RESUMEN

Resumen: El liposarcoma pleomórfico es una neoformación de tejidos blandos, que afecta principalmente las extremidades. Los pacientes que los presentan son candidatos a resección amplia o incluso amputación del miembro afectado. Como parte de una técnica anestésica integral y multimodal, destaca la utilización de bloqueos ecoguiados que disminuirán los requerimientos de opioides, teniendo un impacto importante en la preservación de la inmunidad del paciente oncológico, lo que le permitirá aumentar la tasa de supervivencia y su período libre de enfermedad; adicionando además un alfa 2 agonista, el cual nos brinda una adecuada analgesia postoperatoria, y realizando los bloqueos previos a la amputación, tenemos mayor tasa de éxito en la prevención del dolor y síndrome de miembro fantasma.

Abstract: Pleomorphic liposarcoma is a neoformation, which mainly affects the extremities. Being the patient candidate to perform a wide resection or even amputation of the affected limb. As part of a multimodal anesthetic technique, the use of ultrasound-guided blocks are useful, reducing opioid requirements, having an important impact on the preservation of the cancer patient's immunity, also adding an alpha 2 agonist, which provides adequate postoperative analgesia, and performing the blocks prior to amputation, we have a higher success rate in the prevention of pain and phantom limb syndrome.

RESUMEN

Describir las características clínicas de un grupo de pacientes con abstinencia moderada/grave tratados con dexmedetomidina de forma adyuvante al tratamiento con benzodiacepinas. Métodos. Se realizó un estudio descriptivo y retrospectivo a partir de los registros de historia clínica donde se seleccionó 11 casos que cursaron con diagnóstico de abstinencia alcohólica y que requirieron tratamiento con dexmedetomidina como adyuvante a benzodiacepinas entre el año 2018 y 2022. Las variables de resultado principal dosis máxima diaria alcanzada de dexmedetomidina, dosis total recibida de dexmedetomidina, días de tratamiento con dexmedetomina y días de internación en Unidad de Terapia Intensiva /Unidad de emergencias. Resultados. Once pacientes cumplieron con los criterios de este estudio los cuales recibieron dexmedetomidina en infusión continua durante un promedio de 4,8 días. La dosis máxima que recibieron de forma diaria presentó una media de 1526.18 microgramos. El 27% necesitaron más 7500 microgramos en total durante la internación. Durante la internación, 7 pacientes (63%) intercurrieron con complicaciones. Conclusiones. Puede considerarse a la dexmedetomidina como una opción eficaz en el tratamiento de abstinencia alcohólica

To describe the clinical characteristics of a group of patients with moderate/severe withdrawal treated with dexmedetomidine as an adjunct to treatment with benzodiazepines. Methods. A descriptive and retrospective study was carried out from the clinical history record where 11 cases were selected that were diagnosed with alcohol withdrawal and that required treatment with dexmedetomidine as an adjuvant to benzodiazepines between 2018 and 2022. The main outcome variables were maximum dose. daily dose of dexmedetomidine reached, total dose of dexmedetomidine received, days of treatment with dexmedetomidine and days of hospitalization in the Intensive Care Unit /Emergency Unit. Results. Eleven patients met the criteria for this study who received continuous infusion of dexmedetomidine for an average of 4.8 days. The maximum dose they received on a daily basis presented an average of 1526.18 micrograms. 27% needed more than 7500 micrograms in total during hospitalization. During hospitalization, 7 patients (63%) had complications. Conclusions. Dexmedetomidine can be considered as an effective option in the treatment of alcohol withdrawal

Asunto(s)

RESUMEN

The effective relief of postsurgical pain in patients undergoing knee arthroscopy is important to allow the initiation of activities of daily living. The objective of this study is to demonstrate the analgesic efficacy of dexmedetomidine as an adjuvant added to ropivacaine by the intra-articular route. METHOD: Seventy patients underwent knee arthroscopy which were randomly assigned into two groups (n=35). The RD group received ropivacaine 1.5mg/kg plus dexmedetomidine 1µg/kg intra-articularly. Group R received ropivacaine 1.5mg/kg intra-articularly. The analgesic effect was evaluated by measuring the intensity of pain (VAS score) and the duration of analgesia. RESULTS: A longer duration of the analgesic effect was observed in the RD group (655min) compared to the R group (318min) being statistically significant (p=0.03). CONCLUSION: Dexmedetomidine as an adjuvant to intra-articular ropivacaine improves the quality and duration of postoperative analgesia in patients undergoing knee arthroscopy.

RESUMEN

La Sociedad Americana de Anestesiología (ASA) define vía aérea difícil, como la situación clínica en la que un médico capacitado en el cuidado anestésico experimenta una dificultad anticipada o no, incluyendo uno o más de los siguientes: ventilación con máscara facial, laringoscopia, ventilación mediante una vía aérea supraglótica, intubación traqueal, extubación o vía aérea invasiva. El manejo de vía aérea difícil sigue siendo un reto incluso para expertos en su manejo y más aún si esta se realiza en lugares poco controlados, con escaso equipamiento y con personal sin entrenamiento adecuado. El objetivo de este trabajo es dar a conocer una opción segura en el abordaje del paciente que presenta vía aérea difícil. Presentamos el caso de un paciente masculino, 73 años, llevado a emergencia por dificultad respiratoria secundario a una obstrucción parcial de la vía aérea debido a una masa gigante en cuello, donde se realiza intubación traqueal vigil videoasistida con sedación (ketamina y dexmedetomidina). El paciente con gran parte de su vía aérea invadida por la masa, se preoxigena a través de un dispositivo bolsa- mascarilla previo a intubación orotraqueal, manteniendo la ventilación espontánea con asociado a sedación monitorizada; evitando así un evento fatídico como ser el colapso de la vía aérea. En conclusión, la intubación traqueal vigil videoasistida bajo sedación con ketamina y dexmedetomidina es una opción segura en abordaje de vía aérea difícil...(AU)

Asunto(s)

