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ANESTESICOS LOCALES EN ANESTESIA REGIONAL

ANESTESICOS LOCALES EN ANESTESIA REGIONAL

(especial para SIIC © Derechos reservados)
Esta revisión sobre los anestésicos locales de uso frecuente y sus actividades evalúa la posición actual de su empleo en la anestesia regional avanzada. Se destaca la prevención, la detección y el tratamiento de la toxicidad de los anestésicos locales. Se explica el uso novedoso de intralipid en la cardiotoxicidad inducida por anestésicos locales. Además, se exploran las perspectivas y posibilidades futuras de la investigación.
croll9.jpg Autor:
Scott M. Croll
Columnista Experto de SIIC

Institución:
Walter Reed Army Medical Center


Artículos publicados por Scott M. Croll
Coautores
James V. Winkley* Lisa L. Bleckner** Chester C. Buckenmaier III** 
MD, Staff Anesthesiologist, Moore Regional Hospital, Pinehurst, EE.UU.*
MD, Staff Anesthesiologist, Walter Reed Army Medical Center, Washington DC, EE.UU.**
Recepción del artículo
27 de Julio, 2007
Aprobación
30 de Mayo, 2008
Primera edición
10 de Junio, 2008
Segunda edición, ampliada y corregida
23 de Febrero, 2009

Resumen
La anestesia regional en el siglo XXI, específicamente el bloqueos nervioso periférico y el bloqueo continuo de nervios periféricos, siguen gozando de una popularidad sin precedentes. A pesar de este resurgimiento de la popularidad, la investigación de un anestésico local nuevo y de acción más prolongada e inyectable con mejor perfil de seguridad sigue siendo un objetivo distante y difícil de lograr. Se han creado pocos anestésicos locales nuevos para uso clínico desde comienzos de la década de 1970. Los esfuerzos por mejorar la eficacia, la duración y la seguridad de los anestésicos locales inyectables incluyen aditivos y la nueva tecnología de localización de la aguja. Cualquier explicación convincente de los anestésicos locales de uso frecuente utilizados en la anestesia regional debe incluir un resumen detallado de la toxicidad de los anestésicos locales que incluya prevención, detección y tratamiento. Se plantea un enfoque específico sobre la aparición reciente de intralipid como tratamiento de la cardiotoxicidad inducida por anestésicos locales. Esta revisión de los anestésicos locales examinará la farmacología básica, explorará las tendencias actuales en la práctica de la anestesia regional y describirá los adelantos recientes en el uso clínico de los anestésicos locales y sus aditivos.

Palabras clave
anestésicos locales, anestesia regional, toxicidad de los anestésicos locales


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Abstract
Regional anesthesia in the 21st century, specifically peripheral nerve blocks (PNBs) and continuous peripheral nerve blocks (CPNBs), continues to enjoy unparalleled popularity. Despite this resurgence in popularity, the search for a new, longer-acting local anesthetic (LA) for injection with an improved safety profile remains an elusive and distant goal. A paucity of new local anesthetics has been developed for clinical use since the early 1970's. Efforts to improve the efficacy, duration, and safety of injected LAs include drug additives to LAs and new needle localization technology. Any cogent discussion of the common LAs used with regional anesthesia must include a thorough summary of LA toxicity to include prevention, detection, and treatment. A specific focus on the recent emergence of Intralipid as a treatment for local anesthetic-induced cardiac toxicity will ensue. This LA review will examine basic pharmacology, explore current trends in regional anesthesia practice, and describe recent developments in the clinical use of LA and additives.

Key words
local anesthetics, regional anesthesia, local anesthetic toxicity


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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
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Especialidades
Principal: Anestesiología
Relacionadas: Cirugía, Farmacología, Obstetricia y Ginecología



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Enviar correspondencia a:
Scott M. Croll, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Bldg 2 Ward 44 Room 4402, Washington DC, EE.UU.
Patrocinio y reconocimiento:
Agradecimientos Este manuscrito fue patrocinado por la Army Regional Anesthesia & Pain Management Initiative, Walter Reed Army Medical Center, Washington, DC, Estados Unidos.
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