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2018, Número 3

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Rev Mex Anest 2018; 41 (3)


Anestesia regional en pediatría 2018

Melman-Szteyn E, Zaragoza-Lemus G

Idioma: Español
Referencias bibliográficas: 54
Paginas: 213-227
Archivo PDF: 591.14 Kb.


RESUMEN

La historia de la anestesia regional se remonta al descubrimiento de la cocaína en 1884. A partir de entonces el desarrollo de la misma ha sido vertiginoso, hasta ocupar un sitio preponderante en la práctica diaria. Tiene un margen amplio de beneficios y como toda técnica requiere de experiencia y pericia. Su uso en neonatos, lactantes y niños, como anestésico único o en combinación con anestesia general inhalada, proporciona anestesia y analgesia trans- y postoperatoria. Los anestésicos locales bloquean la propagación de los impulsos nerviosos inactivando los canales iónicos de Na+; su acción no se limita únicamente a los canales de sodio de los nervios involucrados en la transmisión nerviosa, sino también en casos de dosis en exceso, o absorción masiva por inyección intravascular inadvertida, pueden bloquearse los canales de sodio de otros tejidos, tales como los que se encuentran en el sistema nervioso central y cardiovascular, dando lugar a complicaciones muy serias que pueden poner en riesgo la vida. El tratamiento de la toxicidad por anestésicos locales o LAST, debe ser instituido de inmediato conociendo las modificaciones que se han implementado para ello y que se describen en el texto. El uso de técnicas guiadas por ultrasonido para bloqueos centrales o de nervios periféricos ha revolucionado la práctica de la anestesia regional, particularmente en niños pequeños debido a la claridad con la que las estructuras anatómicas pueden visualizarse. Esta técnica muestra clara superioridad sobre la técnica basada en el uso del neuroestimulador, o las referencias anatómicas, al permitir una visualización directa de las estructuras neuraxiales, menor tiempo para llevar a cabo el bloqueo, menor tiempo de inicio de acción del anestésico local y menor volumen depositado in situ. La anestesia regional continúa evolucionando hacia técnicas de mayor calidad y seguridad, para beneficio de nuestros pacientes pediátricos.


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