RESUMEN

La dependencia del alcohol se encuentra entre los principales factores de riesgo para la salud en la mayoría de los países desarrollados y en desarrollo.El éxito terapéutico en la abstinencia modera-grave podría incrementarse con tratamiento adyuvante a las benzodiacepinas. En nuestro medio los agonistas alfa2 (clonidina y dexmedetomidina), ácido valproico y carbamazepina son los de mayor uso. El objetivo de este trabajo fue realizar la búsqueda exhaustiva, análisis crítico y resumen de la evidencia para proporcionar una visión general de la efectividad de estos fármacos cuando son utilizado sin tiempo determinado de tratamiento comparados entre sí, contra ninguna intervención, placebo u otras intervenciones. Se realizó una búsqueda bibliográfica en bases de datos (Pubmed/MEDLINE, LILACs, EMBASE). Dos revisores seleccionaron, extrajeron los datos y evaluaron el riesgo de sesgo de los estudios incluidos de forma independiente mediante el software Covidence. Los desacuerdos fueron resueltos por consenso. Realizamos metanálisis utilizando RevMan 5. 3 y análisis de subgrupos por diseño de estudio. Se incluyeron 22 estudios donde ninguno de ellos presentó bajo riesgo de sesgo en todos los dominios, y la mayoría de los estudios presentaron al menos un dominio con alto riesgo de sesgo. Estudios con resultados estadísticamente bajos mostraron que la dexmedetomidina y el ácido valproico disminuyen los requerimientos de benzodiacepinas en pacientes que recibían placebo. Además, cuando se combinan ácido valproico con benzodiacepinas logran una disminución estable y continua de la abstinencia medido en escala CIWA-Ar. La clonidina fue la única descripta que presentaba disminución en la frecuencia cardiaca frente a placebo con alta significancia, situación clínica a tener presente frente al síndrome simpaticomimético que caracteriza al síndrome de abstinencia por alcohol.

Alcohol dependence is among the main risk factors for health in most developed and developing countries. Therapeutic success in moderate-Grave abstinence could be increased with adjuvant treatment to benzodiazepines. In our environment, agonists Alfa 2 (clonidine and dexmedetomidine), valproic acid and carbamazepine are the most used. The objective of this work was to carry out the thorough search, critical analysis and summary of the evidence to provide an overview of the effectiveness of these drugs when used without a certain time of treatment compared to each other, against any intervention, placebo or other interventions. A bibliographic search was carried out in databases (Pubmed/ Medline, Lilacs, Embase). Two reviewers selected, extracted the data and evaluated the bias risk of independently included studies using the COVIDENCE software. The disagreements were resolved by consensus. We perform meta-analysis using Revman 5. 3 and subgroup analysis by study design. 22 studies were included where none of them presented under a risk of bias in all domains, and most studies presented at least one domain with high bias risk. Studies with statistically low results showed that dexmedetomidine and valproic acid decrease the requirements of benzodiazepines in patients receiving placebo. In addition, when valproic acid is combined with benzodiazepines achieve a stable and continuous decrease in abstinence measured in CIWA-AR scale. Clonidine was the only one described that presented a decrease in heart rate against placebo with high significance, clinical situation to be in mind in front of the sympathomimetic syndrome that characterizes alcohol withdrawal syndrome

Asunto(s)

RESUMEN

Abstract Background Neuropathic pain typically refers to the pain caused by somatosensory system injury or diseases, which is usually characterized by ambulatory pain, allodynia, and hyperalgesia. Nitric oxide produced by neuronal nitric oxide synthase (nNOS) in the spinal dorsal cord might serve a predominant role in regulating the algesia of neuropathic pain. The high efficacy and safety, as well as the plausible ability in providing comfort, entitle dexmedetomidine (DEX) to an effective anesthetic adjuvant. The aim of this study was to investigate the effect of DEX on the expression of nNOS in spinal dorsal cord in a rat model with chronic neuropathic pain. Methods Male Sprague Dawley (SD) rats were randomly assigned into three groups: sham operation group (sham), (of the sciatic nerve) operation (CCI) group, and dexmedetomidine (DEX) group. Chronic neuropathic pain models in the CCI and DEX groups were established by sciatic nerve ligation. The thermal withdrawal latency (TWL) was measured on day 1 before operation and on day 1, 3, 7 and 14 after operation. Six animals were sacrificed after TWL measurement on day 7, and 14 days after operation, in each group, the L4-6 segment of the spinal cords was extracted for determination of nNOS expression by immunohistochemistry. Results Compared with the sham group, the TWL threshold was significantly decreased and the expression of nNOS was up-regulated after operation in the CCI and DEX groups. Compared with the CCI grou[, the TWL threshold was significantly increased and the expression of nNOS was significantly down-regulated on day 7 and 14 days after operation in the DEX group. Conclusion Down-regulated nNOS in the spinal dorsal cord is involved in the attenuation of neuropathic pain by DEX.

Resumo Antecedentes A dor neuropática refere-se tipicamente à dor causada por lesões ou doenças do sistema somatossensorial. De modo geral, é caracterizada por dor à ambulação, alodinia e hiperalgesia. O óxido nítrico produzido pela enzima óxido nítrico sintase neuronal (nNOS) na medula espinhal dorsal pode ter um papel predominante na regulação da dor neuropática. A alta eficácia e segurança, bem como a plausível capacidade de proporcionar conforto, faz com que a dexmedetomidina (DEX) seja um adjuvante anestésico eficaz. O objetivo deste estudo foi investigar o efeito da DEX na expressão de nNOS na medula espinhal dorsal em um modelo de ratos com dor neuropática crônica. Métodos Ratos Sprague Dawley (SD) machos foram distribuídos aleatoriamente em três grupos: grupo de cirurgia simulada (sham), grupo de cirurgia (do nervo ciático; CCI) e grupo dexmedetomidina (DEX). Os modelos de dor neuropática crônica nos grupos CCI e DEX foram estabelecidos por ligadura do nervo ciático. A latência de retirada térmica (TWL) foi medida no dia 1 antes da cirurgia e nos dias 1, 3, 7 e 14 após o procedimento. Seis animais de cada grupo foram eutanasiados após a medida de TWL nos dias 7 e 14 após a cirurgia e o segmento L4-6 da medula espinhal foi extraído para determinação da expressão de nNOS por imuno-histoquímica. Resultados Em comparação ao grupo sham, o limiar de TWL diminuiu significativamente e a expressão de nNOS foi regulada de maneira positiva após a cirurgia nos grupos CCI e DEX. Comparado ao grupo CCI, o limiar de TWL aumentou de forma significativa e a expressão de nNOS caiu significativamente diminuída nos dia 7 e 14 após a cirurgia no grupo DEX. Conclusão A regulação negativa de nNOS na medula espinhal dorsal está envolvida na atenuação da dor neuropática pela DEX.

