Revista española de anestesiología y reanimación
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Meperidine was the first synthetic opioid agent. It acts mainly as an antagonist of mu (#m) receptors and has an analgesic potency ten times greater than that of morphine. Like other opioid drugs, meperidine causes nausea, vomiting, urinary retention and respiratory depression; a point of difference, however, is that it acts on nerve fibers and has properties similar to those of local anesthetics. ⋯ An intravenous route has been used for treating moderate to severe pain, for regional anesthesia, for premedication and for analgesia during anesthesia. Meperidine's action on kappa receptors has meant that it is considered the most effective drug for treating postanesthetic trembling. Although meperidine has been used effectively to treat non-surgical pain, mainly from colic, this review focuses on its usefulness in the perioperative period.
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Rev Esp Anestesiol Reanim · Feb 2000
Review[Immune response in the surgical patient: effect of anesthesia and blood transfusion].
Anesthesiology has progressed spectacularly over the last two decades, largely parallel to developments in basic and clinically applied sciences such as immunology. The anesthesiologist's involvement now extends to all matters involved in perioperative care. Surgery, anesthetic procedures themselves, and other associated techniques such as blood transfusion all alter the patient's immune response and all fall within the range of procedures monitored by the anesthesiologist. ⋯ Replacement of lost red blood cells is another factor leading to immunological changes. New anesthetic techniques, the optimization of methods already in use, and the development of modern, less immunodepressant drugs and of alternatives to homologous blood transfusion are all solutions that have been proposed. This is an exciting field of study in which today, perhaps more than ever, the anesthesiologist has a critical role to play.
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Rev Esp Anestesiol Reanim · Feb 2000
Review[Postoperative nausea and vomiting. Controversies, evidence and new drugs].
In spite of the availability of drugs to control postoperative nausea and vomiting, emesis remains an unresolved problem for the anesthesiologist. The etiology of postoperative nausea and vomiting is multifactorial: some causes are well-defined whereas others continue to be the object of debate. Statistical methods applying logistical regression have proven valuable for assessing the risk of emesis in individual patients. ⋯ The therapeutic options available for postoperative nausea and vomiting are moderately effective and are distinguishable by their side effects and prices. Clinical trials with a new group of drugs (neurokinin receptor antagonists) are currently underway. With their wider spectrum of action and absence of side effects, these drugs may represent a qualitative advance in the treatment of postoperative nausea and vomiting.
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Rev Esp Anestesiol Reanim · Nov 1999
Review[Esmolol in anesthesiology: pharmacology and indications].
Esmolol is a beta-adrenergic receptor antagonist with a relatively specific affinity for beta 1 adrenergic receptors. Its mechanism of action is therefore largely cardioselective and only high doses block beta 2 adrenergic receptors. The pharmacologic features of the drug give it rapid onset of beta-blocking action (distribution half-life = 2 minutes) and a short duration of action due to rapid clearance (clearance half-life = 9 minutes). ⋯ The esmolol dose is therefore manageable and individual adjustments can be made in function of a patient's clinical status. Such properties mean that esmolol is indicated for short-term treatment of hypertension and tachycardia during the perioperative period and in clinical situations that require easy unblocking of beta receptors. Hypertension and bradycardia are the most frequent complications associated with the administration of esmolol, such that blood pressure, heart rate and electrocardiographic data must be monitored.
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Rev Esp Anestesiol Reanim · Aug 1999
Review[Continuous renal replacement therapy: management of acute renal insufficiency in critical care units].
Acute renal insufficiency is characterized by a sudden decrease in renal function. Various causes are implicated and the physiopathological mechanisms are quite complex. When kidney failure is associated with other organ or system failure, the patient is usually treated in an intensive care unit. ⋯ Such aspects of renal function as electrolyte regulation of nitrogenated products, inflammatory mediators and so forth are replaced or supplemented by various continuous modes available. In this review we discuss the functions and indications for the continuous renal replacement techniques available. The components of each technique are studied exhaustively with a view to obtaining benefit.