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1.
A A Pract ; 15(8): e01502, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34403375

RESUMO

Adenotonsillectomies are one of the most common otolaryngologic surgeries performed to alleviate obstructive sleep-disordered breathing and apnea in children. The pain management following adenotonsillectomy continues to be a challenge for both pediatric anesthesiologists and otolaryngologists due to the mortality that stems from the use of opioid pain medications in children who have an increased baseline risk airway obstruction and apnea that is exacerbated by any exposure to opioids. We present a case utilizing bilateral suprazygomatic maxillary nerve (SZMN) blocks or, more accurately, suprazygomatic infratemporal-pterygopalatine fossa injections to achieve opioid-free perioperative analgesia for pediatric adenotonsillectomy with nasal turbinate reduction.


Assuntos
Analgésicos Opioides , Tonsilectomia , Analgésicos Opioides/uso terapêutico , Criança , Humanos , Dor Pós-Operatória/tratamento farmacológico , Fossa Pterigopalatina , Conchas Nasais
3.
J Cardiothorac Vasc Anesth ; 34(11): 2986-2993, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32622712

RESUMO

OBJECTIVES: To examine postoperative serum lidocaine levels in patients with intermittent lidocaine bolus erector spinae plane block (ESPB) catheters after cardiac surgery with or without cardiopulmonary bypass (CPB). DESIGN: A retrospective study. SETTING: Single-center pediatric quaternary teaching hospital. PARTICIPANTS: Patients who received ESPB catheters after congenital cardiac surgery from April 2018 to March 2019. INTERVENTIONS: Postoperative serum lidocaine levels were extracted from the record. MEASUREMENTS AND MAIN RESULTS: Twenty-seven of 40 patients were included in the final analyses (19 with CPB and 8 with no CPB, age 1-47 years, undergoing congenital heart repair). Patients who received ropivacaine or were missing data were excluded. The initial intraoperative bolus of lidocaine ranged from 0- to- 3.72 mg/kg, and the range of postoperative intermittent lidocaine boluses ranged from 0.35- to- 0.83 mg/kg, which were administered every hour. Serum lidocaine levels were measured by the hospital laboratory and ranged from <0.05- to- 3.0 µg/mL in the CPB group and from <0.05- to- 3.2 µg/mL in the no- CPB group. CPB was not associated with differences in lidocaine levels when controlling for time (P = 0.529). Lidocaine concentrations ranged from 0.50- to- 1.68 µg/mL in the CPB group and 0.86- to- 2.07 µg/mL in the no- CPB group. There was a normally distributed overall mean peak level of 1.818 ± standard deviation of 0.624 µg/mL, with 95% confidence interval of 0.57- to- 3.06 µg/mL. No patients had clinical signs of toxicity. CONCLUSION: Postoperative serum lidocaine concentrations did not appreciably differ due to CPB. Serum lidocaine concentrations did not reach near- toxic doses despite the presence of additional lidocaine in the cardioplegia. The results suggested that lidocaine for ESPBs after cardiac surgery is below systemic toxic range at the doses described.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Bloqueio Nervoso , Absorção Fisiológica , Adolescente , Adulto , Cateteres , Criança , Pré-Escolar , Humanos , Lactente , Lidocaína , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Drugs Aging ; 36(3): 213-234, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30680678

RESUMO

Ultrasound-guided regional anesthesia is an important part of the practice of anesthesia for the elderly population, the growth of which will continue to outpace that of the younger population due to improvements in lifespan worldwide. The elderly patient is uniquely vulnerable to the effects of systemic anesthetic drugs, and our understanding of the potential toxicities that general anesthetics can have on the elderly brain and body continues to evolve. Aging impacts both the pharmacokinetics and pharmacodynamics of sedative medications and local anesthetics. Alongside the physiologic aging process often comes a myriad of pathologic co-morbidities that can accumulate with age, and result in a great variability of physiologic reserve. This variability in overall functional status is described by a newer concept termed 'frailty,' which is used to evaluate and risk-stratify elderly patients perioperatively. The choice for regional anesthesia is based on a combination of factors such as duration of surgery, pre-existing patient risk factors, and the skill and technique of the anesthesiologist. The utilization of preoperative and intraoperative sedation is now recognized as a key component in maximizing the safety and success rate of regional anesthesia. Excellent pain management with minimal to no sedation during the operation may have benefits that extend far beyond the immediate perioperative setting. Regional anesthesia is increasingly integrated as an important part of multimodal enhanced recovery after surgery (ERAS) protocols, which aim to decrease the cost, enhance safety, and improve the patient's subjective experience during and after hospitalization. Ultrasound-guided techniques, recently developed regional blocks, medications for sedation, and local anesthetics are reviewed in this article.


Assuntos
Anestesia por Condução/métodos , Fatores Etários , Idoso , Anestesia por Condução/efeitos adversos , Anestesia por Condução/normas , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Avaliação Geriátrica , Geriatria/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia/métodos
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