RESUMEN

Resumen: Introducción: la dexmedetomidina es un adyuvante en el manejo anestésico perioperatorio y si se administra por vía nasal las dosis requeridas tienen mínimos efectos secundarios. Material y métodos: ensayo clínico aleatorizado doble ciego en pacientes sometidos a colecistectomía laparoscópica con anestesia general, comparando la dexmedetomidina intranasal (1 μg/kg de peso ideal) contra placebo, se comparó el efecto analgésico postoperatorio por medio de la escala visual análoga del dolor (EVA) y el consumo de opioides transanestésico. El análisis estadístico se realizó con t de Student y exacta de Fisher. Resultados: se incluyeron 54 pacientes aleatorizados en dos grupos: dexmedetomidina y control. El 81.5% de los sujetos fueron mujeres, no se encontró diferencia entre los grupos en las variables demográficas. La media de la calificación EVA a los 60 minutos para el grupo dexmedetomidina fue (2.89 ± 1.9), estadísticamente inferior comparada contra el grupo control (5.78 ± 2.3) (p ˂ 0.0001). El consumo de opioides para dexmedetomidina fue (0.424 ± 0.074 μg/h) estadísticamente menor al control (0.697 ± 0.136 μg/h) (p ˂ 0.0001) con un tamaño del efecto de Cohen de 250%. Conclusiones: disminución significativa en EVA y en el consumo de opioides con el uso de dexmedetomidina intranasal en colecistectomía laparoscópica.

Abstract: Introduction: dexmedetomidine is and useful adjuvant agent in the perioperative anesthetic management associated to nasal administration with minimum adverse effects. Material and methods: a randomized, controlled, double blind, clinical trial was carried out in elective patients undergoing laparoscopic cholecystectomy with general anesthesia. Aim of this study was to compare the postoperative analgesic effect through visual analogue scale (VAS) and the perioperative opioid consumption. Dexmedetomidine was administrated intranasally (1 μg/kg dose) versus placebo. Statistical analysis was realized through student t and Fisher Test. Results: 54 patients were randomized in two groups: dexmedetomidine vs control. Not significant differences were found between both groups in demographic variables but 81.5% were women. Mean of VAS score at 60 minutes was significantly inferior (2.89 ± 1.9) versus control group (5.78 ± 2.3) (p ˂ 0.0001). Mean of opioids consumption in dexmedetomidine group (0.424 ± 0.074 μg/h) was significant minor of control group (0.697 ± 0.136 μg/h) (p ˂ 0.0001). Size effect through Cohen test was 250%. Conclusion: statistically decrease in VAS and in opioid consumption was observed using dexmedetomidine nasally in laparoscopic cholecystectomy.

RESUMEN

Resumo Fundamento A dexmedetomidina (DEX), um agonista específico do receptor α2-adrenérgico, é protetora contra lesão de isquemia/reperfusão miocárdica (I/R). No entanto, a associação entre a cardioproteção induzida pelo pré-condicionamento DEX e a supressão da mitofagia permanece pouco clara. Objetivo Portanto, nosso objetivo foi investigar se o pré-condicionamento com DEX alivia a I/R, suprimindo a mitofagia via ativação do receptor α2-adrenérgico. Método Sessenta corações de ratos isolados foram tratados com ou sem DEX antes de induzir isquemia e reperfusão; um antagonista do receptor α2-adrenérgico, a ioimbina (YOH), também foi administrado antes da isquemia, isoladamente ou com DEX. A frequência cardíaca (FC), pressão diastólica do ventrículo esquerdo (PDVE), pressão diastólica final do ventrículo esquerdo (PDFVE), taxa máxima e mínima de desenvolvimento da pressão ventricular esquerda (±dp/dtmax) e tamanho do infarto do miocárdio foram medidos. A ultraestrutura mitocondrial e as autofagossomas foram avaliadas por microscopia eletrônica de transmissão. O potencial de membrana mitocondrial e os níveis de espécies reativas de oxigênio (ROS) foram medidos usando os ensaios JC-1 e diacetato de diclorodi hidrofluoresceína, respectivamente. Os níveis de expressão das proteínas associadas à mitofagia Beclin1, relação LC3II/I, p62, PINK1 e Parkin foram detectados por western blotting. Resultados Em comparação com o grupo controle, no grupo isquemia/reperfusão, a FC, PDVE e ±dp/dtmax foram notavelmente diminuídas (p<0,05), enquanto os tamanhos da PDFVE e do infarto aumentaram significativamente (p<0,05). O pré-condicionamento com DEX melhorou significativamente a disfunção cardíaca, reduziu o tamanho do infarto do miocárdio, manteve a integridade estrutural mitocondrial, aumentou o potencial de membrana mitocondrial, inibiu a formação de autofagossomas e diminuiu a produção de ROS e a relação Beclin1, relação LC3II/I, expressão PINK1, Parkin e p62(p<0,05). Quando DEX e YOH foram combinados, o YOH cancelou o efeito da DEX, enquanto o uso de YOH sozinha não teve efeito. Conclusão Portanto, o pré-condicionamento DEX foi cardioprotetor contra I/R em ratos, suprimindo a mitofagia por meio da ativação do receptor α2-adrenérgico.

