados en inglés o español hasta mayo de 2020 y con acceso  a texto completo. Se emplearon los términos MeSH: "Drug Incompatibility" AND "Opioid Free Anesthesia" AND "Administration,  Intravenous" AND "Dexmedetomidine" AND "Lidocaine" AND "Ketamine"  AND "Sulphate Magnesium" OR "Infusions, Intravenous". Se realizó una  primera búsqueda en PubMed/Medline incluyendo casos clínicos de  anestesia general tipo anestesia libre de opiáceos. Los resultados  obtenidos se estructuraron en una base de datos. La segunda búsqueda  fue sobre incompatibilidades de las mezclas intravenosas. Se recogieron  medicamentos compatibles/ incompatibles; concentraciones de referencia; tiempo de estabilidad a temperatura ambiente (23 ± 2 °C) y en  refrigeración (4 ± 2 °C); tipo de administración recomendada y resultados  y conclusiones relevantes. Se crearon phardos tablas bidimensionales de la compatibilidad de cada combinación de fármacos para la administración en Y o en mezcla en una sola solución.Resultados: Se identificaron 780 artículos; se accedió al texto completo de 203. Se recogieron de forma cronológica los 4.762 casos  tratados en 32 diferentes publicaciones con protocolos de anestesia libre de opiáceos. El uso de dos fármacos fue la asociación más frecuente (42,4%). Los fármacos más empleados fueron dexmedetomidina (25 trabajos), clorhidrato de ketamina (25 trabajos) y lidocaína (14  trabajos). Se recopiló información de compatibilidad/incompatibilidad de  11 medicamentos, asociados a 7 grupos farmacológicos, encontrándose  compatibilidad en Y en 43 de 55 combinaciones (78,18%) y en mezcla en  una sola solución en 13 de 55 combinaciones de fármacos (23,63%). En  ningún trabajo publicado se expone algún tipo de evento adverso en  relación con una posible incompatibilidad farmacológica.Conclusiones: Existen múltiples protocolos de anestesia libre de  piáceos, pero los estudios de compatibilidad entre las diferentes mezclas  de fármacos empleadas son muy limitados cuando se trata de mezclas  binarias, y no existe información en el caso de mezclas ternarias y  cuaternarias.