Introduction: Pediatric postoperative delirium is a frequent complication for which preventive pharmacological measures have been suggested. The use of midazolam as a prophylactic strategy has not yet been thoroughly assessed. Notwithstanding the fact that it is used in pediatric presurgical separation anxiety, its role in delirium is yet to be established.
Objective: To quantify the incidence of pediatric postoperative delirium in patients undergoing low risk surgical interventions, exposed to oral midazolam-based premedication and to explore the protective and risk factors associated with the development of delirium.
Materials and methods: Prospective, analytical observational study with a cohort design. Children were conveniently selected in accordance with the daily list of surgical procedures in the operating rooms. The inclusion criteria were children between 2 and 10 years old, ASA I-II, undergoing low risk surgeries. Concurrent and longitudinal follow-up was then conducted upon admission to the post-anesthesia care unit (PACU) for the first hour.
Results: A total of 518 children were included. The overall incidence of delirium was 14.4 % (95 % CI: 11.4 %-17.5 %). In the subgroup exposed to midazolam, 178 children were analyzed, with an incidence of delirium of 16.2% (95% CI of 10,8 %-21,7). These patients exhibited a higher tendency to delirium with the use of sevoflurane or fentanyl, and/or when presenting with severe postoperative pain. Patients exposed to propofol and/or remifentanil showed lower incidences.
Conclusions: No reduction in the incidence of emergency pediatric delirium associated with the use of pre-surgical oral midazolam in low risk surgical procedures. Prospective controlled trials and additional research are required to study the effectiveness and safety of this intervention.
a b s t r a c tIntroduction: Remifentanil has an attractive pharmacological profile for use in obstetric analgesia as a technique for mass application, with similar benefits and satisfaction as epidural analgesia.Objective: To assess the efficacy, equivalence and safety of remifentanil vs. epidural analgesia in obstetrics.Methods: Systematic review and meta-analysis of clinical trials using the Cochrane methodology.Results: No equivalence was found in relation to epidural analgesia; however, efficacy was found in the remifentanil group at different time points during the evaluation. The incidence of adverse effects was similar in the two groups, except for nausea. ଝ Please cite this article as: González Cárdenas VH, González FDM, Barajas WJG, Cardona AM, Rosero BR, Manrique AJ. Remifentanil vs. analgesia Epidural para manejo del dolor agudo relacionado con el trabajo de parto. Revisión sistemática y meta-análisis. Rev Colomb Anestesiol. 2014;42:281-294. r e v c o l o m b a n e s t e s i o l . 2 0 1 4;4 2(4):281-294 Conclusions: Remifentanil is not equivalent to epidural analgesia but could certainly decrease the intensity of pain. Remifentanilo vs. analgesia epidural para el manejo del dolor agudo relacionado con el trabajo de parto. Revisión sistemática y meta-análisis Palabras clave: Trabajo de Parto Anestesia de Conducción Meta-análisis Dolor agudo Analgésicos opioidesr e s u m e n Introducción: El remifentanilo presenta un perfil farmacológico atractivo para definirse como analgesia obstétrica, dada la necesidad de una técnica de empleo masivo, con similares beneficios y satisfacción que la analgesia epidural.Objetivo: Evaluar la eficacia, la equivalencia y la seguridad del remifentanilo vs. Analgesia epidural en analgesia obstétrica.Métodos: Revisión sistemática y meta-análisis de experimentos clínicos siguiendo la metodología Cochrane.Resultados: No hallamos equivalencia con respecto a analgesia epidural, pero sí eficacia en el grupo de remifentanilo a diferentes horas de evaluación. La incidencia de efectos adversos fue similar en ambos grupos, salvo para las náuseas.Conclusiones: El remifentanilo puede no ser equivalente a la analgesia epidural, pero podría disminuir la intensidad del dolor consonante con los niveles de satisfacción de cada artículo.
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