Abstract Background Dexmedetomidine (DEX), a specific α2-adrenergic receptor agonist, is protective against myocardial ischemia/reperfusion injury (MIRI). However, the association between DEX preconditioning-induced cardioprotection and mitophagy suppression remains unclear. Objective Hence, we aimed to investigate whether DEX preconditioning alleviates MIRI by suppressing mitophagy via α2-adrenergic receptor activation. Method Sixty isolated rat hearts were treated with or without DEX before inducing ischemia and reperfusion; an α2-adrenergic receptor antagonist, yohimbine (YOH), was also administered before ischemia, alone or with DEX. The heart rate (HR), left ventricular diastolic pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), maximal and minimal rate of left ventricular pressure development (±dp/dtmax), and myocardial infarction size were measured. The mitochondrial ultrastructure and autophagosomes were assessed using transmission electron microscopy. Mitochondrial membrane potential and reactive oxygen species (ROS) levels were measured using JC-1 and dichloride hydrofluorescein diacetate assays, respectively. The expression levels of the mitophagy-associated proteins Beclin1, LC3II/I ratio, p62, PINK1, and Parkin were detected by western blotting. Results Compared with the control group, in the ischemia/reperfusion group, the HR, LVDP, and ±dp/dtmax were remarkably decreased (p< 0.05), whereas LVEDP and infarct sizes were significantly increased (p< 0.05). DEX preconditioning significantly improved cardiac dysfunction reduced myocardial infarction size, maintained mitochondrial structural integrity, increased mitochondrial membrane potential, inhibited autophagosomes formation, and decreased ROS production and Beclin1, LC3II/I ratio, PINK1, Parkin, and p62 expression(p< 0.05). When DEX and YOH were combined, YOH canceled the effect of DEX, whereas the use of YOH alone had no effect. Conclusion Therefore, DEX preconditioning was cardioprotective against MIRI in rats by suppressing mitophagy via α2-adrenergic receptor activation.

RESUMEN

Abstract Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine. Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block. Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment. Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon's opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment. Conclusions: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.

Resumen Introducción: El manejo hemodinámico intraoperatorio y la analgesia postoperatoria durante la cirugía artroscópica de hombro sigue siendo un desafío. Aun cuando el bloqueo interescalénico del plexo braquial (BIE) se considera ideal para la anestesia del hombro, a diferencia del uso de la dexmedetomidina intravenosa (IV), el BIE requiere destreza y maestría. Objetivo: El presente estudio aleatorizado se llevó a cabo para observar la eficacia de la infusión de dexmedetomidina que es menos invasiva y exige menos destreza que el bloqueo del plexo. Metodología: Todos los pacientes programados para cirugía artroscópica electiva de hombro bajo anestesia general, se asignaron o bien al grupo DEX, para recibir un bolo de dexmedetomidina IV de 0,5 mcg/kg en 20 minutos, seguido de una infusión de 0,5 mcg/kg/hora que se detuvo 30 minutos antes del final de la cirugía; o, al grupo BLOQUEO al cual se le administró un BIE ecoguiado con 20ml debupivacaína 0,25%. El desenlace primario evaluado fue la hemodinamia intraoperatoria; los desenlaces secundarios fueron el dolor postoperatorio inmediato, la condición operatoria evaluada por el cirujano, el tiempo de recuperación y la satisfacción del paciente después de 24 horas. Para la evaluación se utilizaron el investigador ciego y puntajes compuestos. Resultados: Ambos grupos mostraron puntajes equivalentes en la hemodinamia intraoperatoria, en tanto que el BIE dio como resultado una mejor analgesia en el postoperatorio (p < 0.001). La opinión del cirujano y el tiempo de recuperación fueron comparables. En general, la experiencia de los pacientes fue satisfactoria con ambas técnicas, de acuerdo con la evaluación de calidad. Conclusiones: La infusión de dexmedetomidina IV es una alternativa efectiva al BIE para cirugías reconstructivas de hombro bajo anestesia general.

RESUMEN

Objetivos: evaluar el efecto de dexmedetomidina sublingual frente a dexmedetomidina vía nasal más remifentanilo -propofol con bomba de infusión en procedimientos ginecológicos. Métodos: ensayo clínico no controlado, doble ciego, prospectivo. 68 pacientes con criterios de inclusión dividas en 3 grupos, grupo A [dexmedetomidina sublingual a 0.75 ug/kg], grupo B [dexmedetomidina vía nasal a 0,9 gg/kg] y grupo C [control] más adición de remifentanil y propofol por bombas de infusión. Análisis estadístico de variables cualitativas con chi cuadrado, variables cuantitativas de distribución libre se usó Kruskal-Wallis y distribución normal Anova. Nivel de confianza del 95 % y margen de error del 9 %. Resultados: edad con un rango de 30 a 32 años, la dosis de inicio y sostén tanto del remifentanilo y propofol se disminuyó hasta la mitad comparada con el grupo control, a predominio en el grupo A. Con poca variabilidad en los parámetros hemodinámicos sin repercusión clínica. Efectos adversos más frecuentes como depresión respiratoria en el grupo control, no se observó analgesia con el uso de dexmedetomidina. Y con menor tiempo de estancia en salas de recuperación en pacientes que se administró dexmedetomidina vía nasal. Conclusiones: la administración sublingual es superior con la nasal debido al menor requerimiento de propofol, menos cambios en la presión sanguínea media, sin efectos adversos que se puedan manejar, con mayor facilidad en su administración. Aunque la administración nasal produce un despertar más rápido y mejor control de la frecuencia cardiaca.

