Video Experimental Relacionado
Updated: Aug 1, 2026
14:56
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Anestesia epidural y analgesia y resultado de la cirugía mayor: un ensayo aleatorizado
John R A Rigg1, Konrad Jamrozik, Paul S Myles
1Department of Public Health, University of Western Australia, Western, Crawley, Australia. john.rigg@sjog.org.au
Lancet (London, England)
|April 20, 2002
Resumen
La anestesia epidural combinada con anestesia general no redujo significativamente los resultados adversos generales en pacientes con cirugía de alto riesgo. Sin embargo, sí redujo las tasas de insuficiencia respiratoria y mejoró el manejo del dolor, lo que sugiere beneficios para pacientes selectos.
Área de la Ciencia:
- Anestesiología Anestesiología.
- Resultados quirúrgicos.
- Medicina de cuidados críticos Medicina de cuidados críticos.
Sus antecedentes:
- El bloqueo epidural es una técnica analgésica común para la cirugía abdominal mayor.
- Existe incertidumbre con respecto a los riesgos y beneficios del bloqueo epidural en pacientes quirúrgicos de alto riesgo.
- Los ensayos aleatorizados multicéntricos son cruciales para evaluar estrategias anestésicas complejas.
Objetivo del estudio:
- Para comparar los resultados adversos en pacientes de alto riesgo sometidos a cirugía abdominal mayor utilizando bloqueo epidural versus regímenes analgésicos alternativos.
- Evaluar la eficacia y seguridad de la anestesia epidural y general combinadas en una población quirúrgica de alto riesgo.
- Evaluar el impacto de la analgesia epidural en la morbilidad y mortalidad postoperatorias.
Principales métodos:
- Un ensayo multicéntrico aleatorizado que involucró a 915 pacientes de alto riesgo sometidos a cirugía abdominal mayor.
- Los pacientes fueron asignados para recibir anestesia epidural intraoperatoria y analgesia epidural postoperatoria de 72 horas con anestesia general o un grupo de control.
- El objetivo primario fue la mortalidad a los 30 días o la morbilidad posquirúrgica mayor, analizada por intención de tratar.
Principales resultados:
- No hubo diferencias significativas en el criterio de valoración compuesto de muerte o morbilidad mayor entre el grupo epidural (57,1%) y el grupo de control (60,7%).
- La mortalidad a los 30 días fue baja y similar en ambos grupos (5,1% epidural vs 4,3% control).
- Las técnicas epidurales se asociaron con una reducción significativa de la insuficiencia respiratoria (23% vs. 30%) y mejoraron las puntuaciones de dolor postoperatorio.
Conclusiones:
- La anestesia epidural y general combinada con analgesia epidural postoperatoria no redujo la mayoría de los resultados adversos en pacientes quirúrgicos de alto riesgo.
- La reducción observada en la insuficiencia respiratoria y la mejora de la analgesia sugieren beneficios potenciales para grupos específicos de pacientes de alto riesgo.
- La baja incidencia de eventos adversos graves asociados con la inserción del catéter epidural apoya su seguridad en esta población.
Videos de Conceptos Relacionados
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:25Analgesia and Pain Management
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
01:24General Anesthesia: Overview
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...