Objectives: to evaluate the effect of sublingual dexmedetomidine versus nasal dexmedetomidine plus remifentanil-propofol infusion pump in gynecological procedures. Methods: Uncontrolled, double-blind, prospective clinical trial. 68 patients with inclusion criteria were divided into 3 groups, group A [sublingual dexmedetomidine at 0.75 ug/kg], group B [nasal dexmedetomidine at 0.9 ug/kg] and group C [control] plus the addition of remifentanil and propofol by infusion pumps. Statistical analysis of qualitative variables with chi- square, quantitative variables with free distribution used Kruskal-Wallis and normal distribution Anova. Confidence level of 95% and margin of error of 9%. Results: age with a range of 30 to 32 years, the starting and maintenance dose of both remifentanil and propofol was halved compared to the control group, mainly in group A. With little variability in hemodynamic parameters without clinical repercussion. The most frequent adverse effects were respiratory depression in the control group, no analgesia was observed with the use of dexmedetomidine. And with a shorter stay in recovery rooms in patients who received nasal dexmedetomidine. Conclusions: sublingual administration is superior to nasal due to the lower requirement of propofol, less changes in mean blood pressure, with no adverse effects that can be managed, and with greater ease of administration. Although nasal administration produces a faster awakening and better control of heart rate.

RESUMEN

Dexmedetomidine (DXM), is a potent, versatile and highly selective a-2 adrenergic receptor agonist, currently described as an agent with sedative, anxiolytic, sympatholytic, and hypnotic effects that preserve the integrity of respiratory functions. It has highly lipophilic chemical characteristics and conforms to a two-compartment distribution and elimination model. Among its unique pharmacodynamic characteristics, at the cardiac level there is a biphasic hemodynamic effect, with a transient increase in blood pressure and reflex bradycardia determined by its plasma concentration, at the renal level it improves ischemic damage by improving external medullary blood flow through local renal vasodilation and allowing an increase in glomerular filtration. At the respiratory level, it induces a minimal depressant effect, allowing a wide margin of safety in various surgical and sedation scenarios outside the operating room. From its neuroprotective characteristics, it is suggested that the catecholamine pathways at the level of a-2 adrenoceptors modulate the release of neurotransmitters in the central and peripheral sympathetic nervous system. They are diverse clinical applications from a "cooperative sedation", anxiolysis in pediatric patients, during the intubation process in difficult airways, as well as its use in cardiovascular and neurological surgery and management of the critical patient.

La dexmedetomidina (DXM), un agonista de los receptores adrenérgicos a-2 potente, versátil y altamente selectivo, actualmente descrito como un agente con efectos sedantes, ansiolíticos, simpaticolíticos e hipnóticos que permite conservar la integridad de las funciones respiratorias. De características químicas altamente lipofilicas se ajusta a un modelo de distribución y eliminación bicompartimental. Entre sus rasgos farmacodinámicos únicos, a nivel cardíaco se produce un efecto hemodinámico bifásico, con un aumento transitorio de la presión arterial y bradicardia refleja determiando por su concentración plasmática, a nivel renal mejora el daño por isquemia, mejorando el flujo sanguíneo medular externo, a través de la vasodilatación renal local y permitiendo un aumento en la filtración glomerular. A nivel respiratorio, induce un mínimo efecto depresor, permitiendo un amplio margen de seguridad en diversos escenarios quirurgicos y de sedación fuera de quirófano. Su propiedad de neuroprotección, modulan la liberación de neurotransmisores en el sistema nervioso simpático central y periférico. Resalta un amplio expectro de aplicaciones clínicas desde una "sedación cooperativa", ansiolisis en pacientes pediátricos, durante el proceso de intubación en vías áreas difíciles, al igual que su uso en cirugía cardiovascular, neurológica y manejo del paciente crítico.

Asunto(s)

RESUMEN

Resumo Fundamento A cardiopatia isquêmica atraiu muito atenção devido às altas taxas de mortalidade, custos do tratamento e a crescente morbidade na população jovem. Estratégias de reperfusão reduziram a mortalidade. Porém, a reperfusão pode levar à morte do cardiomiócito e subsequente dano irreversível ao miocárdio. No momento, não há um tratamento eficiente e direcionado para a lesão de isquemia-reperfusão (I/R). Objetivos Avaliar se a dexmedetomidina (DEX) tem efeito protetivo na I/R do miocárdio e explorar os possíveis mecanismos por trás dela. Métodos Corações de ratos foram perfundidos com o sistema de perfusão de Langendorff e aleatoriamente distribuídos em cinco grupos: grupo controle, perfundido com solução de Krebs-Henseleit (K-H) por 205 minutos sem isquemia; e quatro grupos de teste que foram submetidos a 40 minutos de isquemia global e 120 minutos de reperfusão. O Grupo DEX, o grupo ioimbina (IO) e o grupo DEX + IO foram perfundidos com DEX (10 nM), IO (1 μM) ou a combinação de DEX e IO antes da reperfusão, respectivamente. A hemodinâmica cardíaca, o tamanho do infarto do miocárdio e a histologia do miocárdio foram avaliados. A expressão da proteína-78 regulada pela glicose (GRP78), a proteína quinase do retículo endoplasmático (PERK), a PERK fosforilada, o fator de iniciação eucariótico 2α (eIF2α), eIF2α fosforilado, o fator de transcrição 4 (TCF-4) e a proteína homóloga à proteína ligadora do acentuador CCAAT (CHOP) foram avaliados. P< 0,05 foi considerado para indicar a diferença estatisticamente significativa. Resultados O pré-condicionamento com DEX melhorou a função cardíaca nos corações com I/R, reduziu o infarto do miocárdio, a apoptose do miocárdio e a expressão de GRP78, p-PERK, eIF2α, p-eIF2α, TCF-4 e CHOP. Conclusões O pré-tratamento com DEX reduziu a lesão de I/R no miocárdio ao suprimir a apoptose, o que foi induzido pela via PERK.

Abstract Background Ischemic heart disease has attracted much attention due to its high mortality rates, treatment costs and the increasing morbidity in the young population. Strategies for reperfusion have reduced mortality. However, reperfusion can lead to cardiomyocyte death and subsequent irreversible myocardial damage. At present, the timely and targeted treatment of ischemia-reperfusion (I/R) injury is often lacking. Objectives To evaluate if dexmedetomidine (DEX) has a protective effect in myocardiual I/R and explore the possible mechanism behind it. Methods Rat hearts were perfused with a Langendorff perfusion system, and randomly assigned to five groups: control group, perfused with Krebs-Henseleit (K-H) solution for 205 minutes without ischemia; and four test groups that underwent 40 minutes of global ischemia and 120 min of reperfusion. The DEX group, the yohimbine (YOH) group and the DEX + YOH group were perfused with DEX (10 nM), YOH (1 μM) or the combination of DEX and YOH prior to reperfusion, respectively. Cardiac hemodynamics, myocardial infarct size, and myocardial histology were evaluated. The expression of glucose-related protein 78 (GRP78), protein kinase R-like ER kinase (PERK), phosphorylated PERK, eukaryotic initiation factor 2α (eIF2α), phosphorylated eIF2α, activating transcription factor 4 (ATF4), and CCAAT/enhancer-binding protein homologous protein (CHOP) were assessed. P<0.05 was considered to indicate a statistically significant difference. Results DEX preconditioning improved the cardiac function of I/R hearts, reduced myocardial infarction, myocardial apoptosis, and the expression of GRP78, p-PERK, eIF2α, p-eIF2α, ATF4 and CHOP. Conclusions DEX pretreatment reduced myocardial I/R injury by suppressing apoptosis, which was induced by the PERK pathway.

Asunto(s)

RESUMEN

RESUMO O manejo cardíaco, ventilatório e renal no ambiente de terapia intensiva tem melhorado nas últimas décadas. Cognição e sedação representam dois dos últimos desafios a vencer. Como a sedação convencional não é ideal, e a sedação evocada por agonistas adrenérgicos alfa-2 (sedação "cooperativa" com dexmedetomidina, clonidina ou guanfacina) representa uma alternativa valiosa, este artigo abrange três tópicos práticos para os quais há lacunas na medicina baseada em evidência. O primeiro deles é a mudança de sedação convencional para sedação cooperativa ("mudança"): a resposta curta consiste em retirada abrupta de sedação convencional, implantação imediata de infusão de um agonista alfa-2 e uso de "sedação de resgate" (bolos de midazolam) ou "sedação agressiva" (haloperidol em bolos) para estabilizar a sedação cooperativa. O segundo tópico é a mudança de sedação convencional para sedação cooperativa em pacientes instáveis (por exemplo: delirium tremens refratário, choque séptico, síndrome do desconforto respiratório agudo etc.), pois, para evitar a hipotensão e a bradicardia provocadas por desativadores simpáticos, a resposta curta é manter o volume sistólico por administração de volume, vasopressores e inotrópicos. Por fim, para evitar essas mudanças e dificuldades associadas, os agonistas alfa-2 podem ser sedativos de primeira linha. A resposta curta é administrar agonistas alfa-2 lentamente desde a admissão ou intubação endotraqueal, até estabilização da sedação cooperativa. Dessa forma, conclui-se que os agonistas alfa-2 são, ao mesmo tempo, agentes desativadores simpáticos e sedativos, bem como a desativação simpática implica na manutenção do volume sistólico e na avaliação persistente da volemia. A medicina baseada em evidência deve documentar esta proposta.

ABSTRACT Cardiac, ventilatory and kidney management in the critical care setting has been optimized over the past decades. Cognition and sedation represent one of the last remaning challenges. As conventional sedation is suboptimal and as the sedation evoked by alpha-2 adrenergic agonists ("cooperative" sedation with dexmedetomidine, clonidine or guanfacine) represents a valuable alternative, this manuscript covers three practical topics for which evidence-based medicine is lacking: a) Switching from conventional to cooperative sedation ("switching"): the short answer is the abrupt withdrawal of conventional sedation, immediate implementation of alpha-2 agonist infusion and the use of "rescue sedation" (midazolam bolus[es]) or "breakthrough sedation" (haloperidol bolus[es]) to stabilize cooperative sedation. b) Switching from conventional to cooperative sedation in unstable patients (e.g., refractory delirium tremens, septic shock, acute respiratory distress syndrome, etc.): to avoid hypotension and bradycardia evoked by sympathetic deactivation, the short answer is to maintain the stroke volume through volume loading, vasopressors and inotropes. c) To avoid these switches and associated difficulties, alpha-2 agonists may be considered first-line sedatives. The short answer is to administer alpha-2 agonists slowly from admission or endotracheal intubation up to stabilized cooperative sedation. The "take home" message is as follows: a) alpha-2 agonists are jointly sympathetic deactivators and sedative agents; b) sympathetic deactivation implies maintaining the stroke volume and iterative assessment of volemia. Evidence-based medicine should document our propositions.

Asunto(s)

RESUMEN

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

RESUMO Objetivo Analisar os resultados do uso de dexmedetomidina (D) no tratamento de pacientes com doenças degenerativas da coluna lombar com técnicas de punção. Métodos O estudo incluiu 77 pacientes submetidos à punção cirúrgica em doenças degenerativas da coluna lombar com o uso de um agonista alfa-2 adrenérgico: denervação percutânea das articulações facetárias com laser (n = 46) e discectomia endoscópica transforaminal posterolateral (n = 31). Foram avaliados o nível de sedação usando a Escala de Sedação de Ramsay (RSS) e a Escala de Sedação e Agitação de Richmond (RASS); a dinâmica intraoperatória dos parâmetros dos sistemas cardiovascular e respiratório; o nível de síndrome de dor de acordo com a EVA. Resultados Determinou-se um alto nível intraoperatório de sedação pela RASS (-2, -3) e pela Ramsay (III, IV). Ao transferir um paciente para outro setor (depois de 90 minutos), esse parâmetro era 0 em RASS e II em Ramsay. Não houve alterações significativas na hemodinâmica central e na depressão respiratória. O nível mínimo de dor foi determinado imediatamente após a cirurgia, 30 e 60 minutos depois da cirurgia e antes da transferência para o outro setor (90 minutos depois): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Constatou-se que não era necessária analgesia adicional no primeiro dia pós-operatório. Conclusões O uso de D reduz significativamente o nível de dor mantendo a comunicação verbal necessária com o paciente e fornece a proteção neurovegetativa necessária sem depressão respiratória e os parâmetros hemodinâmicos reduzidos durante o período perioperatório. Nível de evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença. Série de casos, Estudo retrospectivo.

RESUMEN Objetivo Analizar los resultados del uso de dexmedetomidina (D) en el tratamiento de pacientes con enfermedades degenerativas de la columna lumbar con técnicas de punción. Métodos El estudio incluyó a 77 pacientes con enfermedades degenerativas de la columna lumbar que se sometieron a punción quirúrgica mediante el uso de un agonista adrenérgico alfa-2: denervación percutánea de las articulaciones facetarias con láser (n = 46) y discectomía endoscópica transforaminal posterolateral (n = 31). Fueron evaluados el nivel de sedación mediante la Escala de Sedación de Ramsay (RSS) y la Escala de Sedación y Agitación de Richmond (RASS); la dinámica intraoperatoria de los parámetros de los sistemas cardiovascular y respiratorio; el nivel del síndrome de dolor según la EVA. Resultados Se determinó un alto nivel de sedación intraoperatoria en RASS (-2, -3) y por Ramsay (III, IV)Al transferir un paciente a otro sector (después de 90 minutos), este parámetro fue 0 en RASS y II en Ramsay. No hubo cambios significativos en la hemodinámica central y la depresión respiratoria.El nivel mínimo de dolor se determinó después de la cirugía, 30 y 60 minutos después de la cirugía y antes del traslado al otro sector (90 minutos después): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Se verificó que no era necesaria analgesia adicional el primer día postoperatorio. Conclusiones El uso de D reduce significativamente el nivel de dolor al mismo tiempo que se mantiene la necesaria comunicación verbal con el paciente y brinda la protección neurovegetativa necesaria sin depresión respiratoria y parámetros hemodinámico reducidos durante el período perioperatorio. Nivel de evidencia II; Estudios de pronóstico: Investigación del efecto de la característica de un paciente sobre el desenlace de la enfermedad. Serie de casos, Estudio retrospectivo.

Asunto(s)

RESUMEN

Background: The brown bear (Ursus arctos) is considered one of the largest terrestrial carnivores, native from temperate forest regions of North America, Europe and Asia. In Brazil, they are founded in captivity and their safe capture and immobilization are obtained with one effective anesthesia for management and surgical and diagnostic procedures. Some anesthetic protocols are described for these purposes, however, there is a lack for data on the anesthetic and adverse effects they have on bears when used. The aim of this case is to report the use and effects of the association of dexmedetomidine with tiletamine and zolazepam in the chemical containment of a captive adult brown bear. Case: A 33-year-old female brown bear, weighing 100 kg, belonging to the Zoobotanic Park of Teresina, Piauí, Brazil, was chemically immobilized for an incisional biopsy of a cutaneous nodule with 1.0 cm diameter in the right face region. The anesthetic protocol included 6 µg/kg of dexmedetomidine associated with 3 mg/kg of tiletamine and zolazepam, administered intramuscularly by dart into the gluteal region of the right pelvic limb. The animal showed moderate ataxia at 5 min and assumed sternal decubitus 7 min after anesthetic administration. The bear's degree of sedation was considered adequate and safe to perform the biopsy at 10 min after administration. Heart rate (47 ± 3 bpm), respiratory rate (17 ± 2 mpm) and rectal temperature (38.7 ± 0.1ºC) were monitored. The bear remained immobile and unconscious throughout the procedure, with intense muscle relaxation, bilateral eyeball rotation, absent lateral palpebral reflex and mild medial reflex and without nystagmus. Complementary sedative doses were not necessary. At the beginning of anesthetic recovery, the bear received 6 µg/kg of atipamezole, intramuscularly. After 25 min of administration of atipamezole, the animal showed signs of recovery in the level of consciousness and reactivity to external stimuli, and assumed the quadrupedal position at 60 min after reverser application. Discussion: Even in captivity, the bears behavior is unpredictable and attack can occur, causing trauma or death to people. For this, the chemical immobilization is important to keep safety of everyone. This procedure was performed using blowgunassisted darts thrown by a staff member who had experience in using this method, who darted accurately and effectively. The latency time observed after administration of the anesthetic protocol used is similar to reported in other studies with bears that also received intramuscular dexmedetomidine and tiletamine and zolazepam and showed intense muscle relaxation and immobility. The doses used contributed to the absence of bradycardia and hypoventilation and, performing the procedure in the morning, when the temperature is milder in the city, minimized the chance of hyperthermia and thermal stress in the animal, not requiring body cooling. The use of dexmedetomidine in chemical containment protocols for short and minimally invasive procedures allows the subsequent use of its antagonist, atipamezole, contributing to a shorter recovery time, return of the animal's degree of consciousness and lower incidence of ataxia after assuming a quadrupedal position. The anesthetic protocol used was considered efficient, providing a quick and gentle chemical containment, adequate anesthetic plan and good anesthetic recovery in an adult brown bear from captivity.

Asunto(s)

RESUMEN

Background: The anatomical, physiological, and pharmacological characteristics of reptiles make anesthesia in chelonians particularly challenging. Specific literature regarding safe anesthetic protocols that provide immobilization, antinociception, amnesia, and unconsciousness are scarce. Thus, this paper aims to report the case of a red-footed tortoise submitted to long-duration general anesthesia to celiotomy for foreign body removal. Case: An adult red-footed tortoise (Chelonoides carbonaria), 5.9 kg, was admitted due to hyporexia after ingesting a metallic fishhook. Serial radiographs confirmed the diagnosis and location of the foreign body in the stomach. The animal was premedicated with 0.03 mg/kg dexmedetomidine, 6 mg/kg ketamine, and 0.4 mg/kg butorphanol intramuscularly. After 90 min we inserted a 22G jugular catheter and proceeded to anesthesia induction with 5 mg/kg propofol. We intubated the animal with a 2.5 mm uncuffed endotracheal and started fluid therapy at a rate of 5 mL/kg/h. Surgical anesthesia was maintained with isoflurane in 0.21 oxygen, in a non-rebreathing circuit (baraka), under spontaneous breathing. Expired isoflurane was maintained between 3 and 4.5%. Due to reduced respiratory rate and hypercapnia, we opted for implementing manually-assisted positive pressure ventilation. Morphine (0.5 mg/kg) was administered at 10 and 87 min after the beginning of the surgery for further analgesia when the isoflurane requirement increased significantly. We did not detect any alterations in heart and body temperature. Surgical anesthesia lasted 6 h. During anesthesia recovery, voluntary head retraction and coordinated movement of the limbs occurred at 240 and 540 min after the extubation, respectively. In 2 days, the patient returned to voluntary feeding, being very active and responsive to stimulus. The post-surgical hematologic evaluation was unremarkable. Discussion: Pre-anesthetic medication aimed to promote sedation and preemptive analgesia. Due to its minimal cardiorespiratory depression, we chose the combination of ketamine, dexmedetomidine, and butorphanol. Dexmedetomidine reduced the ketamine dose and caused sufficient muscle relaxation and immobilization to perform the jugular catheter placement. Butorphanol is an agonist-antagonist opioid; that is why we decided to add it to the protocol for antinociception. However, due to signs of nociceptive response (increased isoflurane requirements and heart rate), and considering the evidence of a predominance of µ receptors in reptiles, we administered low-dose morphine twice during the procedure. Propofol was chosen as an induction agent at a dose sufficient to allow endotracheal intubation. Since reptilians often show apnea in the presence of 100% oxygen, we used a 0.21 oxygen fraction. Despite this, the patient showed respiratory depression. Due to right to left cardiac shunt, sudden changes in the direction of the blood can lead to very rapid changes in the serum concentrations of isoflurane, which leads to frequent oscillations in the anesthetic depth and consequently the need for vaporizer adjustments, which may justify the high expired isoflurane fraction during the procedure. Despite that, physiological parameters were maintained within normal ranges for the species, with slight variations during the surgical procedure. We conclude that the proposed anesthetic protocol is safe for long-duration anesthesia in chelonians, ensuring cardiovascular and respiratory stability. Thus, this report may help veterinarians to perform safe anesthesia in tortoises submitted to invasive surgical procedures.

Asunto(s)

RESUMEN

INTRODUCCIÓN: actualmente no se cuenta con experiencia sobre el uso de dexmedetomidina intranasal para procedimientos ginecológicos en el medio. OBJETIVOS: demostrar los efectos del uso intranasal de dexmedetomidina en sedación para procedimientos gineco-obstétricos. MÉTODOS: es un ensayo clínico no controlado, prospectivo a simple ciego; tomando 24 pacientes de un universo de 80 pacientes, se administró 0,9 µg/kg de dexmedetomidina intranasal antes de realizar el procedimiento; se procesó en IBM-SPPS v.25 ®. Cálculo de media y DE en cuantitativas y valor p < 0,05 significativo. RESULTADOS: edad media de 32 años; frecuencia cardiaca basal 70 lat/min, siendo significativo posterior a la inducción y al concluir el procedimiento; la presión arterial media se mantuvo entre 82 a 73 mmHg, no significativo; la Escala Visual Numérica se encontró de 0 en 18 pacientes; durante la inducción y mantenimiento con Infusión Controlada se encontró entre 2 ng/ml de remifentanil y 2 mcg/ml de propofol; 18 pacientes no presentaron complicaciones. CONCLUSIONES: provee estabilidad hemodinámica a la dosis usada, sin efectos adversos tras administración de dexmedetomidina y produce una reducción de las dosis de los medicamentos de inducción y mantenimiento(AU)

INTRODUCTION: we do not have experience on the use of intranasal dexmedetomidine for gynecological procedures in the environment. OBJECTIVES: to demonstrate the effects of intranasal use of dexmedetomidine in sedation for obstetric gynecological procedures. METHODS: a prospective, longitudinal, single-blind, uncontrolled clinical trial was conducted; Taking 24 patients from a universe of 80 patients, 0.9 µg/kg of intranasal dexmedetomidine was administered prior to performing the procedure. It was processed in IBM-SPPS v.25®. Calculation of mean and SD in quantitative and p value <0.05 significant. RESULTS: average age of 32 years old; basal heart rate 70 beats / min, being significant after induction and at the end of the procedure; the mean arterial pressure remained between 82 to 73 mmHg, not significant; Visual Numeric Scale was found from 0 in 18 patients; during induction and maintenance with Target Control Infusion it was found between 2 ng / ml of remifentanil and 2 mcg / ml of propofol. There were no complications in 18 patients. CONCLUSIONS: it provides hemodynamic stability at the dose used without adverse effects after administration of dexmedetomidine and produces a reduction in the doses of induction and maintenance drugs(AU)

Asunto(s)

RESUMEN

BACKGROUND AND OBJECTIVES: Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes. METHODS: We enrolled 120 patients (2-7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg-1 in addition to either propofol (1 mg.kg-1) or dexmedetomidine (0.5 µg.kg-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored. RESULTS: There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes respectively, p <0.001). The P-K group showed more oxygen desaturation. Eleven and six patients experienced SpO2 <92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p=0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction. CONCLUSIONS: The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses. REGISTRATION NUMBER: Clinical trials.gov (NCT02863861).

Asunto(s)

RESUMEN

Abstract Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.

Resumo A Distrofia Miotônica (DM) tipo-1 (Doença de Steinert) é uma doença multissistêmica progressiva autossômica dominante em que a crise miotônica pode ser desencadeada por vários fatores, incluindo dor, estresse emocional, hipotermia, tremores e estímulo mecânico ou elétrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinação com peridural torácica para colecistectomia laparoscópica em paciente com Doença de Steinert. Para evitar laringoscopia, a intubação traqueal foi realizada utilizando cateter de intubação Aintree guiado por broncofibroscopia óptica. Os efeitos anestésicos prolongados do propofol foram revertidos e a recuperação anestésica foi acelerada pelo uso de infusão intravenosa de teofilina.

Asunto(s)